Effect of a Multidirectional Power Toothbrush and a Manual Toothbrush in Individuals Susceptible to Gingival Recession: A 12‐Month Randomized Controlled Clinical Study

Background: Clinical studies have explored the relationship between toothbrushing and development of gingival recession (GR), but relevant GR data for the multidirectional power toothbrush (PT) are lacking. The aim of this study is to evaluate the effect of brushing with either a multidirectional PT or American Dental Association reference manual toothbrush (MT) on mid‐buccal preexisting GR (PreGR) during 12 months. Methods: This was a 12‐month prospective, single‐masked, parallel‐group, randomized, controlled clinical study. Healthy participants without periodontitis with at least two teeth showing PreGR ≥2 mm were randomized to a group brushing with either an MT or PT. The primary outcome parameter was change at sites with PreGR ≥2 mm. All clinically based GR measurements were performed by one calibrated examiner at baseline, 6, and 12 months. Secondary outcomes were changes of GR at all mid‐buccal sites (with or without PreGR), changes in percentage of GR sites demonstrating a change of ≥1 mm, and changes in probing depths. Results: A total of 107 participants completed the study (PT: 55, MT: 52). During the 12‐month study period the mean recession at sites with PreGR ≥2 mm decreased significantly from 2.2 to 2.1 mm in both groups (P <0.05). The extent of GR parameters did not differ between MT and PT groups at any time point. GR evaluated clinically and on stone casts was well correlated. Conclusion: Neither the PT nor MT led to an increase in PreGR during 12 months of daily use.     

Long‐Term Outcomes of Untreated Buccal Gingival Recessions: A Systematic Review and Meta‐Analysis

Background: This review aims to: 1) assess the long‐term outcomes of untreated buccal gingival recession (GR) defects and the associated reported esthetic and functional alterations; and 2) evaluate which factors influence the progression/worsening of dental and periodontal tissue conditions of untreated GR defects. Methods: Interventional and observational studies with duration of ≥24 months reporting outcomes from adult patients with localized or multiple GR defects not treated by root coverage or gingival augmentation procedures were considered eligible for inclusion. MEDLINE and EMBASE databases were searched for articles published through July 2015. Random‐effects meta‐analyses were performed comparing baseline versus most recent follow‐up outcomes (i.e., number of patients with ≥1 GR and number of sites with GR). Results: Of 378 potentially eligible articles, eight (reporting six studies) met inclusion criteria. Of 1,647 GR defects with baseline and follow‐up information, 78.1% experienced GR depth increase during the follow‐up period, whereas the remaining experienced decrease or no change. Moreover, there was a 79.3% increase in the number of GR defects among the patients followed (i.e., new GR defects). Pooled estimates (data from four studies) showed significantly increased odds of recession development long term, regarding either number of patients (odds ratio 2.43; P = 0.03) or number of sites with GR (odds ratio 2.16; P = 0.0005). Conclusion: Untreated recession defects in individuals with good oral hygiene have a high probability of progressing during long‐term follow‐up.     

Use of Platelet‐Rich Fibrin Membrane in the Treatment of Gingival Recession: A Systematic Review and Meta‐Analysis

Background: The aim of this systematic review is to evaluate the effects of platelet‐rich fibrin (PRF) membranes on the outcomes of clinical treatments in patients with gingival recession. Methods: Articles that were published before June 2015 were searched electronically in four databases without any date or language restrictions and searched manually in regular journals and unpublished studies. The eligibility criteria comprised randomized controlled trials (RCTs) and prospective controlled trials with follow‐up periods of ≥6 months that compared the performance of PRF to other biomaterials in the treatment of Miller Class I or II gingival recessions. For the meta‐analysis, the inverse variance method was used in fixed‐ or random‐effect models, which were chosen according to heterogeneity. The estimates of the intervention effects were expressed as the mean differences in percentages or millimeters. Results: Six RCTs and one prospective clinical trial are included in this review. Root coverage (RC) and clinical attachment level (CAL) did not differ significantly between the analyzed subgroups (P = 0.57 and P = 0.50, respectively). The keratinized mucosa width (KMW) gain was significantly greater (P = 0.04) in the subgroup that was treated with connective tissue grafts. Conclusion: The results of the meta‐analysis suggest that the use of PRF membranes did not improve the RC, KMW, or CAL of Miller Class I and II gingival recessions compared with the other treatment modalities.     

