Microbiota around teeth and dental implants in periodontally healthy,partially edentulous patients: is pre‐implant microbiological testing relevant?

Meijndert L, van der Reijden WA, Raghoebar GM, Meijer HJA, Vissink A. Microbiota around teeth and dental implants in periodontally healthy, partially edentulous patients: is pre‐implant microbiological testing relevant? Eur J Oral Sci 2010; 118: 357–363. © 2010 The Authors. Journal compilation © 2010 Eur J Oral Sci This study aimed to assess the prevalence of seven periodontal marker pathogens, before implant placement and 1 yr after loading, in periodontally healthy individuals and to assess the long‐term effectiveness of pre‐implant reduction of pathogens to below threshold levels. In 93 individuals needing single tooth replacement, pooled subgingival microbiological samples from standard sites were cultured and analyzed before implant treatment and 1 yr after loading. Threshold levels commonly used in periodontology to predict periodontal breakdown were applied. Subjects with levels of pathogens above these thresholds received initial periodontal treatment including systemic antibiotics when indicated. At baseline, 49.5% of periodontally healthy subjects harboured one or more marker pathogens above threshold levels. Periodontal treatment reduced the pathogen levels below threshold values in 78.3% of these initially colonized subjects. In all cases Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis were reduced to below threshold. At 1 yr after loading, periodontal pathogens were present above threshold levels in 74.1% of all subjects. It is concluded that in almost half of periodontal healthy individuals the subgingival biofilm harbours periodontal pathogens above threshold values. Long‐term effectiveness of pre‐implant reduction of the selected marker pathogens appeared limited in our patient population, making pre‐implant reduction unpredictive for post‐implant levels of these pathogens. Thus, considering the applied microbiological criteria, generalized pre‐implant microbiological testing is not contributory in periodontally healthy subjects.     

Dental implants in patients with Sjögren’s syndrome: a case series and a systematic review

The purpose of this study was to assess the clinical outcomes of dental implants in patients with Sjögren’s syndrome (SS). The study consisted of two parts: report of a case series and a systematic review of the literature. The results of the clinical series revealed that 19 patients received 107 implants and were followed for a mean of 125 months. Two patients lost three implants (failure rate 2.8%, 3/107). At the last follow-up, there was a mean marginal bone loss (MBL) of ?2.190 ± 1.384 mm; estimated MBL after 30 years was 4.39 mm. The review identified 18 studies, resulting in 19 studies for analysis including the present clinical series. A total of 712 implants were placed in 186 patients; 705 implants were followed up for a mean of 72.5 months (failure rate 4.1%, 29/705; failed at a mean time of 12.9 ± 31.7 months). The probability of failure was 2.8% (95% confidence interval 1.6–4.1%). Primary SS patients had a lower implant failure rate (2.5%, 3/118) than secondary SS patients (6.5%, 12/184). In conclusion, dental implants should be considered by dentists as a viable treatment option for patients with SS, as the failure rate is fairly low. SS patients may, however, present a higher MBL around implants than patients from the general population.     

Is there an association between weight and dental caries among pediatric patients in an urban dental school? A correlation study

Obesity in the young is a public health priority. The prevalence of overweight children in the United States has risen almost threefold in the last two decades. An association between weight and oral health has been suggested in adults, whereas evidence supporting this association in children is controversial at best. The aim of our study was to evaluate the association between weight and dental caries in a random prospective cohort of children at their initial visit at an urban dental school. One hundred and thirty-five children were recruited in a four-month period. The DS/ds index was used to assess caries, and BMI percentile was calculated based on age and gender-adjusted published scales. Correlation analyses, linear, and multivariate regression including age, gender, and BMI were calculated with a significance threshold of p>0.05. No correlation between dental decay in obese and non-obese children was detected (p=0.99). These findings support recent U.S. population-based literature that reports an inverse association between caries and weight in certain pediatric groups. Nevertheless, the impact of interventions to address the epidemic in the dental setting has not been investigated. As part of a health care team, dental students should be exposed to the changing demographics and sequelae of overweight in children.     

Early function of splinted implants in maxillas and posterior mandibles, using Brånemark System Tiunite implants: an 18-month prospective clinical multicenter study

Background: Immediate or early loading of implants placed in maxillas and posterior mandibles has been a concern as bone density is often low in these areas, making it difficult to establish good initial implant stability. By adapting implant design and insertion protocols, however, high initial implant stability may be achieved in these regions. Further, a modified implant surface texture has been proved to help in maintaining stability during the initial healing period. Purpose: The aim of the present study was to investigate the clinical performance of oxidized titanium implants (TiUnite?, Nobel Biocare AB, Gothenburg, Sweden) when used for early function in the maxilla and in the posterior mandible, locations where the bone density often is low. A further aim was to evaluate the marginal bone level at oxidized implants and compare it with that of machined‐surface implants used in a previous study. Materials and Methods: Thirty‐one patients were consecutively included in the study, and 37 edentulous areas in maxillas and posterior mandibles were treated. Bruxism and uncontrolled periodontal disease were exclusion criteria. Temporary prostheses were generally placed within 9 days but not after 16 days from implant placement. A previous study applying the same study design and clinical protocol but using machined‐surface implants was used for comparisons. Results: Of the 111 implants installed, 1 failed, giving an overall survival rate of 99.1% after 18 months. The prosthesis survival was 100%. The marginal bone resorption was 0.8 mm (standard deviation ISD], 1.0), as opposed to 1.6 mm (SD, 1.3) in the previous study with machined‐surface implants, but was not statistically significantly different (p= .10). Conclusion: The present clinical protocol (aiming at high primary stability) and the use of oxidized titanium implants for early functional loading in the maxilla and the posterior mandible resulted in a high implant survival rate and a favorable marginal bone level during a follow‐up of 18 months. The difference in marginal bone resorption between the oxidized implants in the present study and the machined implants from a previous investigation with the same study design was not statistically significant.     

