Search

Background: The recently published Clinical Practice Guidelines (CPGs) for the treatment of stages I-IV periodontitis provided evidence-based recommendations for treating periodontitis patients, defined according to the 2018 classification. Peri-implant diseases were also re-defined in the 2018 classification. It is well established that both peri-implant mucositis and peri-implantitis are highly prevalent. In addition, peri-implantitis is particularly challenging to manage and is accompanied by significant morbidity., Aim: To develop an S3 level CPG for the prevention and treatment of peri-implant diseases, focusing on the implementation of interdisciplinary approaches required to prevent the development of peri-implant diseases or their recurrence, and to treat/rehabilitate patients with dental implants following the development of peri-implant diseases., Materials and Methods: This S3 level CPG was developed by the European Federation of Periodontology, following methodological guidance from the Association of Scientific Medical Societies in Germany and the Grading of Recommendations Assessment, Development and Evaluation process. A rigorous and transparent process included synthesis of relevant research in 13 specifically commissioned systematic reviews, evaluation of the quality and strength of evidence, formulation of specific recommendations, and a structured consensus process involving leading experts and a broad base of stakeholders., Results: The S3 level CPG for the prevention and treatment of peri-implant diseases culminated in the recommendation for implementation of various different interventions before, during and after implant placement/loading. Prevention of peri-implant diseases should commence when dental implants are planned, surgically placed and prosthetically loaded. Once the implants are loaded and in function, a supportive peri-implant care programme should be structured, including periodical assessment of peri-implant tissue health. If peri-implant mucositis or peri-implantitis are detected, appropriate treatments for their management must be rendered., Conclusion: The present S3 level CPG informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to maintain healthy peri-implant tissues, and to manage peri-implant diseases, according to the available evidence at the time of publication., (© 2023 The Authors. Journal of Clinical Periodontology published by John Wiley & Sons Ltd.)

Aim: To evaluate the efficacy of different types of rehabilitation with fixed or removable full-arch implant-supported prosthesis designs in terms of implant loss and success in patients with at least one edentulous jaw, with tooth loss mainly due to periodontitis., Materials and Methods: Clinical studies with at least 12 months reporting on implant loss and implant success were searched. Meta-analysis was conducted to estimate cumulative implant loss considering different prostheses designs., Results: A total of 11 studies with unclear to low risk of bias were included in the analysis. Estimated cumulative implant loss for fixed prostheses within 1 year and 5 years was 0.64% (95% confidence interval [CI]: 0.31%-1.31%) and 1.85% (95% CI: 0.85%-3.95%), respectively. The corresponding values for removable prostheses amounted to 0.71% (95% CI: 0.22%-2.28%) and 4.45% (95% CI: 2.48%-7.85%). Peri-implantitis affected 10%-50% of the patients restored with implant-supported fixed prostheses., Conclusions: Based on the limited low-quality data, the present analysis points to a low and similar cumulative implant loss within 1 year for patients with tooth loss mainly due to stage IV periodontitis restored with either removable or fixed implant-supported full-arch prosthesis. At 5 years of functioning, there was a tendency for better outcomes using fixed designs., (© 2021 The Authors. Journal of Clinical Periodontology published by John Wiley & Sons Ltd.)

Aim: To investigate the dynamic changes of peri-implant microbiome in patients with a history of periodontitis and to construct a microbial prediction model., Materials and Methods: The prospective study was performed at one month (T1), one year (T2) and two years (T3) after restoration. Clinical examinations [probing depth (PD), bleeding on probing (BOP), suppuration (SUP)], radiographic examinations and sample collection were conducted at three timepoints. Peri-implant sulcular fluid (PISF) was collected and analysed by 16S rRNA gene sequencing. Generalized linear mixed model (GLMM) was used to identify differences., Results: Totally, 168 subjects were assessed for eligibility. Twenty-two patients were recruited in the longitudinal study. Eventually, 67 PISF samples from 24 implants of 12 patients were collected and analysed. Peri-implant microbiome showed increasing diversity and complexity over time. Disease-associated genera Porphyromonas, Tannerella, Treponema and Prevotella dramatically increased from T1 to T3. The prediction model for clinical suppuration at T1 showed a high accuracy of 90%., Conclusion: The dysbiosis of peri-implant microbiome increased with time during the two-year observation in patients with a history of periodontitis. Genera of Porphyromonas, Tannerella, Treponema and Prevotella were biomarkers of peri-implant mucositis. Microbiota at the early stage could predict subsequent microbial dysbiosis and clinical suppuration., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The aim of this study was to test a non-submerged reconstructive approach for peri-implantitis osseous defects, by removing the prosthetic components, augmenting of the infraosseous bony compartment, and flap readaptation around the replaced healing abutments, without obtaining a primary wound closure.Methods: Twenty-nine implants in 24 patients were treated. Implant suprastructures were removed at the time of the intervention, to aid with the debridement process which included curettage, implantoplasty, air-power driven devices, and locally delivered antibiotics. The infraosseous part of peri-implant defects were augmented using a composite bone graft and an absorbable membrane to be secured around the replaced healing abutments without attempting to submerge the implants. After 8 months, direct peri-implant defect measurements were obtained to serve as the primary outcome. Secondary outcomes included of radiographic bone changes, and probing depth (PD) and bleeding on probing (BOP) changes at 12 months.Results: At the time of the surgical re-entry (8 months), a statistically significant clinical and radiographic defect fill was observed (average of 2.33 and 1.63 mm, respectively). Approximately 3 months after crown replacement, 12 months from the surgical intervention, a significant PD (1.51 mm) and BOP (65%) reduction were also noted.Conclusions: Considering its limitations, the use of a non-submerged approach (with removal of implant crowns) led to significant improvements in clinical (defect fill, PD, BOP) and radiographic outcomes. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to assess the reconstructive potential of a submerged healing approach for the treatment of infraosseous peri-implantitis defects.Methods: Patients with a diagnosis of peri-implantitis were recruited. Implant suprastructures were removed before the surgical treatment, which included implant surface and defect detoxification using implantoplasty, air-power driven devices, and locally delivered antibiotics. The augmentation procedure included a composite bone graft and a non-resorbable membrane followed by primary wound coverage and a submerged healing of 8 months, at which point membranes were removed, and peri-implant defect measurements were obtained as the primary outcome. Secondary endpoints included assessment of cone-beam computed tomography (CBCT) and probing depth (PD) reductions.Results: Thirty implants in 22 patients were treated. A significant clinical bone gain of 3.22 ± 0.41 mm was observed at 8 months. Radiographic analysis also showed an average gain of 3.47 ± 0.41 mm. Three months after installment of new crowns, final PD measures showed a significant reduction compared to initial examinations and a significant reduction in bleeding on probing compared to examinations at the pre-surgical visit.Conclusions: Reconstruction of infraosseous peri-implantitis defects is feasible with thorough detoxification of implant sites, and a submerged regenerative healing approach. [ABSTRACT FROM AUTHOR]