Gingival Margin Stability After Mucogingival Plastic Surgery. The Effect of Manual Versus Powered Toothbrushing: A Randomized Clinical Trial

Background: Oscillating‐rotating power toothbrushes have been proven to be clinically efficacious. To the best of the authors’ knowledge, a clinical evaluation of the safety of these toothbrushes after surgical root coverage procedures has not been published. The aim of this study is to evaluate the gingival margin (GM) stability with the use of an oscillating‐rotating toothbrush compared with a manual toothbrush. Methods: Sixty healthy individuals with at least one Miller Class I or II gingival recession underwent a surgical root coverage procedure. Soft‐bristle manual and powered toothbrushes were given to participants randomly assigned to control and test groups, respectively. Full‐mouth plaque score (FMPS), full‐mouth bleeding score (FMBS), probing depth (PD), and recession depth (RD) were recorded at baseline and 1, 3, and 6 months after completion of the surgical procedure. Data analyses were performed using linear random‐intercept models to take into account within‐participant correlations over time. Temporal trend differences across treatments by including treatment–time interaction terms were then tested using a global Wald test. Results: Use of a powered toothbrush resulted in a significantly greater reduction of recorded periodontal clinical indices compared with a manual device (FMPS, P = 0.05; FMBS, P = 0.005; RD, P = 0.004). No significant differences were noticed between the two experimental groups both for PD (P = 0.03) and clinical attachment level (P = 0.11). Complete root coverage was significantly higher in participants who used the powered toothbrush compared with the manual toothbrush at 6 months (control, 66.67%; test, 96.67%; P = 0.002). Conclusion: Use of an oscillating‐rotating powered toothbrush with a soft‐bristle head resulted in higher GM stability after root coverage procedures compared with the use of a manual soft‐bristled toothbrush.     

Soft Tissue Changes Around Immediately Placed Implants: A Systematic Review and Meta‐Analyses With at Least 12 Months of Follow‐Up After Functional Loading

Background: Immediate implant placement (IIP) is predictable but can lead to esthetic challenges, including midfacial recession (MFR) and papillary height (PH) loss. The aim of this systematic review is to examine the effect of IIP on MFR and PH after at least 12 months of functional loading. Methods: Literature review of the Cochrane and MEDLINE electronic databases and hand search up to January 2016 identified eligible studies. Four reviewers independently assessed data quality and methodology. Results: A total of 106 articles satisfied the inclusion criteria. Twelve studies qualified for three meta‐analyses. MFR was slightly less in conventional implant placement (CIP) than in IIP, but the result was not statistically significant (mean difference [MD] ?0.064 mm; P = 0.687). Similarly, there was better PH maintenance in CIPs, with statistical significance for distal PH (DPH) only (cumulative PH: MD ?0.396, P = 0.010; DPH: MD ?0.765, P <0.001; mesial PH [MPH]: MD ?0.285, P = 0.256). MFR was slightly less in IIP with thick versus thin biotypes, but not statistically significantly different (MD ?0.373, P = 0.243). Pooled data showed statistically significantly less MFR and better PH maintenance in IIP with thick biotype (MFR: MD ?0.478, P <0.001; cumulative PH: MD ?0.287, P <0.001; MPH: MD ?0.288, P <0.001; DPH: MD ?0.310, P <0.001). Non‐significantly less MFR (MD 0.253, P = 0.384) and significantly better PH maintenance were found in IIP with immediate provisionalization versus conventional restoration (MD ?0.519, P = 0.028). Conclusions: IIP in thick biotype and with immediate provisionalization had less MFR and better PH than IIP in thin biotype or with delayed restoration. However, these findings should be interpreted with caution due to high heterogeneity, which was calculated using comprehensive meta‐analysis statistical software that took into account sample size and different treatment groups, and limited qualified studies.     

