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Objective: The aim of this research was to investigate the role of the cornified epithelium, the outermost layer of the oral mucosa, engineered to prevent water loss and microorganism invasion, in severe forms of periodontitis (stage III or IV, grade C)., Methods: Porphyromonas gingivalis, a major periodontal disease pathogen, can affect cornified epithelial protein expression through chronic activation of signal transducer and activator of transcription 6 (Stat6). We used a mouse model, Stat6VT, that mimics this to determine the effects of barrier defect on P gingivalis-induced inflammation, bone loss, and cornified epithelial protein expression, and compared histologic and immunohistologic findings with tissues obtained from human controls and patients with stage III and IV, grade C disease. Alveolar bone loss in mice was assessed using micro-computerised tomography, and soft tissue morphology was qualitatively and semi-quantitatively assessed by histologic examination for several proteins, including loricrin, filaggrin, cytokeratin 1, cytokeratin 14, a proliferation marker, a pan-leukocyte marker, as well as morphologic signs of inflammation. Relative cytokine levels were measured in mouse plasma by cytokine array., Results: In the tissues from patients with periodontal disease, there were greater signs of inflammation (rete pegs, clear cells, inflammatory infiltrates) and a decrease and broadening of expression of loricrin and cytokeratin 1. Cytokeratin 14 expression was also broader and decreased in stage IV. P gingivalis-infected Stat6VT mice showed greater alveolar bone loss in 9 out of 16 examined sites, and similar patterns of disruption to human patients in expression of loricrin and cytokeratins 1 and 14. There were also increased numbers of leukocytes, decreased proliferation, and greater signs of inflammation compared with P gingivalis-infected control mice., Conclusions: Our study provides evidence that changes in epithelial organisation can exacerbate the effects of P gingivalis infection, with similarities to the most severe forms of human periodontitis., Competing Interests: Conflict of interest None disclosed., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: The objective of the study was to assess whether computer-assisted periodontal diagnosis can improve the accuracy and homogeneity of classification results obtained by dental students using the 2017 classification of periodontal diseases., Method and Materials: All final year predoctoral dental students from two dental schools were invited to participate in the study. Participants who volunteered for the study were randomly divided into two groups for digital or manual diagnosis, and each participant classified 48 cases. A group of three experienced periodontists provided the reference or gold standard diagnosis., Results: Overall, 27 students completed the evaluation of all cases; 14 students comprised the digital application group and 13 the manual group. The accuracy of the classification results compared with the gold standard committee was 82% for the digital group compared to 50% of the manual group in terms of the extent of gingivitis; 71% vs 56% for the stage of periodontitis; 67% vs 62% for grade of periodontitis; 76% vs 63% for extent of periodontitis; and 43% vs 30% for overall diagnosis accuracy of periodontitis cases respectively., Conclusions: Computer-assisted classification using newly developed software, within the boundaries of this study, was shown to be a sensible support tool for dental practitioners to use when diagnosing periodontal disease. This digital tool can the clinicians' accuracy of diagnosis primarily in the extent and staging of periodontitis.

There is substantial evidence in support of an association between periodontitis and cardiovascular disease. The most important open question related to this association is causality. This article revisits the question of causality by reviewing intervention studies and systematic reviews and meta analyses published in the last 3 years. Where are we now in answering this question? Whilst systematic reviews and epidemiological studies continue to support an association between the diseases, intervention studies fall short in determining causality. There is a dearth of good-quality, blinded randomised control trials with cardiovascular disease outcomes. Most studies use surrogate markers/biomarkers for endpoints, and this is problematic as they may not be reflective of cardiovascular disease status. This review further highlights another issue with surrogate markers/biomarkers: the potential for collider bias. Ethical considerations surrounding nontreatment have led to calls for a well-annotated database containing in-depth dental health data. Finally, a relatively new and important risk factor for cardiovascular disease, clonal haematopoiesis of indeterminate potential, is discussed. Clonal haematopoiesis of indeterminate potential increases cardiovascular risk by more than 40%, and inflammation is a contributing factor. The impact of periodontal disease on this emerging risk factor has yet to be explored. Although the question of causality in the association between periodontal disease and cardiovascular disease remains unanswered, the importance of good oral health in maintaining good heart health is reiterated., Competing Interests: Conflict of interest None disclosed., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Periodontitis is a common disorder affecting >40% of adults in the United States. Globally, the severe form of the disease has a prevalence of 11%. In advanced cases, periodontitis leads to tooth loss and reduced quality of life. The aetiology of periodontitis is multifactorial. Subgingival dental biofilm elicits a host inflammatory and immune response, ultimately leading to irreversible destruction of the periodontium (i.e. alveolar bone and periodontal ligament) in a susceptible host. In order to successfully manage periodontitis, dental professionals must understand the pathogenesis, primary aetiology, risk factors, contributing factors and treatment protocols. Careful diagnosis, elimination of the causes and reduction of modifiable risk factors are paramount for successful prevention and treatment of periodontitis. Initial non-surgical periodontal therapy primarily consists of home care review and scaling and root planing. For residual sites with active periodontitis at periodontal re-evaluation, a contemporary regenerative or traditional resective surgical therapy can be utilised. Thereafter, periodontal maintenance therapy at a regular interval and long-term follow-ups are also crucial to the success of the treatment and long-term retention of teeth. The aim of this review is to provide current concepts of diagnosis, prevention and treatment of periodontitis. Both clinical and biological rationales will be discussed., (Copyright © 2021. Published by Elsevier Inc.)

