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Aim: To obtain input from multiple stakeholders and generate agreement on essential outcomes in implant dentistry using the Delphi methodology and incorporate them into an international consensus defining a core outcome set. Materials and Methods: Candidate outcomes in implant dentistry were generated from scientific evidence through five commissioned systematic reviews and from people with lived experience in dental implants (PWLE) through four international focus groups. A steering committee identified stakeholders among representatives from dental professionals, industry‐related experts and PWLE. Participants underwent a three‐round Delphi survey using a multi‐stakeholder approach; they assessed candidate outcomes and additional outcomes identified in the first Delphi round. The process followed the COMET methodology. Results: From the 665 potential outcomes identified in the systematic reviews and 89 in the PWLE focus group, the steering committee selected 100 and organized them into 13 categories, to be included in the first‐round questionnaire as candidate outcomes. A total of 99 dental experts, 7 dental‐industry‐related experts and 17 PWLE participated in the first round, and 11 additional outcomes were added to the second round. There was no attrition between the first and second rounds, where 61 (54.9%) outcomes exceeded the pre‐established threshold of agreement. PWLE and experts participated in the third round that applied "a priori" standard filters to distil a list of candidate essential outcomes. Conclusion: This Delphi study utilized a standardized, transparent and inclusive methodology and preliminarily validated 13 essential outcomes organized into four core areas. These results informed the final stage of the ID‐COSM consensus. [ABSTRACT FROM AUTHOR]

Objective To compare the effect of placing the definitive abutment at the time of implant placement versus at a later stage, on the soft and hard tissue changes around dental implants. Material and methods Platform-switched implants were placed in the posterior maxilla or mandible of partial edentulous patients and they were randomized to receive the definitive abutment at the moment of implant placement, or 6-12 weeks later. Final prostheses were delivered 2-4 weeks later. Radiographic assessment of vertical bone level changes (primary outcome), clinical status of peri-implant tissues, changes in soft tissues margin, papilla filling, patient-related outcomes and adverse events were assessed 6 and 12 months after loading. Results 60 implants were placed in 40 patients, replacing single or multiple absent teeth. One implant was lost 1 week after insertion (overall survival rate: 98.3%). A statistically significant greater bone resorption from surgery to 6 months post-loading was observed for those implants subjected to abutment change (control group: −1.24 ± 0.79 mm; test group: −0.61 ± 0.40 mm; P = 0.028). Periodontal clinical parameters and patient-related outcomes, however, did not demonstrate significant differences between groups at any time point. A significant increase in papilla height was observed from loading to 12 months in all implants (control group: 1.17 ± 1.47 mm; test group: 0.98 ± 0.89 mm) and a slight but not significant coronal migration of the gingival margin. Conclusions The connection and disconnection of healing abutments is associated with significantly increased bone loss during the healing period between implant placement and 6 months post-loading, when compared to one-time abutment placement. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the expression of an activator of nuclear factor-kappa (RANK), osteoprotegerin (OPG), osteopontin (OPN), and transforming growth factor ß1 (TGF-B1) in gingival crevicular fluid (GCF) of teeth subjected to orthodontic forces. Materials and Methods: A randomized, pilot clinical trial including 10 healthy volunteers was conducted using a split-mouth design. Orthodontic elastic separators were placed between the second premolar and first molar, with the contralateral quadrant serving as a control. The GCF samples were collected from the tension and compression sites at baseline, 24 hours, and 7 days after the placement of separators. The GCF sample volumes were measured using a Periotron 8000, and total protein concentrations were determined. Levels of RANK, OPG, OPN, and TGF-B1 were also analyzed using a multiplex enzyme-linked immunosorbent assay. Results: The control sites remained unchanged throughout the study. In contrast, the concentration of OPG significantly decreased at the compression site by 24 hours, and the amount and concentration of RANK differed significantly between the control, compression, and tension sites after 7 days. A significant increase in absolute TGF-β1 levels was also detected at the compression site versus the control and tension sites after 7 days. Conclusion: Bone metabolism is affected by application of force to the teeth by elastic separators. Both increased expression of bone resorptive mediators (eg, RANK and TGF-β1) and decreased expression of a bone-forming mediator (eg, OPG) on the compression side were detected. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this study was to evaluate masticatory muscle activity and kinematics of mandible changes in children with unilateral posterior cross-bite (UPXB) after orthodontic treatment, and one year after retention. Twenty-five children with UPXB and functional mandibular shift were evaluated before treatment (mean age 12.5years), after treatment (mean age 14.9years), and one year after retention (mean age 16.8years). The same data were collected in a control group of thirty age-matched normocclusive children. Simultaneous bilateral surface electromyographic (sEMG) activity from anterior temporalis (AT), posterior temporalis (PT), masseter (MA), and supra-hyoid (SH) muscle areas were evaluated at rest, during swallowing, mastication and clenching. Kinematic records of rest position, mandibular lateral shift, swallowing and mastication were analyzed. Results showed a lateral shift of the mandible present at rest. During swallowing, sEMG activity of SH predominated before and post-treatment and retention. High frequency of immature swallowing was maintained post-treatment and retention. During mastication, MA activity increased significantly and its asymmetry was corrected post-treatment. During clenching, cross-bite side AT and MA activity increased significantly posttreatment and remained stable after retention, and MA/AT ratio reversed. These findings reinforce the advantages of treating children with UPXB and functional shift as early as possible. [Copyright &y& Elsevier]