Gingival recession in schoolchildren at 7,12 and 17 years of age in Espoo, Finland

The present study was undertaken in response to a growing concern among clinicians about an increase in gingival recession among children and adolescents. Groups of 50 boys and 50 girls aged respectively 7, 12, and 17 yr were examined at Espoo Health Centre in 1983. Gingival recession was measured on the facial and lingual aspects of all permanent teeth. Whenever the gingival margin was located on root cementum, the distance from the gingival margin to the enamel border was measured to the nearest 0.5 mm. Recession was categorized as "slight" (0.5 or 1 mm) or "extensive" (1.5-3.5 mm). The prevalence of gingival recession was 5% at 7 yr, 39% at 12 yr, and 74% at 17 yr of age. More girls than boys had recession in the two youngest age groups. At 17 yr recession was equally common in both sexes and both "slight" and "extensive" recession was most often recorded on facial surfaces of first molars, premolars and canines. The alarmingly high prevalence of gingival recession at young age warrants further study of both the reasons and the consequences of early cementum exposure.     

Generalized Aggressive Periodontitis as a Risk Factor for Dental Implant Failure: A Systematic Review and Meta‐Analysis

Background: Dental implant placement is a widely used treatment that provides functional and esthetic resolution for patients suffering from tooth loss. However, the incidence of peri‐implant diseases has been rising recently. Periodontal diseases and peri‐implant diseases share many similarities. Hence, it is important to find out whether patients with aggressive periodontal disease possess a higher risk of developing peri‐implant diseases. The aim of this study is to study whether generalized aggressive periodontitis (GAgP) has similar survival rates (SRs) and marginal bone loss (MBL) when compared with patients with chronic periodontitis (CP) and/or healthy patients (HPs). Methods: An electronic literature search was conducted by one reviewer (AM) in several databases from 2000 to 2013, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register databases, for articles written in English up to November 2013. Human clinical trials, either prospective or retrospective, that compared implant SR and MBL in patients with a history of GAgP versus those with CP or HPs were included. Results: A total of six non‐randomized prospective clinical trials met the inclusion criteria. The results showed SRs of 83.3% to 100% (GAgP), 96.4% to 100% (CP), and 96.9% to 100% (HP) over a mean period of 48.01 ± 71.99 months, with an overall risk ratio of 0.96 (95% confidence interval [CI] = 0.91 to 1.01, P = 0.14, GAgP versus HP) and 0.94 (95% CI = 0.87 to 1.01, P = 0.09, GAgP versus CP). However, when the “failure rate” as studied outcome was examined, meta‐analysis presented an overall risk ratio of 4.00 for the comparison between patients with AgP and HPs and an overall risk ratio of 3.97 when compared with patients with CP. The MBL weighted mean difference for each subgroup was 0.15 mm (95% CI = 0.04 to 0.26, HP versus CP), ?0.28 mm (95% CI = ?0.36 to ?0.19, HP versus GAgP), and ?0.43 mm (95% CI = ?0.53 to ?0.33, CP versus GAgP) over a mean period of 30 ± 18 months. Conclusions: Implant placement in patients with a history of GAgP might be considered a viable option to restore oral function with survival outcomes similar to those found in both patients with CP and HPs. However, the risk ratio for failure in patients with AgP is significantly higher when compared with HPs (4.0) and those with CP (3.97).     

The Effect of Flapless Surgery on Implant Survival and Marginal Bone Level: A Systematic Review and Meta‐Analysis

Background: The clinical outcomes of implants placed using the flapless approach have not yet been systematically investigated. Hence, the present systematic review and meta‐analysis aims to study the effect of the flapless technique on implant survival rates (SRs) and marginal bone levels (MBLs) compared with the conventional flap approach. Methods: An electronic search of five databases (from 1990 to March 2013), including PubMed, Ovid (MEDLINE), EMBASE, Web of Science, and Cochrane Central, and a hand search of peer‐reviewed journals for relevant articles were performed. Human clinical trials with data on comparison of SR and changes in MBL between the flapless and conventional flap procedures, with at least five implants in each study group and a follow‐up period of at least 6 months, were included. Results: Twelve studies, including seven randomized controlled trials (RCTs), one cohort study, one pilot study, and three retrospective case‐controlled trials (CCTs), were included. The SR of each study was recorded, weighted mean difference (WMD) and confidence interval (CI) were calculated, and meta‐analyses were performed for changes in MBL. The average SR is 97.0% (range, 90% to 100%) for the flapless procedure and 98.6% (range, 91.67% to 100%) for the flap procedure. Meta‐analysis for the comparison of SR among selected studies presented a similar outcome (risk ratio = 0.99, 95% CI = 0.97 to 1.01, P = 0.30) for both interventions. Mean differences of MBL were retrieved from five RCTs and two retrospective CCTs and subsequently pooled into meta‐analyses; however, none of the comparisons showed statistical significance. For RCTs, the WMD was 0.07, with a 95% CI of ?0.05 to 0.20 (P = 0.26). For retrospective CCTs, the WMD was 0.23, with a 95% CI of ?0.58 to 1.05 (P = 0.58). For the combined analysis, the WMD was 0.03, with a 95% CI of ?0.11 to 0.18 (P = 0.67). The comparison of SR presented a low to moderate heterogeneity, but MBL presented a considerable heterogeneity among studies. Conclusion: This systematic review revealed that the SRs and radiographic marginal bone loss of flapless intervention were comparable with the flap surgery approach.     

