Bleeding on probing and pocket probing depth in relation to probing pressure and mucosal health around oral implants

Objectives: To assess the bleeding on probing (BOP) tendency and periodontal probe penetration when applying various probing forces at implant sites in patients with a high standard of oral hygiene with well-maintained peri-implant tissues.
Material and methods: Seventeen healthy patients with excellent oral hygiene in a maintenance program after having been treated for periodontitis or gingivitis were recruited. Missing teeth had been replaced using oral implants. The BOP and probing depth (PPD) were assessed at the mid-buccal, mid-oral, mesial and distal aspects of the buccal surfaces of each implant. Moreover, contralateral teeth were designated and assessed for BOP and PPD in the same locations and at the same observation visits. At each visit, implants and contralateral teeth were randomly assigned to one of the standardized probing forces (0.15 or 0.25 N). The second probing force was applied at the repetition of the examination 7 days later.
Results: Increasing the probing pressure by 0.1 N from 0.15 N resulted in an increase of BOP percentage by 13.7% and 6.6% for implants and contralateral teeth, respectively. There appeared to be a significant difference of the mean BOP percentage at implant and tooth sites when a probing pressure of 0.25 N was applied. A significantly deeper mean PPD at implant sites compared with tooth sites was found irrespective of the probing pressure applied.
Conclusions: The results of the present study demonstrated that 0.15 N might represent the threshold pressure to be applied to avoid false positive BOP readings around oral implants. Hence, probing around implants demonstrated a higher sensitivity compared with probing around teeth.     

Peri‐implant mucosal aspects of ITI implants supporting overdentures. A five‐year longitudinal study.

Sixty‐six ITI implants placed in the mandible of 33 edentulous elderly patients (mean age: 69 years) were observed longitudinally for 5 years. The implants served as overdenture anchorage either by means of a connecting bar or single spherical attachments. During the study period, 2 implants failed (one because of a peri‐implant lesion and one because of a fracture) and had to be removed. At the beginning of the study, all implants were osseointegrated and had successfully been in function for 335 months. Oral hygiene practices and the peri‐implant mucosal status were assessed according to the criteria of conventional periodontal parameters. Approximately 50% of the implants had been installed into lining mucosa and hence were to surrounded by keratinized mucosa. The peri‐implant mucosal tissue was maintained healthy during the whole observation period, and no or only minimal loss of attachment was observed. The probing depths averaged approximately 3 mm. At the end of the study, orthopantomographic radiographs were obtained from all patients to assess the peri‐implant bony structures. Small local angular bony defects were detected on 16 implants (22%) in 12 patients. Slightly increased probing depths were observed when angular bony defects were present. Loss of attachment was significantly less frequent when the implants had been placed following a prolonged period of edentulousness (<5 years). This study demonstrated that advanced age, reduced dexterity of elderly patients and environmental conditions of overdentures do not represent a 1 higher risk for the development of peri‐implant lesions.     

Osmotic pressure of periimplant sulcular and gingival crevicular fluids: a split-mouth, randomized study of its measurement and clinical significance

