Impact of a triclosan‐containing toothpaste during the progression of experimental peri‐implant mucositis: Clinical parameters and local pattern of osteo‐immunoinflammatory mediators in peri‐implant fluid

1 Background

This study evaluated the influence of a triclosan‐containing toothpaste in the profile of osteo‐immunoinflammatory mediators in peri‐implant crevicular fluid (PICF) and in clinical parameters during progression of peri‐implant mucositis.

2 Methods

Twenty‐two clinically healthy patients with an implant‐supported single‐unit crown were enrolled in this double‐blind, randomized, crossover study carried out in two phases of 21 days each. During an experimental 3‐week period of undisturbed plaque accumulation in the implants, patients were randomly assigned to use three times/day: triclosan (n = 11), triclosan/copolymer/fluoride toothpaste; or placebo (n = 11), fluoride toothpaste. After a professional prophylaxis, a washout period of 30 days was established. Clinical parameters and 15 osteo‐immunoinflammatory mediators in the PICF were evaluated at baseline and at 3, 7, 14, and 21 days.

3 Results

Both groups showed increase in plaque index at implant sites from the 3rd until the 21st day (P < 0.05). Only triclosan treatment was able to avoid an increase in bleeding on probing (BOP) throughout the follow‐ups (P > 0.05), whereas a significant intensification in BOP was observed from the 14th day in the placebo‐treated sites (P < 0.05). Lower interleukin (IL)‐10 concentrations were detected in the placebo group at the 21st day when compared with triclosan‐treated implant sites (P < 0.05). IL‐10 levels were reduced and IL‐1β concentrations were increased at 21 days when compared with baseline only in placebo‐treated sites (P < 0.05). Osteoprotegerin levels significantly increased from the 14th until the 21st day only in triclosan‐treated sites (P < 0.05).

4 Conclusion

Triclosan‐containing toothpaste controls clinical inflammation and interferes positively in the profile of osteo‐immunoinflammatory mediators during progression of experimental peri‐implant mucositis.     

Human periodontal ligament cells exhibit no endotoxin tolerance upon stimulation with Porphyromonas gingivalis lipopolysaccharide

Background/Objectives

Endotoxin tolerance is characterized by a state of hyporesponsiveness after confrontation with endotoxins such as lipopolysaccharides (LPS) at low concentrations. The aim of this study was to investigate, whether pretreatment with Porphyromonas gingivalis leads to endotoxin tolerance induction and possible alterations in toll‐like receptor (TLR) 2‐ and 4‐induced response in human periodontal ligament cells (hPDLCs).

Material and Methods

Primary hPDLCs were pretreated with P. gingivalis (0.1 or 0.3 μg/mL) LPS for 24 hours and afterwards treated with one of the following stimuli: P. gingivalis LPS (1 μg/mL); TLR4 agonist Escherichia coli LPS (0.1 μg/mL; 1 μg/mL); TLR2 agonist Pam3CSK4 (0.1 μg/mL; 1 μg/mL). The protein expression of interleukin (IL)‐6, IL‐8 and monocyte chemotactic protein‐1 was analyzed with quantitative polymerase chain reaction and enzyme‐linked immunosorbent assay. Gene expression levels of TLR2 and TLR4 were determined by quantitative polymerase chain reaction.

Results

Pretreatment of cells with low concentrations of P. gingivalis LPS did not result in lower production of IL‐6, IL‐8 and monocyte chemotactic protein‐1 compared to control group. In some cases, pretreated cells exhibited lower gene expression levels of TLR2 and TLR4 compared to non‐pretreated cells.

Conclusion

The results of this study implicate that hPDLCs do not develop endotoxin tolerance. Furthermore, the amplitude of the inflammatory response shows no significant dependency on TLR2 and TLR4 expression levels.     

Self‐assembling peptide matrix for treatment of dentin hypersensitivity: A randomized controlled clinical trial

1 Background

Patient‐reported dentin hypersensitivity [DHS] pain is a common finding linked with periodontal disease. This pilot clinical study investigates a novel therapeutic regimen using self‐assembling peptide matrix [SAPM] gel (test) compared with use of an 8% arginine and calcium carbonate [ACC] toothpaste (control) for treatment of DHS.