Background: Clinicians predominantly use personal judgment for risk assessment. Periodontal risk assessment tools (PRATs) provide an effective and logical system to stratify patients based on their individual treatment needs. This retrospective longitudinal study aimed to validate the association of different risk categories of four PRATs (Staging and grading; Periodontal Risk Assessment (PRA); Periodontal Risk Calculator; and PerioRisk) with periodontal related tooth loss (TLP), and to compare their prognostic performance.Methods: Data on medical history, smoking status, and clinical periodontal parameters were retrieved from patients who received surgical and non-surgical periodontal treatment. A comparison of the rate of TLP and non-periodontal related tooth loss (TLO) within the risk tool classes were performed by means of Kruskal-Wallis test followed by post-hoc comparison with the Bonferroni test. Both univariate and multivariate Cox Proportional hazard regression models were built to analyze the prognostic significance for each single risk assessment tool class on TLP.Results: A total of 167 patients with 4321 teeth followed up for a mean period of 26 years were assigned to four PRATs. PerioRisk class 5 had a hazard ratio of 18.43, Stage 4 had a hazard ratio of 7.99, and PRA class 3 had a hazard ratio of 6.13 compared with class/stage I. With respect to prognostic performance, PerioRisk tool demonstrated the best discrimination and model fit followed by PRA.Conclusion: All PRATs displayed very good predictive capability of TLP. PerioRisk showed the best discrimination and model fit, followed by PRA. [ABSTRACT FROM AUTHOR]

Peri-implantitis is an immune-mediated biological complication that is attributed to bacterial biofilms on the implant surface. As both periodontitis and peri-implantitis have similar inflammatory phenotypes when assessed cross-sectionally, treatment protocols for peri-implantitis were modeled according to those used for periodontitis. However, lack of efficacy of antimicrobial treatments targeting periodontal pathogens coupled with recent discoveries from open-ended microbial investigation studies create a heightened need to revisit the pathogenesis of peri-implantitis compared with that of periodontitis. The tale of biofilm formation on intraoral solid surfaces begins with pellicle formation, which supports initial bacterial adhesion. The differences between implant- and tooth-bound biofilms appear as early as bacterial adhesion commences. The electrostatic forces and ionic bonding that drive initial bacterial adhesion are fundamentally different in the presence of titanium dioxide or other implant alloys vs mineralized organic hydroxyapatite, respectively. Moreover, the interaction between metal surfaces and the oral environment leads to the release of implant degradation products into the peri-implant sulcus, which exposes the microbiota to increased environmental stress and may alter immune responses to bacteria. Clinically, biofilms found in peri-implantitis are resistant to beta-lactam antibiotics, which are effective against periodontal communities even as monotherapies and demonstrate a composition different from that of biofilms found in periodontitis; these facts strongly suggest that a new model of peri-implant infection is required. [ABSTRACT FROM AUTHOR]

Background: A cross-sectional study was designed to shed light on the clinical sequelae and patient satisfaction after dental implant removal (IR).Methods: Patients undergoing ≥1 IRs were eligible. The reasons for implant failure, clinical and radiological parameters before and after IR, and the surgical and prosthetic treatments offered after IR was assessed. Patient satisfaction was recorded and the Oral Health Impact Profile (OHIP)-14 was used to document patient self-reported dysfunction and discomfort attributed to IR. Lastly, patient expectations after IR were also evaluated.Results: Thirty-one patients with 45 implants were analyzed. Peri-implantitis was the main reason for IR (64.5%). The average implant survival time before IR was 120.3 ± 88.2 months. Signs of infection (51.7%) and bleeding on probing (37.5%) were common signs detected at the time of IR. Guided bone regeneration was the intervention most commonly applied simultaneously to IR (74.1%). The reported degree of satisfaction was high, and the overall OHIP-14 score was low. However, a certain patient reluctance to undergo future implant placement in the same clinic or with the same professional was recorded, and a statistically significant increase in adherence to the implant maintenance routine was observed after IR.Conclusions: Peri-implantitis is the leading cause for IR. Guided bone regeneration is commonly applied to attenuate the clinical sequelae of IR. Nonetheless, IR does not seem to affect patients' satisfaction nor their quality of life, though a certain patient reluctance to undergo future implant placement in the same clinic or with the same professional was reported. [ABSTRACT FROM AUTHOR]

Objective: To retrospectively assess the interproximal bone loss (CBL) in external hexagon implants (EHI), with different surface micro‐topography, placed in the posterior mandible in patients with a history of periodontitis undergoing supportive periodontal care. Material and methods: 268 consecutive patients received 755 EHI implants in the mandibular molar region between 2007 and 2015 with the following surface characteristics: 72 turned, 145 hybrids (double acid‐etched/turned), and 538 anodized. CBL was yearly evaluated by analysing calibrated digital periapical radiographs, with a follow‐up of 1–6 years. Data on implant survival were also calculated. Results: At 6 years (53 patients), the mean CBL was 1.34/1.42 mm at patient/implant level, respectively (range: 0–5.2 mm). Significantly higher CBL was detected in anodized implants than in turned and hybrid implants (1.92/1.46/1.02 mm) (p <.01). The maximum CBL values were found in 2 anodized implants at 4 years (6.3 and 8.1 mm). CBL ≥2 mm was detected in 18% of implants at 3 years and 35% at 6 (p < 2.2 × 10−16), this prevalence being 2.6 times higher in the anodized than in the hybrid and turned group (40%/15.6%, p <.0094). At 6 years, 25 anodized implants presented CBL ≥3 mm (18%). 6 anodized implants (5 patients) were removed between 4 and 5 years. Conclusion: A significant higher CBL was observed in anodized, compared to hybrid and turned implants, when placed in the mandibular molar region of periodontal patients, with a follow‐up of 1 to 6 years. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to report 10‐year results of osteotome sinus floor elevation (OSFE) without grafting severely atrophic maxilla (residual bone height ≤4 mm). Materials and Methods: Patients undergoing OSFE without grafting and implant placement were included for 10‐year examinations. Implant survival, complication‐free survival, modified bleeding index (mBI), modified plaque index (mPI), pocket probing depth (PPD), peri‐implant marginal bone loss (MBL), endo‐sinus bone gain (ESBG) and mean cost of recurrence were evaluated. Results: Overall, 23 patients with 35 implants attended 10‐year examination. Cemented implant crowns or implant‐supported fixed dental prostheses were delivered to the patients. Kaplan–Meier implant survival was 89.2% at implant level and 84.1% at patient level. Complication‐free survival was 26.0% at patient level and 37.0% at implant level. The average complication‐free survival time was 74.6 months (95% CI: 63.2–86.0 months) at implant level and 69.1 months (95% CI: 54.8–83.4 months) at patient level. The mBI, mPI, PPD, MBL and ESBG at 10‐year follow‐up were 0.91 ± 0.58, 0.48 ± 0.51, 2.94 ± 0.79 mm, 1.63 ± 0.83 mm and 2.72 ± 0.51 mm, respectively. The cost of managing recurrence was 43.6% of the initial cost of treatment. Conclusion: The results of the present study indicate that OSFE without grafting is a reliable treatment option in severely atrophic maxilla. Acceptable survival rate, stable MBL and ESBG could be achieved within 10 years. Low complication‐free survival and high costs of recurrence management need to be considered. [ABSTRACT FROM AUTHOR]

