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A discussion of advancements in diagnosis of periodontal diseases looks first at the screening process, reviews specific periodontal diseases and their clinical signs and symptoms, and explains both traditional and newly developed diagnostic tests. A framework for understanding the tests' clinical usefulness is also presented. (MSE)

Nonsurgical scaling and/or root planning (SRP) is an effective treatment for periodontitis. Some of the challenges encountered while analyzing the clinical study data are explored, and the anesthetic efficacy of Oraqix, a noninjectable anesthetic gel, are presented.

Pregnant women who have periodontal disease during pregnancy have a higher risk of premature birth, according to a study of 1,313 pregnant women. For this reason, dentists should advise all pregnant women to take good care of their teeth and gums.

A chlorhexidine (CHX) chip placed in periodontal pockets following tooth scaling and root planing (SRP) may improve the treatment of periodontal disease, compared to SRP alone. SRP removes dead and infected tissue below the gumline and allows the gums to reattach to the tooth root in patients with severe gum disease. The CHX chip is a sustained-release antibiotic chip placed below the gum after SRP. Researchers compared the techniques in 416 patients. Additional maintenance procedures were required by 54% of patients treated by SRP alone and 46% who underwent SRP and received the CHX chip. The CHX chip improved gum healing without significantly increasing the cost of treatment.

The 1996 World Workshop in Periodontics focused on objective evidence-based approaches to diagnosis and treatment rather than subjective experience-based ones. With such stringent methods as the double-blind placebo-controlled clinical trial, evidence-based approaches to a therapy can be quantified to determine their strengths and weaknesses. The workshop discussed techniques of diagnosis, nonsurgical treatments of gingivitis and periodontitis, and surgical procedures of periodontal therapy. It is hoped that incorporation into individual practice of innovative procedures based on scientific research will serve to benefit doctor and patient alike.

Changes in the dental education system are necessary to ensure the adequate preparation of future dental professionals. The Institute of Medicine (IOM) assessed the dental education system and issued recommendations for change. The dental profession must align itself closely with the medical profession. Medical advances and the needs of an aging population necessitate this partnership. Educators must reflect the positive aspects of dental practice through the establishment of patient-friendly, efficient dental school clinics. Clinical learning should provide students with greater patient quantity and a breadth of experience. Dental schools must prove their worth to their parent institutions and must establish commonality with their larger body. Continued accreditation and licensure reforms are required to remedy existing deficiencies. Dental schools must test different educational models and experiment with various methods to assess dental practice and performance.

Various tests may be used to detect periodontal (gum) disease. Merely probing the teeth and gums or even examining x-rays may not be enough to determine why a patient has periodontal disease or how to prevent it from becoming worse. Periodontitis occurs when bacteria infect a susceptible host patient. Infection leads to metabolic changes of the connective tissue and bone, which lead to anatomic changes. The validity of a test may be determined by its sensitivity, specificity, positive predictive value, and negative predictive value. Sensitivity measures the test's ability to detect disease, whereas specificity describes how well the test can rule out progressive disease. Tests for causative factors such as various bacteria and for host susceptibility, tests for metabolic changes, and tests for anatomic changes are described. Reasons for adopting a new test are given.

Older women are at an increased risk for osteoporosis and both tooth and oral bone loss. There also may be a relationship between osteoporosis and tooth loss in older women. A drop in estrogen levels and increasing age are associated with osteoporosis. Plaque infection is associated with periodontitis, an inflammation of the gums and alveolar bone. Loss of teeth may lead to residual ridge resorption, which may result in atrophy of the jawbone. Smoking and increasing age are related to both osteoporosis and periodontitis. Long-term use of steroids also appears to be associated with bone loss. Strategies for preventing oral bone loss include plaque control and removal, and the use of antibiotics if necessary. Preventing oral diseases that might lead to tooth loss will help prevent residual ridge resorption.

A review is presented of newly developed approaches to the treatment of periodontal disease (disease of the gums and other structures that support the teeth). If untreated, periodontitis (inflammation of the gums and other structures around the teeth) can lead to loss of bone, teeth, and jaw mobility, as well as to the formation of abscesses. Older methods of evaluating periodontal health include probing and radiography, but these provide only limited information about the ongoing nature of disease. Radiographs (X-rays), for instance, cannot tell when visible damage occurred, and probing only reveals damage when it has progressed considerably. Newer methods allow testing for bacteria in the mouth that are believed to cause periodontal disease. Formerly, bacteria had to be grown under laboratory conditions to allow their identification, a process impossible for many mouth bacteria, which die on exposure to air. Now, DNA probe technology can compare the DNA of sampled bacteria with known patterns, regardless of whether the bacteria are dead or alive. Progress has also been made in knowledge regarding the bacterial strains that cause periodontal disease: at least 15 such strains are believed to be pathogens in adults. Immunological tests to evaluate host (patient) response to pathogens are under development, as are tests that evaluate the activity of periodontal disease. Some of these simply involve the insertion of strips into the area near the tooth to test for concentrations of enzymes associated with tissue damage or destruction. Bone scans can help gauge the extent of bone disease, and radiographic techniques have been improved so that very small changes can be detected. Electronic probes can reduce the errors and variability inherent in manual probing. (Consumer Summary produced by Reliance Medical Information, Inc.)