2 Methods

A total of 50 patients with history of supportive periodontal therapy were enrolled in this prospective, randomized monocentric clinical study, of which 45 (test: n = 22; control: n = 23) fulfilled all the study visits. Test group patients performed ex‐office application of SAPM gel over 1 week, while control group patients performed ex‐office application of ACC toothpaste over 90 days. DHS was assessed in office by Visual Analog Scale [VAS], and patient's perception of pain relief was evaluated by questionnaire. In support of the clinical data, scanning electron microscopy images were recorded to investigate tubule occlusion of both control and test product.

3 Results

Both SAPM and ACC significantly reduced DHS in patients throughout the study, with the patient questionnaire indicating higher patient satisfaction at the earlier time points for the test group.

4 Conclusions

Both SAPM gel and ACC toothpaste were successful in providing relief from DHS and showed similar outcomes on VAS and verbal response scale (VRS) throughout the study period of 90 days. The new therapeutic regimen using SAPM resulted in higher patient satisfaction at day 7, as indicated by the patient questionnaire and the higher number of pain‐free patients at day 7 and day 90. This is a pilot study describing a novel therapy for DHS.     

The effects of crown venting or pre‐cementing of CAD/CAM‐constructed all‐ceramic crowns luted on YTZ implants on marginal cement excess

Objectives

The purpose of this study was to analyze the cement excess produced when cementing CAD/CAM‐fabricated lithium disilicate (L) or zirconium dioxide (Z) crowns using adhesive cement (A) or resin‐modified glass ionomer cement (B). Three different cementation techniques were applied: palatal venting (PV), pre‐cementation with custom analogs (CA), and conventional standard procedure (SP).

Materials and Methods

Seventy‐two crowns (36 each material) were assigned to 12 experimental groups depending on the restoration material (L, Z), type of cement (A, B), and cementation technique (PV, CA, SP). Weight measurements were taken during cementation, and the amounts of excess cement, cement retained in crown, and relative excess cement were calculated and statistically analyzed.

Results

A significant direct relation between the amounts of cement applied and excess cement was observed in groups CA and SP. Vented crowns showed least amounts of marginal excess cement (0.8 ± 0.3 μl) followed by CA (4.2 ± 1.1 μl) and SP (8.8 ± 2.5 μl; p < .001). In CA, 32.1% less excess cement (95%CI: 28.4, 35.7) was produced than in the SP group (p < .001), but 27.4% more than in the PV group (95%CI: 23.8,31.0; p < .001). Overall, slightly smaller amounts of adhesive cement (A) than of glass ionomer cement (B) were retained in crowns.

Conclusions

Using crown venting was the most effective measure to reduce the amount of marginal excess cement, followed using a pre‐cementation device. To keep the marginal excess cement of one‐piece zirconia implants to a minimum, both techniques should be considered for clinical application.     

Influence of ageing on self‐etch adhesives: one‐step vs. two‐step systems

The aim of this study was to evaluate microtensile bond strength (μTBS) to dentine, interfacial nanoleakage expression, and stability after ageing, of two‐step vs. one‐step self‐etch adhesives. Human molars were cut to expose middle/deep dentine, assigned to groups (n = 15), and treated with the following bonding systems: (i) Optibond XTR (a two‐step self‐etch adhesive; Kerr), (ii) Clearfil SE Bond (a two‐step self‐etch adhesive; Kuraray), (iii) Adper Easy Bond (a one‐step self‐etch adhesive; 3M ESPE), and (iv) Bond Force (a one‐step self‐etch adhesive; Tokuyama). Specimens were processed for μTBS testing after 24 h, 6 months, or 1 yr of storage in artificial saliva at 37°C. Nanoleakage expression was examined in similarly processed additional specimens. At baseline the μTBS results ranked in the following order: Adper Easy Bond = Optibond XTR ≥Clearfil SE = Bond Force, and interfacial nanoleakage analysis showed Clearfil SE Bond = Adper Easy Bond = Optibond XTR> Bond Force. After 1 yr of storage, Optibond XTR, Clearfil SE Bond, and Adper Easy Bond showed higher μTBS and lower interfacial nanoleakage expression compared with Bond Force. In conclusion, immediate bond strength, nanoleakage expression, and stability over time were not related to the number of steps of the bonding systems, but to their chemical formulations.     

Titanium‐prepared platelet‐rich fibrin provides advantages on periodontal healing: A randomized split‐mouth clinical study

1 Background

The aim of this study to evaluate the contributions of titanium‐prepared platelet‐rich fibrin (T‐PRF) combined with open flap debridement (OFD) on biological markers in gingival crevicular fluid (GCF)and periodontal outcomes.