Objectives: To assess and compare dietpractices, body mass index (BMI), and oral health-related quality of life (OHRQoL) in adults with and without periodontitis., Methods: Demographics, health-related behaviors, BMI, dental and periodontal parameters, diet practices, and Oral Health Impact Profile-14 (OHIP-14) were collected from 62periodontitis patients and 100 controls without periodontitis., Results: Havingperiodontitis was positively associated with male sex ( p =0.004), older age ( p <0.001), smoking pack-years ( p = 0.006), weight ( p = 0.008), BMI ( p = 0.003), number of meals per day ( p <0.001) and had a negative associationwithdecayed teeth ( p = 0.013), alcohol ( p = 0.006), and sweets ( p = 0.007) consumption.Periodontitis patients were more likely to avoid carbonated beverages ( p = 0.028), hot ( p = 0.003), and cold drinks ( p = 0.013), cold ( p = 0.028), hardtextured ( p = 0.002), and fibrous foods ( p = 0.02) thanthe controls, and exhibited higher global OHIP-14 ( p <0.001) andmost domain scores. Age ( p <0.001), BMI ( p =0.045), number of meals per day ( p = 0.024), and global OHIP-14 score ( p <0.001) remained positivelyassociated with periodontitis in the multivariate analysis., Conclusions: Periodontitis patients exhibitedhigher BMI and altered dietpracticesand OHRQoL as compared to controls. Assessment of diet practices, BMI,and OHRQoLshould bepart of periodontal work-up. Dentists and dietitians shouldcollaborate to design strategies to addressthese challenges., Competing Interests: The authors declare no conflict of interest.

Objectives: To analyse and compare associations between metabolic syndrome (MetS) and its components in periodontitis compared to control patients., Methods: This 7-year cross-sectional study retrospectively analysed medical records of 504 individuals aged 18-90 who attended the student dental clinic between 2008 and 2014. Demographics, smoking habits, blood pressure, waist circumference, as well as presence of: periodontitis, MetS, diabetes, hypertension, hyperlipidaemia, stroke, heart disease, cancer and psychiatric disorders were recorded., Results: The study population composed of 231 (45.8%) males and 273 (54.2%) females, with an average age of 55.79 ± 16.91 years. A patient profile associated with periodontitis was identified and included male sex, older age, smoking, higher smoking pack-years, abdominal obesity, higher systolic and diastolic blood pressures, the presence of MetS or its components, hypertension, hyperlipidaemia, diabetes or diseases associated with its consequences such as ischaemic heart disease and stroke. Following multivariate logistic regression analysis, age and smoking retained a significant association with periodontitis, whereas the systemic disorders did not., Conclusions: The association between periodontitis and MetS may be explained by shared common profile and risk factors. An appropriate risk factors management approach should be adopted by both dental and general health clinicians and health authorities, to control common high-risk behaviours., (© 2019 John Wiley & Sons Ltd.)

Background: Patients with a history of periodontitis might have a higher risk for implant failure as compared with periodontally healthy subjects. The aim of the present study was to look into this risk factor by examining the association between plaque scores, probing depths (PD), and bleeding on probing (BOP) around teeth and immediately restored dental implants up to 1 year after implant surgery., Methods: Patients with partial edentulism, diagnosed with and previously treated for generalized chronic periodontitis, received dental implants, abutments, and cemented provisional prostheses up to 72 hours after implant surgery. Plaque scores, PD, and BOP were recorded and evaluated 6 and 12 months postsurgery., Results: Plaque scores deteriorated slightly around teeth and improved around implants. No significant change was observed in the distribution of PD around teeth. The proportion of shallow pockets increased around implants. Improvement in plaque scores was associated with a stable/reduced PD, whereas deterioration in plaque scores was associated with increased PD around implants and teeth., Conclusions: A direct relationship was found between plaque score improvement and stable/reduced PD. Therefore, partially edentulous patients with a history of periodontitis should be encouraged to improve their plaque scores to maintain shallower pockets around implants.

Objective: The aim was to review the literature on aggressive periodontitis diagnosed during or before the initiation of orthodontic treatment and to propose preventive recommendations before, during and after orthodontic treatment., Materials and Methods: Literature searches of free text and MeSH terms were performed by using PubMed, Embase and the Cochrane Library and the appropriate studies were selected. The retrieved articles were analyzed and the relevant data was tabulated according to different parameters., Results: A total of 220 articles were found in the preliminary search. Eighteen studies, all case reports, describing 21 cases from this search met all the criteria. The mean age of the reported cases was 21.12 years, all treated with combined periodontal and orthodontic modalities. Most of the reported cases were female., Conclusion: An interdisciplinary dental team must approve the periodontal health prior to and during the course of the orthodontic therapy. In subjects with periodontal pathology, a periodontal consultation and interceptive/corrective therapy should be performed prior to commencing with orthodontic treatment. Orthodontic treatment should be postponed or replanned in order to shorten treatment duration and reduce the orthodontic forces exerted on the aggressive periodontitis involved dentition.