Lau L, Sanz, M, Herrera D, Morillo JM, Martín C, Silva A: Quantitative real-time polymerase chain reaction versus culture: a comparison between two methods for the detection and quantification of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythensis in subgingival plaque samples. J Clin Periodontol 2004; 31: 1061–1069. doi: 10.1111/j.1600-051X.2004.00616.x.© Blackwell Munksgaard, 2004.The purpose of this investigation was to validate a real-time quantitative polymerase chain reaction (PCR) assay in identifying and quantifyingActinobacillus actinomycetemcomitans,Porphyromonas gingivalisandTannerella forsythensisfrom subgingival plaque samples taken from subjects with different periodontal conditions, when compared with conventional cultural procedures.Ninety-two adult subjects participated in this study, 32 with periodontitis, 30 with gingivitis and 30 healthy. A pooled subgingival sample was obtained from every patient. Culturing procedures were carried out using standard techniques. For real-time PCR analysis, primers were selected from sequences of the LktC (A. actinomycetemcomitans), Arg-gingipain (P. gingivalis) and BspA antigen (T. forsythensis) genes. Contingency tables were constructed to compare the qualitative results, while quantitative data were evaluated by pairedt-test.A. actinomycetemcomitanswas the least frequently recovered species with both techniques. Prevalence ofP. gingivaliswas low in healthy patients, increased in gingivitis and peaked in periodontitis patients. The frequency of detection ofT. forsythensisshowed marked differences between culture and PCR, although the same tendency of an increase in prevalence from health to gingivitis and to periodontitis was observed with both methods. Contingency tables demonstrated a good level of agreement between PCR and culture procedures forA. actinomycetemcomitansandP. gingivalis, especially in periodontitis patients.P. gingivalisculture counts were significantly higher than those obtained by PCR. The opposite was true forT. forsythensis, and statistically significant higher counts were obtained by PCR for gingivitis and periodontitis patients.This study demonstrated a good agreement between the quantitative PCR technology and the culture procedure. The high sensitivity and specificity of the quantitative PCR technology justify its use in epidemiological studies and as an adjunct in clinical diagnosis of periodontal patients. [ABSTRACT FROM AUTHOR]

Objective Materials and methods Results Conclusions The aim of this investigation was to evaluate the effect on clinical and radiological outcomes of the one‐abutment, one‐time protocol (test) versus placing the definitive abutment on the day of functional loading after having disconnected and connected three times the healing abutment during the prosthetic phase (control).Forty patients with 80 implants were randomly allocated to either the test or the control group. Changes in the radiographic marginal bone levels (MBLs), clinical outcomes, prosthetic‐related outcomes, and patient‐reported outcomes measures (PROMs) were assessed and compared 6 and 12 months after functional loading.Thirty‐seven patients with 74 implants were followed at 12 months. A statistically significant bone remodeling was observed in both groups following implant placement. MBLs were significantly greater in the control group at the 6‐ (−0.13 mm vs. −0.61 mm) and 12‐month visits (−0.01 mm vs. −0.53 mm). Bone loss was significantly greater in the control group from surgery to 6 and 12 months and from loading to 6 and 12 months. The abutment height was significantly greater in the test group, however, there were no significant differences in the restorative angle. Similarly, there were no statistically significant differences between groups for the measured clinical variables (probing depth, plaque, and bleeding index) and PROMs.Disconnecting and reconnecting the healing abutment was associated with significantly higher bone loss after 12 months, as compared to the placement of the definitive abutment at implant installation. [ABSTRACT FROM AUTHOR]

Objective: To assess the clinical, microbiological, and patient-based effects of using a cetylpyridinium chloride (CPC) toothpaste and mouth rinse in orthodontic patients., Design: Parallel randomized controlled, triple-blinded trial (participants, examiners, outcomes' assessors). A computer-generated list was used to allocate treatments. Central allocation was used for concealment., Participants: Thirty-one placebo (10 males, 21 females; mean age 15.2 ± 2.1) and 32 test patients (15 males, 17 females; mean age 15.0 ± 1.8) with fixed orthodontic appliance were included in the study., Interventions: Patients were randomly assigned to both brush and rinse with placebo or with CPC-based products. Products were purposely prepared in white opaque bottles. After screening and professional prophylaxis, patients received a baseline examination, and started to use the assigned products. Patients were monthly assessed during a 3-month period., Main Outcome Measures: Plaque (PlI) and gingival (GI) indexes. Secondary outcome variables: Calculus index, tooth staining, subgingival microbiological samples, patient-based variables (questionnaire, compliance, and remaining mouth rinse), side-effects (debonded braces or mucosal injuries)., Results: Sixty-three patients were randomized, 13 patients were excluded from analysis because of early dropout, leaving 50 patients for intention to treat analysis. PlI in the upper jaw diminished (0.18; SD = 0.82) after 1 month in the test group, while it increased (0.26; SD = 0.62) in the placebo group (P = 0.024). Statistically significant higher GI values were observed in the placebo group at 1 month (mean increase = 0.05; SD = 0.33 versus mean decrease = 0.03; SD = 0.38) and 3 months (mean = 0.05; SD = 0.43 versus mean = 0.02; SD = 0.34). The taste of the test product was rated higher than the placebo at 2- and 3-month visits (P < 0.05). Non-significant changes were observed in microbiological parameters, overgrowth of opportunistic species or remaining secondary outcome variables, including side-effects., Conclusion: The use of CPC-based toothpaste and mouth rinse in orthodontic patients had limited effect in reducing plaque accumulation and gingival inflammation. Effects were little and highly variable. The use of the test products was not associated with relevant adverse effects., Trial Registration: Trial registration: Local internal reference: P07/133.