2 Methods

Twenty‐nine participants with chronic periodontitis were treated either with autologous T‐PRF+OFD or OFD alone. GCF growth factor levels and relative receptor activator nuclear factor kappa‐B/osteoprotegerin (RANKL/OPG) ratio at baseline and 2, 4, and 6 weeks postoperatively were analyzed, and clinical parameters such as probing depth (PD), relative attachment level (RAL) and gingival margin level (GML) at baseline and 9 months after surgery were compared.

3 Results

The mean PD reduction, RAL gain, and GML change were significantly greater in the OFD+T‐PRF sites than in the OFD sites (P = 0.033, P = 0.029, and P = 0.026, respectively). Both groups demonstrated increased growth factor levels at week 2 compared with baseline, followed by reductions at weeks 4 and 6. GCF growth factor levels in the test group were seen at higher concentrations with respect to control group until 6 weeks post‐surgery. During this 6‐week period, relative RANKL/OPG ratio was found significantly lower in the OFD+T‐PRF group compared to the OFD group(P < 0.05).

4 Conclusions

Using T‐PRF membrane combined with OFD provided significantly higher concentrations of growth factors and lower RANKL/OPG ratio in GCF for approximately 4 to 6 weeks, and improved periodontal healing compared to conventional flap sites.     

The effects of low-fluoride toothpaste supplemented with calcium glycerophosphate on enamel demineralization

Objectives

The aim of the present study was to evaluate the effects of different concentrations of calcium glycerophosphate (CaGP) in toothpastes with low-fluoride (low-F) concentrations on enamel demineralization by using a bovine enamel and pH cycling model.

Materials and methods

Experimental toothpastes containing 0 or 500 μg F/g (NaF) and CaGP concentrations of 0, 0.1, 0.25, 0.5, 1, and 2 % were manufactured. A commercial toothpaste was used as a positive control (1,100 μg F/g). After polishing and hardness tests, enamel blocks were subjected to pH cycling for 5 days and toothpaste treatment twice daily. The treatment regimen involved soaking all blocks in the corresponding slurry for 1 min (2 ml/block). Surface and cross-sectional hardness and fluoride concentrations in enamel were analyzed. The hardness data were analyzed using a one-way ANOVA followed by a Bonferroni post hoc test. Fluoride concentrations were analyzed using a Kruskal–Wallis followed by a Student–Newman–Keuls post hoc test.

Results

The mineral loss with the toothpaste containing 500 μg F/g and 0.25 % CaGP was lower than that in the other groups (p?<?0.05). Fluoride concentrations in the enamel treated with 0.1, 0.25, and 0.5 % CaGP toothpastes were similar to those in the enamel treated with the 500 μg F/g toothpaste (p?>?0.05). A greater concentration of CaGP reduced the fluoride levels in enamel (p?<?0.05).

Conclusions

The results from the present in vitro study show that a low-F (500 μg F/g) toothpaste is capable of maintaining the efficacy of 1,100 μg F/g toothpaste when supplemented with 0.25 % of CaGP.

Clinical relevance

The developed toothpaste prevents caries as a standard one and is safe for individuals of any age group.     

Effect of Periodontal Therapy With Amoxicillin–Metronidazole on Pharyngeal Carriage of Penicillin‐ and Erythromycin‐Resistant Viridans Streptococci

Background: Previous studies have focused on antibiotic resistance of Gram‐negative bacteria before and after periodontal therapy. The purpose of this analysis is to assess changes in resistance patterns of the commensal Gram‐positive microbiota. The viridans group streptococci (VGS) have been suggested to serve as reservoirs of resistance genes for more pathogenic streptococci and may be implicated in some non‐oral infections. Methods: In this randomized clinical trial, 80 patients with periodontitis are distributed randomly into two groups. In group A, patients received 375 mg amoxicillin and 500 mg metronidazole three times per day for 7 days during the non‐surgical treatment phase (T1). In group B, the antibiotics were administered during the surgical phase (T2). Resistance of VGS to penicillin and erythromycin was determined by the epsilometer test. Results: At baseline, VGS from 12.5% (group A) and 11.8% (group B) of patients had a minimum inhibitory concentration (MIC) >2 μg/mL to penicillin. Three months after T1, VGS from 15.6% and 16.7% of patients had an MIC >2 μg/mL, respectively. Six months after T2 VGS from 5.9% and 5.9% and 12 months after T2 VGS from 6.1% and 6.3% patients had an MIC >2 μg/mL. There was no effect of therapy with antibiotics, administered either in T1 or T2, on the carriage of penicillin‐resistant VGS. Erythromycin resistance was high at baseline and remained unchanged throughout the study. MICs for penicillin and erythromycin were correlated (P <0.05). Conclusion: Amoxicillin plus metronidazole did not significantly affect the resistance pattern of the VGS to penicillin or erythromycin.     