Background: The aims of the present study were to compare the microbial differences between peri-implant mucositis sites with or without suppuration, and to construct a classification model with microbiota.Methods: Twenty-four implants with peri-implant mucositis were divided into suppuration (SUP) group and non-suppuration (Non-SUP) group. Clinical assessments of bleeding index, probing depth, suppuration following probing (SUP) were recorded. Submucosal samples were collected from mesiobuccal sites and distobuccal sites, and analyzed by 16S rRNA gene sequencing. Generalized linear mixed model was used to adjust age, gender, location of implants, and intraindividual correlation.Results: It was demonstrated that the microbial richness was lower in SUP group. The relative abundance of some pathogenic taxa, such as genera of Fusobacterium, Tannerella, and Peptostreptococcus, were significantly higher in SUP group than Non-SUP group. In addition, SUP group had less Gram-positive bacteria, aerobic bacteria, and more metabolic pathway related to life activity. The classification model constructed with 12 genera got a 100% accuracy in identifying sites with or without suppuration.Conclusions: The results from this study demonstrate a higher pathogenicity of microbiome at peri-implant mucositis sites with suppuration than without suppuration, which supports suppuration as a clinical indicator for higher microbial risk. [ABSTRACT FROM AUTHOR]

Background: Effectiveness of scaling and root planing (SRP) with/without adjunct probiotic (Lactobacillus reuteri) treatment towards the reduction in periodontal inflammatory parameters (clinical attachment loss [AL], marginal bone loss [MBL], plaque index [PI], and bleeding on probing [BOP] in shamma users and non-users [controls] with chronic periodontitis [CP]) remains uninvestigated. The aim of the present randomized controlled trial was to compare the efficacy of SRP with and without adjunct probiotic therapy (PT) in the treatment of CP among shamma users and controls (individuals not using tobacco in any form).Methods: The study was conducted in accordance with the Consolidated Standards of Reporting Trials guidelines. Patient demographics were recorded using a questionnaire. Therapeutically, patients were allotted into four groups as follows: 1) group 1: Shamma chewers that underwent SRP alone; 2) group 2: Shamma-chewers that underwent SRP + PT; 3) group 3: Non-chewers that underwent SRP alone; and 4) group 4: Non-chewers that underwent SRP + PT. Periodontal parameters (PI, BOP, PD, clinical AL and mesial and distal MBL) were measured on all teeth except third molars at baseline and at 3- and 6-month follow-ups. Level of significance was set at P < 0.05.Results: In total, 31, 32, 31, and 33 individuals were included in groups 1, 2, 3, and 4, respectively. Among shamma users, there was no significant difference in the scores of PI, BOP, PD, clinical AL and MBL when SRP was performed with/without adjunct PT. Amongst controls, SRP with adjunct PT was more effective in reducing PI (P < 0.05), BOP (P < 0.05) and PD (P < 0.05) at 3-month follow-up. There was no significant difference in periodontal parameters at 3- and 6-month follow-ups in patients that underwent SRP with and without adjunct PT.Conclusions: Habitual shamma use compromises the outcome of SRP in patients with CP. Among patients that do not use any form of ST product, SRP is an effective treatment modality for the treatment of CP, and this relationship is independent of use of adjunct PT. [ABSTRACT FROM AUTHOR]

Aim: To examine the adjunctive effect of a Lactobacillus reuteri probiotic (ATCC PTA 5289 & DSM 17938) on the re‐instrumentation of residual pockets. Materials and Methods: This randomized, double‐blind, placebo‐controlled study included 39 previously non‐surgically treated periodontitis patients. A re‐instrumentation was carried out, and probiotic and/or placebo drops were applied according to the study protocoll. Patients afterwards received lozenges to use 2×/day for 12 weeks. Probing pocket depth (PPD), recession, bleeding on probing and plaque levels were analysed, next to the microbiological impact. Results: No effects of the probiotic drops could be found. However, after 24 weeks, the overall PPD in the probiotic lozenges group (2.64 ± 0.33 mm) was significantly lower compared to the control lozenges (2.92 ± 0.42 mm). This difference was even more pronounced in moderate (4–6 mm) and deep (≥7 mm) pockets. In the probiotic lozenges group, there were also significantly more pockets converting from ≥4 mm at baseline to ≤3 mm at 24 weeks (67 ± 18% versus 54 ± 17%) and less sites in need for surgery (4 ± 4% versus 8 ± 6%). However, the probiotic products did not influence the microbiological counts of the periodontopathogens. Conclusion: The adjunctive consumption of L. reuteri lozenges after re‐instrumentation improved the PPD reduction, without an impact on pocket colonization with periodontopathogens. [ABSTRACT FROM AUTHOR]

The purpose of this systematic review and meta‐analysis was to assess the prevalence, incidence and risk factors of peri‐implantitis in the current literature. An electronic search was performed to identify publications from January 1980 until March 2016 on 9 databases. The prevalence and incidence of peri‐implantitis were assessed in different subgroups of patients and the prevalences were adjusted for sample size (SSA) of studies. For 12 of 111 identified putative risk factors and risk indicators, forest plots were created. Heterogeneity analysis and random effect meta‐analysis were performed for selected potential risk factors of peri‐implantitis. The search retrieved 8357 potentially relevant studies. Fifty‐seven studies were included in the systematic review. Overall, the prevalence of peri‐implantitis on implant level ranged from 1.1% to 85.0% and the incidence from 0.4% within 3 years, to 43.9% within 5 years, respectively. The median prevalence of peri‐implantitis was 9.0% (SSA 10.9%) for regular participants of a prophylaxis program, 18.8% (SSA 8.8%) for patients without regular preventive maintenance, 11.0% (SSA 7.4%) for non‐smokers, 7.0% (SSA 7.0%) among patients representing the general population, 9.6% (SSA 9.6%) for patients provided with fixed partial dentures, 14.3% (SSA 9.8%) for subjects with a history of periodontitis, 26.0% (SSA 28.8%) for patients with implant function time ≥5 years and 21.2% (SSA 38.4%) for ≥10 years. On a medium and medium‐high level of evidence, smoking (effect summary OR 1.7, 95% CI 1.25‐2.3), diabetes mellitus (effect summary OR 2.5; 95% CI 1.4‐4.5), lack of prophylaxis and history or presence of periodontitis were identified as risk factors of peri‐implantitis. There is medium‐high evidence that patient’s age (effect summary OR 1.0, 95% CI 0.87‐1.16), gender and maxillary implants are not related to peri‐implantitis. Currently, there is no convincing or low evidence available that identifies osteoporosis, absence of keratinized mucosa, implant surface characteristics or edentulism as risk factors for peri‐implantitis. Based on the data analyzed in this systematic review, insufficient high‐quality evidence is available to the research question. Future studies of prospective, randomized and controlled type including sufficient sample sizes are needed. The application of consistent diagnostic criteria (eg, according to the latest definition by the European Workshop on Periodontology) is particularly important. Very few studies evaluated the incidence of peri‐implantitis; however, this study design may contribute to examine further the potential risk factors. [ABSTRACT FROM AUTHOR]