Periodontal treatment is based on tooth prognosis evaluation. Different approaches for determining tooth prognosis have been described in the literature. The vast majority are based on clinical and radiographic findings, as well as patient-related factors. The availability of various systems for assigning tooth prognosis complicates both the assignment process and the communication between clinicians regarding patient status and treatment plan. In addition, performance evaluation of several systems reveals that the accuracy of prediction differs between teeth of various conditions in most methods, as well as the factors providing significant predictive power. As a standardized prognostic classification system is still lacking, an overall evaluation based on a uniform dataset could provide an objective comparison of all methods, and help progress towards developing novel approaches. The main features of such approaches should include the selection of predictive factors, their assigned weights in accordance with different tooth conditions, and the estimated period of time applicable for reevaluation of prognosis. In this paper, we propose a different approach for prognosis evaluation, suggesting reevaluating tooth prognosis at several time points during the treatment plan, and taking into consideration some of the most important issues of patient compliance, oral hygiene, and plaque control. The suggested approach attempts to address prognosis from a different perspective, viewing the process as a dynamic and recurring evaluation embedded within each step of the treatment plan. Due to the fact that accurate tooth prognosis evaluation is still (and might forever be) unavailable, a more humble and less aggressive approach should be adopted, trying to preserve more and extract less.

Objective: This retrospective study analyzed radiographic bone levels of 10,871 dental implants in a cohort of 4,247 patients over a 22-year period. The objectives of the study were to assess and explore risk factors associated with the radiographic bone level of dental implants. Method and materials: A longitudinal observational cohort study based on data collected from 1995 to 2019 was conducted on implants placed by a single periodontist. Inclusion criteria included both partially and fully edentulous sites. Exclusion criteria were patients who were considered ASA 3 or greater. Information on medical and dental status prior to implant placement such as diabetes and smoking were included in the analysis. Implant factors such as the implant characteristics (length and diameter) and surgical site were recorded. The outcome assessed was the prevalence of bone loss around implants and any associative factors related to the bone loss. Results: Overall, dental implants lost an average of 0.05 ± 0.38 mm of bone 2 to 3 years after placement and 0.21 ± 0.64 mm 8 years after placement. The soft tissue condition was evaluated using the Implant Mucosal Index (IMI), and bone loss around dental implants was significantly higher when bleeding on probing was multi-point and moderate, multi-point and profuse, and when infection with suppuration was recorded. The mean difference in bone level between smokers and nonsmokers was 0.26 mm (P < .01) over a 4-year period. A mean difference of 0.10 mm (P = .04) in bone loss over 4 years was found between those with an autoimmune disease compared to those without. The diameter of the implant and immediate loading of the dental implant did not influence the radiographic bone levels over time. Conclusions: This large dataset of dental implants highlights predictive risk factors for bone loss around dental implants and the impact these risk factors have on the implant bone level. Consideration of these risk factors by both the dental team and the patient prior to dental implant placement will promote success of the treatment. [ABSTRACT FROM AUTHOR]

Home care therapy is indispensable to manage periodontal disease successfully. Often, during and following initial periodontal treatment, it is unclear how much of the clinical improvement was due to patients' home care or to professional intervention, as these two therapeutic components are often amalgamated in clinical practice as well as in studies. In this case series, four patients with periodontal disease received education on using oral hygiene devices and used them competently prior to initiation of professional periodontal treatment. The changes in their clinical presentations, solely attributed to their home care therapy, were documented. The rationale and suggested clinical guidelines are also presented. Conclusion: Home care therapy is an indispensable but often overlooked step in the successful management of periodontal diseases. Ideally, this step should be solidified prior to proceeding with any professional treatment. By motivating patients to participate in the treatment more actively, clinicians can significantly improve the outcome and longevity of their professional interventions. [ABSTRACT FROM AUTHOR]

Orthodontic treatment can preserve, harm or benefit the periodontal condition. During orthodontic treatment, patients may be at a greater risk of developing periodontal disease or conditions. Thus, the treating clinicians should carefully evaluate their patients' periodontal conditions prior to, during, and after the completion of orthodontic treatment. This literature review describes the damage situations and the methods of preventing and repairing them as well as situations in which the orthodontic intervention contributes to the periodontal status. Recommended protocols for periodontal screening, maintenance and follow-up are presented as well. Clinicians should conduct a complete periodontal evaluation prior to initiating orthodontic treatment, help patients develop an effective home care therapy regimen, ensure the absence of periodontal disease and or mucogingival deformities and conditions that may worsen during orthodontic treatment, and determine the appropriate recall maintenance program for the patient. During the active orthodontic phase, patients' periodontal conditions should be carefully monitored, compared to their baseline clinical and radiographic measurements, and treated if necessary. Patients' compliance with the suggested home oral care should be carefully evaluated and reinforced. If necessary, the orthodontic treatment may need to be stopped temporarily until patients' home oral care improves. [ABSTRACT FROM AUTHOR]

Introduction: Tooth prognosis evaluation involves continual assessments to guide patient-centered treatment plans. This means that the tooth prognosis may dictate whether a tooth is restored, extracted, or maintained.

