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According to retrospective clinical studies periodontal treatment retains teeth. However, evidence on the effectivity of periodontal treatment stemming from the general population is lacking.We analysed data of periodontally treated patients from routine data of a major German national health insurance (BARMER-MV; subsample of the Federal State of Mecklenburg-Vorpommern) and from a clinical cohort (Greifswald Approach to Individualized Medicine, GANI_MED), as well as periodontally untreated and treated participants of the Study of Health in Pomerania (SHIP-TREND) with either ≥2 or ≥4 teeth with pocket depths ≥4 mm. Yearly tooth loss estimates, incidence rates were evaluated.For moderately to severely affected groups, yearly tooth loss and incidence rates were higher in BARMER-MV patients (0.35 and 0.18, respectively) compared to untreated SHIP-TREND controls (0.19 and 0.08, respectively). In line, treated SHIP-TREND participants exhibited higher yearly tooth loss rates than untreated SHIP-TREND controls (0.26 versus 0.19). For severely affected groups, results with respect to tooth loss were inconclusive regarding beneficial effects of periodontal treatment either conducted in the university (GANI_MED data) or in the general practice.Until 2021, periodontal treatment performed in German general dental practices within the national health insurance system was probably not efficient in retaining more teeth in the short- to mid-term. Since reimbursement schemes were changed in 2021 and now cover periodontal treatment to a much larger extent, future will show, whether these new reimbursement codes will improve the quality of periodontal treatment and whether they will lead to more long-term tooth retainment. This article is protected by copyright. All rights reserved.

Frühkindliche Karies ist eine vermeidbare Erkrankung, die bei Kindern unter 6 Jahren weiterhin verbreitet ist. Ihre Entstehung ist multifaktoriell und zeigt in allen Altersgruppen eine starke soziale Polarisierung. Für die Prävention ist eine frühzeitige gemeinsame Betreuung der Kinder durch alle Berufsgruppen entscheidend. Dabei sollten neben Kinder-/Jugendärzt*innen und Zahnärzt*innen auch Hebammen eingebunden werden.

© 2021 The Authors. Journal of Clinical Periodontology published by John Wiley & Sons Ltd.Aims: Various studies have reported that young European women are more likely to develop early-onset periodontitis compared to men. A potential explanation for the observed variations in sex and age of disease onset is the natural genetic variation within the autosomal genomes. We hypothesized that genotype-by-sex (G × S) interactions contribute to the increased prevalence and severity. Materials and methods: Using the case-only design, we tested for differences in genetic effects between men and women in 896 North-West European early-onset cases, using imputed genotypes from the OmniExpress genotyping array. Population-representative 6823 controls were used to verify that the interacting variables G and S were uncorrelated in the general population. Results: In total, 20 loci indicated G × S associations (P < 0.0005), 3 of which were previously suggested as risk genes for periodontitis (ABLIM2, CDH13, and NELL1). We also found independent G × S interactions of the related gene paralogs MACROD1/FLRT1 (chr11) and MACROD2/FLRT3 (chr20). G × S-associated SNPs at CPEB4, CDH13, MACROD1, and MECOM were genome-wide-associated with heel bone mineral density (CPEB4, MECOM), waist-to-hip ratio (CPEB4, MACROD1), and blood pressure (CPEB4, CDH13). Conclusions: Our results indicate that natural genetic variation affects the different heritability of periodontitis among sexes and suggest genes that contribute to inter-sex phenotypic variation in early-onset periodontitis.

Einfuhrung: Milchmolaren-Hypomineralisation (MMH) und Molaren-Inzisiven-Hypomineralisation (MIH) bezeichnen eine Strukturveranderung in beiden Dentitionen. Ziel dieser retrospektiven Untersuchung war die Analyse von pseudonymisierten MMH respektive hypomineralisierten Milcheckzahnen und MIH-Befunden aus 8 kinderzahnarztlichen Praxen in Norddeutschland. Methoden: Die Untersucher wurden vor Studienbeginn kalibriert. Alle Probanden zeigten entweder eine MMH, MIH oder sowohl eine MIH als auch eine MMH. Es wurden nur Inzisiven eingeschlossen, wenn ein betroffener Molar vorlag. Die Klassifikation der MIH und MMH erfolgte nach Wetzel und Reckel (1991). Der Schweregrad (SG) I entsprach klinisch einzelnen cremefarbenen bis braunen Arealen an Kauflachen/Hockerspitzen bei erhaltener Zahnmorphologie, SG III grosen gelblich-braunen Arealen im gesamten Zahnbereich mit Defekten in der Kronenmorphologie, starken Schmelzverlusten, gekoppelt mit einer hohen Empfindlichkeit der Zahne. Die Auswertung erfolgte primar deskriptiv. Ergebnisse: Es wurden 338 Befunde ausgewertet. Die Geschlechter waren annahernd gleich verteilt (m: n = 170, 50,3 %, w: n = 168, 49,7 %). Das Durchschnittsalter betrug 7,1 (2,84) Jahre (SD [Standardabweichung]) ["range" 3,0-18,0]. Der leichte SG I trat bei der MMH (76,6 %) und der MIH (76,7 %) am haufigsten auf. Der SG III fand sich okklusal am haufigsten bei der MIH (34,9 %) und MMH (39,5 %). Schlussfolgerung: Es fanden sich nur wenige Zahne mit SG III bei Patienten mit einer MMH und MIH mit starkster Auspragung an den Milchfunfern und den 1. permanenten Molaren. Es konnte keine Korrelation zwischen MMH und MIH nachgewiesen werden, hingegen wurde eine Abhangigkeit zwischen der Anzahl der betroffenen Zahnflachen und dem SG der Erkrankung gefunden.

