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Objective: The study aimed to compare self-perceived oral health and orofacial appearance in three different cohorts of 60-year-old individuals., Method: A cross-sectional design, based on data obtained from a questionnaire used in the Swedish National Study of Aging and Care. The sample comprised 478 individuals, from baseline, 2001-2003 (n = 191), 2007-2009 (n = 218) and 2014-2015 (n = 69). Comparisons were made within and between the cohorts, with bivariate analysis and Fisher's exact test. Statistical significance was considered at p < 0.05., Results: The result showed that a low number of the participants reported self-perceived problems with oral health. Of the problems reported, a higher proportion in cohort 2014-2015 (39.3%) experienced problems with bleeding gums. The experience of bleeding gums increased between the cohorts 2001-2003 and 2014-2015 (p = 0.040) and between 2007-2009 and 2014-2015 (p = 0.017). The prevalence of discomfort with sensitive teeth was experienced in 7%-32%. Twice as many women compared to men experienced discomfort in all cohorts (no significant differences between the cohorts). Satisfaction with dental appearance was experienced in 75%-84%. Twice as many women compared to men were dissatisfied with their dental appearance in 2001-2003 (p = 0.011) and with discoloured teeth (p = 0.020). No significant differences could be seen between the cohorts regarding discomfort with dental appearance or discoloured teeth., Conclusion: The 60-year-olds irrespective of birth cohort, perceived their oral health and orofacial appearance as satisfactory., (© 2023 The Authors. International Journal of Dental Hygiene published by John Wiley & Sons Ltd.)

Aim: To assess whether guided bone regeneration (GBR) treatment of peri-implantitis-related bony defects could improve healing compared to open flap debridement (OFD) at 36 months., Materials and Methods: In a multi-centre, randomized clinical trial, 32 individuals received OFD (control group [CG]) and 34 GBR treatment (test group [TG]). Radiographic defect fill (RDF), probing pocket depth (PPD), bleeding on probing (BOP) suppuration (SUP), mucosal recession (MREC) and patient-reported outcomes (PROs) were evaluated at 36 months., Results: Fifty individuals attended a supportive peri-implant therapy program and completed the 36-month follow-up. GBR treatment resulted in an RDF of 2.13 ± 1.26 mm compared to 1.64 ± 1.54 mm following OFD (p = .18). No difference was found in PPD, BOP, SUP, REC or PROs between the groups. Successful treatment (no additional bone loss, PPD ≤ 5 mm, no BOP and no SUP) was achieved in 46.2% in TG and 20% in CG (p = .053). Treatment results obtained at 12 months were generally maintained up to 36 months. No significant changes were noticed between 12 and 36 months., Conclusions: At 36 months, treatment results obtained at 1 year were sustained following both GBR and OFD in patients attending supportive peri-implant therapy. GBR resulted in more RDF and higher composite treatment success rate than OFD (ClinicalTrials.gov Identifier [NCT02375750])., (© 2024 The Author(s). Journal of Clinical Periodontology published by John Wiley & Sons Ltd.)

Background: The number of older individuals with mild cognitive impairment and neurocognitive diseases is increasing, which may rapidly deteriorate oral health and Quality of life. Therefore, removing dental biofilm is essential for maintaining good oral health. The present study aimed to investigate whether introducing a powered toothbrush reduces the presence of dental plaque, bleeding on probing, and periodontal pockets ≥4 mm, leading to maintained or improved oral health and improved Quality of life in a group of older individuals with mild cognitive impairment., Methods: Two hundred and thirteen individuals aged 55 or older living without official home care with a Mini-Mental State Examination (MMSE) score between 20 and 28 and a history of memory problems in the previous 6 months were recruited and screened for the study. The individuals received a powered toothbrush and thorough instructions on how to use it. Clinical oral examinations, Quality of life examinations, and MMSE tests were conducted at baseline, 6, 12, and 24 months. The intervention group was compared to control groups at baseline and 24-month examination. It was divided into an MMSE high group with a score of more than 26 and an MMSE low group with a score of 26 and lower or decreasing two steps or more for 12 months., Results: PI, BOP, and PPD≥4 mm improved continuously in both MMSE groups during the 24 months of the study. The values for QoL-AD deteriorated over time, while the oral health-related Quality of life did not show any statistically significant changes., Conclusions: Introducing a powered toothbrush improved PI, BOP, and PPD≥4 mm over 24 months, even among individuals with low or declining MMSE scores. Improved oral health is associated with a preserved OHR-QoL., (© 2024 The Author(s). Special Care in Dentistry published by Special Care Dentistry Association and Wiley Periodicals LLC.)

Objectives: To analyze whether self-perceived oral health and orofacial appearance change with increasing age., Methods: This longitudinal study is based on data from a questionnaire used in the Swedish National Study of Aging and Care. The sample comprises 160 participants 60 years of age at baseline 2001-2003. The same participants were re-examined at 66-, 72-, and 78 years of age. To analyze whether perceptions of oral health and orofacial appearance changed with increasing age, Cochran's Q test was conducted. Statistical significance was considered at p  ≤  0.05, and the calculated value Q must be equal to or greater than the critical chi-square value (Q ≥ 7.82). Significance values have been adjusted for the Bonferroni correction for multiple tests., Results: Self-perceived mouth dryness, both day (Q = 7.94) and night (Q = 23.41), increased over the 18-year follow-up. When divided by gender, significant differences were only seen for mouth dryness at nighttime. A decrease in sensitive teeth was perceived with increasing age, and an increase in self-perceived satisfaction with dental appearance, and a decrease in self-perceived problems with dental gaps between the ages of 60 and 78. These changes were, however, not statistically significant. Men experienced a higher proportion of discomfort with discolored teeth at age 78 than at 60 (Q = 9.09)., Conclusions: Self-perceived oral health and orofacial appearance were relatively stable, with few changes over an 18-year follow-up.

