FISHing for gutta‐percha‐adhered biofilms in purulent post‐treatment apical periodontitis

This study investigated the possibility of depicting individual taxa in clinically relevant biofilms using fluorescent in situ hybridization (FISH). Gutta‐percha samples were collected from the apical aspect of root canals associated with a chronic apical abscess (test samples, n = 8). Corresponding control samples were obtained from previously filled root canals with apparently normal periapical tissues (n = 3). The transport medium was investigated for detached biofilm fragments using FISH staining and conventional epifluorescence microscopy. Gutta‐percha samples were stained by multiplex FISH, and inspected using confocal laser scanning microscopy. FISH of the transport medium confirmed the presence of the main species formerly identified by conventional methods in post‐treatment purulent endodontic infections, most prominently Fusobacterium spp., Bacteroidetes and Prevotellaceae. Treponemes were identified in five of eight cases associated with purulent infections, but Enterococcus faecalis and Staphylococcus spp. were not identified. The biofilms on gutta‐percha from root canals associated with apical periodontitis showed dense aggregates of variable composition. Control samples contained few, if any, bacteria in the transport medium, and featured no biofilms on the respective gutta‐percha specimens. The current study revealed some direct, visual in situ information on the nature of biofilms associated with purulent periapical infections in man.     

Attenuation of radiation‐ and chemoradiation‐induced mucositis using gamma‐d‐glutamyl‐l‐tryptophan (SCV‐07)

Oral Diseases (2010) 16 , 655–660 Objective: To evaluate the efficacy of a novel immunomodulating peptide (SCV‐07) in attenuating the course of radiation‐induced mucositis in an established animal model of oral mucositis (OM). Material and Methods: In three separate experiments, golden Syrian hamsters received either an acute radiation challenge to the buccal mucosa of eight fractionated doses of 7.5 Gy of radiation over a 2‐week‐period, or a combination of acute radiation and cisplatin. In each experiment, animals were treated with varying doses or schedules of SCV‐07 or placebo. OM was scored in a blinded fashion using digital images obtained during the experimental period. Results: We found that SCV‐07 reduced the severity and duration of both acute and fractionated radiation‐induced OM. Similarly, when radiation and chemotherapy were used to induce OM, treatment with SCV‐07 significantly reduced the duration of ulcerative OM. The therapeutic benefit was dependent on both dose and schedule of administration. Conclusion: Taken together, we found SCV‐07 was able to modify the duration and severity of oral mucositis and was dependent on schedule and dose.     

Supportive periodontal therapy for high‐ and low‐risk patients

Aim: The validity of the risk assessment in predicting tooth loss due to periodontitis or disease progression was explored. Methods: Systemic factors, smoking status, bleeding on probing (BoP) percentage, number of residual pockets (probing pocket depth ≥6 mm), tooth loss, and alveolar bone loss in relation to age were the variables of the risk assessment. Based on an improving or deteriorating risk assessment in 2005 compared with 1999, 89 patients were divided into either a high‐ or low‐risk group. Findings were compared with the 2008 outcome. Results: Using BoP ≤ 20% as the cut‐off, the relationship between BoP and interleukin‐1 genotype status was neither significant in 2005 nor in 2008. Neither the high‐ nor low‐risk group was predictive for tooth loss. Patients displayed similar proportions of probing pocket depths ≥6 mm in 2005 and in 2008. Linear stepwise regression analysis demonstrated that only the number of supportive periodontal therapy visits explained the number of teeth lost due to periodontitis (P < 0.01). Conclusions: The categorization of patients into high‐ and low‐risk groups, according to the periodontal risk assessment model applied within a supportive periodontal therapy period of 3 years, had limitations in predicting future tooth loss.     

Animal models for peri‐implant mucositis and peri‐implantitis

The treatment of infectious diseases affecting osseointegrated implants in function has become a demanding issue in implant dentistry. Since the early 1990s, preclinical data from animal studies have provided important insights into the etiology, pathogenesis and therapy of peri‐implant diseases. Established lesions in animals have shown many features in common with those found in human biopsy material. The current review focuses on animal studies, employing different models to induce peri‐implant mucositis and peri‐implantitis.     