In vitro evaluation of controlled‐release 14% doxycycline gel for decontamination of machined and sandblasted acid‐etched implants

1 Background

Peri‐implant infections are associated with the establishment and maturation of a bacterial biofilm characterized by a predominance of Gram‐negative fusiform anaerobic species. The decontamination of implant surfaces is then crucial for a successful peri‐implant therapy.

2 Methods

Twenty‐one smooth and 21 rough implants, divided into four groups according to surface and treatment modality, were contaminated with Streptococcus sanguinis and then placed in an incubator with the atmosphere of 5% CO2 at 37°C for 24 hours to allow the bacteria to grow. After 24 hours, the test groups were treated with controlled release 14% doxycycline gel injecting the gel circumferentially over the surface of the implant for 3 minutes, while the control groups were irrigated with sterile saline for 1 minute. The implants were then vortexed into triptych soy broth to allow the bacteria to detach from the surface, diluted 1:100 and plated. Colony forming units (CFU) were counted 48 hours after incubation.

3 Results

The use of a 14% doxycycline gel minimized CFU counts compared to control groups, with the difference being statistically significant (P < 0.05). The reduction of CFUs in the smooth test group is more marked than in the rough test group, but the difference doesn't reach statistically significance (P = 0.215).

4 Conclusions

The use of 14% doxycycline gel in implant surface decontamination was efficacious in this in‐vitro study. Adjunctive use of locally delivered 14% doxycycline gel might be a viable option in the management of peri‐implantitis and peri‐implant mucositis considering its efficacy in reducing bacterial colonization.     

Comparison of peri‐implant clinical and radiographic inflammatory parameters among cigarette and waterpipe (narghile) smokers and never‐smokers

1 Background

The authors hypothesized that peri‐implant clinical and radiographic inflammatory parameters are worse in waterpipe smokers (WS) and cigarette smokers (CS) compared with never‐smokers (NS). The aim of the present retrospective study is to compare peri‐implant clinical and radiographic inflammatory parameters among WS, CS, and NS.

2 Methods

Forty‐four CS (group 1), 41 WS (group 2), and 43 NS (group 3) were included. Demographic data were collected using a questionnaire. Peri‐implant plaque index (PI), bleeding on probing (BOP), and probing depth (PD) were measured, and crestal bone loss (CBL) was assessed on standardized digital radiographs. Sample size was estimated, and statistical analyses were performed using Kruskal–Wallis and Wilcoxon rank‐sum tests. For multiple comparisons, Bonferroni post hoc test was performed. P values < 0.05 were considered statistically significant.

3 Results

Peri‐implant PI and PD were higher in groups 1 (P < 0.05) and 2 (P < 0.05) compared with group 3. Peri‐implant BOP was significantly higher in group 3 compared with individuals in groups 1 (P < 0.01) and 2 (P < 0.01). Peri‐implant total marginal bone loss was significantly higher in groups 1 (P < 0.05) and 2 (P < 0.05) compared with group 3. There were differences in PI, BOP, PD, and CBL among participants in groups 1 and 2.

4 Conclusions

Peri‐implant soft tissue inflammatory parameters and CBL are worse in CS and WS compared with NS. There is no difference in these parameters between CS and WS.     

Combination of ultrasonic decontamination,soft tissue curettage,and submucosal air polishing with povidone‐iodine application for non‐surgical therapy of peri‐implantitis: 12‐month clinical outcomes

1 Background

The aim of this study is to evaluate clinical outcomes of a concept for non‐surgical peri‐implantitis combining stepwise mechanical debridement measures with adjuvant povidone‐iodine application with and without systemic antibiotics.