Objectives: In this study, the aim was to investigate the medium- to long-term impact of peri-implantitis treatment upon clinical parameters and implant stability quotient values and to ascertain if magnetic resonance frequency analysis can be used as a diagnostic tool to demonstrate postoperative healing following treatment of peri-implantitis., Materials and Methods: A total of n = 26 patients (n = 86 implants) diagnosed with peri-implantitis were recruited for this prospective cohort study and four different treatment modalities were used. Baseline measurements of a number of clinical parameters as well as implant stability measurements in the form of ISQ were recorded. These measurements were repeated at 6, 12, and 24-36 months following treatment. Analysis of variance was performed for all implants treated as well as separately for each treatment modality. A regression model was also used to determine factors affecting ISQ measurements over time., Results: Treatment of peri-implantitis resulted in significant improvements of both average PPDs and BOP (p < .0001 and p < .01). ISQ values marginally improved initially for all treatment modalities, but improvement was only maintained for 2-3 years in treatment modalities I (+1.28), III (+1.49), and IV (+2.92). There was a statistically significant negative linear correlation between average PPD and the ISQ values recorded both at baseline (r = -.618, p < 0.0001) and at 2/3 years (r = -.604, p < 0.0001)., Conclusion: Over the 2-3-year follow-up period, all four treatment modalities led to improved clinical and radiographic peri-implant parameters but implant stability posttreatment, as indicated by the fact that the recorded ISQ scores remained stable. As a result, use of MRFA as an adjunct to the traditionally used periodontal and radiographic tools for the evaluation of postoperative implant stability following the treatment of peri-implant disease cannot be recommended., (© 2023 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Objectives: The study aimed to investigate how the objective use of a powered toothbrush in frequency and duration affects plaque index, bleeding on probing, and periodontal pocket depth ≥ 4 mm in elderly individuals with MCI. A second aim was to compare the objective results with the participants' self-estimated brush use., Materials and Methods: Objective brush usage data was extracted from the participants' powered toothbrushes and related to the oral health variables plaque index, bleeding on probing, and periodontal pocket depth ≥ 4 mm. Furthermore, the objective usage data was compared with the participants' self-reported brush usage reported in a questionnaire at baseline and 6- and 12-month examination., Results: Out of a screened sample of 213 individuals, 170 fulfilled the 12-month visit. The principal findings are that despite the objective values registered for frequency and duration being lower than the recommended and less than the instructed, using powered toothbrushes after instruction and information led to improved values for PI, BOP, and PPD ≥ 4 mm in the group of elderly with MIC., Conclusions: Despite lower brush frequency and duration than the generally recommended, using a powered toothbrush improved oral health. The objective brush data recorded from the powered toothbrush correlates poorly with the self-estimated brush use., Clinical Relevance: Using objective brush data can become one of the factors in the collaboration to preserve and improve oral health in older people with mild cognitive impairment., Trial Registration: ClinicalTrials.gov Identifier: NCT05941611, retrospectively registered 11/07/2023., (© 2023. The Author(s).)

Background: Periodontitis and oral pathogenic bacteria can contribute to the development of rheumatoid arthritis (RA). A connection between serum antibodies to Porphyromonas gingivalis ( P. gingivalis ) and RA has been established, but data on saliva antibodies to P. gingivalis in RA are lacking. We evaluated antibodies to P. gingivalis in serum and saliva in two Swedish RA studies as well as their association with RA, periodontitis, antibodies to citrullinated proteins (ACPA), and RA disease activity., Methods: The SARA (secretory antibodies in RA) study includes 196 patients with RA and 101 healthy controls. The Karlskrona RA study includes 132 patients with RA ≥ 61 years of age, who underwent dental examination. Serum Immunoglobulin G (IgG) and Immunoglobulin A (IgA) antibodies and saliva IgA antibodies to the P. gingivalis -specific Arg-specific gingipain B (RgpB) were measured in patients with RA and controls., Results: The level of saliva IgA anti-RgpB antibodies was significantly higher among patients with RA than among healthy controls in multivariate analysis adjusted for age, gender, smoking, and IgG ACPA (p = 0.022). Saliva IgA anti-RgpB antibodies were associated with RA disease activity in multivariate analysis (p = 0.036). Anti-RgpB antibodies were not associated with periodontitis or serum IgG ACPA., Conclusion: Patients with RA had higher levels of saliva IgA anti-RgpB antibodies than healthy controls. Saliva IgA anti-RgpB antibodies may be associated with RA disease activity but were not associated with periodontitis or serum IgG ACPA. Our results indicate a local production of IgA anti-RgpB in the salivary glands that is not accompanied by systemic antibody production., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Svärd, Kastbom, Ljungberg, Potempa, Potempa, Persson, Renvert, Berglund and Söderlin.)