Purpose: A new tissue-level implant design with angulations of 17, 30, and 45 degrees has been introduced to allow the use of the existing bone while maintaining the restorative platform at an angle to ensure an optimal functional and esthetic result for treatment of edentulous patients. The aim of this study was to measure implant survival, bone loss, and peri-implant health of the novel tissue-level angled-head dental implant system. Materials and Methods: A retrospective analysis of cases from three private offices that were using the new implant system was performed. Data regarding patients' demographics, number and location of implants, restoration type, bone loss, implant failure, bleeding, and pocket depths were collected and analyzed. The data collected were analyzed using mainly descriptive statistics. Results: A total of 29 participants were selected, and 185 dental implants were placed. The average patient age was 61 ± 7 years, and 52% were female. Some of the patients were medically compromised; 7% were diabetic, 20% were smokers, and 7% had osteoporosis. The average time from dental implant placement to the placement of the screw-retained crowns was 6 ± 5 months. Four implants failed with an average time to failure of 18 ± 8 months. Implant survival rate was 97.8%. The average bone loss was 0.014 ± 0.082 mm at 1 year, 0.133 ± 0.306 mm at 5 years, and 0.426 ± 0.903 mm at 10 years. Overall, 18.9% of implants were associated with bleeding, and only one implant had a pocket depth greater than or equal to 5 mm. Conclusion: The new tissue-level implant design with angulations of 17, 30, and 45 degrees has demonstrated predictable survival and success rates with minimal bone loss. The long-term follow-up seems highly promising; however, further studies are warranted to validate the results. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to systematically review the literature regarding the effect of root coverage procedures on tooth survival and periodontal outcomes. Data sources: A systematic search of the literature was performed according to the PRISMA guidelines. A PICO-based search strategy was performed in six databases. Eligibility criteria included studies comparing tooth survival and periodontal outcomes of teeth treated with root coverage procedures versus teeth that had no treatment. The search resulted in 3,646 articles; 212 articles were downloaded for review, and six articles (three studies) were included. Only a single study reported on tooth survival and found no difference between teeth that underwent root coverage procedures versus those that did not. Although the surgeries described in each study were mostly successful in reducing recession and increasing keratinized gingiva, teeth which did not undergo surgery did not seem to have a clinically significant change in recession. The study with the longest follow-up (18 to 35 years) showed an average increase in recession of 0.5 ± 0.9 mm and a decrease in keratinized tissue of 0.3 ± 0.8mm in the control group. Conclusion: This systematic review highlights the need for randomized controlled trials to assess the influence of root coverage surgeries on tooth longevity in order to better inform evidence-based practice. When compared to no surgical intervention, there is presently no evidence to suggest that root coverage surgeries increase tooth longevity. Furthermore, the amount of recession does not appear to increase a clinically significant amount over time without surgical intervention in the presence of proper maintenance and home care. [ABSTRACT FROM AUTHOR]

Biologic complications around dental implants may be categorized into peri-implant mucositis and peri-implantitis. Peri-implant mucositis is defined as reversible inflammation in the peri-implant mucosa without any apparent bone destruction. Peri-implantitis refers to inflammatory process that resulted in destruction of alveolar bone and attachment. Potential etiologic and contributing factors to both diseases are discussed in this review. By targeting and eliminating the etiologic factors nonsurgically as well as surgically, dental implants presenting with peri-implant diseases may be rescued, and then maintained with proper long-term peri-implant supportive therapy. Furthermore, clinical cases and their management are presented to demonstrate the available treatment options. Implant therapy should be carefully planned and executed with consideration of potential etiologic and contributing factors to developing biologic complications. During the initial consideration, patients should be informed of the potential biologic complications in dental implant therapy. Clinicians should monitor implants for any development or recurrence of peri-implant disease to ensure timely therapeutic intervention. [ABSTRACT FROM AUTHOR]

Cause-related therapy is key in the management and resolution of the two most common oral diseases: dental caries and periodontal disease. This is the first phase of treatment for those diseases. The aim is to remove, reduce, or eliminate the main causes of the disease. When referring to caries and periodontal disease, the primary etiology is bacterial plaque so the cause-related therapy phase should include plaque control as a major component. This can be achieved by constantly and continuously educating patients about the pathophysiology of the diseases and by helping them develop proper daily plaque removal techniques. Furthermore, various professional therapeutic interventions are delivered as necessary to eliminate or suppress other etiologic or risk factors. In this case series, the principles of proper cause-related therapy are demonstrated through three cases that were successfully managed by nonsurgical periodontal therapy. Biologic and clinical rationales are also discussed. [ABSTRACT FROM AUTHOR]