Objectives: This study comparatively investigated periimplant sulcular fluid (PISF) and gingival crevicular fluid (GCF) by means of the osmotic pressure (OP) levels of PISF (PISFOP) and GCF (GCFOP). It was a preliminary research that aimed to quantify PISFOP and GCFOP as well as to evaluate their clinical significances around implants and teeth. Material and methods: Partially edentulous implant patients treated by the same clinicians and using the same implant system were randomized in a split‐mouth trial design. Fifty‐four implants and teeth from these patients were selected in the same mouth and jaw as matched pairs of samples, i.e. as symmetrical or corresponding implant and tooth. PISFOP/GCFOP measurement was performed by an osmometer following PISF/GCF sampling procedures. Clinical significance was evaluated by the correlations between PISFOP/GCFOP and some clinical examination parameters of periimplant/periodontal soft tissues. These parameters included Silness–Löe plaque index (PI), Löe–Silness gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD) and probing attachment level (PAL). Results: PISFOP was higher than GCFOP, and GI, BOP, PPD and PAL were higher in the implant group than in the tooth group (P<0.05). PISFOP positively correlated with the clinical parameters of implants (P<0.01 for PI, GI and BOP; P<0.05 for PPD and PAL), and GCFOP positively correlated with the clinical parameters of teeth (P<0.01 for PPD; P<0.05 for PI, GI, BOP and PAL). Conclusions: The results reveal that PISFOP and GCFOP may be measured by osmometer, and their levels may be related with the clinical conditions of periimplant/periodontal soft tissues. To cite this article:
Sakallιo?lu U, Lütfio?lu M, Sakallιo?lu EE, Sert S, Ceylan G. Osmotic pressure of periimplant sulcular and gingival crevicular fluids: a split‐mouth, randomized study of its measurement and clinical significance.
Clin. Oral Impl. Res. 22 , 2011; 706–710
doi: 10.1111/j.1600‐0501.2010.02044.x     

Association between periodontal and peri-implant conditions: a 10-year prospective study

OBJECTIVES: The aims of this study were to (1) compare prospectively the clinical and radiographic changes in periodontal and peri-implant conditions, (2) investigate the association of changes in periodontal parameters and peri-implant conditions over a mean observation period of 10 years (8-12 years) after implant installation, and (3) evaluate patient risk factors known to aggravate the periodontal conditions for their potential influence on the peri-implant tissue status. MATERIALS AND METHODS: Eighty-nine partially edentulous patients with a mean age of 58.9 years (28-88 years) were examined at 1 and 10 years after implant placement. The patients contributed with 179 implants that were placed after comprehensive periodontal treatment and restored with crowns or fixed partial dentures. One hundred and seventy-nine matching control teeth were chosen as controls. Also, the remaining teeth (n=1770) in the dentitions were evaluated. Data on smoking habits and general health aspects were collected at 1 and 10 years as well. RESULTS: At 10 years, statistically significant differences existed between implants and matching control teeth with regard to most of the clinical and radiographic parameters (P<0.01) with the exception of plaque index (PII) and recession. Multiple regression analyses were performed to associate combinations of periodontal diagnostic parameters to the peri-implant conditions: probing attachment level (PAL) at implants at 10 years was associated with implant location, full-mouth probing pocket depth (PPD) and full-mouth PAL (P=0.0001, r2=0.36). PPD at implants at 10 years correlated to implant location, full-mouth PPD and full-mouth PAL (P<0.001, r2=0.47). Marginal bone level at implants at 10 years was significantly associated to smoking, general health condition, implant location, full-mouth PAL and change over time in full-mouth PPD (P<0.001, r2=0.39). CONCLUSIONS: These results present evidence for the association between periodontal and peri-implant conditions and the changes in these tissues over 10 years in partially edentulous patients.     

Comparison of periodontal and peri‐implant probing by depth‐force pattern analysis

The purpose of this study was to compare the tissue resistance to probing and the accuracy of depth determination at different force levels around implants and teeth. In 11 subjects 1 implant and 1 tooth at a comparable location and with comparable probing depth were investigated. The sites were located on either the mesial or distal aspect of the tooth and the implant. A probing device was used which allowed simultaneous monitoring of probing force and probe penetration and which standardized the insertion pathway for repeated measurements. The probing instrument was fitted with an attachment for an aiming device to take a radiograph with the probe tip in the sulcus, using a standardized projection geometry. Probing depth values were determined at 0.25,0.50, 0.75, 1.00 and 1.25 N probing force. The standard error of the individual measurement (S₁), evaluated by comparison of repeated measurements in the same session, was 0.2 mm on implants and 0.1 mm on teeth. For implants there was a trend for slightly better reproducibility at higher force levels. Curve analysis of depth force patterns showed that a change in probing force had more impact on the depth reading in the peri-implant than in the periodontal situation. The mean distance between the probe tip and the periimplant bone crest amounted to 0.75±0.60 mm at 0.25 N probing force. It is concluded that peri‐implant probing depth measurements are more sensitive to force variation than periodontal pocket probing.     