Gingival recession and toothbrushing in an Italian School of Dentistry: a pilot study

The aim of this pilot study was to evaluate the prevalence of gingival recession at buccal tooth surfaces in a student population of Bologna University Dental School. A total of 55 subjects, attending the 1st and 5th year of the course were examined. The clinical examination involved assessment of plaque, calculus, width of keratinized gingiva, buccal probing depth and buccal gingival recession. Information about toothbrushing behavior was collected in an interview. The multiple regression analysis showed that level of education (p=0.002), toothbrushing technique (p=0.013) and toothbrushing frequency (p=0.016) are significant contributors to gingival recession. Notwithstanding the limits of a preliminary study, a higher prevalence of buccal recession is observed in the final year students, which have also a significantly lower % of buccal surfaces with calculus (p=0.014). In addition, it clearly appears that there is the necessity to investigate other factors connected with toothbrushing (pressure, time, toothpaste quantity) in order to provide an oral hygiene education without undesired effects.     

The effect of partially exposed connective tissue graft on root‐coverage outcomes: a systematic review and meta‐analysis

The aim of this systematic review was to compare the root‐coverage outcomes of using a partially exposed connective tissue graft (CTG) technique with a fully covered CTG technique for root coverage. An electronic search up to February 28^th, 2017, was performed to identify human clinical studies with data comparing outcomes of root coverage using CTG, with and without a partially exposed graft. Five clinical studies were selected for inclusion in this review. For each study, the gain of keratinized gingiva, reduction of recession depth, number of surgical sites achieving complete root coverage, percentage of root coverage, gain of tissue thickness, and changes of probing depth and clinical attachment level were recorded. Meta‐analysis for the comparison of complete root coverage between the two techniques presented no statistically significant differences. A statistically significant gain of keratinized tissue in favor of the sites with an exposed CTG and a tendency of greater reduction in recession depth were seen at the sites with a fully covered CTG. Based on the results, the use of a partially exposed CTG in root‐coverage procedures could achieve greater gain in keratinized gingiva, while a fully covered CTG might be indicated for procedures aiming to reduce recession depth.     

Quality Assessment of Systematic Reviews on Short Dental Implants

Background: Critical analysis of published systematic reviews may help in understanding their strengths and weaknesses and identifying areas that need improvement. Short dental implants are becoming an important addition to the existing dental armamentarium. The aim of this overview is to analyze the quality of published systematic reviews focused on short dental implants using established checklists such as the assessment of multiple systematic reviews (AMSTAR). Methods: A search was conducted to retrieve reviews that used a systematic approach in article selection focusing on short dental implants in humans. Based on a set of inclusion and exclusion criteria, a total of 10 reviews were selected. Two independent reviewers appraised the quality of the selected reviews using AMSTAR and the checklist proposed by Glenny et al. in 2003. Each article was given a total score based on the number of criteria that it fulfilled. Results: Six reviews satisfied ≤4 of the 11 AMSTAR items, and only two reviews satisfied nine of the 11 items. This study shows that published systematic reviews on short dental implants exhibit significant structural and methodological variability. Quality assessment using the Glenny checklist further confirmed the variability in the way systematic reviews were conducted and/or reported. A high correlation was observed between the two checklists’ scores. Conclusions: Uniformity in the way systematic reviews are conducted and/or reported will increase the validity and clinical applicability of future reviews.     