Objectives: The aim of the study is to investigate whether the use of a powered toothbrush could maintain oral health by reducing the dental plaque (PI), bleeding on probing (BOP), and periodontal pocket depth (PPD) ≥4 mm in a group of individuals with MCI and also if changes in oral health affect various aspects of quality of life., Background: People with cognitive impairment tend to have poor oral hygiene and poorer Quality of life. In the present study, the participants were asked to use a powered toothbrush for at least 2 min morning and evening and no restrictions were given against the use of other oral care products. The participant survey conducted at each examination demonstrated that 61.2% of participants at baseline claimed to have experience of using a powered toothbrush, 95.4% at 6 months and 95% after 12 months. At the same time, the use of manual toothbrushes dropped from 73.3% to 44.7% from baseline to the 12-month check-up. This shows that several participants continue to use the manual toothbrush in parallel with the powered toothbrush, but that there is a shift towards increased use of the powered toothbrush. Removal of dental biofilm is essential for maintaining good oral health. We investigated whether using a powered toothbrush reduces the presence of dental plaque, bleeding on probing and periodontal pockets ≥4 mm in a group of older individuals with mild cognitive impairment., Materials and Methods: Two hundred and thirteen individuals with the mean age of 75.3 years living without official home care and with a Mini-Mental State Examination (MMSE) score between 20 and 28 and a history of memory problems in the previous six months were recruited from the Swedish site of a multicenter project, Support Monitoring And Reminder Technology for Mild Dementia (SMART4MD) and screened for the study. The individuals received a powered toothbrush and thorough instructions on how to use it. Clinical oral examinations and MMSE tests were conducted at baseline, 6 and 12 months., Results: One hundred seventy participants, 36.5% women and 63.5% men, completed a 12-month follow-up. The use of a powered toothbrush resulted, for the entire group, in a significant decrease in plaque index from 41% at baseline to 31.5% after 12 months (P < .000). Within the same time frame, the values for bleeding on probing changed from 15.1% to 9.9% (P < .000) and the percentage of probing pocket depths ≥4 mm from 11.5% to 8.2% (P < .004). The observed improvements in the Oral Health Impact Profile 14 correlate with the clinical improvements of oral health., Conclusion: The use of a powered toothbrush was associated with a reduction of PI, BOP and PPD over 12 months even among individuals with low or declining MMSE score. An adequately used powered toothbrush maintain factors that affect oral health and oral health-related Quality of Life in people with mild cognitive impairment., (© 2022 The Authors. Gerodontology published by Gerodontology Association and John Wiley & Sons Ltd.)

Objectives: The aim of this study was to assess the long-term efficacy of reconstructive treatment of peri-implantitis intraosseous defects., Material and Methods: Peri-implant intraosseous defects were augmented using either an autogenous bone graft (AB) or a bovine-derived xenograft (BDX) in combination with a collagen membrane. Maintenance was provided every third month., Results: In the AB group, 16 patients with 25 implants remained at year five. In the BDX group, 23 patients with 38 implants remained. Between baseline and year 5, bleeding on probing (BOP) and probing pocket depth (PPD) scores were reduced in both groups (p < .001). In the AB and BDX groups, mean PPD between baseline and year five was reduced by 1.7 and 2.8 mm, respectively. The difference between groups was significant (p < .001). In the AB group, the mean bone level change at implant level between baseline and years three and five was-0,2 and -0.7 mm, respectively. In the BDX group, the mean bone level change at implant level between baseline and years three and five was 1.6 and 1.6 mm, respectively. The difference between the groups was significant (p < .001). Successful treatment (no bone loss, no probing pocket depth (PPD) > 5 mm, no suppuration, maximum one implant surface with bleeding on probing (BOP) at year five) was obtained in 9/25 implants (36%) in the AB group and in 29/37 implants (78.3%) in the BDX group., Conclusions: Reconstructive surgical treatment of peri-implant defects using BDX resulted in more predictable outcomes than using autogenous bone over 5 years., (© 2022 The Authors. Clinical Oral Implants Research published by John Wiley & Sons Ltd.)

Objective: This study aimed to analyze the oral health status of four different birth cohorts: two cohorts of 60-year-olds born in 1941-1943 and 1954-1955 and 2 cohorts of 81-year-olds born in 1920-1922 and 1933-1934., Material and Methods: The study was based on data from an ongoing longitudinal population project, The Swedish National Study on Aging and Care (SNAC). Oral health status was repeatedly examined clinically and radiographically in 2001-2003 and 2014-2015, including 60- and 81-year-olds, in total 412 individuals. Statistical analyses were performed using independent-samples t test and Pearson's χ 2 test., Results: More individuals were dentate in 2014-2015 compared to 2001-2003 in the two age groups: 60 and 81 years (p < 0.001 for both). The mean number of teeth increased in the 60-year-olds from 24.2 to 27.0 and in the 81-year-olds from 14.3 to 20.2. The numbers of at least one intact tooth increased for both age groups (p < 0.001 and p < 0.004, respectively). In the age groups 81 years, there was an increase in having at least one PPD ≥ 6 mm (p < 0.016) and bone loss ≥ 5 mm (p < 0.029) between the two examinations. No such differences were found in the age groups of 60 years., Conclusion: Over 13 years, oral health improved for both 60- and 81-year-old age groups. The most significant changes were in the 81-year-olds where oral health had improved except for periodontal status., Clinical Relevance: More natural teeth and impaired periodontal status potentially impact oral health and should increase focus on preventive and supportive dental care in older individuals., (© 2022. The Author(s).)

Peri-implantitis is an infectious disease that leads to progressive bone loss. Surgical therapy has been advocated as a way of halting its progression and re-establishing peri-implant health. One of the most challenging but crucial tasks in the management of peri-implantitis is biofilm removal to achieve reosseointegration and promote the reduction of peri-implant pockets. A wide variety of strategies have been used for implant surface decontamination. Mechanical means have been demonstrated to be effective in eliminating calculus deposits and residual debris; however, the presence of undercuts and the grooves and porosities along the roughened implant surface make it difficult to achieve an aseptic surface. In conjunction with mechanical measures, use of chemical adjuncts has been advocated to dilute bacterial concentrations, destroy the bacteria's organic components and eliminate endotoxins. Pharmacological adjuncts have also been recommended to diminish the bacterial load. Other strategies, such as use of lasers, implantoplasty and electrolysis, have been suggested for implant surface decontamination to promote predictable clinical and radiographic outcomes.