Reproducibility of automated periodontal probing around teeth and osseointegrated oral implants

Three different probing devices (Audio‐Probe®, Florida‐Probe®, Peri‐Probe®) were tested in order to determine the clinical probing depth (CPD) around clinically stable oral implants and their homologous teeth and to evaluate their reproducibility. In all 37 patients. in the age range of 24–80 years, who had undergone periodontal therapy and placement of 1 or more oral implants (ITI®), were selected for the study. The CPD was determined on 75 oral implants in total and at 4 sites of both the implants and the control teeth at 3 visits, each 1 week apart. At the 1st visit, the Florida‐Probe® and the Audio‐Probe® were used. At the 2nd visit, the Florida‐Probe® and the Peri‐Probe® and, at the 3rd visit, again, the Florida‐Probe® and the Audio‐Probe® were used. At each visit bleeding on probing (BOP) was registered. A statistically significant ( P <0.05) difference between the mean scores of implant and tooth sites was found showing slightly higher values for implant sites. A tendency for the deeper pockets to bleed more frequently than the shallow pockets was observed. The comparisons of differences of the readings of the Audio‐Probe® on 2 different occasions were smaller than for the Florida‐Probe®. However, comparisons between 2 different probes showed significantly greater measurement errors than when comparing the probes alone. There was a tendency for the Peri‐Probe® to yield the highest and the Audio‐Probe® the lowest values in inflamed sites. It was concluded that all 3 probing devices appeared to have adequate reproducibility both around teeth and oral implants. For clinical use in daily practice, the Audio‐Probe® was found to be the most simple device with the highest 1 reproducibility.     

CrossLaps and beta-glucuronidase in peri-implant and gingival crevicular fluid

Collagen degradation products of the carboxyterminal region possibly reflect bone and attachment loss. In the present study, the Serum CrossLaps One-Step enzyme-linked immunosorbent assay was used to determine a specific part of the carboxyterminal region of type I collagen, the CrossLaps. Samples of peri-implant and gingival crevicular fluid of 111 implants and 53 teeth from 47 partially or completely edentulous patients were examined in reference to levels of CrossLaps and beta-glucuronidase (beta G), an established marker of periodontal disease. Clinical probing pocket depth (PPD), bleeding on probing (BOP), plaque accumulation, mobility, radiographic bone loss, and the occurrence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia were assessed. The mean values were: for PPD at implants 3.76 +/- 1.41 mm, at teeth 3.44 +/- 0.88 mm; for beta G at implants 0.364 +/- 0.392 pU/min, at teeth 0.314 +/- 0.209 pU/min; for CrossLaps at implants 0.069 +/- 0.059 pmol/min, at teeth 0.082 +/- 0.053 pmol/min. Bleeding on probing was significantly higher on implants than on teeth (McNemar test, P = .004). No significant difference of beta G levels was found between teeth and implants (Wilcoxon test). A negative correlation was found between beta G levels and CrossLaps levels at teeth (Pearson-rank correlation, P = .002). On implants, no significant correlation of these 2 parameters was seen, but significant correlations were found between sulcus fluid flow rate and PPD (P = .012), beta G levels and bone loss (P < 0.0005), and CrossLaps levels and PPD (P = .011). CrossLaps can be detected in both gingival and peri-implant crevicular fluid. While rising levels of beta G may indicate acute peri-implantitis, CrossLaps may not, but could play a role as a marker of ongoing attachment loss.     