Purpose: To assess the prevalence of periodontitis in young populations (previously termed aggressive periodontitis - AgP) and report on the earliest known occurrence of this disease.Materials and Methods: A search was performed covering the last 18 years utilising the following databases: Medline (Ovid), PubMed and Embase. Four reviewers evaluated each study. Review findings were summarised using the PRISMA Statement for reporting and Joanna Briggs Institute (JBI) Critical Appraisal tools for quality assessment, respectively. Twenty-two articles were included in this systematic review, consisting of 6 prevalence studies and 16 case reports. Only prevalence studies were considered for prevalence estimates.Results: The average reported prevalence of periodontitis in young populations was 1.7% (ranging from 0.66% in Argentina to 5.9% in Israel). The prevalence was higher for the localised form of this disease. Permanent teeth were the most common dentition affected (114 out of 115 affected patients). In terms of age, the prevalence was 0.6%, 0.8% and 1.6% for the age groups 2-12, 20-25 and 13-20, respectively. There was no significant difference noted between males and females. The earliest age diagnosed with periodontitis was 3 years 7 months.Conclusion: The prevalence of periodontitis in young patients is ranges widely, which could indicate populational predispositions, underdiagnosing or lack of standardisation in diagnosis. [ABSTRACT FROM AUTHOR]

In chronic periodontitis and peri-implantitis, cells of the innate and adaptive immune systems are involved directly in the lesions within the tissues of the patient. Absence of a periodontal ligament around implants does not prevent a biologic process similar to that of periodontitis from affecting osseointegration. Our first focus is on factors in the biology of individuals that are responsible for the susceptibility of such individuals to chronic periodontitis and to peri-implantitis. Genetic factors are of significant importance in susceptibility to these diseases. Genetic factors of the host affect the composition of the oral microbiome in the same manner that they influence other microbiomes, such as those of the intestines and of the lungs. Our second focus is on the central role of stem cells in tissue regeneration, in the functioning of innate and adaptive immune systems, and in metabolism of bone. Epithelial cell rests of Malassez (ERM) are stem cells of epithelial origin that maintain the periodontal ligament as well as the cementum and alveolar bone associated with the ligament. The tissue niche within which ERM are found extends into the supracrestal areas of collagen fiber-containing tissues of the gingivae above the bony alveolar crest. Maintenance and regeneration of all periodontal tissues involves the activity of a variety of stem cells. The success of dental implants indicates that important groups of stem cells in the periodontium are active to enable that biologic success. Successful replantation of avulsed teeth and auto-transplantation of teeth is comparable to placing dental implants, and so must also involve periodontal stem cells. Biology of teeth and biology of implants represents the biology of the various stem cells that inhabit specialized niches within the periodontal tissues. Diverse biologic processes must function together successfully to maintain periodontal health. Osseointegration of dental implants does not involve formation of cementum or collagen fibers inserted into cementum - indicating that some stem cells are not active around dental implants or their niches are not available. Investigation of these similarities and differences between teeth and implants will help to develop a better understanding of the biology and physiologic functioning of the periodontium. [ABSTRACT FROM AUTHOR]

For the past several thousand years, until development of the titanium dental implant, only a few missing teeth were replaced successfully in a very small number of individuals. Nowadays, placement of dental implants has become suffi- ciently commonplace that there is a need to interchange information between what we know about periodontal health and disease and what we know about health and disease involving dental implants. This review discusses the similarities and differences between teeth and dental implants with regards to anatomy, biology, physiology, and pathologic processes. The concept of biologic width is discussed in the context of interaction of periodontal and peri-implant tissues with microbial products produced by periodontal biofilms. The periodontal microbiome is discussed as networks of organisms interacting not only with periodontal and peri-implant tissues, but also with each other as networks of competing organisms. Overall, the transfer of biologic knowledge from what we know about peri-implantitis and what we know about periodontitis should help to develop new directions for biologic understanding about both health and disease of teeth and dental implants. [ABSTRACT FROM AUTHOR]

Atherosclerosis is a progressive narrowing of arteries that may lead to occlusion as a consequence of lipid deposition. It underlies coronary heart disease, as well as myocardial and cerebral infarctions. Recent attention has been directed towards the potential contribution of chronic inflammatory processes that may amplify vascular inflammation in atherosclerosis, as it is recognized as a chronic inflammatory disease. In this category are two of the most prevalent oral diseases: periodontal disease and apical periodontitis (AP). There is increasing epidemiologic evidence for a positive association between periodontal disease and cardiovascular disease (CVD) as well as between AP and CVD. A review of the literature, as well as a potential mechanism for the linkage between AP and atherosclerosis, are presented in this article. [ABSTRACT FROM AUTHOR]

Evidence on periodontal education areas in which students have difficulties and their factors are limited. In this study, third- and fourth-year dental students' knowledge was assessed as well as their confidence and ability in five periodontal educational areas using a mixed-method approach. A survey was used to collect data related to history-taking, medical examination, diagnosis, treatment planning, and follow-up. Student answers were compared to the consensual answers of an expert panel using the cosine-similarity index (CSI). Descriptive statistics assessed confidence and ability for diagnosis. Semi-structured individual interviews were used to collect data on reported reasons for difficulties in periodontal education. A content analysis was employed to analyze the interview data. Eighteen third- and fourth-year dental students completed the survey and eleven were interviewed. Students' knowledge was adequate regarding diagnosis and treatment planning. Third-year students' median CSI were 0.93 and 0.89, respectively. Fourth-year students' median CSI were 0.9 and 0.93, respectively. Students felt confident in history-taking and examination but lacked confidence and ability in diagnosis and treatment planning. Reported reasons for difficulties in periodontal education were linked to both preclinical and clinical pedagogical issues. Further improvements in preclinical and clinical periodontal education are needed to address students' lack of knowledge, confidence, and skills in key periodontal areas. [ABSTRACT FROM AUTHOR]