Objectives SOPs recommend high-volume evacuation (HVE) for aerosol-generating procedures (AGPs) in dentistry. Therefore, in the exploratory study, the area of splatter contamination (SCON in %) generated by high-speed tooth preparation (HSP) and air-polishing (APD) was measured when different suction cannulas of 6 mm diameter (saliva ejector (SAE)), 11 mm (HC11), or 16 mm (HC16) were utilized versus no-suction (NS). Materials and methods Eighty tests were performed in a closed darkened room to measure SCON (1m circular around the manikin head (3.14 m2) via plan metrically assessment through fluorescence technique. HSP (handpiece, turbine (Kavo, Germany)) or APD (LM-ProPowerTM (Finland), Airflow®-Prophylaxis-Master (Switzerland)) for 6 min plus 5 s post-treatment were performed either without suction or with low-flow (150 l/min for SAE) or high-flow rate (250 l/min/350 l/min for HC11/HC16) suction. All tests were two-tailed (p≤0.05, Bonferroni corrected for multi-testing). Results Irrespective the AGP, SCON was higher for NS (median [25th; 75th percentiles]: 3.4% [2.6; 5.4]) versus high-flow suction (1.9% [1.5; 2.5]) (p=0.002). Low-flow suction (3.5% [2.6; 4.3]) versus NS resulted in slightly lower but not statistically significantly lower SCON (p=1.000) and was less effective than high-flow suction (p=0.003). Lowest contamination values were found with HC16 (1.9% [1.5; 2.5]; p≤0.002), whereat no significant differences were found for HC11 (2.4% [1.7; 3.1]) compared to SAE (p=0.385) or NS (p=0.316). Conclusions Within study’s limitations, the lowest splatter contamination values resulted when HC16 were utilized by a high-flow rate of ≥250 l/min. Clinical relevance It is strongly recommended to utilize an HVE with suction cannulas of 16mm diameter for a high-flow rate during all AGPs and afterwards also to disinfect all surface of patients or operators contacted.

The present study explored the effects of ascorbic-acid (AA)/retinol and timed inflammation on the stemness, the regenerative potential, and the transcriptomics profile of gingival mesenchymal stem/progenitor cells’ (G-MSCs). STRO-1 (mesenchymal stem cell marker) immuno-magnetically sorted G-MSCs were cultured in basic medium (control group), in basic medium with IL-1β (1 ng/mL), TNF-α (10 ng/mL) and IFN-γ (100 ng/mL, inflammatory-medium), in basic medium with AA (250 µmol/L) and retinol (20 µmol/L) (AA/retinol group) or in inflammatory medium with AA/retinol (inflammatory/AA/retinol group; n = 5/group). The intracellular levels of phosphorylated and total β-Catenin at 1 h, the expression of stemness genes over 7 days, the number of colony-forming units (CFUs) as well as the cellular proliferation aptitude over 14 days, and the G-MSCs’ multilineage differentiation potential were assessed. Next-generation sequencing was undertaken to elaborate on up-/downregulated genes and altered intracellular pathways. G-MSCs demonstrated all mesenchymal stem/progenitor cells characteristics. Controlled inflammation with AA/retinol significantly elevated NANOG (p < 0.05). The AA/retinol-mediated reduction in intracellular phosphorylated β-Catenin was restored through the effect of controlled inflammation (p < 0.05). Cellular proliferation was highest in the AA/retinol group (p < 0.05). AA/retinol counteracted the inflammation-mediated reduction in G-MSCs’ clonogenic ability and CFUs. Amplified chondrogenic differentiation was observed in the inflammatory/AA/retinol group. At 1 and 3 days, the differentially expressed genes were associated with development, proliferation, and migration (FOS, EGR1, SGK1, CXCL5, SIPA1L2, TFPI2, KRATP1-5), survival (EGR1, SGK1, TMEM132A), differentiation and mineral absorption (FOS, EGR1, MT1E, KRTAP1-5, ASNS, PSAT1), inflammation and MHC-II antigen processing (PER1, CTSS, CD74) and intracellular pathway activation (FKBP5, ZNF404). Less as well as more genes were activated the longer the G-MSCs remained in the inflammatory medium or AA/retinol, respectively. Combined, current results point at possibly interesting interactions between controlled inflammation or AA/retinol affecting stemness, proliferation, and differentiation attributes of G-MSCs.