改良根向复位瓣技术在上颌后牙区种植二期手术中的应用效果评价

目的 探讨上颌后牙区种植体颊侧角化龈重建方法,评估其临床疗效及对种植体牙周状况的影响。方法 筛选种植二期手术且伴有角化龈不足的患者11例,共11个上颌后牙区种植位点,应用改良根向复位瓣技术在种植二期手术同期为患者进行角化龈重建。于二期手术后6周进行冠修复,并于冠修复3个月后复诊。分别记录术前、冠修复时和冠修复完成3个月后的角化龈宽度。拍摄根尖片,测量牙周探诊深度（PD）和探诊出血位点百分比（BOP）。采用SPSS 19.0软件包对数据进行配对样本t检验。结果 冠修复完成时,角化龈宽度为（3.30±0.36） mm,术前为（1.44± 0.34）mm,平均增加1.86 mm（P<0.01）。重建的角化龈宽度在冠修复3个月后仍然保持稳定,平均（3.34±0.33） mm（P=0.58）,无明显炎症与骨吸收。PD为（2.83±1.20） mm,BOP比为18.2%。结论 在种植二期手术同期,采用改良根向复位瓣技术能有效重建上颌后牙区种植体颊侧附着龈,短期内可以保证良好、稳定的效果。     

Histologic probe penetration in healthy and inflamed peri‐implant tissues

Periodontal probing is commonly used for assessing both the status of gingival health and the connective tissue attachment level around teeth.The role of probing around endosseous implants still remains unclear. The purpose of this study was to determine the histological level of probe penetration in healthy and inflamed mucosal tissues around implants. Five beagle dogs were used and a total of 30 one‐stage. Titanium Plasma Spary (TPS)‐coated implants of the ITI type were placed in the mandibles. After the healing period with meticulous oral hygiene. the dogs were divided into 3 groups: 1) clinical healthy mucosal tissues; 2) experimental mucositis (3 dogs); and 3) experimental ligature‐induced peri‐implantitis (2 dogs). Four months after implant placement, respectively 6 months in the third group, 60 probes were placed with a standardized force of 0.2 N and fixed at the mesial and distal aspects of the implants. Probing depth. clinical attachment level (CAL), Plaque index (PII) and Gingival Index (GI) were assessed throughout the study. Tissue sections were obtained for histometrical analysis. In the healthy group, the mean PII was 0.47. the GI 0.06 and the clinical probing depth (CPD) 2.12 mm. In the mucositis group the PII was 1.61, the GI 1.61 and the CPD 1.87 mm. In the peri‐implantitis group the PII was 1.96, the GI 2.05 and the CPD 3.73 mm. The histologic results show that the probes were able to identify the connective tissue adhesion level in the healthy group with a mean error of −0.05 mm (mean histologic probing depth (HPD): 1.75 mm) and, in the mucositis group, with −0.02 mm (mean HPD: 1.62 mm). Probe penetration increased with the degree of inflammation and in the peri‐implantitis group the probe exceeded the connective tissue level by a mean 0.52 mm (mean HPD: 3.8 mm). Therefore, probing around implants represents a good technique for assessing the status of peri-implant mucosal health disease.     

Clinical analysis of the soft tissue integration of non-submerged (ITI) and submerged (3i) implants: a prospective-controlled cohort study

Aim: The aim of this study was to compare the soft tissue integration of submerged and non‐submerged implants by means of periodontal parameter assessments and analysis. Material and methods: Thirty‐one patients, who received 42 non‐submerged implants (ITI) and 48 submerged implants (3i), participated in the study. There was no significant difference (P>0.05) between both groups considering gender; educational level; handedness; toothbrushing frequency; the number of auxiliary devices used; and smoking habits. The parameters assessed were gingival index (GI), plaque index (PII), retention index (RI), pocket probing depth (PPD) and keratinized mucosa index. Results: At evaluation, 66.67% of all sites showed a GI of 0; 72.22% a PI of 0, and 93.33% the absence of calculus. The average PPD was 2.56 mm in the non‐submerged and 2.70 mm in the submerged group. With regard to the width of keratinized mucosa, 100% of the ITI implants showed a band of keratinized gingiva around the implant, whereas 14.58% in the 3i group showed a complete absence of keratinized mucosa. The intra‐examiner reproducibility was 90.96% for all parameters and the Kendall tau‐b analysis showed a powerless correlation between the chosen parameters for both studied groups. Conclusions: The study material showed no major differences between submerged and non‐submerged dental implants regarding GI, PII, RI and PPD, except the width of keratinized mucosa. Regarding the presence of keratinized mucosa, there is a need for further longitudinal studies to elucidate a possible benefit of one implant system over the other.     