Abstract: The objective of this review is to identify case definitions and clinical criteria of peri‐implant healthy tissues, peri‐implant mucositis, and peri‐implantitis. The case definitions were constructed based on a review of the evidence applicable for diagnostic considerations. In summary, the diagnostic definition of peri‐implant health is based on the following criteria: 1) absence of peri‐implant signs of soft tissue inflammation (redness, swelling, profuse bleeding on probing), and 2) the absence of further additional bone loss following initial healing. The diagnostic definition of peri‐implant mucositis is based on following criteria: 1) presence of peri‐implant signs of inflammation (redness, swelling, line or drop of bleeding within 30 seconds following probing), combined with 2) no additional bone loss following initial healing. The clinical definition of peri‐implantitis is based on following criteria: 1) presence of peri‐implant signs of inflammation, 2) radiographic evidence of bone loss following initial healing, and 3) increasing probing depth as compared to probing depth values collected after placement of the prosthetic reconstruction. In the absence of previous radiographs, radiographic bone level ≥3 mm in combination with BOP and probing depths ≥6 mm is indicative of peri‐implantitis. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: This narrative review provides an evidence‐based overview on peri‐implantitis for the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions. Methods: A literature review was conducted addressing the following topics: 1) definition of peri‐implantitis; 2) conversion from peri‐implant mucositis to peri‐implantitis, 3) onset and pattern of disease progression, 4) characteristics of peri‐implantitis, 5) risk factors/indicators for peri‐implantitis, and 6) progressive crestal bone loss in the absence of soft tissue inflammation. Conclusions: 1)Peri‐implantitis is a pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri‐implant connective tissue and progressive loss of supporting bone. 2)The histopathologic and clinical conditions leading to the conversion from peri‐implant mucositis to peri‐implantitis are not completely understood. 3)The onset of peri‐implantitis may occur early during follow‐up and the disease progresses in a non‐linear and accelerating pattern. 4a)Peri‐implantitis sites exhibit clinical signs of inflammation and increased probing depths compared to baseline measurements. 4b)At the histologic level, compared to periodontitis sites, peri‐implantitis sites often have larger inflammatory lesions. 4c)Surgical entry at peri‐implantitis sites often reveals a circumferential pattern of bone loss. 5a)There is strong evidence that there is an increased risk of developing peri‐implantitis in patients who have a history of chronic periodontitis, poor plaque control skills, and no regular maintenance care after implant therapy. Data identifying “smoking” and “diabetes” as potential risk factors/indicators for peri‐implantitis are inconclusive. 5b)There is some limited evidence linking peri‐implantitis to other factors such as: post‐restorative presence of submucosal cement, lack of peri‐implant keratinized mucosa and positioning of implants that make it difficult to perform oral hygiene and maintenance. 6)Evidence suggests that progressive crestal bone loss around implants in the absence of clinical signs of soft tissue inflammation is a rare event. [ABSTRACT FROM AUTHOR]

Background: This study aims to investigate association between peri-implant maintenance therapy (PIMT) and the frequency of peri-implant diseases and to further identify factors that contribute to failure of PIMT compliance.Methods: A cross-sectional study on patients who were healthy and partially edentulous was conducted. They were grouped in the following categories according to PIMT compliance: 1) regular compliers (RC) (≥2 PIMT/year); 2) erratic compliers (EC) (<2 PIMT/year); and 3) non-compliers (NC) (no PIMT). Radiographic and clinical analyses were carried out including probing depth (PD), plaque index (PI), bleeding on probing (BOP), mucosal redness (MR), suppuration (SUP), keratinized mucosa dimension, and marginal bone loss. A multiple logistic regression model was estimated at implant and patient level to obtain adjusted odds ratios (ORs) and to control possible confounding effects among variables.Results: Overall, 206 implants in 115 patients fulfilled inclusion criteria. At patient level, it was shown that association between compliance and peri-implant condition was statistically significant (P = 0.04). Compliance was associated with 86% fewer conditions of peri-implantitis. The probability of PIMT compliance was substantially associated with frequency of peri-implantitis (OR = 0.13, P = 0.01). Patients with a history of periodontal disease multiplied their probability of being EC (versus NC) 4.23 times with respect to not having a history of periodontal disease (P = 0.02). Moreover, light smokers significantly resulted to be NC compared with RC (P = 0.04) and EC (P = 0.02). Nevertheless, mucositis was not found to be statistically associated with level of compliance. In addition, PD, PI, BOP, MR, and SUP varied significantly according to PIMT compliance and peri-implant condition.Conclusions: Peri-implant maintenance compliance ≥2 PIMT/year seems to be crucial to prevent peri-implantitis in healthy patients. Furthermore, history of periodontal disease and disease severity, as well as its extent and a smoking habit, appear to be factors that influence the compliance risk profile (NCT02789306). [ABSTRACT FROM AUTHOR]

Aim The primary aim of this study was to evaluate 23 pathogens associated with peri-implantitis at inner part of implant connections, in peri-implant and periodontal pockets between patients suffering peri-implantitis and participants with healthy peri-implant tissues; the secondary aim was to estimate the predictive value of microbiological profile in patients wearing dental implants using data mining methods. Material and Methods Fifty participants included in the present case─control study were scheduled for collection of plaque samples from the peri-implant pockets, internal connection, and periodontal pocket. Real-time polymerase chain reaction was performed to quantify 23 pathogens. Three predictive models were developed using C4.5 decision trees to estimate the predictive value of microbiological profile between three experimental sites. Results The final sample included 47 patients (22 healthy controls and 25 diseased cases), 90 implants (43 with healthy peri-implant tissues and 47 affected by peri-implantitis). Total and mean pathogen counts at inner portions of the implant connection, in peri-implant and periodontal pockets were generally increased in peri-implantitis patients when compared to healthy controls. The inner portion of the implant connection, the periodontal pocket and peri-implant pocket, respectively, presented a predictive value of microbiologic profile of 82.78%, 94.31%, and 97.5% of accuracy. Conclusion This study showed that microbiological profile at all three experimental sites is differently characterized between patients suffering peri-implantitis and healthy controls. Data mining analysis identified Parvimonas micra as a highly accurate predictor of peri-implantitis when present in peri-implant pocket while this method generally seems to be promising for diagnosis of such complex infections. [ABSTRACT FROM AUTHOR]