2 Methods

Forty‐five patients with chronic periodontitis and a total of 164 screw‐typed implants with peri‐implantitis were included. Peri‐implantitis was defined as radiographic bone loss of > 2 mm, probing depth (PD) ≥5 mm with bleeding on probing (BOP). Stepwise treatment of implants was performed with ultrasonic debridement, soft tissue curettage (STC), glycine powder air polishing (GPAP), and a repeated submucosal application of povidone‐iodine. Teeth with PD > 4 mm were treated simultaneously according to the same concept except STC. In cases with severe periodontitis (n = 24), amoxicillin and metronidazole (AM) were prescribed for 7 days.

3 Results

After 12 months, implants treated without AM showed significant reductions (P < 0.05) of mean PD (1.4 ± 0.7 mm), clinical attachment level (CAL) (1.3 ± 0.8 mm), and BOP (33.4% ± 17.2%). In deep pockets (PD > 6 mm) changes of mean PD (2.3 ± 1.3 mm), CAL (2.0 ± 1.6 mm), and BOP (44.0% ± 41.7%) were more pronounced. Intake of AM did not significantly influence the changes in these parameters. However, the reduction of implant sites with PD > 4 mm and BOP was significantly higher in patients with AM than in those without AM (31.8% ± 12.6% versus 20.8% ± 14.7%; P < 0.05).

4 Conclusions

The combination of ultrasonic debridement, STC, and GPAP with adjuvant povidone‐iodine led to significant clinical improvements at implants. Systemic antibiotics had limited effects on the reduction of persisting implant sites with treatment need.     

Advanced platelet‐rich fibrin and freeze‐dried bone allograft for ridge preservation: A randomized controlled clinical trial

1 Background

Advanced platelet‐rich fibrin (A‐PRF) is an autogenous blood product with applications in dento‐alveolar surgery. However, there is minimal information regarding its optimal clinical application or efficacy. The aim of this multi‐arm parallel randomized controlled clinical trial was to evaluate the efficacy of A‐PRF alone or with freeze‐dried bone allograft (FDBA) in improving vital bone formation and alveolar dimensional stability during ridge preservation.

2 Methods

Forty patients requiring extraction of non‐molar teeth and replacement with dental implants were randomized into one of four ridge preservation approaches: A‐PRF, A‐PRF+FDBA, FDBA, or blood clot. A‐PRF was prepared at 1,300 rpm for 8 minutes. Non‐traumatic extractions and ridge preservation was performed. After an average of 15 weeks healing, bone core samples were harvested at the time of implant placement for micro‐CT and histomorphometric analysis. Ridge dimensions were measured immediately after extraction and before implant placement.

3 Results

Significantly greater loss of ridge height was noted in the blood clot group (3.8 ± 2.0 mm) compared to A‐PRF (1.8 ± 2.1 mm) and A‐PRF+FDBA (1.0 ± 2.3 mm) groups (P < 0.05). No significant differences in ridge width reduction were noted between groups. Significantly more vital bone was present in the A‐PRF group (46% ± 18%) compared to the FDBA group (29% ± 14%) (P < 0.05). Bone mineral density was significantly greater in the FDBA group (551 ± 58 mg/cm³) compared to blood clot (487 ± 64 mg/cm³) (P < 0.05).

4 Conclusions

This study demonstrates A‐PRF alone or augmented with FDBA is a suitable biomaterial for ridge preservation. This study represents the first randomized controlled clinical trial comparing A‐PRF with and without FDBA to FDBA alone for ridge preservation.     

Antimicrobial resistance and virulence traits of Enterococcus faecalis from primary endodontic infections

Objectives

To determine the phenotypic and molecular characteristics of Enterococcus faecalis recovered from primary endodontic infections in Brazilian patients.

Methods

Twenty isolates of E. faecalis recovered from 43 Brazilian patients with primary endodontic infections were identified by biochemical profiling (API20Strep) and 16S rDNA sequencing. Antimicrobial susceptibility was ascertained by agar dilution, using the recommended protocol of the Clinical and Laboratory Standards Institute (CLSI). PCR with validated primers was used to detect genes associated with antibiotic resistance and specific virulence factors.

Results

All isolates were deemed susceptible to penicillin G, erythromycin and vancomycin. However, nine isolates had a minimum inhibitory concentration of 4 μg/mL to vancomycin (the resistance breakpoint). Fourteen isolates (70% of isolates) were also resistant to tetracycline with MICs of >64 μg/mL. PCR products for tetracycline resistance genes were detected in test isolates, while erythromycin and vancomycin resistance genes were not evident. Gelatinase, aggregation substance and enteroccocal surface protein genes were detected in 20, 18 and 12 isolates, respectively.