A multi‐country comparison of reasons for dental non‐attendance

The purpose of this study was to describe differences across countries with respect to the reasons for dental non‐attendance by Europeans currently 50 yr of age and older. The analyses were based on retrospective life‐history data from the Survey of Health, Ageing, and Retirement in Europe and included information on various reasons why respondents from 13 European countries had never had regular dental visits in their lifetime. A series of logistic regression models was estimated to identify reasons for dental non‐attendance across different welfare‐state regimes. The highest proportion of respondents without any regular dental attendance throughout their lifetime was found for the Southern welfare‐state regime, followed by the Eastern, the Bismarckian, and the Scandinavian welfare‐state regimes. Factors such as patients’ perception that regular dental treatment is ‘not necessary’ or ‘not usual’ appear to be the predominant reason for non‐attendance in all welfare‐state regimes. The health system‐level factor ‘no place to receive this type of care close to home’ and the perception of regular dental treatment as ‘not necessary’ were more often referred to within the Southern, Eastern, and Bismarckian welfare‐state regimes than in Scandinavia. This could be relevant information for health‐care decision makers in order to prioritize interventions towards increasing rates of regular dental attendance.     

Personalized periodontal treatment for the tobacco‐ and alcohol‐using patient

The use of various forms of tobacco is one of the most important preventable risk factors for the incidence and progression of periodontal disease. Tobacco use negatively affects treatment outcomes for both periodontal diseases and conditions, and for dental implants. Tobacco‐cessation programs can mitigate these adverse dental treatment outcomes and may be the most effective component of a personalized periodontal treatment approach. In addition, heavy alcohol consumption may exacerbate the adverse effects of tobacco use. In this review, the microbiology, host/inflammatory responses and genetic characteristics of the tobacco‐using patient are presented as a framework to aid the practitioner in developing personalized treatment strategies for these patients. These personalized approaches can be used for patients who use a variety of tobacco products, including cigarettes, cigars, pipes, smokeless tobacco products, e‐cigarettes and other tobacco forms, as well as patients who consume large amounts of alcohol. In addition, principles for developing personalized tobacco‐cessation programs, using both traditional and newer motivational and pharmacological approaches, are presented.     

Experience with anti‐TNF‐α therapy for orofacial granulomatosis

J Oral Pathol Med (2011) 40 : 14–19 Background: Orofacial granulomatosis (OFG) can be challenging to treat and experience with anti‐TNF‐α therapy is limited. We report our experience with infliximab (IFX) and adalimumab (ADA) for OFG in 14 patients, the largest reported series to date. Methods: A review of patients receiving induction and maintenance IFX for OFG +/? Crohn’s disease (CD) for active oral disease failing other therapies was performed. Clinical response defined by global physician assessment, aided by oral disease activity scores, was assessed at 2 months, 1 and 2 years. ADA was considered for patients failing IFX. Adverse events were recorded. Predictors of need for anti‐TNF‐α therapy were determined by comparison with OFG patients not requiring anti‐TNF‐α from our overall OFG database (n = 207). Results: Fourteen patients (9 men) were treated with IFX [OFG only (n = 7), OFG with CD (n = 7)]. Nine patients received concomitant immunosuppression. Median duration of treatment was 18 months. Short‐term response was achieved in 10/14 (71%) patients. Eight of 14 (57%) and 4/12 (33%) patients remained responsive at 1 and 2 years, respectively. Two patients who failed IFX responded to ADA. Factors predicting need for anti‐TNF‐α therapy were oral sulcal involvement, intestinal CD and a raised C‐reactive protein (CRP). Oral sulcal involvement predicted response at 1 and 2 years. Intestinal CD did not predict response. The only significant adverse event was an IFX infusion reaction. Conclusion: IFX provided good short‐term response for most OFG patients; however, a significant proportion lost response long term. Adverse events were uncommon. Patients failing IFX may respond to ADA.     