Peri-implant diseases at implant sites represent the most considerable concern for many dental clinicians nowadays due to their detrimental effect on implant longevity. Preventive measures include patient education and motivation, supportive peri-implant therapy and routine assessment of the hard and soft tissues. Nevertheless, the reliability of clinical parameters to monitor peri-implant conditions is subject to debate. As such, the primary purpose of the present review was to gain further insight into the diagnostic accuracy of probing as a clinical tool to monitor dental implants and assist clinicians in preventing peri-implant diseases. Studies have recommended periodic probing to monitor the condition of the peri-implant tissues. Increased probing pocket depth, profuse bleeding on probing and suppuration at implants are clinical signs that have been associated with peri-implantitis; thus, if these clinical parameters are present, radiographic assessment is encouraged to make a definitive diagnosis considering potential inaccuracies related to local and/or systemic factors identified in the present review.

Objective: There is a need to develop easy-to-use tools to screen for periodontal conditions in daily practice. This study aimed to evaluate the FDI World Dental Federation "Chairside Guide" (FDI-CG) developed by the Task Team of the FDI Global Periodontal Health Project (GPHP) as a potential tool for screening., Methods: Databases from 3 centres in Germany, Hong Kong, and Spain (n = 519) were used to evaluate the association of the FDI-CG and its individual items with the periodontitis case definitions proposed by the Centers for Disease Control and Prevention (CDC) and the American Academy of Periodontology (AAP) for population-based surveillance of periodontitis., Results: Statistically significant differences were observed among the databases for the prevalence of periodontitis and the items included in the FDI-CG. The FDI-CG score and its individual components were significantly associated with the periodontal status in the individual databases and the total sample, with bleeding on probing showing the strongest association with severe periodontitis (odds ratio [OR] = 12.9, 95% CI [5.9; 28.0], P < .001, for those presenting bleeding on probing >50%), followed by age (OR = 4.8, 95% CI [1.7; 4.2], P = .004, for those older than 65 years of age). Those subjects with a FDI-CG score >10 had an OR of 54.0 (95% CI [23.5; 124.2], P < .001) and presented with severe periodontitis. A significant correlation was found between the different FDI-CG scoring categories (mild, moderate, and severe) and the categories for mild, moderate, and severe periodontitis using the Centers for Disease Control and Prevention and the American Academy of Periodontology criteria (r = 0.57, Spearman rank correlation test, P < .001)., Conclusion: The FDI Chairside Guide may represent a suitable tool for screening the periodontal condition by general practitioners in daily dental practice., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: We studied cytokines in gingival crevicular fluid (GCF) in a cross-sectional population-based cohort of rheumatoid arthritis (RA) patients ≥61 years of age with and without a diagnosis of periodontitis., Background Data: Earlier studies on cytokines in GCF in RA patients have not given clear results., Methods: In a population-based cross-sectional study of patients ≥61 years of age, 233 RA patients were identified. 132 (57%) dentate RA patients participated. All participants received rheumatological and dental examinations, and had a panoramic radiograph taken. GCF was sampled on each patient. Interleukins 1-β (IL-1β), IL-4, IL-6, IL-10, IL-17A, tumor necrosis factor alpha (TNF-α), interferon gamma (IFN-γ), and chemokines RANTES/CCL5, eotaxin and monocyte chemoattractant protein (MCP-1) were analyzed in GCF. These cytokines were stratified for periodontitis, age, gender, body mass index (BMI), smoking, and anti-cyclic citrullinated protein (anti-CCP) status. Binary logistic regression analyses with periodontitis as outcome were performed adjusting for the above mentioned confounding factors including anti-rheumatic medication, disease duration and the cytokine in question., Results: Periodontitis was diagnosed in 80/132 (61%) of study participants. The 110 RA patients not participating were older, had a higher mean erythrocyte sedimentation rate (ESR), had a higher mean DAS28ESR (Disease Activity Score 28 using ESR) and were less often on biologic treatment. Only RANTES was associated with periodontitis (p = .049, OR 1.001, 95% CI 1.000-1.002) in the binary logistic regression analyses., Conclusion: In this population-based elderly RA cohort, neither pro-inflammatory nor anti-inflammatory cytokines in GCF were clearly associated with a diagnosis of periodontitis., (© 2021 The Authors. Journal of Periodontal Research published by John Wiley & Sons Ltd.)

Aim: To assess whether the use of deproteinized bovine bone mineral (DBBM) and native bilayer collagen membrane (NBCM) improved healing of peri-implantitis-related bone defects at 12 months., Materials and Methods: In a multi-centre, randomized clinical trial, 32 individuals received surgical debridement (control group [CG]), and 34 received adjunct use of DBBM and NBCM (test group [TG]). Radiographic defect fill (RDF), probing pocket depth (PPD), bleeding on probing (BOP), suppuration (SUP), recession (REC), cytokines (IL-1β, IL-1RA, IL-6, IL-8, IL-12, IP10, PDGF-BB, TNF-α, VEGF), and patient-reported outcomes (PROs) were evaluated at 3, 6, 9, and 12 months., Results: RDF at the deepest site amounted 2.7 ± 1.3 mm in TG and 1.4 ± 1.2 mm in CG (p <.0001). PPD was reduced by 1.9 mm in TG and 2.3 mm in CG (p = .5783). There were no significant differences between groups regarding reductions of BOP, SUP, REC, cytokines levels, or oral health impact profile (OHIP)-14 scores at 12 months. Successful treatment (RDF ≥ 1.0 mm, PPD ≤5 mm, ≤1/4 site with BOP grade 1, no SUP) was identified in 32% in TG and 21% in CG., Conclusions: DBBM and NBCM resulted in significantly more RDF than debridement alone. No difference was found in any clinical parameters or PROs between the groups. ClinicalTrials.gov Identifier: NCT02375750., (© 2021 The Authors. Journal of Clinical Periodontology published by John Wiley & Sons Ltd.)