Although dental implants are proven to be a predictable longterm treatment for patients, it is important to realize that not all implants that survive are necessarily successful. Successful implants are those that remain fully functional and healthy within the oral cavity. Peri-implantitis is a disease that is associated with implant failure, and is becoming rather prevalent. Assessing risk factors and stabilizing existing oral disease prior to the placement of implants will aid in preventing implant disease and failure. After implant placement, a strict follow-up regime with a dental professional should be implemented in order to monitor the implant and surrounding teeth for disease. The dental professional should continually encourage the patient to adhere to consistent homecare to prevent peri-implantitis from occurring, and in turn increase the success of their implants. Early diagnosis and elimination of inflammatory processes around the implants will improve the longterm prognosis as well. [ABSTRACT FROM AUTHOR]

Achieving predictable guided bone regeneration in critical size defects for future endosseous dental implant therapy poses a great challenge to clinicians. A novel technique utilizing autogenous osteogenic progenitor cells, calcium sulfate activated platelet-rich plasma in addition to particulate allograft was successfully used to augment a severely deficient maxillary anterior edentulous ridge. After 6 months of healing, satisfactory radiographic and clinical bone gain was noted with significant increase in alveolar ridge width. Endosseous implants were placed and restored successfully. The techniques with underlying clinical and biologic rationales are presented and discussed in this report. [ABSTRACT FROM AUTHOR]

The two most common forms of oral disease, dental caries and periodontal disease, share their main etiologic factor, dental plaque. By specifically targeting their main etiologic factor, bacteria in dental plaque, cause-related therapy allows clinicians and patients to achieve successful control of these diseases. Clinicians should continuously guide and educate patients to understand the pathophysiology of their diseases so that patients will actively participate in the therapy by mechanically removing dental plaque at home. When this is combined with professional intervention (ie, removal of active caries and periodontal mechanical debridement) as well as frequent maintenance therapy, dental caries and periodontal disease can be successfully managed and controlled. This review outlines the steps and components of cause-related therapy as well as its proven long-term clinical benefit. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate implant and patient characteristics in a prospective clinical study involving immediate fixed restoration of delayed placement of dental implants. Materials and Methods: Patients diagnosed with generalized chronic periodontitis and previously treated were accepted into the study when they expressed a wish to receive immediate restoration of dental implants. Treatment planning and implant placement were computer assisted, using computerized tomography, planning software, and a surgical template. Patients received abutments and cemented provisional prostheses no later than 72 hours following implant surgery. Patients were followed at 2 and 4 weeks, and 3, 6, and 12 months. Results: Eighteen patients were accepted and completed the study, ages ranged from 34 to 69 years (mean 54.5 ± 8.5 years). Five patients (27.8%) were smokers (2.5 to 60 pack years). Fifty implants were placed, ranging between 1 to 8 implants per patient. Median implant length was 13 mm (range, 10 to 13 mm) and median implant diameter was 3.75 mm (range, 3.75 to 5 mm). Mean insertion torque was 43 NCm ± 6.2 SD (range 30 to 50 NCm). Mean implant stability quotient was 71 ± 11 (range 37 to 85). One implant in a patient who smoked and three implants in another patient who smoked failed for a total of four failed implants. At 12 months, the overall survival rate was 92% (100% and 73% among nonsmokers and smokers, respectively). Conclusions: The survival of immediately restored dental implants in periodontally treated patients is greater than 90%. Smokers with a past history of chronic periodontitis seem to have a lower implant survival rate. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to investigate whether a peptide‐based coating can prevent the adhesion of Porphyromonas gingivalis, a key human pathogen associated with periodontitis and peri‐implantitis. Background: Nonsurgical and surgical interventions have been used for the treatment of peri‐implantitis; however, the effectiveness of these approaches is usually unsatisfactory. The main reason is that dental plaque on the surface of the implant is difficult to remove due to its rough surface and thread design. Recently, a peptide‐based coating for implant surfaces that can reject the adhesion of Escherichia coli and improve the attachment of host cells was developed. Methods: A salivary pellicle was created on the surfaces of peptide‐coated bare discs and verified with anti‐human immunoglobulin G, A and M, and anti‐fibrinogen. Early colonizers, Veillonella parvula and Streptococcus sobrinus, and the later colonizer, Porphyromonas gingivalis, were labelled with green and red fluorescent dyes, respectively, and seeded on the discs. Bacterial attachment was semi‐quantified by fluorescence intensity. Results: The salivary pellicle was evenly distributed on the discs, with or without the peptide coating, with an average thickness of 3.84 µm. A multi‐species dental biofilm was created on the salivary pellicle. The peptide coating resulted in an approximate 25% reduction in the attachment of Veillonella parvula and Streptococcus sobrinus, and a 50% reduction in Porphyromonas gingivalis, when compared to control, uncoated implant discs. Conclusion: The novel peptide‐based coating can inhibit the attachment of Porphyromonas gingivalis. It may have the potential to impede the development of peri‐implantitis. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of toothbrush design on brushing skills and plaque removal among young healthy adults. Method and Materials: A population of 200 healthy young adults was approached. Patients were randomly assigned to one of two research groups: one used a manual single-headed toothbrush, while the other used a manual triple-headed toothbrush. At the start of the study, participants were asked to brush their teeth using the provided toothbrush with no prior guidance or instructions. Plaque Index (PI) was measured. Immediately afterward, participants were personally instructed on how to brush their teeth using the provided toothbrush. Toothbrushing performance skill was evaluated and scored using the toothbrushing performance skill index (TB-PS-I/Ashkenazi index) following the first brushing, as well as on a recall visit 1 week later. Results: Following the first, uninstructed brushing, PI values ranged from 0.41 to 1.33, with higher plaque scores for the single-headed toothbrush group. One week after receiving brushing instructions, PI decreased in the both toothbrush groups and ranged between 0.12 and 0.81, with higher PI scores for the single-headed toothbrush group. Following the first, uninstructed brushing, total TB-PS-I scores, as well as component scores ("reaching" and "staying") showed no difference between the two toothbrush groups. One week after receiving brushing instructions, the TB-PS-I in the triple-headed toothbrush group was significantly higher than that in the single-headed toothbrush group. Conclusion: The triple-headed toothbrush was found to promote easier toothbrushing and plaque removal both before and after receiving toothbrushing instructions. [ABSTRACT FROM AUTHOR]