Objectives High-speed tooth preparation requires effective cooling to avoid thermal damage, which generates spray mist, which is a mixture of an aerosol, droplets and particles of different sizes. The aim of this experimental study was to analyze the efficacy of spray mist reduction with an intraoral high-volume evacuation system (HVE) during simulated high-speed tooth preparation for suboptimal versus optimal suction positions of 16 mm sized cannulas and different flow rates of the HVE. Material and methods In a manikin head, the upper first premolar was prepared with a dental turbine, and generated particles of 5–50 microns were analyzed fifty millimeters above the mouth opening with the shadow imaging technique (frame: 6.6×5.3×1.1 mm). This setup was chosen to generate a reproducible spray mist in a vertical direction towards an imaginary operator head (worst case scenario). The flow rate (FR) of the HVE was categorized into five levels (≤120 l/min up to 330 l/min). The number of particles per second (NP; p/s) was counted, and the mass volume flow of particles per second (MVF; μg/s*cm3) was calculated for 10 sec. Statistical tests were nonparametric and two-sided (p≤0.05). Results With increasing flow rate, the NP/MVF values decreased significantly (eta: 0.671/0.678; p≤0.001). Using a suboptimally positioned cannula with an FR≤160 l/min, significantly higher NP values (mean±SD) of 731.67±54.24 p/s (p≤0.019) and an MVF of 3.72±0.42 μg/s*cm3 (p≤0.010) were measured compared to those of the optimal cannula position and FR≥300 l/min (NP/MVF: 0/0). No significant difference in NP and MVF was measurable between FR≥250 l/min and FR>300 l/min (p = 0.652, p = 0.664). Conclusion Within the limitations of the current experimental study, intraoral high-flow rate suction with ≥300 l/min with an HVE effectively reduced 5–50 μm sized particles of the spray mist induced by high-speed tooth preparation with a dental turbine.

Simple Summary Due to the COVID-19 pandemic, the oncology community was challenged with the need to protect a vulnerable population from a potentially fatal infection without jeopardizing cancer treatments. The impact of the crisis on the medical care of patients with oral cancer is largely unexplored. This multicenter cohort study from Germany aims to assess the consequences of the COVID-19 pandemic by comparing the healthcare of patients during the lockdown and post-lockdown periods in 2020 with the corresponding periods in 2018/19. We found the closure of dental practices during lockdown to possibly delay the diagnosis of oral cancer. Even if during this period no higher incidence of oral cancer was observed, data point to potentially fatal consequences for longer periods of treatment delay. Abstract (1) Background: In response to the global COVID-19 pandemic, governmental measures have been undertaken. The impact of the crisis on the healthcare of patients with cancer is largely unexplored. This multicenter cohort study aimed to investigate a potential screening delay and its consequences in patients with oral cancer (OC) during the pandemic. (2) Material and Methods: Data of patients who were first diagnosed with OC during different periods were collected, especially in terms of OC incidence, tumor stage/entity and time to intervention. The periods lockdown (LD) (13 March–16 June 2020), post-lockdown (PLD) (17 June–1 November 2020), and the corresponding equivalents in 2018/19 were differentiated and compared. (3) Results: There was no obvious trend towards a higher incidence of OC or higher tumor stages, whereas a trend towards a shorter time to intervention during the LD2020 could be observed. Subgroup analyses revealed an increased incidence in OC within the PLD2020 in Mainz, which might be explained by the partial closure of dental practices in this federal state during LD. (4) Conclusions: While there was no overall higher incidence of OC, we found closure of practices during LD to possibly delay cancer diagnosis. Therefore, measures must be taken to identify patients at risk and to ensure basic healthcare, especially in the context of dental screening measures.