More and more patients may come to their dentist with information they found on the Internet. Dentists should encourage their patients to become informed, but they should explain that not all information found on the Internet has been subjected to scientific evaluation.

In early 2020, a new health threat arose with symptoms and mode of transmission comparable to severe acute respiratory syndrome (SARS). Both SARS and the new disease, COVID-19, are caused by coronaviruses and share similar characteristics, especially their severity and high mortality rates and an apparently greater likelihood of transmission. Seasonal influenza is caused by numerous and changing groups of viruses and, for most people, is much less serious. The purpose of this article is to help clinicians compare seasonal influenza, SARS, and COVID -19. It discusses what constitutes best evidence in a time of pandemic, describing the hierarchy of evidence. It is intended to assist dental professionals in providing accurate, current information in answer to patients' questions regarding testing and treatment. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the effect of cigarette smoking and residual native bone height on the survival of dental implants placed immediately in grafted sinuses. In this retrospective study, 334 subject records were screened, and 75 subjects (155 implants) were included. Data collection based on treatment notes and radiographs included age, sex, smoking status, sinus floor bone height, dental implant information, and implant survival. The survival rates of implants for nonsmokers and smokers at stage-two surgery were 93% and 84%, respectively. After 12 months of functional loading, the survival rates of implants for nonsmokers and smokers were 87% (81 of 93) and 79% (49 of 62), respectively (P < .000). Analysis revealed that the effect of smoking on implant survival is significant when the preoperative bone height is less than 4 mm, with an 82.4% implant survival rate in nonsmokers compared to 60% in smokers (P < .05). Smoking should be considered as a high risk factor when implants are placed immediately in grafted sinuses, particularly in areas of limited bone height. [ABSTRACT FROM AUTHOR]

Meta-analyses have been widely used to estimate treatment effects in evidence-based dentistry. Few conferences, however, have used a systems approach to assure coherent data management and analysis. The purpose of this section is to describe the data management and statistical analysis for the State of the Science of Implant Dentistry (SSID) conference. This overview includes (a) a description of widely used clinical trial designs for implant dentistry, (b) a description of data management procedures specifically designed for the SSID conference, and (c) a description of the data analysis methodology, including descriptive analyses and meta-analyses. The use of the systems approach facilitated data abstraction and analysis. [ABSTRACT FROM AUTHOR]

The article presents the professional opinions of experts in the field of oral and maxillofacial implants on the topic of whether the use of oral bisphosphonates places patients at risk for developing osteonecrotic lesions of the jaw. Opinions are given by Nicholas M. Dello Russo, of Massachusetts General Hospital and the Harvard School of Dental Medicine; Marjorie K. Jeffcoat, of the University of Pennsylvania School of Dental Medicine; Robert E. Marx, of the Miller School of Medicine at the University of Miami; and Paul Fugazzotto, the senior editor of the journal "Implant Realities."