Background: Because peri-implant mucositis may progress to peri-implantitis, effective treatment resulting in resolution of inflammation could prevent peri-implantitis. Current treatment protocols for this condition are still unpredictable. The purpose of this study is to analyze efficacy of non-surgical treatment for patients with peri-implant mucositis during a 6-month follow-up period.Methods: This controlled, randomized, double-masked clinical trial included 37 patients diagnosed with peri-implant mucositis, randomly assigned into test group (basic periodontal therapy + 0.12% chlorhexidine) with 61 implants; and control group (basic periodontal therapy + placebo) with 58 implants. Therapy consisted of adaptation of the full-mouth scaling and root planing protocol. Clinical parameters of visible plaque index (VPI), gingival bleeding index (GBI), probing depth (PD), and bleeding on probing (BOP) were measured in implants and were evaluated at baseline and at 1, 3, and 6 months post-therapy. Data were analyzed using the split-plot analysis of variance and χ2 tests with a significance level of 5%.Results: Intragroup analysis showed that VPI, GBI, PD, and BOP presented statistically significant improvements compared with baseline. No statistically significant differences were found between the test and control groups at any time.Conclusions: Both isolated mechanical therapy and its association with 0.12% chlorhexidine mouthwash reduced peri-implant mucositis. Therefore, 0.12% of chlorhexidine was not more effective than placebo. [ABSTRACT FROM AUTHOR]

Peri-implant diseases (peri-implantitis and peri-implant mucositis) are bacterially driven infections. Peri-implantitis leads to aggressive bone resorption and eventual loss of the implant. Traditionally, peri-implantitis was regarded as microbially similar to periodontitis, and translocation of periodontal pathogens into the peri-implant crevice was considered as a critical factor in disease causation. However, evidence is emerging to suggest that the peri-implant and periodontal ecosystems differ in many important ways. The purpose of this review is to examine the evidence supporting microbial congruence and discordance in these two communities. Current evidence suggests that osseointegrated implants truly create unique microenvironments that force microbial adaptation and selection. Further studies that revisit the "microbial reservoir" hypothesis and identify species that play an etiologic role in peri-implant disease and examine their transmission from teeth are needed. [ABSTRACT FROM AUTHOR]

Aim To examine the existing evidence in identifying risk indicators in the etiology of peri-implantitis. Material and methods A literature search was performed in MEDLINE via PubMed database of the US National Library of Medicine, for articles published until October 2014 using Medical Subject Heading search terms + free text terms and in different combinations. Results The microbiota associated with peri-implantitis is complex, demonstrating differences and similarities to the one seen at periodontitis sites. Plaque accumulation at dental implants triggers the inflammatory response leading to peri-implant mucositis/peri-implantitis. Individuals with a history of periodontal disease and smokers have an increased risk of developing peri-implantitis. There is some evidence to support the role of genetic polymorphism, diabetes, and excess cement as risk indicators for the development of peri-implantitis. There is also evidence to support that individuals on regular maintenance are less likely to develop peri-implantitis and that successful treatment of periodontitis prior to implant placement lowers the risk of peri-implantitis. Conclusions Plaque accumulation at implants will result in the development of an inflammation at implants. A history of periodontal disease, smoking, excess cement, and lack of supportive therapy should be considered as risk indicators for the development of peri-implantitis. [ABSTRACT FROM AUTHOR]

Aim To assess the presence of periodontal and opportunistic organisms in patients with peri-implantitis. Material and methods Thirty-three partially edentulous subjects (22 women, 11 men), aged 32-90 years, who had one or more implants with peri-implantitis were included. Peri-implantitis was defined as: (i) the presence of bleeding on probing and/or suppuration and (ii) radiographic images showed marginal bone loss >1.8 mm after 1 year in function. Criteria for inclusion were: (i) partially edentulous patients having at least one implant diagnosed with peri-implantitis; (ii) no antibiotic therapy for 6 months prior to clinical examination. Following this definition, a total of 48 implants were diagnosed with peri-implantitis. Subgingival bacterial samples were obtained with sterile paper points from infected implants and selected teeth of each individual. Periodontopathogens ( Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia and Treponema denticola) were detected by multiplex PCR targeting 16S rDNA. Samples were placed in reduced transport medium and cultured for opportunistic pathogens ( Staphylococcus aureus, enteric bacteria, Pseudomonas and yeasts). Results Twenty-two patients yielded positive results for P. gingivalis, 25 for T. forsythia, eight for P. intermedia and 13 for T. denticola. None of the patients yielded a positive result for A. actinomycetemcomitans. Non-periodontal species were found in five patients (15% of total). P. aeruginosa was found in four (12%) patients, and C. albicans (3%) and S. aureus in one patient (3%) each. In two cases of peri-implantitis, none of the periodontal or opportunistic microorganisms studied were detected in either implant or tooth samples. When results of the periodontopathic bacteria from the implant and tooth samples of the same patient were compared, 18 patients (54%) showed the same results for both samples and 15 (45%) patients different results. Conclusions The implant surface may be colonized with pathogens different from periodontal bacteria. Opportunistic pathogens such as P. aeruginosa, S. aureus and C. albicans may be associated with implant failure. [ABSTRACT FROM AUTHOR]

Aim The aim of this randomized placebo-controlled clinical trial was to evaluate the effects of Lactobacillus reuteri-containing probiotic lozenges as an adjunct to scaling and root planing ( SRP). Material and Methods Thirty chronic periodontitis patients were recruited and monitored clinically and microbiologically at baseline, 3, 6, 9 and 12 weeks after therapy. All patients received one-stage full-mouth disinfection and randomly assigned over a test ( SRP + probiotic, n = 15) or control ( SRP + placebo, n = 15) group. The lozenges were used two times a day for 12 weeks. Results At week 12, all clinical parameters were significantly reduced in both groups, while there was significantly more pocket depth reduction ( p < 0.05) and attachment gain ( p < 0.05) in moderate and deep pockets; more Porphyromonas gingivalis reduction was observed in the SRP + probiotic group. Conclusions The results indicate that oral administration of L. reuteri lozenges could be a useful adjunct to SRP in chronic periodontitis. [ABSTRACT FROM AUTHOR]