Prediction models learn patterns from available data (training) and are then validated on new data (testing). Prediction modeling is increasingly common in dental research. We aimed to evaluate how different model development and validation steps affect the predictive performance of tooth loss prediction models of patients with periodontitis. Two independent cohorts (627 patients, 11,651 teeth) were followed over a mean ± SD 18.2 ± 5.6 y (Kiel cohort) and 6.6 ± 2.9 y (Greifswald cohort). Tooth loss and 10 patient- and tooth-level predictors were recorded. The impact of different model development and validation steps was evaluated: 1) model complexity (logistic regression, recursive partitioning, random forest, extreme gradient boosting), 2) sample size (full data set or 10%, 25%, or 75% of cases dropped at random), 3) prediction periods (maximum 10, 15, or 20 y or uncensored), and 4) validation schemes (internal or external by centers/time). Tooth loss was generally a rare event (880 teeth were lost). All models showed limited sensitivity but high specificity. Patients’ age and tooth loss at baseline as well as probing pocket depths showed high variable importance. More complex models (random forest, extreme gradient boosting) had no consistent advantages over simpler ones (logistic regression, recursive partitioning). Internal validation (in sample) overestimated the predictive power (area under the curve up to 0.90), while external validation (out of sample) found lower areas under the curve (range 0.62 to 0.82). Reducing the sample size decreased the predictive power, particularly for more complex models. Censoring the prediction period had only limited impact. When the model was trained in one period and tested in another, model outcomes were similar to the base case, indicating temporal validation as a valid option. No model showed higher accuracy than the no-information rate. In conclusion, none of the developed models would be useful in a clinical setting, despite high accuracy. During modeling, rigorous development and external validation should be applied and reported accordingly.

Psoriasis is associated with periodontitis, a chronic inflammation of the gingival tissue. However, data about periodontal and dental status of psoriasis patients are sparse. Therefore, we conducted a prospective study comparing psoriasis patients with control individuals. 100 psoriasis patients presenting at the outpatient service of a specialized psoriasis center and 101 nonpsoriatic control individuals were included in the study. Oral health was assessed with standardized measures including Bleeding on Probing, Community Periodontal Index, and dental parameters according to the DMFT index (a cumulative index in which teeth [T] are registered as decayed [D], missing [M], and filled [F]). For analysis, a postmatching strategy was applied with 53 pairs of psoriasis patients and nonpsoriatic individuals in which relevant factors with possible impact on oral health status were considered. Logistic regression analyses were executed on the entire psoriasis and control population. According to the results, the matched psoriasis group had significantly higher values on Bleeding on Probing and the Community Periodontal Index compared with matched control individuals. Logistic regression analyses identified significant correlations of the psoriasis group with high Bleeding on Probing and Community Periodontal Index values but not, however, with missing teeth. Psoriasis patients had significantly higher values for parameters addressing periodontal inflammation. Psoriasis management should, therefore, include regular dental checks on periodontal status and respective treatment where required.

There is uncertainty regarding the benefits of periodontal endoscopy (PE) for subgingival instrumentation. Moreover, the influence of operators’ experience and training with such a device on treatment results is unclear. Therefore, we compared in an in vitro study the use of PE for scaling and root planing (SRP) with the conventional non-surgical therapy, hypothesizing that using a PE allows to remove more simulated hard deposits than without (nPE), influenced by the operators’ experience and training. A sonic device and Gracey curettes were utilized by 11 operators (six dentists, five dental hygienists) in periodontitis manikins heads. The time required for treatment and the proportion of removed simulated hard deposits by SRP were measured. Using the PE led to a significant difference in removal of simulated hard deposits (%) (mean ± SD) irrespective of operators’ experience (PE 90.78 ± 12.10% (range 58.80–100%); nPE 79.98 ± 22.15% (range 38.10–100%, p

Periodontitis is one of the most common inflammatory diseases, with a prevalence of 11% worldwide for the severe forms and an estimated heritability of 50%. It is classified into the widespread moderate form chronic periodontitis (CP) and the rare early-onset and severe phenotype aggressive periodontitis (AgP). These different disease manifestations are thought to share risk alleles and predisposing environmental factors. To obtain novel insights into the shared genetic etiology and the underlying molecular mechanisms of both forms, we performed a two step-wise meta-analysis approach using genome-wide association studies of both phenotypes. Genotypes from imputed genome-wide association studies (GWAS) of AgP and CP comprising 5,095 cases and 9,908 controls of North-West European genetic background were included. Two loci were associated with periodontitis at a genome-wide significance level. They located within the pseudogene MTND1P5 on chromosome 8 (rs16870060-G, P = 3.69 × 10(−9), OR = 1.36, 95% CI = [1.23–1.51]) and intronic of the long intergenic non-coding RNA LOC107984137 on chromosome 16, downstream of the gene SHISA9 (rs729876-T, P = 9.77 × 10(−9), OR = 1.24, 95% CI = [1.15–1.34]). This study identified novel risk loci of periodontitis, adding to the genetic basis of AgP and CP.