Microbial findings at failing implants

The aim of this study was to evaluate qualitative differences in the subgingival microbiota at titanium implants, ad modum Bråmnark, demonstrating clinical and radiographic signs of loss of supporting tissues )peri-implantitis) as compared to implants surrounded by healthy tissues. A total of 37 patients demonstrating 1 or more implants with bone loss ≥3 threads, bleeding on probing and/or suppuration and 51 patients with clinically healthy mucosa and no bone loss were recruited for the study. In each patient subgingival bacterial samples were obtained using paper-points, and subjected to microbiological analysis by culture. The two types of clinical conditions showed distinct bacterial profiles. For implants with peri-implantitis putative periodontal pathogens, such as Porphyuonmnas gingivulis, Prevotella intermedial Prevotella nigresscens and Actinobacillus actinomycetemcomitans, were found in 60% of the cases and microorganisms primarily not associated with periodontitis, such as Staphylococcus spp., enterics and Candida spp., were found in 55% of the peri-implant lesions. In contrast, implants surrounded by healthy tissue demonstrated a microbiota associated with periodontal health. The results indicate that the microbiota of the healthy peri-implant sulci is similar to that from corresponding conditions around teeth. However, in peri-implant areas staphylococci, enter& and yeasts were found almost as frequently as periopathogens indicating differences as compared to the microbiota around periodontitis affected teeth. A microbiological diagnosis may therefore be of guidance for the choice of antimicrobial treatment in patients with peri-implant infection.     

The effect of periodontal parameters on the subgingival microbiota around implants

The study aimed to examine the relationship between the subgingival flora around implants and their periodontal parameters. Plaque samples from 561 implants (297 patients) were analyzed by means of differential phase contrast microscopy and compared with the sample site's probing depth. bleeding tendency on probing, and plaque and gingivitis indices. If possible, one implant with deep and one with shallow pockets were selected within the same patient. The impact of the intraoral exposure time on the microbial composition around the implants was examined cross‐sectionally, with the same group of patients. Only tendencies can be detected by the latter, and no concrete conclusions can be drawn. From the clinical parameters, increased probing depth was found to detrimentally increase the proportion of spirochetes and motile organisms, whereas the other parameters were found to be of minor importance. For partially edentulous patients only, there was a tendency for increased proportions of spirochetes and motile organisms the longer the intraoral exposure time. These observations emphasize the importance of the periodontal health of the remaining teeth (as a reservoir of pathogenic micro organisms) in partial edentulous patients rehabilitated by means of implants and indicate the importance of shallow pockets around imnlants (flan trimming when aesthetics and phonetics allow).     

Immediate transmucosal implants using the principle of guided tissue regeneration. (II). A cross‐sectional study comparing the clinical outcome 1 year after immediate to standard implant placement.