Aim The microbial differences between peri-implantitis and periodontitis in the same subjects were examined using 16S rRNA gene clone library analysis and real-time polymerase chain reaction. Materials and methods Subgingival plaque samples were taken from the deepest pockets of peri-implantitis and periodontitis sites in six subjects. The prevalence of bacteria was analysed using a 16S rRNA gene clone library and real-time polymerase chain reaction. Results A total of 333 different taxa were identified from 799 sequenced clones; 231 (69%) were uncultivated phylotypes, of which 75 were novel. The numbers of bacterial taxa identified at the sites of peri-implantitis and periodontitis were 192 and 148 respectively. The microbial composition of peri-implantitis was more diverse when compared with that of periodontitis. Fusobacterium spp. and Streptococcus spp. were predominant in both peri-implantitis and periodontitis, while bacteria such as Parvimonas micra were only detected in peri-implantitis. The prevalence of periodontopathic bacteria was not high, while quantitative evaluation revealed that, in most cases, prevalence was higher at peri-implantitis sites than at periodontitis sites. Conclusions The biofilm in peri-implantitis showed a more complex microbial composition when compared with periodontitis. Common periodontopathic bacteria showed low prevalence, and several bacteria were identified as candidate pathogens in peri-implantitis. [ABSTRACT FROM AUTHOR]

Aim A clear relationship between tongue coating and oral malodour has been observed in many clinical trials. Why or when this coating is formed remains an open question. The aim of this study was to analyse possible factors related to the presence of tongue coating in a population complaining from oral malodour. Materials and Methods Patients were recruited from a halitosis clinic ( UZ Leuven). Medical history, dietary and oral hygiene habits were retrieved via a questionnaire. Data were recorded on organoleptic score and level of sulphur compounds in breath, anatomical features of the tongue dorsum, amount of tongue coating (according to three indices: Miyazaki, Winkel and modified Winkel), tongue coating wet weight and salivary flow. The correlation between the presence of tongue coating and a series of parameters was analysed. Results The level of oral hygiene was the strongest determinant factor for the presence of tongue coating. Smoking, presence of a denture, periodontal status and dietary habits also correlated although less obvious. Conclusion The presence of tongue coating appears to be related to several factors of which oral hygiene is the strongest. [ABSTRACT FROM AUTHOR]

Aim Although it is established that peri-implantitis is a bacterially induced disease, little is known about the bacterial profile of peri-implant communities in health and disease. The purpose of the present investigation was to examine the microbial signatures of the peri-implant microbiome in health and disease. Materials and methods Subgingival and submucosal plaque samples were collected from forty subjects with periodontitis, peri-implantitis, periodontal and peri-implant health and analysed using 16 S pyrosequencing. Results Peri-implant biofilms demonstrated significantly lower diversity than subgingival biofilms in both health and disease, however, several species, including previously unsuspected and unknown organisms, were unique to this niche. The predominant species in peri-implant communities belonged to the genera Butyrivibrio, Campylobacter, Eubacterium, Prevotella, Selenomonas, Streptococcus, Actinomyces, Leptotrichia, Propionibacterium, Peptococcus, Lactococcus and Treponema. Peri-implant disease was associated with lower levels of Prevotella and Leptotrichia and higher levels of Actinomyces, Peptococcus, Campylobacter, non-mutans Streptococcus, Butyrivibrio and Streptococcus mutans than healthy implants. These communities also demonstrated lower levels of Prevotella, non-mutans Streptococcus, Lactobacillus, Selenomonas, Leptotrichia, Actinomyces and higher levels of Peptococcus, Mycoplasma, Eubacterium, Campylobacter, Butyrivibrio, S. mutans and Treponema when compared to periodontitis-associated biofilms. Conclusion The peri-implant microbiome differs significantly from the periodontal community in both health and disease. Peri-implantitis is a microbially heterogeneous infection with predominantly gram-negative species, and is less complex than periodontitis. [ABSTRACT FROM AUTHOR]

Aim This 1-year prospective RCT compared the outcome of minimally (turned) and moderately rough (TiUnite®) implant surfaces. Material and methods Two subgroups of patients were formed; one group ( n = 10) where all teeth had been extracted due to severe periodontitis, another group ( n = 8) with teeth in the antagonistic jaw with a history of periodontitis and some remaining medium pockets (4-6 mm). Implants ( n = 85, 43 turned & 42 TiUnite®) were installed randomly in each patient. After 3-6 months of submerged healing, healing abutments were connected, followed by final abutments 2 weeks later, all with the same surface characteristics as the supporting implant. Peri-implant parameters and intra-oral radiographs were recorded up to 1 year after abutment connection. Results Two turned implants failed in the partial edentulous group during the initial healing period ( CSR: 95%) and none of the TiUnite® ( CSR: 100%) surface. No statistically significant differences in clinical parameters could be observed between both surfaces. The partial edentulous subgroup showed more bone loss compared to the full edentulous subgroup. Conclusion Moderately rough implants have a similar clinical outcome (at 1 year of loading in periodontitis susceptible patients) compared to minimally rough implants. [ABSTRACT FROM AUTHOR]

Background Most current implants have a moderately rough surface (compared with older minimally rough 'turned' implants) to facilitate osseointegration. This randomized controlled trial ( RCT), with split-mouth design, examined whether this increased surface roughness influenced the initial subgingival plaque formation. Material and methods Ten fully edentulous and eight partially edentulous patients, all with a history of severe periodontitis, received 4-6 implants (mandible or maxilla). Per jaw, both minimally (turned) and moderately rough ( TiUnite) implants ( MKIII; Nobel Biocare) were alternated. Also, the healing and final abutments had similar surface characteristics. Subgingival biofilm formation was followed up for 1 year, and samples were analyzed by culture technique, qPCR and checkerboard Results Over the entire period, no statistically significant differences could be detected in subgingival microbiota between the minimally and moderately rough surfaces. In partially edentulous patients, the biofilm matured to a higher concentration of pathogens when compared with fully edentulous patients. The subgingival implant composition and concentration in partially edentulous patients were comparable to the subgingival microbiota along teeth. Conclusion The roughness of the more modern implants did not influence the biofilm formation during the first year of implant loading. [ABSTRACT FROM AUTHOR]

The article explores the similarities and dissimilarities between the disease entities of periodontitis and peri-implantitis. Analysis on the etiology and pathogenesis of both diseases show that they have more similarities than differences. The initiation of both diseases depends on the presence of a biofilm containing pathogens. Differences in their host response explain the occasional rapid progression of peri-implantitis lesions.