Objective/aim To identify small particle concentrations (eight categories: ≤0.1 µm × ≤5.0 µm) induced by aerosol-generating procedures (AGPs; high-speed tooth preparation, ultrasonic scaling; air polishing) under high-flow suction with a 16-mm intraoral cannula with and without an additional mobile extraoral scavenger (EOS) device during student training. Materials and methods Twenty tests were performed (16.94 m2 room without ventilation with constant temperature (26.7 (1.1) °C and humidity (56.53 (4.20)%)). Data were collected 2 min before, 2 min during, and 6 min after AGPs. The EOS device and the air sampler for particle counting were placed 0.35 m from the open mouth of a manikin head. The particle number concentration (PN, counts/m3) was measured to calculate ΔPN (ΔPN = [post-PN] − [pre-PN]). Results Mean ΔPN (SD) ranged between −8.65E+06 (2.86E+07) counts/m3 for 0.15 µm and 6.41E+04 (2.77E+05) counts/m3 for 1.0 µm particles. No significant differences were found among the AGP groups (p > 0.05) or between the AGP and control groups (p > 0.05). With an EOS device, lower ΔPN was detected for smaller particles by high-speed tooth preparation (0.1–0.3 µm; p Discussion A greater reduction in the number of smaller particles generated by the EOS device was found for high-speed tooth preparation. Low ΔPN by all AGPs demonstrated the efficacy of high-flow suction. Conclusions The additional use of an EOS device should be carefully considered when performing treatments, such as high-speed tooth preparation, that generate particularly small particles when more people are present and all other protective options have been exhausted.

(1) Background: In Germany, new recommendations for dental examinations of children and the use of fluorides have been introduced. The pediatrician (PA) should refer the patient to the dentist for dental examinations and check-ups (DEs) from the sixth month of age. Therefore, our aim was to determine with a questionnaire the extent to which PAs find DE useful, make referrals for DE and recommend fluoride. (2) Methods: The nationwide empirical survey was conducted with a self-developed and validated standardized online questionnaire. In addition to personal information, 16 items were collected. Agreement with the items was recorded using Likert scales. The data were primarily analysed descriptively. (3) Results: 696 PAs participated in the survey (age: 51.7 (8.4) years, women/men: 428/286 (61.5/38.5%). A total of 11% of PAs found referral by eruption of first tooth very important (important/neutral/unimportant: 13.8/32/43.2%), compared to 70% for complete deciduous teeth (21.3/7.3/1.4%). A total of 48.8% of PAs always recommended fluoridated toothpaste from the first tooth (often/occasionally/rarely/never: 18.3/7.8/8/17.1%) and 50.6% completely refused to recommend fluoride-free toothpaste (always/often/occasionally/rarely: 9.8/9/14.7/15.9%). A total of 44.8% never recommended the use of fluoridated toothpaste if the child cannot yet spit (always/often/occasionally/rarely: 19.2/13.9/7.8/14.3%). (4) Conclusions: Among PAs, referral to DEs was increasingly implemented as children grew older. Specific fluoride recommendations were accepted.

It is well established that dental plaque on teeth leads to gingivitis and periodontitis, and that several mechanical and chemical methods of plaque control can prevent gingivitis. The aim of the current review is to summarize and synthesize the available scientific evidence supporting practices for mechanical oral hygiene to prevent periodontal diseases. Evidence for contemporary practices of mechanical oral hygiene to prevent periodontal disease relies on studies of gingivitis patients. General recommendations concerning the ideal oral hygiene devices and procedures are still inconclusive. However, toothbrushing and interdental cleaning remain the mainstays of prevention of periodontal diseases. The primary approach requires individually tailored instruction for implementation of a systematic oral hygiene regimen.

To assess if long-term treatment costs in periodontitis patients differ between stage III vs. IV and grade B vs. C according to the 2018 classification of periodontal diseases.A cohort of 231 periodontitis patients (followed over a mean of 18.4 years) was evaluated. Costs for active periodontal therapy (APT, including scaling and root planning, open flap debridement, root resections) and supportive periodontal therapy (SPT, including also restorative, endodontic, prosthetic and surgical treatment) were estimated from a mixed payer-perspective in Germany (in Euro 2020). Multi-dimensional staging and grading was applied. The impact of stage, grade, sex and age on total and annual costs was assessed.Mean (SD) total and annual treatment costs were 7154 (2554) Euro and 437 (222) Euro. Costs were generated during SPT (92 %) and by periodontal treatment (88 %) and decreased significantly with longer follow-up (p0.001). Total costs were 7120 (2692) Euro in stage III (n = 154) vs. 7221 (2271) Euro in stage IV (n = 77; p0.05), and 6256 (1605) Euro in grade B (n = 35) vs. 7314 (2660) Euro in grade C (n = 196; p0.001). Annual costs were 426 (219) Euro vs. 459 (228) Euro for stage III vs. stage IV (p0.05) and 308 (163) Euro vs. 460 (224) Euro for grade B vs. grade C (p0.001). Multivariable modelling found grade, but not stage, sex and age significantly associated with costs.Within the limitations of this study, and in patients with severe periodontitis who were systematically treated long-term, grading, but not staging was associated with costs.Treatment costs were higher in patients with more progressive periodontitis and were found to decrease during follow-up. Dentists need to consider costs during treatment planning and communication with patients.