Conclusions

Endodontic E. faecalis isolates exhibit high level of resistance to tetracycline, an antibiotic that has use in local treatment of dental infections. This opens up a much-needed debate on the role and efficacy of this antibiotic for oral infections. Furthermore, these isolates were shown to possess genes that could contribute to pathogenicity in the pulp cavity.     

High serum procalcitonin levels in patients with periodontitis and chronic migraine

1 Background

To evaluate the contribution of chronic periodontitis (CP) to serum procalcitonin (proCT) levels in chronic migraine (CM) patients in a cross‐sectional study.

2 Methods

We included 138 subjects divided into 4 groups based on clinical features of CM and periodontal parameters: systemically and periodontally healthy individuals (n = 37), systemically healthy and CP patients (n = 19), CM and periodontally healthy patients (n = 34), and CM+CP patients (n = 48). Demographic, neurological, clinical data as well as full‐mouth periodontal records were obtained. ProCT and high sensitive C‐reactive protein (hs‐CRP) serum levels were determined from blood samples taken during migraine interictal period.

3 Results

Patients from the CP+CM group (0.056±0.006 ng/mL) had significantly higher serum proCT levels in comparison with the systemically and periodontally healthy group (0.029±0.019 ng/mL), CM group (0.041±0.002 ng/mL), or CP group (0.034±0.014 ng/mL) (p < 0.001). There were no significant differences in hs‐CRP between groups (p = 0.081). Multiple linear regression analysis showed that CP was associated with increased proCT levels in CM patients (R² = 0.293, p < 0.001).

4 Conclusions

CP independently contributes to elevated serum proCT levels in CM patients. These findings suggest that CP could play a role in migraine chronification.     

Narrow‐ and regular‐diameter implants in the posterior region of the jaws to support single crowns: A 3‐year split‐mouth randomized clinical trial

Objectives

The objective of this 3‐year split‐mouth randomized controlled clinical study was to compare narrow‐diameter implants (NDIs) to regular‐diameter implants (RDIs) in the posterior region of the jaws (premolars and molars) in regards to (i) the marginal bone level (MBL) and (ii) implant and prosthesis survival and success rates.

Material and Methods

A total of 22 patients were included in the study. Each patient received at least one implant of each diameter (Ø3.3 and Ø4.1 mm), placed either in the maxilla or mandible to support single crowns. A total 44 implants (22 NDIs and 22 RDIs) were placed and included in the study. Twenty‐one implants were placed in the premolar, whereas 23 were placed in molar areas. Radiographic evaluations to access the MBL were performed immediately after implant placement, 1 and 3 years after implant loading. Peri‐implant clinical variables including probing pocket depth (PPD) and bleeding on probing (BoP) were obtained after crown delivery, 1 and 3 years after loading. Furthermore, the survival and success rates of the implants and prosthesis were also evaluated.

Results

Twenty patients were able to complete the study. There was no statistically significant difference regarding MBL between groups at implant placement (p = .084), 1‐year (p = .794) and 3‐year (p = .598) time intervals. The mean peri‐implant bone loss at 3‐year follow‐up was ?0.58 ± 0.39 mm (95% CI: ?0.751 to ?0.409) and ?0.53 ± 0.46 mm (95% CI: ?0.731 to ?0.329) for NDIs and RDIs, respectively. BoP was present at 15% and 10% of NDIs and RDIs, respectively, at 3‐year follow‐up. PPD >5 mm was observed in 5% and 0% of the implants of NDIs and RDIs, respectively, at 3‐year follow‐up. At the 3‐year examination, the implant success rates were in the NDIs and RDIs sites, respectively, 95% and 100%. The corresponding values for prosthesis success rates were 90% for NDIs and 95% for RDIs.

Conclusion

The present study demonstrated that NDIs placed to support single crowns in the posterior region did not differ to RDIs in regards to MBL, implant survival, and success rates.     