Objectives: To evaluate the implant survival rate, periodontal and radiographic parameters of non-submerged screw implants with two different surfaces (TPS and SLA) in periodontally non-susceptible patients (NSP) and in patients with chronic adult periodontitis (CAP) or with generalized aggressive periodontitis (GAP). Material and methods: In 110 healthy partially edentulous subjects, 68 patients with CAP and 16 patients with GAP, a total of 513 implants were installed and followed for on average 48.1±25.9 months. Only fixed partial dentures were used as suprastructures. All patients were offered a supportive periodontal maintenance program. Smoking habits, health impairment, plaque score, bleeding on probing (BOP), type of surface, bone score, bone loss on radiographs and the number of failed implants were noted. Results: Implant survival in the NSP and CAP group was 98% and 96% after 140 months (NS), but only 80% after 100 months in the GAP group ( P=0.0026). The overall rate of implant loss was 4.7%, but 15.25% in the GAP group (6/16 patients). The average marginal bone loss for all implants was 0.12±0.71 mm on the mesial side and 0.11±0.68 mm on the distal side. Bone loss/year was 0.08±0.31 and 0.07±0.3 mm in the NSP group, but 0.17±0.2 and 0.17±0.19 mm in the GAP group. Only in the GAP group, was bone loss significantly related to BOP, age, inflammation, presence of plaque, probing depth. Implants with a TPS surface had a lower survival than implants with an SLA surface (93% vs. 97%; P=0.06), especially in the GAP group (80% vs. 83%; P=0.005). Smoking habits had a significant influence on implant survival only in the GAP group ( P=0.07), declining in current smokers to 63%, and to 78% in former smokers. Overall, impaired general health had no significant influence ( P=0.85). However, impaired health further reduced implant survival in the GAP group (survival: 71%). In a statistical model to predict the chance for implant failing, only periodontal classification ( P=0.012) and implant surface type ( P=0.027) were significant. Conclusion: Periodontally healthy patients and patients with CAP show no difference in peri-implant variables and implant survival rate, but patients with GAP have more peri-implant pathology, more marginal bone loss and a lower implant survival implant rate. SLA surface had a better prognosis than the TPS surface. [ABSTRACT FROM AUTHOR]

Aim: The purpose of the present review was to determine the clinical effect of the use of bioactive agents (BAs) for the treatment of intra-osseous and furcation defects. Material and Methods: The effectiveness of the BAs was evaluated when used in addition to open flap debridement either alone or in association with grafts and/or guided tissue regeneration (GTR). Among the included agents, recombinant human platelet-derived growth factor-BB (rhPDGF-BB), platelet-rich plasma (PRP), commercially available enamel matrix derivative (cEMD) and peptide P-15 (P-15) have been clinically tested for treating periodontal defects. Results and Conclusions: The results of the present review indicate that: (1) cEMD either alone or in combination with grafts can be effectively used to treat intra-osseous defects and the clinical results appear to be stable long term; (2) the additional use of a graft seems to enhance the clinical outcome of cEMD; (3) the combined use of rhPDGF-BB and P-15 with a graft biomaterial has shown beneficial effects in intra-osseous defects; (4) contrasting results were reported for PRP and graft combinations; and (5) limited evidence supports the use of BAs either alone or in association with graft/GTR for the treatment of furcation defects. [ABSTRACT FROM AUTHOR]

Peri-implant diseases are inflammatory lesions which may affect the peri-implant mucosa only (peri-implant mucositis) or also result in loss of supporting bone (peri-implantitis). Peri-implantitis may lead to loss of the implant. Diagnosis of peri-implant disease requires the use of conventional probing to identify the presence of bleeding on probing, and suppuration, both signs of clinical inflammation. Radiographs are required to detect loss of supporting bone. Baseline probing measurements and radiographs should be obtained once the restoration of the implant is completed to allow longitudinal monitoring of peri-implant conditions. Two cross-sectional reports from Sweden indicate that the prevalence of peri-implant disease is high. Smokers and patients who have a history of periodontitis are more at risk for peri-implant disease. The main goal of treatment of peri-implant disease is to control the infection and to prevent disease progression. A number of studies have documented the successful treatment of peri-implant mucositis combining mechanical debridement and chemical plaque control. There is evidence supporting antimicrobial treatment regimens in combination with non-surgical or surgical debridement for peri-implantitis treatment. Long-term data to support these treatment protocols is limited. Whilst it is possible to treat peri-implantitis, prevention is the goal of supportive therapy. [ABSTRACT FROM AUTHOR]

Objective: This review searched for a relationship between susceptibility to periodontitis and peri-implantitis, with implant outcome as the primary outcome variable and supportive periodontal therapy (SPT) and implant surface roughness as confounding factors. Material and Methods: It is based on a MEDLINE search up to June 2006. Only 16 fulfilled the selection criteria. The heterogeneity of the studies (e.g. periodontal status, SPT, prosthetic design, ...) rendered a meta-analysis impossible. The impact of a history of periodontitis on early implant loss was negligible. Only five papers reported sub-data for patients with different degrees of periodontitis. Four out of five papers indicate a higher incidence of late implant loss and/or marginal bone loss in patients with a history of periodontitis. This difference was most obvious for very rough implants (three papers), and/or when SPT was not organized (one paper). Other confounding factors were often neglected. Another 10 papers only reported the outcome of implants in patients with a history of periodontitis. In case of SPT and when avoiding roughened surfaces, late implant loss remained below 3%, and marginal bone loss remained low. Conclusions: These results seem to indicate that periodontally compromised patients can be successfully treated with minimally/moderately rough implants, in the presence of SPT. [ABSTRACT FROM AUTHOR]

Biofilm formation on oral implants can cause inflammation of peri-implant tissues, which endangers the long-term success of osseointegrated implants. It has been reported previously that implants revealing signs of peri-implantitis contain subgingival microbiota similar to those of natural teeth with periodontitis. The purpose of the first part of this study was an atraumatic, quantitative investigation of biofilm formation on oral implant abutments; the objective of the second part was to investigate whether Haemophilus actinomycetemcomitans and Porphyromonas gingivalis were present in the crevicular fluid around oral implants. Biofilm formation on 14 healing abutments, inserted for 14 days in 10 patients, was analysed quantitatively by use of secondary-electron and Rutherford-backscattering-detection methods. A 16S rRNA-based polymerase chain reaction detection method was used to detect the presence of H. actinomycetemcomitans and P. gingivalis in the crevicular fluid. For this investigation, samples of sulcus fluid were collected with sterile paper points at four measurement points per abutment. The difference between biofilm coverage of supragingival surfaces (17·5 ± 18·3%) and subgingival surfaces (0·8 ± 1·0%) was statistically significant ( P < 0·05). By use of universal primers, bacteria were found in all the samples taken, although the two periodontal pathogens were not found in any of the samples. The absence of periodontal pathogens from the sulcus fluid during initial bacterial colonization, despite massive supragingival biofilm formation, substantiates the assumption that cellular adherence of peri-implant tissue by means of hemidesmosoma, actin filaments and microvilli reduces the risk of formation of anaerobic subgingival pockets. [ABSTRACT FROM AUTHOR]