Objective: The present study assessed if individuals ≥ 60 years of age with periodontitis are more likely to develop stroke or ischemic heart diseases, or at a higher risk of death for 17 years., Material and Methods: At baseline individuals ≥ 60 received a dental examination including a panoramic radiograph. Periodontitis was defined as having ≥ 30% sites with ≥ 5-mm distance from the cementoenamel junction to the marginal bone level. Medical records were annually reviewed from 2001 to 2018. Findings from the medical records identifying an ICD-10 code of stroke and ischemic heart diseases or death were registered., Results: Associations between periodontitis and incidence of ischemic heart disease were found in this 17-year follow-up study in all individuals 60-93 years (HR: 1.5, CI: 1.1-2.1, p = 0.017), in women (HR: 2.1, CI: 1.3-3.4, p = 0.002), and in individuals 78-96 years (HR: 1.7, CI: 1.0-2.6, p = 0.033). Periodontitis was associated with mortality in all individuals (HR: 1.4, CI: 1.2-1.8, p = 0.002), specifically in men (HR: 1.5, CI: 1.1-1.9, p = 0.006) or in ages 60-72 years (HR: 2.2, CI: 1.5-3.2, p = 0.000). Periodontitis was more prevalent among men (OR: 1.8, CI: 1.3-2.4, p = 0.000)., Conclusions: Individuals with periodontitis have an increased risk for future events of ischemic heart diseases and death., Clinical Relevance: Improving periodontal health in older individuals may reduce overall mortality and ischemic heart diseases. Both dental and medical professionals should be aware of the associations and ultimately cooperate.

Objectives: The aim of the present study was to investigate whether peri-implant clinical parameters (modified plaque index (mPI), bleeding and/or suppuration on probing (B/SOP)) and local factors (type of prostheses, screw emergence, platform diameter, and abutment angulation) might contribute to the development of additional bone loss and peri-implantitis around dental implants., Materials and Methods: Two hundred seventy-seven external hex connection implants placed in the posterior maxilla of 124 patients were retrospectively evaluated. They were divided into two groups: physiologic bone loss < 2 mm (PBL) or additional bone loss ≥ 2 mm (ABL). GEE logistic regression was applied to evaluate the influence of type of prostheses (implant-supported single crown (ISSC), fixed partial denture (ISFPD), and full denture (ISFD)) and clinical parameters (mPI and S/BOP) on bone loss., Results: Among the 277 implants, 159 (57.4%) presented PBL and 118 (42.6%) presented ABL. Within the ABL group, 20.6% implants were diagnosed with peri-implantitis. mPI significantly correlated with the type of prosthesis and the highest value of mPI (index = 3) was observed in ISFD (23.8%). Moreover, peri-implantitis was more frequently associated with ISFD (32.79%) than ISSC and ISFDP (13.79% and 13.48, respectively) CONCLUSIONS: ISFD in the posterior maxilla presented high rates of ABL and showed a higher prevalence of peri-implantitis. None of the local factors seemed to contribute to the development of these conditions. Further investigations are needed to prospectively support the results of the present study., Clinical Relevance: Patients rehabilitated with ISFD should be carefully monitored and have more frequent maintenance visits to prevent or control peri-implant bone loss.

Objectives: To report a follow-up of patients following the surgical anti-infective treatment of peri-implantitis and to identify possible risk indicators for the progression of disease during supportive peri-implant therapy., Material and Methods: Following peri-implant surgery, 41 patients (213 implants) were enrolled in a supportive peri-implant therapy. At the 2-year follow-up, two groups of patients were identified, with or without residual peri-implant pockets (responding and non-responding group). Eighteen patients (85 implants) of the non-responding group were followed for further 8 years., Results: At the 2-year examination, 73 of the 117 treated implants (62.4%) presented healthy peri-implant condition, while 44 (37.6%) presented persisting peri-implantitis associated with substantial bone loss before treatment. The 10-year examination of the non-responding group revealed that 1) 84% of the implants that regained health following surgery remained healthy during the entire observation period; 2) 66% of the implants with residual pockets following surgery maintained stable peri-implant condition; and 3) 29% of all treated implants showed disease progression, and 11 of those were extracted. Presence of pockets at 3-4 sites of the implants was identified as risk indicator for progression of peri-implantitis., Conclusion: The peri-implant health achieved following therapy was maintained for most of the implants during the follow-up. Residual pockets were a frequent finding at implants with substantial bone loss before treatment. Presence of pockets around the entire circumference of the implants resulted as a risk indicator for further disease progression. The probability of progression of peri-implant disease increased with increased observation time., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The aim of this study was to compare the effect of an autogenous blood concentrate (L-PRF) with the effect of white porous titanium granules (WPTG) on buccal bone remodeling. These materials were used to graft the void between the implant and the buccal bone following immediate implant placement. Clinical measurements were made at two time points, and the mean buccal bone horizontal dimension at placement was 2.94 ± 0.59 mm for L-PRF and 3.49 ± 0.99 mm for WPTG. At reentry, the values were 1.19 ± 0.90 mm and 2.12 ± 0.87 mm, respectively. Overall, there was no difference observed in the performance of the two materials regarding buccal bone resorption.