AIM This pilot study assessed the oral-health-related quality of life (OHRQoL) after long-term periodontal therapy and explored OHRQoL differences along the 2018 Classification of Periodontal Diseases. METHODS Sixty patients were examined before (T0) and after active periodontal therapy (APT/T1) and 32.0 ± 2.9 [range: 27-38] years of supportive periodontal therapy (SPT/T2). Periodontal diagnosis at T0 was assessed according to the 2018 Classification of Periodontal Diseases (stage 1/2/3/4: n = 1/3/44/13; grade n = A/B/C: 0/8/53). OHRQoL at T2 was measured using the Oral Health Impact Profile-G14 (OHIP-G14). Patients' Eichner's classification, accumulated tooth loss and treatment outcomes (SSO criteria) were assessed at T2. Generalized linear modelling (GLM) assessed associations between different factors and OHrQoL. RESULTS Mean OHIP-G14 sum score was 3.7 (SD 5.6). There was no statistically significant association between OHIP-G14 and gender, stage, SSO criteria and tooth loss. OHIP-G14 was significantly lower in older patients (-0.2[-0.3;0] per year, p = .008), non-smokers (-5.9[-9.9;-1.9] p = .003) and former smokers (-7.4[-11.6;-3.2]; p

Background Aggregatibacter-actinomycetemcomitans (A.actinomycetemcomitans) are strongly associated with localized-aggressive-periodontitis (LAgP). The study’s aim was to test for the first time the effect of total sonicated A.actinomycetemcomitans-bacterial-fragments on gingival mesenchymal stem/progenitor cells’ (G-MSCs) proliferation and regenerative gene expression in-vitro. Material and Methods G-MSCs were isolated, characterized, expanded and stimulated by total sonicated A.actinomycetemcomitans-bacterial-fragments (0 (negative-control), 15, 60, 120 and 240µg/ml; serovar-b; n=6/group). Cellular proliferation and NF-κβ (NFKB1), Alkaline Phosphatase (ALPL), Collagen-I (COL1A1), Collagen-III (COL3A1), Osteonectin (SPARC) and Osteopontin (SPP1) m-RNA expression were assessed via reverse-transcription-polymerase-chain-reaction (RT-PCR) at 24, 48 and 72 hours and CFUs-ability evaluated at twelve days. Results G-MSCs demonstrated stem/progenitor cells’ characteristics. A.actinomycetemcomitans-bacterial-fragments (up to 72 hours) resulted in marked G-MSCs’ proliferation over-time (p0.05; Friedman-test). Longer-term stimulation for twelve days reduced G-MSCs’ CFUs. Conclusions Sonicated A.actinomycetemcomitans-bacterial-fragments’ exert beneficial short-term effects on G-MSCs’ proliferative and non-mineralized tissue forming aptitude. Results shed new light on the importance of periodontal treatment for LAgP patients, using power driven sonic/ultrasonic devices, which, in addition to reducing the subgingival microbial load, produces cell-stimulatory A.actinomycetemcomitans-bacterial-fragments, with positive attributes on tissue reparative/regenerative responses of tissue resident stem/progenitor cells in their niche. Key words:Ultrasonic, Aggregatibacter actinomycetemcomitans, stem cells, gingiva, Aggressive periodontitis.

Objectives Whereas the key role of subgingival instrumentation in periodontal therapy is well known, the influence of operators’ experience/training with different devices on treatment results is yet uncertain. Therefore, we assessed untrained undergraduate students, working on manikins, as to how effectively they learn to use curettes (GRA) and sonic scalers (AIR); hypothesizing that AIR will result in higher relative cleaning efficacy (RCE) than GRA. Material and methods Before baseline evaluation (T0), 30 operators (9 males, 21 females) received a 2-h theoretical lesson for both instruments, followed by a 12-week period with a weekly digitized training program for 45 min. During three sessions (T1–T3), the operators had to instrument six equivalent test teeth with GRA and AIR. At T0–T3, treatment time, proportion of removed simulated biofilm (RCE-b), and hard deposits (RCE-d) were measured. Results At T0, RCE-b was in mean(SD) 64.18(25.74) % for GRA, 62.25(26.69) % for AIR; (p = 0.172) and RCE-d 85.48(12.32) %/ 65.71(15.27) % (p < 0.001). At T3, operators reached highest RCE-b in both groups (GRA/AIR 71.54(23.90) %/71.75(23.05)%; p = 0.864); RCE-d GRA/AIR: 84.68(16.84) %/77.85(13.98) %; p < 0.001). Both groups achieved shorter treatment times after training. At T3, using curettes was faster (GRA/AIR 16.67(3.31) min/19.80(4.52) min; p < 0.001). Conclusions After systematic digitized training, untrained operators were able to clean 70% of the root surfaces with curettes and sonic scalers. Clinical relevance It can be concluded that a systematic digitized and interactive training program in manikin heads is helpful in the training of root surface debridement.