Background: Periodontitis and peri-implantitis are linked to the presence of several key pathogens. The treatment of these infectious processes therefore involves the reduction/eradication of bacteria associated with periodontitis. Methods: This prospective, split-mouth, single-blind study followed the colonization of ‘pristine’ sulci created in 42 partially edentulous patients during implant surgery (e.g. abutment connection). The hypothesis was that the composition of the maturing subgingival plaque in these ‘fresh’ peri-implant pockets would soon (within 2 weeks) be comparable to the subgingival microbiota of teeth with similar clinical parameters (reference sites), including the presence of bacteria associated with periodontitis. Per patient, four subgingival plaque samples were taken from shallow and medium pockets around implants (test sites), and teeth within the same quadrant (undisturbed microbiota as control sites), 1, 2, 4, 13, 26 and 78 weeks after abutment connection, respectively. The samples were analysed by either checkerboard DNA–DNA hybridization, or cultural techniques, or real-time polymerase chain reaction (PCR) for intra-subject comparisons (teeth vs. implant, for comparable probing depths). Results: Checkerboard DNA–DNA hybridization and real-time PCR revealed a complex microbiota (including several pathogenic species) in the peri-implant pockets within 2 weeks after abutment connection. After 7 days, the detection frequency for most species (including the bacteria associated with periodontitis) was already nearly identical in samples from the fresh peri-implant pockets (5% and 20% of the microbiota belonging to red and orange complex, respectively) when compared with samples from the reference teeth. Afterwards (e.g. between weeks 2 and 13), the number of bacteria in peri-implant pockets only slightly increased (±0.1 log value), with minor changes in the relative proportions of bacteria associated with periodontitis (8% and 33% of the microbiota belonging to red and orange complex, respectively). Although small differences were seen between teeth and implants at week 2 with cultural techniques, a striking similarity in subgingival microbiota was found with this technique from month 3 on, with nearly identical detection frequencies for bacteria associated with periodontitis for both abutment types. Conclusions: This study indicates that the initial colonization of peri-implant pockets with bacteria associated with periodontitis occurs within 2 weeks. [ABSTRACT FROM AUTHOR]

Assesses the efficacy of guided tissue regeneration (GTR) in the treatment of periodontal infrabony defects measured against the current standard of surgical periodontal treatment, open flap debridement with respect to clinical and patient-centered and economic outcomes. Characteristics of GTR; Comparison of the intervention with conventional periodontal surgery; Evaluation of health care interventions.

Evidence from cross-sectional and case-control studies in various populations demonstrates that adult smokers are approximately three times as likely as non-smokers to have periodontitis. The association between smoking and attachment loss is even stronger when the definition of periodontitis is restricted to the most severely affected subjects. Smokers have a diminished response to periodontal therapy and show approximately half as much improvement in probing depths and clinical attachment levels following non-surgical and various surgical modalities of therapy. Implant failures in smokers are twice those of non-smokers, with a higher failure rate in the maxillary arch accounting for the majority of the difference. Tobacco-induced alterations in microbial and host factors contribute to these deleterious effects of smoking on the periodontium. In longitudinal studies, the rate of periodontal disease progression is increased in smokers, but decreases to that of a non-smoker following tobacco cessation. Likewise, recent non-smokers respond to periodontal therapy in a manner similar to patients who have never smoked. Data regarding the impact of smoking on periodontal status included in this review will be helpful to dental health professionals as they counsel their patients regarding tobacco use. The role of dental health professionals in tobacco cessation is discussed, including the use of the five A's: ask -- identify tobacco users; advise - advise them to quit; assess -- evaluate the patient's readiness to quit; assist - offer assistance in cessation; and arrange -- follow up on the patient's cessation efforts. The addition of pharmacotherapy to behavioral therapy, including nicotine replacement therapy and bupropion, can increase cessation rates. The most popular form of nicotine replacement therapy is the patch, and its use has been shown to double cessation rates compared to behavioral therapy alone. Use of bupropion in combination with nicotine replacement therapy may be particularly helpful for heavy smokers or smokers who have experienced multiple failed attempts at cessation. The American Academy of Periodontology Parameters of Care include tobacco cessation as a part of periodontal therapy, and the 2000 Surgeon General's Report on Oral Health in America encourages dental professionals to become more active in tobacco cessation counseling. Doing so will have far-reaching positive effects on our patients' oral and general health. [ABSTRACT FROM AUTHOR]

Background: Factors influencing the outcome of regenerative therapy of Class II furcations are incompletely and poorly understood. The purpose of this 24-month prospective study was to examine the relationship of patient-, site-, and treatment-related factors to the clinical closure of randomly selected mandibular Class 11 furcations. Results of therapy were evaluated at 1 and 2 years postoperatively. One-year outcome data are presented in this report. Methods: A total of 43 otherwise healthy individuals with chronic periodontitis (26 male, 17 female), 36 to 70 years of age, completed the 12-month evaluation of the study. Entry criteria included clinical and radiographic evidence of two or more mandibular facial Class II furcation defects (≥3 mm horizontal probing depth). Surgical therapy was completed by four periodontists (two each) in either a university clinic or private practice. Each patient contributed two furcation defects that were treated by combination therapy using an expanded polytetrafluoroethylene (ePTFE) membrane and demineralized freeze-dried bone allograft (DFDBA). Clinical measurements included a gingival index, plaque index, mobility, and. referencing an occlusal stent, probing depth (PD), probing attachment level-vertical (PAL-V), and probing attachment level-horizontal (PAL-H). Multiple linear measurements were recorded for each site clinically and after surgical debridement to characterize defect morphology, root configuration, and barrier placement. Defect volume was computed mathematically. Postsurgical maintenance care was provided at 1 to 2, 4, 6, and a weeks, and then biweekly until 3 months, with subsequent supportive periodontal maintenance visits at 3-month intervals. The clinical status of the furcation (open or closed), measured by a non-treating periodontist at 1 and 2 years, was the primary outcome measure. The association of patient-related factors (e.g., smoking), site-related factors (e.g., root configuration and defect morphology), and treatment-related factors (e.g., membrane exposure) to clinical status of furcations was assessed using random effects hierarchical logistic regression analysis, controlling for design and demographic variables. Non-parametric analysis was used for specific group comparisons. Results: Complete clinical closure was achieved in 74% of all sites. Of the residual furcation defects, 6B% were reduced to Class I. Mo defects progressed to Class III. Significant improvements in mean PD and PAL-V were obtained following surgical therapy. Although the proportion of sites demonstrating complete furcation closure was comparable for smokers and non-smokers, the proportion of Class II residual defects was significantly higher among smokers than non-smokers (62.5% versus 14.3%, respectively). Increases in presurgical PAL-H were associated with monotonic decreases in the percentage of sites demonstrating complete clinical closure, with only 53% of lesions ≥5 mm responding with complete closure. Similarly, significant reductions in the frequency of clinical closure were associated with increases in the distance between the roof of furcation and crest of bone, roof of furcation and base of defect, depth of horizontal defect, and divergence of roots at the crest of bone. Conclusions: The successful clinical closure of Class II furcations was achievable at 1 year following combination therapy with an ePTFE membrane and DFDBA The highest frequency of clinical furcation closure was observed in early Class II defects Furcations with vertical or horizontal bone loss of 5 mm or greater responded with the lowest frequency of complete clinical closure. Nevertheless, complete furcation closure was achievable in 50% of molars with extensive bone loss. Also, 15 out of 22 (68%) of all residual defects were reduced to Class I and only seven (B%) failed to improve, demonstrating that successful clinical resolution of advanced defects remains an attainable goal. [ABSTRACT FROM AUTHOR]