Background: The association between rheumatoid arthritis (RA) and periodontitis remains unclear., Methods: We studied oral health and periodontitis in a population-based case-control study of individuals with ≥10 remaining teeth ≥61 years of age and either with, or without a diagnosis of RA. 126 dentate individuals with RA were recruited together with age-matched control individuals without RA. The control individuals were recruited from the general population from the same city ( n  = 249). A dental examination including a panoramic radiograph was performed on all participants. All individuals with RA were examined and medical records were reviewed by a rheumatologist. In the control group, none of the participants presented with symptoms of RA and their medical records were also negative., Results: The RA group included more women (66.7% vs. 55.8%) ( p  < 0.01). Individuals in the RA group had a higher body mass index (BMI) ( p  < 0.001). A diagnosis of periodontitis was more common in the RA group (61.1%) than in the control group (33.7%) ( p  = 0.001). Binary logistic regression analysis identified that a BMI > 25 (OR 6.2, 95% CI 3.6, 10.5, p  = 0.000), periodontitis (OR 2.5 95% CI 1.5, 4.2 p  = 0.000), and female gender (OR 2.3, 95% CI 1.3-4.0, p  = 0.003) were associated with RA., Conclusion: RA was associated a diagnosis of periodontitis., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

Approximately 90% of halitosis cases originate within the oral cavity (intra-oral halitosis). With a focus on intra-oral halitosis, this narrative review article provides a current summary of the epidemiology, diagnosis and management of halitosis and discusses practical considerations for healthcare professionals (HCPs), including dentists, dental hygienists, general practitioners, community pharmacists, nurses and medical specialists. MEDLINE and PubMed were searched up to 31 December 2019. Additional information was sourced from reference lists of relevant published literature. Full-text articles which reported on the epidemiology, diagnosis and management of halitosis were considered for inclusion. Halitosis affects substantial numbers of individuals globally and is an underestimated problem in dental practice. Current estimates of the prevalence of halitosis, in addition to diagnostic methods and management considerations for halitosis, are discussed. Although not a life-threatening condition, halitosis has a significant impact on patients' quality of life and can result in psychological consequences including social, professional and affective limitations. Using a simple step-wise approach for diagnosis and treatment, dentists and dental hygienists are ideally placed to respond to an initial consultation for halitosis., Competing Interests: S Renvert received an honorarium from Mylan for attending the Advisory Board meeting. MJ Noack regularly acts as a scientific consultant to manufacturers of mouth rinses and home cleaning products, including CP GABA, Mylan and Johnson & Johnson and receives honoraria for sponsored lectures; regarding the current paper, MJ Noack received an honorarium from Mylan for attending the Advisory Board meeting. C Lequart received an honorarium from Mylan for attending the Advisory Board meeting. S Roldán received personal fees for lecturing from Colgate, Dentaid and Johnson & Johnson, not related to the present paper, and received an honorarium from Mylan for attending the Advisory Board meeting. ML Laine received a travel grant and her institute received an honorarium from Mylan for attending the Advisory Board meeting and grants from Arkray, outside the submitted work. The authors report no other conflicts of interest in this work., (© 2020 Renvert et al.)

Objectives: A connection between prevalence of rheumatoid arthritis (RA) and periodontitis has been reported. The hypothesis for this association involves increased citrullination in the oral mucosa in patients with periodontitis. Whether ongoing periodontitis has an effect on IgA antibodies to citrullinated peptides (ACPA) in saliva is unknown. We studied IgA ACPA in saliva and serum and their relation to periodontitis and smoking in a population-based elderly RA cohort., Methods: A population-based cohort of patients with RA ≥61 years of age (n=132) was examined by rheumatologists and a dental hygienist. Analyses of IgG ACPA in serum and IgA ACPA in serum and saliva were performed. The presence of ACPA was compared in patients with RA with and without periodontitis., Results: IgA ACPA in serum occurred in 35% of RA patients with periodontitis and in 43% of RA patients without periodontitis (p=0.740). IgG ACPA in serum was found in 66% of RA patients with periodontitis, and in 69% without periodontitis (p=0.740). IgA ACPA in saliva occurred in 20% with periodontitis and 55% without periodontitis (p=0.062). A logistic regression analysis adjusting for age, gender and smoking gave an odds ratio (OR) of 0.456 (95% CI=0.183-1.137, p=0.092) for saliva IgA ACPA positive individuals to have periodontitis., Conclusions: IgA ACPA in serum or saliva was not more common in RA patients with periodontitis. This implies that local production of ACPA by the oral mucosa is not enhanced by periodontal inflammation, in patients with established RA.

Objectives: To assess if (I) the alveolar bone defect configuration at dental implants diagnosed with peri-implantitis is related to clinical parameters at the time of surgical intervention and if (II) the outcome of surgical intervention of peri-implantitis is dependent on defect configuration at the time of treatment., Materials and Methods: In a prospective study, 45 individuals and 74 dental implants with ≥ 2 bone wall defects were treated with either an autogenous bone transplant or an exogenous bone augmentation material. Defect fill was assessed at 1 year., Results: At baseline, no significant study group differences were identified. Most study implants (70.7%, n = 53) had been placed in the maxilla. Few implants were placed in molar regions. The mesial and distal crestal width at surgery was greater at 4-wall defects than at 2-wall defects (p = 0.001). Probing depths were also greater at 4-wall defects than at 2-wall defects (p = 0.01). Defect fill was correlated to initial defect depth (p < 0.001). Defect fill at 4-wall defects was significant (p < 0.05)., Conclusions: (I) The buccal-lingual width of the alveolar bone crest was explanatory to defect configuration, (II) 4-wall defects demonstrated more defect fill, and (III) deeper defects resulted in more defect fill.