This paper presents a case of purulent peri-implantitis at an implant in the maxillary right lateral incisor position. The lesion was unresponsive to close debridement and, thus, open flap surgery was performed. Profound bone loss was evident around the implant and a retained retraction cord at the cervical portion of the implant was observed. Treatment included a sequence of decontamination steps and guided bone regeneration with the aim of eliminating the etiology and enhancing implant survival. In the presented case, it can be speculated that the retraction cord served as a plaque retentive factor which ultimately led to bacterial accumulation and peri-implant disease. Thus, it is crucial to ensure that no plaque retentive factors (cement remnants, retraction cord, ill-fitting margins of crowns, etc.) are present when restoring an implant. Plaque retentive factors might result in a destructive effect on the peri-implant tissues and bone. [ABSTRACT FROM AUTHOR]

Background. For the past few decades, dental implants have served as reliable replacements for missing teeth. However, there is an increasing trend toward replacing diseased teeth with ^At^*^/ dental implants. Types of Studies Reviewed. The authors conducted a systematic review of long-term survival rates of teeth and implants. They searched the MEDLINE database for relevant publications up to March 2013. They considered studies in which investigators assessed the long-term effectiveness of dental implants or that of tooth preservation. They included only studies that had follow-up periods of 15 years or longer. Results. The authors selected 19 articles for inclusion. Investigators in nine studies assessed the tooth survival rate, whereas investigators in 10 studies assessed the implant survival rate. When comparing the overall long-term (that is, 15 years or more) tooth loss rate with that of implants, the authors observed rates ranging between 3.6 and 13.4 percent and 0 and 33 percent for teeth and implants, respectively. They could not perform a meta-analysis because of the substantial differences between the studies. Practical Implications. The results of this systematic review show that implant survival rates do not exceed those of compromised but adequately treated and maintained teeth, supporting the notion that the decision to extract a tooth and place a dental implant should be made cautiously. Even when a tooth seems to be compromised and requires treatment to be maintained, implant treatment also might require additional surgical procedures that might pose some risks as well. Furthermore, a tooth can be extracted and replaced at any time; however, extraction is a definitive and irreversible treatment. [ABSTRACT FROM AUTHOR]

The article presents a study on the periodontal disease as a risk factor for dental implant failure. The study aims to evaluate the long-term survival rates of dental implants based on the patient's periodontal status and to estimate the effect of periodontal status on implant failure. The results show periodontal status, and smoking are significant factors for late implant failures. The hazard ratios for both factors, however, are not constant during the follow-up period.

Objectives: To evaluate the factors associated with long-term implant survival in a large cohort of patients in regular follow-up until data collection. Methods: The study population consisted of 475 patients who were referred to a private clinic limited to Periodontics and Implantology between November 1995 and July 2006. Data were collected from patient files with regards to smoking habits, periodontal condition, diabetes mellitus, implant survival, and time when implant failure occurred. Patients were divided into those who participated in a supportive periodontal program in the clinic and those who only attended the annual free-of-charge implant examination. Results: A total of 1626 implants were placed with a follow-up ranging from 1 to 114 months (average 30.82 ± 28.26 months). Overall, 77 (4.7%) implants were lost in 58 (12.2%) patients after a mean period of 24.71 ± 25.84 months. More than one-half of the patients (246; 51.7%) participated in a structured supportive periodontal program in the clinic, and 229 (48.3%) only attended to the annual free-of-charge implant examination. Smoking and attendance in a regular supportive periodontal program were statistically associated with implant survival. Patients with (treated) moderate-to-advanced chronic periodontal disease demonstrated higher implant failure rates but, this difference did not reach statistical significance. Diabetes mellitus was not related to implant survival in this patient cohort. Conclusions: Smoking and attendance in a regular supportive periodontal program were found to be strongly related to implant survival. Special attention should be given to continuous periodontal supportive programs to implant patients. [ABSTRACT FROM AUTHOR]