Efficacy of lycopene‐enriched virgin olive oil for treating burning mouth syndrome: a double‐blind randomised

Burning mouth syndrome (BMS) is an intensive chronic oral mucosal pain condition of unknown aetiology. The aim of this study was to evaluate the clinical performance of lycopene‐enriched virgin olive oil used to treat the condition, comparing this with a placebo. This study took the form of a double‐bind, randomised clinical trial. A total of 60 patients with BMS were randomly divided into two groups: Group I (n = 30) treated with lycopene‐enriched virgin olive oil (300 ppm) (1·5 mL three times a day) and Group II (n = 30) treated with a placebo (1·5 mL three times a day). Evaluations were made before and after 12 weeks of product/placebo application. Symptoms were evaluated by VAS, whilst patient psychological profiles were assessed using the HAD scale and patient quality of life using the Oral Health Impact Profile‐14 (OHIP‐14) and the Medical Outcome Short Form Health Survey questionnaire (SF36). Fifty patients completed the 12‐week treatment (26 in Group I and 24 in Group II). Visual analogue scale pain values improved in both groups but without statistically significant differences between the groups (P = 0·57). Oral quality of life also improved. Four patients in Group I (treatment) left the study and six left Group II (placebo). No patients experienced any adverse effects resulting from treatment at any of the evaluation times. Patients were lost from the sample due to lack of compliance. It was found that the lipid profile did not change during the 3‐month study period as a result of the application of lycopene‐enriched olive oil (Group I); nor did any change occur in the placebo group (Group II). In this way, the placebo effect was seen to be strong. The topical lycopene‐enriched virgin olive oil is a very safe and an effective similar way that the placebo for treating patients with BMS. However, future studies are required to establish the treatment for patients with chronic and painful syndrome.     

Disparity in embrasure fill and papilla height between tooth‐ and implant‐borne fixed restorations in the anterior maxilla: a cross‐sectional study

Purpose

The objective of the present study was to compare inter‐proximal fill and papilla height between different embrasures.

Material & Methods

One hundred and fifty non‐smoking consecutive patients (mean age 54, range 32–73; 63 males and 87 females) without periodontal disease were selected in a multidisciplinary practice during regular supportive care. All had been treated for multiple tooth loss in the anterior maxilla at least 1 year earlier by means of a fixed restoration on teeth (n = 50) or implants (n = 100) using straightforward procedures (without hard and/or soft tissue augmentation). Embrasure fill was assessed by means of Jemt's papilla index and papilla height was registered following local anaesthesia by means of bone sounding by one clinician.

Results

Tooth‐pontic and tooth‐implant embrasures demonstrated comparable inter‐proximal fill and papilla height (≥58% Jemt's score 3; mean papilla height ≥4.1 mm). Between missing teeth, embrasure fill and papilla height were lower regardless of the embrasure type. The implant‐implant and implant‐pontic embrasure demonstrated comparable outcome (≤42% Jemt's score 3; mean papilla height ≤ 3.3 mm; p ≥ 0.416), which was significantly poorer when compared to the pontic‐pontic embrasure (82% Jemt's score 3; mean papilla height 3.7 mm; p ≤ 0.019). Overall, papilla index and papilla height demonstrated a weak correlation (Spearman's correlation coefficient: 0.198; p = 0.002).

Conclusions

The re‐establishment of a papilla is difficult when there is no tooth involved. In that scenario a short papilla should be expected and implant‐borne restorations demonstrate the poorest outcome. Moreover, an implant with a pontic may not perform better than adjacent implants.     

Five‐year outcomes of a randomized clinical trial comparing bone‐level implants with either submerged or transmucosal healing

Aim

To evaluate the long‐term hard and soft tissue peri‐implant tissue stability of bone‐level implants using a different implant placement protocol (submerged versus transmucosal).

Materials and methods

This study was partly a subset analysis of a multicentre study where in 40 patients, a single bone‐level implant with platform switching and a conical implant‐abutment interface was placed either submerged or transmucosal in non‐molar sites. Changes in the peri‐implant tissues between implant placement and 5 years were assessed clinically and radiologically. Patient‐related outcomes were also recorded.

Results

Thirty patients completed the 5‐year follow‐up. Implant survival rate was 100%. The mean radiographic changes in crestal bone levels between baseline and 5 years were 0.59 (0.92) mm and 0.78 (1.03) mm for the submerged and the transmucosal groups, respectively. No statistical significant differences were found between the groups for any of the investigated variables. Peri‐implantitis, defined as changes in the level of crestal bone of ≥2 mm together with bleeding on probing, was only diagnosed in one patient. Patients in both groups were highly satisfied with the treatment received.

Conclusions

Bone‐level implants with submerged or transmucosal healing protocols demonstrated similar outcomes after 5 years. Both protocols yielded optimal clinical and radiographic results when bone‐level implants were placed in non‐molar positions for single tooth replacement.