Aim: To investigate whether there was an association between periodontitis and airflow limitation in older Swedish individuals., Materials and Methods: Study individuals were randomly selected from the Swedish civil registration database representing the ageing population in Karlskrona, Sweden. Clinical and radiographic examinations were performed, alongside which participants completed questionnaires gathering information on their medical history, social circumstances, demographic background and tobacco use. A physical examination assessed anthropometric measures. Standard spirometry was performed to identify subjects with airflow limitation. Periodontitis was defined based on radiographic periodontal bone loss. Analysis included multiple logistic regression with adjustment for various confounders., Results: A total of 826 Caucasian dentate subjects were included in the analysis. The median age of participants was 73.2 (IQR 66-81) years, and 443 (54.6%) subjects were female. Eighty-six (10.4%) individuals presented with airflow limitation. The proportion of participants presenting with periodontitis in the airflow limitation group was 65.1% compared to 41.5% with normal respiratory function (p < .001). Multiple logistic regression analysis showed that periodontitis was independently associated with airflow limitation with an odds ratio of 2.31 (95% CI 1.27-4.22) p < .01., Conclusion: In this group of older dentate individuals, periodontitis was significantly associated with airflow limitation independent of other known risk factors., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose: This practice-based cross-sectional study aimed to investigate whether common risk indicators for peri-implant diseases were associated with peri-implant mucositis and peri-implantitis in patients undergoing supportive implant therapy (SIT) at least 5 years after implant restoration., Methods: Patients exclusively restored with a single implant type were included. Probing pocket depth (PPD), bleeding on probing (BOP), suppuration, and radiographic bone loss (RBL) were assessed around implants. The case definitions were as follows: peri-implant mucositis: PPD ≥4 mm, BOP, no RBL; and peri-implantitis: PPD ≥5 mm, BOP, RBL ≥3.5 mm. Possible risk indicators were compared between patients with and without mucositis and peri-implantitis using the Fisher exact test and the Wilcoxon rank-sum test, as well as a multiple logistic regression model for variables showing significance ( P <0.05)., Results: Eighty-four patients with 169 implants (observational period: 5.8±0.86 years) were included. A patient-based prevalence of 52% for peri-implant mucositis and 18% for peri-implantitis was detected. The presence of 3 or more implants (odds ratio [OR], 4.43; 95 confidence interval [CI], 1.36-15.05; P =0.0136) was significantly associated with an increased risk for mucositis. Smoking was significantly associated with an increased risk for peri-implantitis (OR, 5.89; 95% CI, 1.27-24.58; P =0.0231), while the presence of keratinized mucosa around implants was associated with a lower risk for peri-implantitis (OR, 0.05; 95% CI, 0.01-0.25; P <0.001)., Conclusions: The number of implants should be considered in strategies to prevent mucositis. Furthermore, smoking and the absence of keratinized mucosa were the strongest risk indicators for peri-implantitis in patients undergoing SIT in the present study., Competing Interests: Conflict of Interest: No potential conflict of interest relevant to this article was reported., (Copyright © 2020. Korean Academy of Periodontology.)

Aim: To evaluate pattern of change in periodontal variables and tooth loss in a twelve-year follow-up study of older adults living in Sweden., Methods: In a prospective population study of older adults, a clinical examination and radiographic dental examination were performed at baseline (2001-2003) and after 12 years (2013-2015). In 375 individuals, the number and proportion of sites with a distance ≥4 mm and ≥5 mm from cemento-enamel junction to the bone level, the number and proportion of teeth with pockets ≥5 mm and number of teeth lost were calculated. Dental caries was registered. Periodontitis was defined as having ≥2 sites with ≥5 mm distance from cemento-enamel junction to the marginal bone level and ≥1 tooth with pockets ≥5 mm., Results: A diagnosis of periodontitis was evident in 39% of the individuals, and 23% of the individuals lost ≥3 teeth over the study period. The proportion of sites with ≥4 mm and ≥5 mm bone loss increased with age, while the proportion of teeth with pockets remained stable. Periodontitis was the strongest predictor for losing ≥3 teeth, OR 2.9 (p < .001) in the final model., Conclusions: Periodontitis is a risk factor for future tooth loss among older adults., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The following consensus report is based on four background reviews. The frequency of maintenance visits is based on patient risk indicators, homecare compliance and prosthetic design. Generally, a 6-month visit interval or shorter is preferred. At these visits, peri-implant probing, assessment of bleeding on probing and, if warranted, a radiographic examination is performed. Diagnosis of peri-implant mucositis requires: (i) bleeding or suppuration on gentle probing with or without increased probing depth compared with previous examinations; and (ii) no bone loss beyond crestal bone level changes resulting from initial bone remodelling. Diagnosis of peri-implantitis requires: (i) bleeding and/or suppuration on gentle probing; (ii) an increased probing depth compared with previous examinations; and (iii) bone loss beyond crestal bone level changes resulting from initial bone remodelling. If diagnosis of disease is established, the inflammation should be resolved. Non-surgical therapy is always the first choice. Access and motivation for optimal oral hygiene are key. The patient should have a course of mechanical therapy and, if a smoker, be encouraged not to smoke. Non-surgical mechanical therapy and oral hygiene reinforcement are useful in treating peri-implant mucositis. Power-driven subgingival air-polishing devices, Er: YAG lasers, metal curettes or ultrasonic curettes with or without plastic sleeves can be used to treat peri-implantitis. Such treatment usually provides clinical improvements such as reduced bleeding tendency, and in some cases a pocket-depth reduction of ≤ 1 mm. In advanced cases, however, complete resolution of the disease is unlikely., (© 2019 FDI World Dental Federation. Published by John Wiley & Sons Ltd.)