Radiographic assessment of the prevalence,pattern and position of maxillary canine impaction in Najran (Saudi Arabia) population using orthopantomograms – A cross-sectional,retrospective study

ObjectiveThe objective of this study is to assess the prevalence and pattern of maxillary canine impaction (MCI) in the population of Saudi Arabia according to the Yamamoto classification.Materials and methodsA total of 5000 orthopantomogram (OPG) images of 2500 males and 2500 females in the age group of 14–40 years who attended the orthodontic clinic in Najran city from a period between January 2016 to February 2019 were evaluated for the presence of maxillary canine impaction. The anatomical position of each maxillary canine impaction was matched to the seven subtypes mentioned in the Yamamoto’s classification.ResultsThe prevalence of MCI was found to be 3.46% in Najran(Saudi Arabia) population. Type I (46%) accounted for the highest prevalence followed by Type II (37%) and Type VI (8%). Type III, V and VII was found to be 3% equally and no case was of Type IV was found in the studied population. MCI was more common in females and left side compared to males and right side respectively.ConclusionThe prevalence of maxillary canine impaction was found to be 3.46% in Najran. Type I pattern of maxillary canine impaction was commonest followed by Type II, VI, III, V and VII.     

Clinicians’ and patients’ acceptance of the virtual clinic concept in maxillofacial surgery: a departmental survey

Virtual clinics have been proposed as a method of reducing costs and improving services in the National Health Service (NHS). The aim of this research was to assess the attitudes of clinicians and patients towards virtual consultations in a department of oral and maxillofacial surgery (OMFS). Patients and clinicians at conventional OMFS adult outpatient clinics were prospectively interviewed using a structured questionnaire. Variables recorded included type of consultation, overall attitude, time travelled, and mode of transport. Patients’ notes were assessed retrospectively to check if examinations had been done. A total of 146 patients (100%) completed the surveys, and 108 of them (74%) were amenable to having virtual consultations in the future. Such appointments may have been suitable for 19 patients who did not have examinations. Chi squared analysis showed no relation between type of appointment and preference for a virtual consultation (p=0.087). To introduce a virtual consultation system in our department and to assess its efficacy once implemented, further development and research are required.     

Epidemiological trends,predictive factors,and projection of tooth loss in Germany 1997–2030: part I. missing teeth in adults and seniors

Clinical Oral Investigations - This is the first part of a report on tooth loss in Germany 1997–2030. Here, we describe trends in the prevalence of tooth loss in adults and seniors...     

Assessments of patients’ pain,nutrition and skin in clinical practice: Registered and enrolled nurses’ perceptions

AimThe aim of the study was to describe registered and enrolled nurses’ perceptions of how they assess patients’ pain, nutrition and skin.IntroductionPlanning for pain, nutrition and skin care management is an essential part of nursing. In Sweden, it is common that registered and enrolled nurses work together in the care of patients.MethodInterviews with nine registered and nine enrolled nurses were analyzed using qualitative content analysis.ResultsOne theme; blurring boundaries between registered and enrolled nurses regarding pain, nutrition and skin suit assessments was identified. The manifest content of interviews is described in four categories: nurse–patient interaction, using oneself as a tool, collaborating with colleagues and listening to patients’ next of kin.ConclusionThe analysis showed a blurring of boundaries between RNs and ENs regarding pain, nutrition and skin suit assessments. How they perform their assessments conforms to a large extent. However, even if the activities are the same, the education levels of RNs and ENs are different and therefore the assessment of the patients might be different in clinical practice. Taking the results into account it is important that RNs and ENs collaborate regarding assessment of the patients’ pain, nutrition and skin suit.     

Knowledgeability,attitude, and practice behaviors of primary care providers toward managing patients’ oral health care in medical practice: Wisconsin statewide survey

BackgroundIn this study, the authors sought to explore the receptivity, preparedness, and rates of adoption of integrated medical-dental models of care (MOCs) in the practice setting among primary care providers (PCPs) treating patients with diabetes mellitus (DM).MethodsThe authors conducted an anonymous statewide survey targeting PCPs across a range of Wisconsin-based practice settings to evaluate knowledgeability, attitude, practice behaviors, and perceived barriers to oral health screening in a medical setting. Qualitative analytical approaches included thematic analyses applied to evaluate the status of and barriers to integrated medical-dental MOC adoption.ResultsThe integrated medical-dental MOC adoption rate was 34%. Top perceived barriers to integrated medical-dental MOC adoption included insurance coverage (71%) and care access (70%). A total of 39% indicated competency for educating patients about the association between DM and periodontitis. Although 72% of PCPs indicated optimal periodicity for oral health assessment as frequent, 39% reported frequently conducting such assessments.ConclusionsAlthough PCPs indicate receptivity to integrated medical-dental MOCs, PCPs identify suboptimal education, lack of adequate training in oral-systemic disease assessment, and barriers to oral health care access as barriers to integrated medical-dental MOC adoption.Practical ImplicationsIntegrated medical-dental MOC adoption in care delivery to patients with DM remains below average. Interdisciplinary efforts and education are needed to address identified barriers to care integration.