The aim of the present study was to compare the peri‐implant mucosal conditions 1 year after immediate transmucosal implant placement without or in combination with guided tissue regeneration with the situation after regular placement of transmucosal 1‐stage procedure implants in partially edentulous patients. The test group consisted of 15 patients who required the immediate replacement of 20 teeth with oral implants in combination with guided tissue regeneration. The control group 1 consisted of 6 patients who received 8 immediate implants, without concomitant bone regeneration procedure due to the small size of the extracted roots in comparison to the diameter of the implants. The 20 patients of the control group 2 were randomly chosen from over 150 partially edentulous patients who received implants of the ITI® Dental Implant System according to the standard procedure. Similar favorable clinical parameters were found around the implants of all the 3 groups with low plaque and mucosal indices, similar amounts of recession, pocket probing depths and clinical attachment levels. The immediate implants demonstrated lower frequencies of sites bleeding on probing. The study has established that immediate oral implants are a feasible treatment modality with high predictability.     

Correlation of peri-implant health and myeloperoxidase levels: a cross-sectional clinical study

OBJECTIVES: At present, there are no diagnostic tools that permit early detection of peri-implantitis. The purpose of this cross-sectional study was to evaluate the correlation of myeloperoxidase (MPO) levels with traditional periodontal clinical parameters around dental implants including peri-implant pocket probing depth (PPD), gingival index (GI) and bleeding on probing (BOP), since MPO has been associated with destruction of periodontal tissues. MATERIAL AND METHODS: Twenty-four healthy adult volunteers (9 men and 15 women) with 64 Ankylos Biofunctional implants (DentsplyFriadent, Mannheim, Germany) were recruited from Tallinn Dental Clinic. Biochemical and clinical parameters evaluated were the following ones: the level of MPO in the peri-implant sulcus fluid (PISF) (an analog for gingival crevicular fluid in natural teeth), PPD (mm), GI (0,1,2 or 3), and BOP (0 or 1). RESULTS AND CONCLUSION: In comparison to the clinically healthy implants, total amounts of MPO were significantly higher in PISF collected around implants with inflammatory lesions. In addition, the levels of MPO were correlated with the clinical parameters. The results confirm the similarity of the inflammatory response of tissues surrounding implants and natural teeth, and suggest that MPO could be promising marker of inflammation around dental implants.     

The influence of periodontitis on the subgingival flora around implants in partially edentulous patients

The hypothesis that teeth act as reservoirs of micro‐organisms for the colonization of oral implants has recently been stated several times. The present study aimed at examining, in partially edentulous patients with severe periodontitis, whether pockets around teeth and implants harbored a comparable micro‐flora. In 6 patients (3 with refractory periodontitis and 3 with advanced chronic adult periodontitis), plaque samples were taken from a deep and shallow pocket around both teeth and implants for differential phase contrast microscopy and DNA probe analysis. The results showed important differences in the sub‐gingival flora between the 2 disease groups, as well as between deep and shallow pockets, around both implants and teeth. On the other hand, when pockets around teeth and implants with equal depths were compared a striking similarity was observed in the microbial composition. These observations confirm the hypothesis that pockets around teeth act as a reservoir and highlight the importance of periodontal health when oral implants are planned.     

Adjunctive local antibiotic therapy in the treatment of peri-implantitis II: clinical and radiographic outcomes

AIM: To monitor over 12 months clinical and radiographic changes occurring after adjunctive local delivery of minocycline microspheres for the treatment of peri-implantitis. MATERIAL AND METHODS: In 25 partially edentulous subjects, 31 implants diagnosed with peri-implantitis were treated. Three weeks after oral hygiene instruction, mechanical debridement and local antiseptic cleansing using 0.2% chlorhexidine gel, baseline (Day 0) parameters were recorded. Minocycline microspheres (Arestin) were locally delivered to each implant site with bone loss and a probing pocket depth (PPD) >or=5 mm. Rescue therapy with Arestin was allowed at Days 180 and 270 at any site exhibiting an increase in PPD>or=2 mm from the previous visit. The following clinical parameters were recorded at four sites/implant at Day 0, 10, 30, 60, 90, 180, 270 and 360: PPD, clinical attachment level (CAL), bleeding on probing (BOP) and plaque index (PlI). RESULTS: Six implants in six subjects were either rescued or exited because of persisting active peri-implantitis. Successful implants showed a statistically significant reduction in both PPD and percentage of sites with BOP between baseline and Day 360 (P<0.05). At mesial implant sites, the mean PPD reduction amounted to 1.6 mm (95% CI: 0.9-2.2 mm, P<0.001) and was accompanied by a statistically significant reduction of the BOP value (P<0.001). Binary regression analysis showed that the clinical parameters and smoking history could not discriminate between successfully treated and rescued or exited implants at any observation time point. CONCLUSION: Non-surgical mechanical treatment of peri-implantitis lesions with adjunctive local delivery of microencapsulated minocycline led to positive effects on clinical parameters up to 12 months.     