Objective: To assess the soft tissue and to determine the potential association between changes in soft and hard tissue after early chin cup treatment in prognathic children., Materials and Methods: A total of 42 children (21 boys, 21 girls) with skeletal Class III malocclusion due to mandibular prognathism were examined before (mean age, 8.5 ± 0.5 years) and after (mean age, 11.4 ± 0.6 years) chin cup treatment. Data were compared with 25 untreated matched controls (12 boys, 13 girls) with mean ages of 8.5 ± 0.5 years at the first and 11.7 ± 0.5 years at the second observation. Lateral cephalograms were taken before and after 36 months of treatment/observation. We evaluated the changes in hard and soft tissue and the correlations between these changes in both groups., Results: The skeletal and soft-tissue facial profiles improved significantly in the treated patients, mainly due to changes in the mandible. The chin cup group revealed significant reductions in the facial-convexity angle and lower-lip inclination, leading to a remarkable improvement in the soft-tissue facial profile. We noted similar correlations between changes in the hard and soft tissue in both groups, except for a significant correlation between a pogonion retrusion and reduction in the facial-convexity angle detected only in the chin cup group. Various correlations were observed between corresponding soft and dentoalveolar changes between groups., Conclusion: Soft-tissue changes accompanied the underlying skeletal and dentoalveolar tissue changes after chin cup treatment.

Objectives: A longitudinal study was performed to evaluate the jaw muscle activity and mandibular kinematics after Teuscher activator treatment and at 2 years after orthodontic treatment completion., Material and Methods: Twenty-seven children with Class II division 1 malocclusion were evaluated before treatment (T0; mean: 11.6 years), after functional treatment (T1; mean: 12.8 years), and 2 years after orthodontic treatment (T2; mean: 18 years). Bilateral surface electromyographic activities of the anterior temporalis, posterior temporalis, masseter, and suprahyoid muscle areas were analyzed at rest and during clenching, swallowing, and mastication. Kinematic recordings of the mandibular maximum opening, lateral shift, right and left lateral excursions, and protrusion were evaluated., Results: Compared to T0, the left masseter activity during clenching was decreased at T1 but increased at T2, similar to the other evaluated muscles. The suprahyoid activity during swallowing was increased at T1 but decreased at T2. The masseter activity during mastication was increased at T1 and further increased at T2. The left and right lateral excursions and protrusion did not show significant changes throughout the experiment., Conclusions: Teuscher activator and subsequent fixed orthodontic treatment improved jaw muscle function; however, a long period was needed to attain complete neuromuscular adaptation.

Objectives: To examine the activity of jaw muscles at rest and during maximal voluntary clenching (MVC) in children with unilateral posterior crossbite (UPXB) and functional lateral shift in the early mixed dentition and to evaluate sex differences., Material and Methods: The sample included 30 children (15 males, 15 females) aged 6 to 10 years old, with UPXB and functional mandibular lateral shift (≥1.5 mm) in the early mixed dentition. sEMG activity coming from the muscle areas (anterior temporalis [AT], posterior temporalis [PT], masseter [MA] and suprahyoid [SH]) were obtained from both the crossbite (XB) and noncrossbite (NONXB) sides at mandibular rest position. sEMG activity of the bilateral AT and MA muscles sides was obtained during MVC. Asymmetry and activity indexes were calculated for each muscle area at rest and during MVC; the MA/TA ratio during MVC was also determined., Results: At rest, no differences were found between sexes for any muscle areas or asymmetry and activity indexes. No differences were found between XB and NONXB sides. During MVC, however, significant sex differences were found in AT and MA activity, with higher sEMG values in males than in females, on both XB and NONXB sides. Asymmetry indexes, activity indexes and MA/AT ratios did not show significant differences between the sexes. Activity was symmetric both in males and in females., Conclusions: At rest, no sex differences were found, but during MVC males showed higher activity than did females in both XB and NONXB AT and MA muscle areas. Muscular activity was symmetrical at rest and during MVC in both sexes. Sexual dimorphism should be considered in the diagnosis and treatment of UPXB and lateral shift in the early mixed dentition.