Aim Tooth loss prediction could improve decision-making for periodontally-affected molars. We analyzed the costs of removing all, none or only those molars predicted to be at-risk for extraction during supportive periodontal therapy (SPT). Methods This is a model-based study using a German private-payer-perspective. Building mainly on cost and effectiveness data from 2039 molars (301 patients) which received long-term SPT, five (exemplary) prediction/decision strategies were compared: Retaining all molars, removing molars with furcation-involvement (FI) ≥I/≥II/III, or removing all molars. Each strategy came with different proportions of molars correctly or erroneously (false positively) removed. Retaining as well as removing molars had long-term cost implications (via SPT or tooth replacement). Using Monte-Carlo microsimulations, we estimated the lifetime costs of an average population in our cohort, and evaluated what accuracy a prediction method needed to have to save costs in different risk groups. Results Removing only molars with FI III (1188 Euro) and removing no molars (1195 Euro) were significantly less costly than removing all molars (1454 Euro). Prediction methods needed to be highly specific in most populations to avoid unnecessary tooth loss and the associated high costs. Conclusions Removing molars prior to SPT should be decided cautiously. This article is protected by copyright. All rights reserved.

Aim This retrospective longitudinal study assessed the risk of and prognostic factors for tooth loss in patients with generalized aggressive periodontitis (GAgP) after periodontal treatment in a university setting. Methods Fifty-seven patients (1,505 teeth) were examined before (T0) and after active periodontal therapy (APT, T1) as well as after 17.4 ± 4.8 [range: 9–28] years of supportive periodontal therapy (SPT, T2). Descriptive statistics and a Cox-proportional-hazards shared-frailty model were applied. Results Overall, 98 and 134 teeth were lost during APT and SPT, respectively, with 0.14 ± 0.18 teeth being lost per patient and year. During SPT, three patients (5%) lost ≥10 teeth, 14 (25%) lost 4–9 teeth, 40 lost 0–3 (70%) teeth, respectively. One-third (n = 19) of all patients lost no teeth. Mean PPD of the teeth surviving SPT was stable from T1 (3.5 ± 1.1 mm) to T2 (3.4 ± 1.1 mm). Nearly, 84% of all survived teeth showed stable or improved bone level at T2. Risk of tooth loss was significantly increased in active smokers (HR[95% CI]: 4.94[1.91/12.75]), the upper dental arch (1.94[1,16/3.25]), with each mm of residual PPD (1.41[1.29/1.53]), teeth with furcation involvement (FI) (HR 4.00–4.44 for different degrees) and mobility (5.39 [2.06/14.1] for degree III). Conclusion Within the provided conservative treatment regimen, GAgP patients lost only few teeth.

Aim The longitudinal study assessed the risk of tooth loss under a non-regenerative treatment regimen and aimed to identify prognostic factors for tooth loss. Methods Three hundred and fifteen patients (8009 teeth) were examined before (T0) and after active periodontal therapy (APT, T1) as well as after (mean ± SD) 18 ± 6 years of supportive periodontal therapy (SPT, T2). Descriptive statistics and a Cox proportional hazards shared-frailty model were applied. Results Overall, 351 and 816 teeth were lost during APT and SPT, respectively, with 0.15 ± 0.17 teeth being lost per patient and year. Seventy-two percentage patients lost 0–3, 24% 4–9 and 4% ≥10 teeth. The proportion of teeth with probing-pocket depths (PPD) >6 mm was 17.2% (T0), 1.6% (T1) and remained stable at 1.7% up to T2. Tooth loss during SPT was significantly increased in older patients [HR (95% CI): 1.04 (1.01–1.07) per year] and smokers [2.62 (1.34–5.14)], with each mm of PPD [1.35 (1.17–1.56)], in multirooted compared with single-rooted teeth [1.86 (1.36–2.56)] and teeth with bone loss [BL; HR up to 23.6 (12.1–45.6) for BL > 70%]. Conclusion The risk of tooth loss was generally low under the provided non-regenerative treatment regimen; a minority of patients were responsible for the majority of teeth lost during SPT.

Aim A range of predictors for tooth loss in periodontitis patients have been reported. We performed a systematic review and meta-analysis to assess the consistency and magnitude of any association between a total of 12 predictors and tooth loss. Materials and methods Medline/Embase/Central were searched for longitudinal studies investigating the association between predictors and tooth loss in periodontitis patients. Random-effects meta-analysis was performed, and study quality assessed. Results Twenty studies (15,422 patients, mean follow-up: 12 years) were included. The mean annual tooth loss/patient was 0.12 (min./max: 0.01/0.36). Older patients (n = 8 studies; OR: 1.05, 95% CI: 1.03-1.08/year), non-compliant ones (n = 11; 1.51, 1.06-2.16), diabetics (n = 7; 1.80, 1.26-2.57), those with IL-1-polymorphism (n = 3; 1.80; 1.29-2.52) and smokers (n = 15; 1.98, 1.58-2.48) had a significantly higher risk of tooth loss. Teeth with bone loss (n = 3; 1.04, 1.03-1.05/%), high probing pocket depth (n = 6; 3.19, 1.70-5.98), mobility (n = 4; 3.71, 1.65-8.38) and molars (n = 4; 4.22, 2.12-8.39), especially with furcation involvement (n = 5; 2.68, 1.75-4.08) also showed higher risks. Gender (n = 16; 0.95, 0.86-1.05) and endodontic affection (n = 3; 3.62, 0.99-13.2) were not significantly associated with tooth loss. Conclusions Older, non-compliant, smoking or diabetic patients, and teeth with bone loss, high probing pocket depth, mobility, or molars, especially with furcation involvement showed higher risks of tooth loss.