Evidence-based periodontal plastic surgery. II. An individual data meta-analysis for evaluating factors in achieving complete root coverage

Background: The aim of this review is to conduct an individual patient data meta‐analysis of randomized controlled clinical trials (RCTs) to evaluate whether baseline recession‐, patient‐, and procedure‐related factors can influence the achievement of complete root coverage (CRC). Methods: A literature search with no restrictions regarding status or the language of publication was performed for MEDLINE (for Medical Literature Analysis and Retrieval System Online), EMBASE (for Excerpta Medica Database), CENTRAL (for Cochrane Central Register of Controlled Trials), and the Cochrane Oral Health Group's Specialized Register databases up to and including March 2011. Only RCTs, with a duration of ≥6 months evaluating recession areas (Miller Class I or II) that were treated by means of root coverage procedures were included. Mixed‐effects logistic regression analyses were conducted to evaluate associations between five baseline variables and CRC. Results: Of the 70 potentially eligible trials, 22 were included in the meta‐analyses. In total, the data from 320 patients and 16 procedures were evaluated. None of the RCTs were classified as low risk of bias. Of the 602 recessions treated, 310 (51.5%) achieved CRC. Subepithelial connective tissue grafts (SCTGs), matrix grafts, and enamel matrix derivative protein (EMD) procedures were superior in achieving CRC when compared to coronally advanced flap (CAF) alone. For the adjusted covariates, the greater the baseline recession depth, the smaller the chance of achieving CRC (individual procedure analysis [odds ratio (OR) = 0.55; 95% confidence interval (CI) = 0.44, 0.70] and grouped procedure analysis [OR = 0.56; 95% CI = 0.45, 0.71]), as well as studies with conflict of interest were more likely to achieve CRC than those without conflict of interest (individual procedure analysis [OR = 6.78; 95% CI = 1.78, 25.86]). Conclusions: SCTGs, matrix grafts, and EMD were superior to CAF in achieving CRC, but SCTGs showed the best predictability. The impossibility of inclusion of all identified RCTs should be taken into consideration when interpreting the present findings.     

Influence of Laser‐Microtextured Surface Collar on Marginal Bone Loss and Peri‐Implant Soft Tissue Response: A Systematic Review and Meta‐Analysis

Background: A laser‐microtextured surface (LMS) dental implant collar appears to promote a more tooth‐like gingival collagen fiber attachment, which may help to stabilize peri‐implant tissues. The purpose of this systematic review is to assess the clinical effect of an LMS versus non‐LMS collar on crestal bone level and peri‐implant soft tissue response. Methods: Electronic and manual literature searches were performed by two independent reviewers for articles written in English up to December 2016. Studies were included if they were human clinical trials with the purpose of evaluating the impact of an LMS collar on peri‐implant hard and soft tissues. Cumulative marginal bone loss (MBL), probing depth (PD), and survival rate (SR) with 95% confidence intervals (CIs) were calculated to show the performance of LMS implant collars. MBL, PD, and SR data were analyzed with a random effects model to compare the influence of LMS collars with non‐LMS collars (e.g., roughened surface and machined surface). Results: Fifteen human clinical studies (three randomized controlled trials, six cohort studies, and six case series) with 772 implants met the inclusion criteria. For the overall data, the weighted mean MBL was 0.72 mm (95% CI: 0.59 to 0.85 mm), PD was 1.81 mm (95% CI: 1.13 to 2.49 mm), and SR was 0.97 (95% CI: 0.95 to 0.98). MBL around an LMS collar was significantly less than around machined‐surface collars (weighted mean difference [WMD]: ?0.77; 95% CI: ?1.01 to ?0.52; I² = 95.2%; P <0.001). PD in the LMS group was significantly shallower than in the machined‐surface group (WMD: ?1.34; 95% CI: ?1.62 to ?1.05; I² = 81.4%; P <0.001). However, no statistically significant difference was detected for MBL between the LMS and roughened‐surface groups (WMD: ?0.04; 95% CI: ?0.16 to 0.08; I² = 0.0%; P = 0.75). No statistically significant difference was found for SR between the LMS and non‐LMS groups (risk ratio: 1.01; 95% CI: 0.97 to 1.04; I² = 0.0%; P = 0.91). Conclusions: Meta‐analysis showed that an LMS collar can reduce the amount of MBL and PD compared with a machined‐surface collar. Due to high heterogeneity between the included studies, results should be interpreted cautiously.     