Long-term stability of periodontal conditions achieved following guided tissue regeneration with bioresorbable membranes: case series results after 6-7 years

OBJECTIVES: To evaluate the results of guided tissue regeneration (GTR) treatment of intrabony defects with bioresorbable membranes after 6-7 years, and to disclose factors that may influence the long-term outcome of the treatment. METHODS: Twenty-five defects in 19 patients were treated by means of polylactic acid/citric acid ester copolymer bioresorbable membranes. At baseline and after 1 and 6-7 years, the following parameters were recorded: (1) probing pocket depth (PPD), (2) gingival recession (REC), (3) probing attachment level (PAL)=PPD+REC, (4) presence/absence of plaque (PI), (5) presence/absence of bleeding on probing (BOP). Smoking habits and frequency of dental-control visits were also recorded. Significance of differences between categorical variables was evaluated with McNemar's test, and between numerical variables with the t-test for paired observations. Generalized linear models were constructed to evaluate the influence of various factors on PAL gain and PPD changes from 1 to 6-7 years. Association of smoking, frequency of dental controls, oral hygiene, and BOP with sites losing > or =2 mm in PAL was evaluated with Fisher's exact test. RESULTS: At baseline, a mean PPD of 8.7+/-1.1 mm and a mean PAL of 9.8+/-1.5 mm was recorded. Statistically significant clinical improvements were observed at 1 and 6-7 years after GTR treatment. An average residual PPD of 3.8+/-1.1 mm and a mean PAL gain of 3.8+/-1.4 mm were observed after 1 year. After 6-7 years the corresponding values were 4.7+/-1.3 and 3.6+/-1.4 mm, respectively. There were no statistically significant differences between the 1- and the 6-7-year values. At the 6-7-year control, only 16% of the sites had lost > or =2 mm (maximum 3 mm), of the PAL gain obtained 1 year after GTR treatment. None of the sites had lost all of the attachment gained 1 year after treatment. Smoking, frequency of dental controls, oral hygiene, and BOP did not seem to influence the change of PPD and PAL gain, or the stability of PAL gain (i.e. losing PAL or not) from 1 to 6-7 years from treatment. CONCLUSION: Clinical improvements achieved by GTR treatment of intrabony defects by means of bioresorbable membranes can be maintained on a long-term basis.     

Influence of different curette insertion depths on the outcome of non-surgical periodontal treatment

This study was undertaken to compare the effects of scaling and root planing (Sc/RP) performed from approximately 1 mm coronal to (test Sc/RP) or at the bottom of (control Sc/RP) the probeable pocket to the gingival margin. 2 male and 5 female patients with moderate to severe periodontitis participated in the study. Initial examination was performed with respect to probing pocket depth (PPD) and probing attachment level (PAL) using a pressure-controlled periodontal probe and stents. The patients received repeated instruction in oral hygiene, and their plaque control reached an excellent level. Baseline examination including PPD and PAL measurements was then performed. Following the baseline examination, single-rooted teeth in 1 quadrant of each dentition were randomly selected and subjected to the test Sc/RP (test teeth) or control Sc/RP (control teeth). The PPD and PAL were measured 1 and 3 months following Sc/RP. It was demonstrated that: (i) the PPD reduction following Sc/RP was larger at the sites with initially deep pockets than at the sites with shallow pockets; (ii) the mean PPD reduction at the sites with an initial PPD > or =3.5 mm was significantly larger in the control teeth than in the test teeth; (iii) there was a significant PAL gain in the initially deep pockets but not in the initially shallow pockets; (iv) the PAL gain in the initially shallow pockets was significantly larger in the control teeth than in the test teeth. In the treatment of periodontitis, trauma caused by Sc/RP to the most coronal part of the connective tissue attachment seems to be of minor importance compared to the effective removal of subgingival deposits.     