Background: The use of postorthodontic fixed retainers made of wire and composite resin bonded to the lingual/palatal tooth aspect is a common practice that can affect gingival health. The purpose of this study was to evaluate the association of orthodontic treatment and fixed retainers with gingival health. Methods: The study included 92 consecutive subjects who arrived for routine dental examination at a military dental clinic between May and August 2007. Plaque and gingival indices, gingival recession, probing depth, and bleeding on probing were measured at the anterior sextants. When a fixed retainer was present, the distance was measured between the retainer and incisal edge and to the cemento-enamel junction. Past orthodontic treatment and smoking habits were self-reported. Postorthodontic patients were sorted by the presence or absence of fixed retainers. Results: The mean probing depth was 1.90 ± 0.2 mm, and gingival recession was 0.06 ± 0.02 mm; 20.8% of all sites exhibited bleeding on probing. Current smoking was reported by 20 (21.7%) patients. Labial gingival recession was significantly greater in treated (0.13 ± 0.2 mm) patients compared to non-treated patients (0.05 ± 0.2 mm; P = 0.03). Localized lingual gingival recession was significantly greater in teeth with fixed retainers (0.09 ± 0.2 mm) compared to teeth with no fixed retainers (0.01 ± 0.l mm; P = 0.0002), as were plaque and gingival indices and bleeding on probing. Plaque on the lingual/palatal aspect showed a weak, positive correlation with lingual gingival recession (r = 0.16; P = 0.033). Conclusion: Orthodontic treatment and fixed retainers were associated with an increased incidence of gingival recession, increased plaque retention, and increased bleeding on probing; however, the magnitude of the difference in recession was of low clinical significance. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to assess the prevalence of aggressive periodontitis among young Israeli army recruits and to evaluate its association with smoking habits and ethnic origin. Methods: The study population consisted of 642 young army recruits (562 men [87.5%] and 80 women [12.5%]), aged 18 to 30 years (average: 19.6 ± 1.6 years), who arrived at a military dental clinic for dental examinations between January and December 2004. Subjects filled out a questionnaire regarding their ethnic origin and family periodontal history, followed by radiographs and a clinical periodontal examination of four first molars and eight incisors. Results: Aggressive periodontitis was found in 5.9% of the subjects (4.3% localized and 1.6% generalized). At least one site with a probing depth ≥5 mm was found in 20.1% of the subjects. A radiographic distance between crestal bone height and the cemento-enamel junction >3 mm was found in 43 (6.7%) subjects. Current smokers (39.9%) (P = 0.03) and subjects of North African origin (P<0.0001]) correlated with a high prevalence of aggressive periodontitis. Conclusion: A relatively high prevalence of aggressive periodontitis was found in young Israeli army recruits, which was particularly associated with smoking and ethnic origin. [ABSTRACT FROM AUTHOR]

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The author reflects on peri-implantitis. He suggests that there has been a large increase in cases of peri-implantitis and that the largest risk factor for the disease is poor oral hygiene. He argues that until a miracle treatment for peri-implantitis is found, dental professionals should adhere to stricter prevention programs and try to avoid the disease rather than having to fix its damage.

The aim of this study was to systematically review and analyze the difference in efficacy of oscillating-rotating toothbrushes compared with other powered toothbrushes. The authors performed a systematic search of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The authors used the population, intervention, comparison, and outcome format to develop a search strategy to answer the study question. The authors searched PubMed-MEDLINE databases. Inclusion criteria were randomized controlled clinical trials comparing oscillating-rotating (OR) toothbrushes with other powered toothbrushes published from January 1, 2009 through March 1, 2019. The authors' search resulted in 454 articles; 21 articles were downloaded for review, 15 articles were included in the report, and 12 could be used for meta-analysis. All of the studies were randomized controlled clinical trials that assessed plaque removal and gingival inflammation indexes. Results of the meta-analysis of the randomized controlled clinical trials showed that OR toothbrushes had superior, statistically significant outcomes for whole-mouth plaque reduction, assessed using the Rustogi Modified Navy Plaque Index (P <.01), and gingivitis, assessed by using number of bleeding sites (P <.001), but not for the modified gingival index (P >.05) or gingival bleeding index (P >.05). There is some evidence to suggest that OR powered toothbrushes might remove more plaque and reduce the number of bleedings sites better than other powered toothbrushes, specifically, sonic action toothbrushes. [ABSTRACT FROM AUTHOR]

The author discusses the importance of prevention in the management of dental diseases including caries and periodontitis. He argues that educating patients on the causes, risks, and preventive measures for disease should be a priority for dental practitioners, noting that a patient who requires no further treatment after a regular checkup should be the goal for successful dental practice.