A network meta‐analysis of interproximal oral hygiene methods in the reduction of clinical indices of inflammation

1 Background

A wide selection of Interdental Oral Hygiene (IOH) aids is available to consumers. Recommendations for selection are, however, limited by the lack of direct comparisons in available studies. We aimed to assess the comparative efficacy of IOH aids using Bayesian Network Meta‐Analysis (BNMA).

2 Methods

Two independent reviewers performed a systematic literature review of randomized clinical trials assessing IOH aids, based on a focused question. Gingival inflammation (Gingival Index (GI), Bleeding‐on‐probing (BOP)) was the primary outcome and plaque and probing depth were secondary outcomes A random‐effects arm‐based BNMA model was run for each outcome; posterior medians and 95% credible‐intervals (CIs) summarized marginal distributions of parameters.

3 Results

A two‐phase selection process identified 22 trials assessing 10 IOH aids as brushing adjuncts. Interdental brushes (IB) yielded the largest reduction in GI (0.23 [95% CI: 0.09, 0.37]) as toothbrushing adjuncts, followed by water‐jet (WJ) (0.19 [95% CI: 0.14, 0.24]). Rankings based on posterior probabilities revealed that IB and WJ had the highest probability of being “best” (64.7% and 27.4%, respectively) for GI reduction, whereas the probability for toothpick and floss being the “best” IOH aids was near zero. Notably, except for toothpicks, all IOH aids were better at reducing GI as compared with control.

4 Conclusions

BNMA enabled us to quantitatively evaluate IOH aids and provide a global ranking of their efficacy. Interdental brushes and water‐jets ranked high for reducing gingival bleeding, whereas toothpicks and floss ranked last. The patient‐perceived benefit of IOH aids is not clear because gingival inflammation measures are physical indicators of periodontal health.     

Effectiveness of Laser Application for Periodontal Surgical Therapy: Systematic Review and Meta‐Analysis

Background: Evidence has shown some improved clinical outcomes and morbidity reduction with the use of lasers for non‐surgical periodontal therapy due to ablation, vaporization, hemostasis, and field sterilization. The purpose of this systematic review is to evaluate and compare studies involving lasers as monotherapy or adjunctive to surgical periodontal treatment. Methods: Electronic and manual searches were conducted by two independent reviewers in several databases for articles written in English up to December 2014. Articles were included in this review if they reported outcomes of surgical periodontal therapy with and without the use of lasers. The primary outcome was probing depth (PD), and secondary outcomes were measured changes in clinical factors such as clinical attachment level (CAL) and gingival recession (GR). For the comparative studies included, the pooled weighted mean difference (WMD) and 95% confidence interval (CI) of each variable were calculated using random‐effects meta‐analysis. Results: Eight and nine articles were included in the quantitative and qualitative analyses, respectively. Although low‐to‐moderate risk of bias was detected, high heterogeneity among studies was found. In flap surgery with or without laser treatment, there was no statistically significant difference in primary outcome. Similarly, in guided tissue regeneration (GTR)/enamel matrix derivative (EMD) with and without laser treatment, the WMD of PD was negligible; however, the GTR/EMD group showed better outcomes (P = 0.005) than the laser group. Regarding the secondary outcomes, in the flap surgery group, the WMD of CAL gain was 1.34 mm, and the WMD of GR was ?0.24 mm; no significant difference was detected between groups. In GTR/EMD with and without laser treatment, the WMD of CAL gain was 0.10 mm and the WMD of recession was ?0.18 mm; again, no significant difference was detected between groups. Conclusions: The available evidence is insufficient to support the effectiveness of dental lasers as an adjunct to resective or regenerative surgical periodontal therapy. However, precautions must be exercised when interpreting the results of this study because of the small sample size and high heterogeneity among studies.     