Comparisons of bacterial patterns present at implant and tooth sites in subjects on supportive periodontal therapy. I. Impact of clinical variables, gender and smoking

OBJECTIVE: (I) To compare the oral microflora at implant and tooth sites in subjects participating in a periodontal recall program, (II) to test whether the microflora at implant and tooth sites differ as an effect of gingival bleeding (bleeding on probing (BOP)), or pocket probing depth (PPD), and (III) to test whether smoking and gender had an impact on the microflora. MATERIAL AND METHODS: Data were collected from 127 implants and all teeth in 56 subjects. Microbiological data were identified by the DNA-DNA checkerboard hybridization. RESULTS: PPD> or =4 mm were found in 16.9% of tooth, and at 26.6% of implant sites (P<0.01). Tooth sites with PPD> or =4 mm had a 3.1-fold higher bacterial load than implant sites (mean difference: 66%, 95% confidence interval (CI): 40.7-91.3, P<0.001). No differences were found for the red, orange, green, and yellow complexes. A higher total bacterial load was found at implant sites with PPD> or =4 mm (mean difference 35.7 x 10(5), 95% CI: 5.2 (10(5)) to 66.1 (10(5)), P<0.02 with equal variance not assumed). At implant sites, BOP had no impact on bacterial load but influenced the load at tooth sites (P<0.01). CONCLUSION: BOP, and smoking had no impact on bacteria at implant sites but influenced the bacterial load at tooth sites. Tooth sites harbored more bacteria than implant sites with comparable PPD. The 4 mm PPD cutoff level influenced the distribution and amounts of bacterial loads. The subject factor is explanatory to bacterial load at both tooth and implant sites.     

Insulin resistance predicts the risk of gingival/periodontal inflammation

1 Objectives

Evaluate whether insulin resistance (IR) predicts the risk of oral inflammation, assessed as the number of sites with bleeding on probing (BOP) and number of teeth with probing pocket depths (PPD) ≥ 4 mm and BOP.

2 Methods

Data on 870 overweight/obese diabetes free adults, aged 40–65 years from the San Juan Overweight Adults Longitudinal Study over a three‐year period, was analyzed. Baseline IR, assessed using the Homeostasis Model Assessment of IR (HOMA‐IR) index, was divided into tertiles. BOP was assessed at buccal and lingual sites, and PPD at six sites per tooth. Negative binomial regression was used to estimate the risk ratios (RRs) for oral inflammation adjusted for baseline age, gender, smoking status, alcohol intake, education, physical activity, waist circumference, mean plaque index, and baseline number of sites with BOP, or number of teeth with PPD≥4 mm and BOP. The potential impact of tertiles of serum TNF‐α and adiponectin on the IR‐oral inflammation association was also assessed in a subsample of 597 participants.

3 Results

Participants in the highest HOMA‐IR tertile at baseline had significantly higher numbers of sites with BOP [RR = 1.19, 95% confidence interval (CI): 1.03–1.36] and number of teeth with PPD ≥ 4 mm and BOP (RR = 1.39, 95% CI: 1.09–1.78) at follow‐up, compared with individuals in the lower two HOMA‐IR tertiles. Neither TNF‐α nor adiponectin confounded the associations.

4 Conclusion

IR significantly predicts gingival/periodontal inflammation in this population.