Background and Aims: Bone augmentation procedures to enable dental implant placement are frequently performed. The remit of this working group was to evaluate the current evidence on the efficacy of regenerative measures for the reconstruction of alveolar ridge defects., Material and Methods: The discussions were based on four systematic reviews focusing on lateral bone augmentation with implant placement at a later stage, vertical bone augmentation, reconstructive treatment of peri-implantitis associated defects, and long-term results of lateral window sinus augmentation procedures., Results: A substantial body of evidence supports lateral bone augmentation prior to implant placement as a predictable procedure in order to gain sufficient ridge width for implant placement. Also, vertical ridge augmentation procedures were in many studies shown to be effective in treating deficient alveolar ridges to allow for dental implant placement. However, for both procedures the rate of associated complications was high. The adjunctive benefit of reconstructive measures for the treatment of peri-implantitis-related bone defects has only been assessed in a few RCTs. Meta-analyses demonstrated a benefit with regard to radiographic bone gain but not for clinical outcomes. Lateral window sinus floor augmentation was shown to be a reliable procedure in the long term for the partially and fully edentulous maxilla., Conclusions: The evaluated bone augmentation procedures were proven to be effective for the reconstruction of alveolar ridge defects. However, some procedures are demanding and bear a higher risk for post-operative complications., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose: Periimplantitis has become an emerging challenge faced by practicing dentists worldwide. When treating periimplantitis, we should attempt to manage this problem via nonsurgical therapies that include addressing all modifiable systemic risk factors and local contributing factors. Hence, the aim of this narrative review was to examine published studies on nonsurgical treatment of periimplantitis and evaluate their effectiveness and limitations., Materials and Methods: A literature search was performed in MEDLINE via PubMed database up to December 31, 2017. Current published clinical approaches focused on mechanical debridement, adjunctive antiseptic therapy, adjunctive antibiotic therapy, laser-assisted therapy, and combination approaches were included in this analysis., Results: Nonsurgical therapy of periimplantitis may result in complete healing of the disease and the patient is then placed on a supportive maintenance program. If the disease is not resolved and surgical intervention is not an option, active nonsurgical retreatment may be considered. In many cases where disease is not resolved, surgical therapy or implant removal could be considered., Conclusions: Nonsurgical treatment of periimplantitis usually provides clinical improvements in reducing bleeding tendency and in some cases pocket reduction. Early diagnosis, detection, and intervention remain the key for managing periimplantitis.

Purpose: The aim of this review is to describe the current guidelines for the differential diagnosis of periimplant diseases., Materials and Methods: Synopsis reviews were conducted to define the differential diagnosis of periimplant disease through an electronic literature search in MEDLINE up to February 2018., Discussion: Periimplant mucositis is defined by the presence of bleeding and/or suppuration on gentle probing with or without an increased probing depth compared with previous examinations and by the absence of bone loss beyond crestal bone-level changes resulting from initial bone remodeling. Periimplantitis is defined by the presence of bleeding and/or suppuration on gentle probing with an increased probing depth compared with previous examinations and by the presence of bone loss beyond crestal bone-level changes resulting from initial bone remodeling. Thus, a combination of clinical registrations (probing pocket depth, bleeding on probing, and presence of pus) combined with radiographic signs of possible bone loss is needed for differential diagnosis., Conclusions: An accurate baseline registration at the time of placement of the prosthesis (probing pocket depth and bone level) with ongoing yearly monitoring is essential for diagnosis and appropriate disease management.

Objective: To assess if carotid calcifications detected in panoramic radiographs are associated with future events of stroke, and/or ischemic heart diseases over 10-13 years in individuals between 60 and 96 years., Materials and Methods: Baseline (2001-2004) panoramic radiographs were assessed for evidence of carotid calcifications from individuals with no previous history of stroke and/or ischemic heart diseases. A radiopaque nodular mass adjacent to the cervical vertebrae, at or below the intervertebral space C3-C4, was interpreted as carotid calcification. Annual medical records were searched for ICD 10 codes through 2014., Results: Signs of carotid calcification was demonstrated in 238/635 (37.5%) of the study individuals. Signs of carotid calcification was associated with future stroke and/or ischemic heart diseases (χ 2  = 9.1, OR 1.6, 95% CI 1.2, 2.2, p < 0.002). In individuals 60-72 years, a significant association between radiographic signs of carotid calcification and stroke and/or ischemic heart diseases (χ 2  = 12.4, OR 2.4, 95% CI 1.5, 4.0, p < 0.000) (adjusted for high blood pressure, diabetes type 2, BMI; OR 1.9, 95% CI 1.1, 3.5, p = 0.03). Individuals (60-72 years) with radiographic evidence of carotid calcifications had a mean cumulative stroke and/or ischemic heart diseases survival time of 12.1 years compared to those without such evidence (13.0 years) (log rank Mantel-Cox χ 2  = 10.7, p = 0.001)., Conclusions: Evidence of carotid calcifications in panoramic radiographs is associated with an event of stroke and/or ischemic heart diseases in 60-96-year-old individuals., Clinical Relevance: Radiographic evidence of carotid calcifications is associated with stroke and/or ischemic heart diseases. Patients with signs of carotid calcifications should therefore be referred for medical examination.