Role of preliminary etching for one‐step self‐etch adhesives

Taschner M, Nato F, Mazzoni A, Frankenberger R, Krämer N, Di Lenarda R, Petschelt A, Breschi L. Role of preliminary etching for one‐step self‐etch adhesives.
Eur J Oral Sci 2010; 118: 517–524. © 2010 Eur J Oral Sci The aim of this study was to analyse the effect of preliminary phosphoric acid etching of enamel and dentine before the application of two, one‐step self‐etch adhesive systems. The systems were applied onto acid‐etched or smear‐layer‐covered enamel and dentine. The treatment groups were as follows: group 1, Adper Easy Bond (3M ESPE) on etched substrate; group 2, Adper Easy Bond (control); group 3, iBond Self‐Etch (Heraeus Kulzer) on etched substrate; and group 4, iBond Self‐Etch (control). Enamel and dentine bond strengths were calculated using microshear and microtensile bond‐strength tests. Additional specimens were prepared to evaluate nanoleakage at the dentine–adhesive interface and were investigated using light microscopy or transmission electron microscopy. Both adhesives demonstrated higher microshear bond strengths when enamel was pre‐acid‐etched with phosphoric acid (Adper Easy Bond 28.7 ± 4.8 MPa; iBond Self‐Etch 19.7 ± 3.6 MPa) compared with controls (Adper Easy Bond 19.2 ± 3.3 MPa; iBond Self‐Etch 17.5 ± 2.7 MPa) and increased microtensile bond strength when applied on acid‐etched (Adper Easy Bond 35.8 ± 5.7 MPa; iBond Self‐Etch 24.3 ± 7.9 MPa) vs. smear‐layer‐covered dentine (Adper Easy Bond 26.9 ± 6.2 MPa; iBond Self‐Etch 17.6 ± 4.3 MPa). Adper Easy Bond showed lower nanoleakage than iBond Self‐Etch, irrespective of preliminary etching. The results of this study support the use of phosphoric acid etching before the application of one‐step self‐etch adhesive systems.     

Risk factors for impaired oral health among 18‐ to 34‐year‐old Australians

Objectives: The objective of this study was to determine risk factors for a summary measure of oral health impairment among 18‐ to 34‐year‐olds in Australia. Methods: Data were from Australia's National Survey of Adult Oral Health, a representative survey that utilized a three‐stage, stratified, clustered sampling design. Oral health impairment was defined as reported experience of toothache, poor dental appearance, or food avoidance in the last 12 months. Multivariate Poisson regression models were used to evaluate effects of sociodemographic characteristics, self‐perceived oral health, dental service utilization, and clinical oral disease indicators on oral health impairments. Effects were quantified as prevalence ratios (PR). Results: The estimated percent of 18‐ to 34‐year‐olds with oral health impairment was 42.4 [95 percent confidence interval (CI) 37.7‐47.2]. In the multivariate model, oral health impairment was associated with untreated dental decay (PR 1.38, 95 percent CI 1.13‐1.68) and presence of periodontal pockets 4 mm+ (PR 1.29, 95 percent CI 1.03‐1.61). In addition to those clinical indicators, greater prevalence of oral health impairment was associated with trouble paying a $100 dental bill (PR 1.37, 95 percent CI 1.12‐1.68), usually visiting a dentist because of a dental problem (PR 1.46, 95 percent CI 1.15‐1.86), reported cost barriers to dental care (PR 1.46, 95 percent CI 1.16‐1.85), and dental fear (PR 1.43, 95 percent CI 1.18‐1.73). Conclusions: Oral health impairment was highly prevalent in this population. The findings suggest that treatment of dental disease, reduction of financial barriers to dental care, and control of dental fear are needed to reduce oral health impairment among Australian young adults.     

One‐piece zirconia oral implants for single‐tooth replacement: Three‐year results from a long‐term prospective cohort study

Aim

This 3‐year report of a prospective long‐term cohort investigation aimed to evaluate the clinical and radiographic outcomes of a one‐piece zirconia oral implant for single‐tooth replacement.

Materials and Methods

Sixty‐five patients received a 1‐stage implant surgery with immediate temporization. Standardized radiographs were taken at implant insertion, after 1 year, and after 3 years to monitor peri‐implant bone levels. A univariate analysis of the association of different baseline parameters on marginal bone loss from implant insertion to 36 months was performed. Soft‐tissue parameters were evaluated at prosthesis insertion, after 6 months, after 1 year, and at the 3‐year follow‐up.

Results

After 3 years, six posterior site implants were lost, giving a cumulative survival rate of 90.8%. The mean marginal bone loss was 1.45 mm; 35% of the implants lost at least 2 mm bone, and 22% more than 3 mm. The univariate analysis did not identify any parameter associated with marginal bone loss. Probing depth, clinical attachment level, and bleeding index increased over 3 years, and plaque index decreased.

Conclusions

The low survival rate of the presented ceramic implant and especially the high frequency of advanced bone loss are noticeable but remain unexplained.