Objectives We aimed to assess how the 2018 and 1999 classifications of periodontal diseases reflect (a) patients' characteristics, (b) disease severity/extent/progression and (c) tooth loss (TL) during observation period. Methods A total of 251 patients were followed over 21.8 ± 6.2 years. For the 1999 classification, using clinical attachment level (CAL), patients were classified as localized/generalized, mild/moderate/severe and aggressive/chronic periodontitis. For the 2018 classification, patients were staged according to their CAL or bone loss (BL) and the number of lost teeth (stages I-IV). Further factors like probing pocket depths (PPD) or furcation involvement modified the stage. The extent was sub-classified as generalized/localized. Patients were graded according to the BL/age index, smoking and/or diabetes. Results According to the 1999 classification, most patients suffered from generalized severe chronic periodontitis (203/251) or generalized aggressive periodontitis (45/251). Patients with aggressive periodontitis were younger and less often female or smokers. They showed similar TL (0.25 ± 0.22 teeth/patient*year) as generalized severe chronic periodontitis patients (0.23 ± 0.25 teeth/patient*year). According to the 2018 classification, most patients were classified as generalized III-C (140/251), III-B (31/251) or IV-C (64/251). Patients' age, smoking status, CAL, PPD and BL were well reflected. TL differed between IV-C (0.36 ± 0.47), generalized III-C (0.21 ± 0.24) and localized forms (0.10-0.15). Conclusions Patients' characteristics, disease severity/extent/progression and TL were well reflected by the 2018 classification.

Aim For periodontitis patients, regular supportive periodontal therapy (SPT) decreases risks of tooth loss, with savings for tooth replacement possibly compensating SPT-costs. We aimed to assess the cost-effectiveness of regular versus irregular SPT, and to compare both strategies with immediate tooth removal. Methods A private payer perspective within German healthcare was adopted. A tooth-level Markov model was constructed. Replacement of 50% of removed teeth via implant-supported crowns was modelled in the base case. Cost-effectiveness was estimated as Euro/tooth retention year using Monte Carlo microsimulations. Scenario analyses were performed. Results Regular SPT was more effective (tooth retention 28.7 versus 26.1 years), but more costly (806 versus 731 Euro per tooth), with an incremental cost-effectiveness ratio (additional costs per tooth retention year) of 29 Euro/year. Regular SPT was less costly if costs for SPT per tooth and visit were

Objectives This study assessed the survival and maintenance needs of splinted teeth in periodontitis patients. Methods Patients receiving active and supportive periodontal treatment involving teeth splinting in a university setting were retrospectively assessed. Tooth and splint survival and number of splint-repairs were recorded. Multilevel Cox and generalized-mixed linear regression analyses were performed. Results Fifty-seven patients with 227 splinted teeth (maxilla/mandible: 148/79) were followed over mean ± SD 11.0 ± 7.2 [range: 2.0–32.4]) years. Twenty-six splinted teeth were extracted during this period, the mean (95% CI) time of splint retention was 7.3 ± 5.7 (0.1–22.7). Splinted teeth did not show significantly increased risk of tooth loss compared with non-splinted teeth (HR; 95% CI: 1.30; 0.87–1.93); while age (1.07; 1.05–1.09), PPD >6 mm (4.24; 1.26–14.31), bone loss (mean HR was 5.07–15.36 depending on severity), tooth location (posterior versus anterior teeth: HR 2.08; 1.24–3.49) and the number of occlusal contact areas (mean HR was 4.38–17.34 depending on the number of antagonistic contact areas) were associated with tooth loss. 75.3% splints required repair, with a mean of 2.6 ± 1.9 [1.0–8.0] repairs per splint during the mean observation time (0.4 ± 0.6 [0.0–3.5] repairs per splint/year). Conclusion Splinting did not significantly increase the risk of tooth loss; splinted teeth showed long-term survival. To maintain splints, frequent repairs were needed. Clinical significance Splinted teeth were not at significantly higher risk of tooth loss than non-splinted teeth. While splinting does not improve the prognosis of periodontally affected teeth, it can assist their retention by reducing their mobility.