Influence of the Utilization Time of Different Manual Toothbrushes on Oral Hygiene Assessed During a 6‐Month Observation Period: A Randomized Clinical Trial

Background: The aim of this randomized clinical trial (RCT) was to investigate whether 6‐month continuous use of different manual toothbrushes (TBs) influences plaque removal and the degree of gingival inflammation compared to short utilization periods of 4 weeks each. Methods: In total, 96 participants were randomly allocated into two groups: continuous use during 6 months (non‐renewal group) or a change in TB every 4 weeks during 6 months (renewal group). Each group was subdivided into four subgroups (groups A to H; n = 12 each) according to the head size (normal or short) and bristle hardness (medium or soft) of the TB used. The modified Quigley–Hein plaque index (QHI), papilla bleeding index (PBI), and gingival index (GI) were recorded at baseline and 2, 8, 12, 16, and 24 weeks after baseline. After 24 weeks, each participant received a new TB, and at week 26, the final QHI, PBI, and GI were determined. The statistical evaluation consisted of analysis of covariance (P <0.05). Results: With time, QHI, PBI, and GI were significantly different between the renewal and the non‐renewal groups (QHI: P = 0.02; PBI: P = 0.04; GI: P <0.01), independent of subgroup. In the renewal group, QHI showed a significant decrease between baseline and each follow‐up visit (P <0.01). In the non‐renewal group, there was a significant decrease compared to baseline up to and including week 16 (P <0.01). PBI in the renewal group showed no significant differences between baseline and each follow‐up visit (P >0.05). In the non‐renewal group, only the normal head/soft subgroup exhibited a significant increase at week 24 (P = 0.02). The GI in the renewal group showed no difference between baseline and all follow‐up visits, whereas in the non‐renewal group, there was a significant decrease up to and including week 12 (P <0.05). Conclusions: Six‐month continuous use reduced the effectiveness of the TB with respect to plaque removal, and gingival inflammation appeared to increase.     

The Frequency of Peri‐Implant Diseases: A Systematic Review and Meta‐Analysis

Background: The peri‐implant diseases, namely peri‐implant mucositis and peri‐implantitis, have been extensively studied. However, little is known about the true magnitude of the problem, owing mainly to the lack of consistent and definite diagnostic criteria used to describe the condition. The objective of the present review is to systematically estimate the overall frequency of peri‐implant diseases in general and high‐risk patients. Methods: The systematic review is prepared according to the Meta‐analysis of Observational Studies in Epidemiology statement. Studies were searched in four electronic databases, complemented by manual searching. The quality of the studies was assessed according to Strengthening the Reporting of Observational Studies in Epidemiology, and the data were analyzed using statistical software. Results: Of 504 studies identified, nine studies with 1,497 participants and 6,283 implants were included. The summary estimates for the frequency of peri‐implant mucositis were 63.4% of participants and 30.7% of implants, and those of peri‐implantitis were 18.8% of participants and 9.6% of implants. A higher frequency of occurrence of peri‐implant diseases was recorded for smokers, with a summary estimate of 36.3%. Supportive periodontal therapy seemed to reduce the rate of occurrence of peri‐implant diseases. Conclusions: Peri‐implant diseases are not uncommon following implant therapy. Long‐term maintenance care for high‐risk groups is essential to reduce the risk of peri‐implantitis. Informed consent for patients receiving implant treatment must include the need for such maintenance therapy.     

Alveolar Bone Architecture: A Systematic Review and Meta‐Analysis

Background: There is a need for studying bone characteristics systematically for a better understanding of planning (i.e., timing of placement and loading) and outcomes of implant therapy. Therefore, the aim of the present review is to evaluate alveolar bone microarchitecture and its modifiers. Methods: Two independent reviewers conducted electronic and manual literature searches in several databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register, for articles published up to February 2015 reporting alveolar bone microstructure. The random‐effect model was applied to calculate the weighted mean (WM) of total bone volume (TBV), which has a range from 0 to 1. TBV was stratified by anatomic locations, atrophic status, and types of specimens. Correlations between TBV and other bone‐related parameters were also analyzed. Results: A total of 800 articles were initially identified. After abstract/full‐text review, 24 articles were included in the systematic review, of which 23 were also included in the quantitative analysis. The WM TBV was 0.365 (95% confidence interval = 0.278 to 0.452), higher in the maxillary/mandibular anterior sites than the maxillary/mandibular posterior sites. However, great variations existed within each anatomic location. Additionally, WM TBV was lower in atrophic sites than non‐atrophic sites. TBV was correlated negatively with trabecular spacing (R² = 0.11). Conclusions: The present systematic review suggests that the TBV might not be different between the defined anatomic locations. However, the atrophy status might influence TBV.