Purpose: Osteoporosis and osteopenia are characterized by reductions in bone mass and may lead to skeletal fragility and fracture. The latest generation of oral bisphosphonate drugs, including alendronate and risendronate, has been approved for the prevention and treatment of osteoporosis. These medications are chemically absorbed into bone, decreasing osteoclast number and activity and thereby decreasing bone resorption. The purpose of this report is to present safety data from 2 controlled studies in patients receiving oral bisphosphonates. Materials and Methods: Study 1 tested the effect of alendronate, an inhibitor of bone resorption, on alveolar bone. A total of 335 patients (162 men and 173 women, aged 30 to 79 years) with moderate or severe periodontal disease were randomized to either placebo or 70 mg alendronate once weekly. Alveolar bone height and safety were assessed over a 2-year period. Study 2 was a longitudinal single-blind controlled design comparing implant success in 50 consecutive patients (210 implants), 25 patients who received bisphosphonate therapy and 25 age-matched control subjects. Implant success and safety, including incidence of osteonecrosis of the jaws (ONJ), was blindly assessed for at least 3 years. Results: In study 1, no cases of ONJ were observed in either treatment group. Furthermore, a trend toward lower incidences of infection and tooth loss was observed in the alendronate group. In study 2, no cases of ONJ were observed in either group, and implant success was greater than 99% in both groups. Conclusion: On the basis of 2 controlled clinical studies, oral bisphosphonate usage was not associated with occurrence of ONJ. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to compare the success of hydroxyapatite (HA) -coated and machined titanium (Ti) implants in a 5-year randomized, controlled clinical trial conducted at 2 centers. Materials and Methods: Each of 120 edentulous patients received HA-coated threaded, HAcoated cylindric, and machined Ti threaded implants in a randomized design using 5 or 6 implants. Digital radiographs allowed for yearly measurements of bone loss. Calibrated clinicians also measured mobility, Gingival Index, Plaque Index, probing depth, and recession. A Kaplan-Meier analysis was used to compare the proportion of ailing implants (defined as less than 2 mm of alveolar bone loss over 5 years) for each type of implant design. The criteria employed to assess implant outcome included the need for successful implants to lose less than 2 mm of bone support over the 5 years following placement of the prosthesis. Results: This analysis revealed that 95.2% of machined Ti threaded implants and 97.92% of HA-coated threaded implants were successful, while 99.0% of HA-coated cylindric implants experienced less than 2 mm of bone loss (P < .06). Discussion: All types of implants placed in this study had success rates above 95%. Conclusion: Over 5 years, the success rate tended to favor HA-coated implants. [ABSTRACT FROM AUTHOR]

Purpose: Controversy over the long-term clinical effectiveness of hydroxyapatite (HA) -coated dental implants still persists, despite numerous clinical studies documenting high survival rates. The Ohio State University College of Dentistry undertook a 5-year prospective study of 429 HA-coated cylindric implants placed into 121 patients to determine the long-term clinical performance of the implants. Materials and Methods: All study subjects were patients screened and evaluated in the university's dental clinic by one of the principal investigators and one member of the surgical team. A total of 429 HA-coated implants were placed in 121 patients. The Ohio State University Human Subjects Committee approved and reviewed this study. Results: At the time of this report, 375 implants had completed 5 years of clinical follow-up. Beyond the 5-year limit of the study, 282 implants had completed 6 years and 114 implants had completed 7 years of clinical monitoring. The cumulative survival rate was 96% at 5 years and 95% at 7 years of follow-up. Mean combined mesial/distal bone loss was 1.2 mm in the mandible and 1.4 mm in the maxilla after 5 years of functional loading. Implant failures were most commonly associated with short implants or angled abutments. Discussion: Prospective clinical data are extremely valuable for clinicians evaluating the reliability of dental implant systems. In the present study, the implants achieved 100% osseointegration with minimal marginal bone loss, and 96% of the implants remained in function at 5 years. Conclusion: The HA-coated cylindric implants in this study provided a predictable means of oral rehabilitation. [ABSTRACT FROM AUTHOR]

Purpose: Although no currently available technique for the measurement of osseointegration is entirely satisfactory, 3 clinical variables can be reasonably associated with the process: probing depth, micromobility, and crestal bone height. Micromobility can be quantified to some extent with the use of the Periotest, a commercially available instrument. In this investigation, the influence of surface characteristics and geometry upon Periotest value (PTV) and probing depth measurements was studied. Materials and Methods: In a multicenter trial, 120 healthy edentulous patients received 5 or 6 implants in the anterior mandible and were followed for 3 years. A total of 634 implants were placed. Every patient received at least 1 implant of each of 3 types: threaded titanium plasma-sprayed (TPS), threaded hydroxyapatite-coated (HA), and cylindric HA-coated. A randomization schedule assured that approximately equal numbers of each type of implant were placed and that they were uniformly distributed over the arch. Results: Of the 4 tested combinations of dependent and independent variables, the only statistically significant (P < .05) effect was that of coating on PTV. At I year after prosthetic restoration, the mean PTV for HA-coated threaded implants was -5.36 ±1.24, compared with -4.86 ± 1.70 for TPS implants. This difference steadily declined in magnitude and significance, until, after 3 years, the groups were indistinguishable. Discussion: This study agrees with the previous observations that HA coating tends to accelerate the initial rate of osseointegration. The absence of a difference between threaded and cylindric implants confirms that the PTV responds to micromobility near the surface, on a scale much smaller than such gross geometric features. Conclusion: On the basis of these results, one may conclude that HA-coated implants exhibit a more rapid decrease in micromobility than do TPS implants of identical geometry. [ABSTRACT FROM AUTHOR]