A Survey: How Periodontists and Other Dental Professionals View the Scope of Periodontics

Background : How do periodontists think of themselves when they define their practices? How do other dental professionals view the scope of the specialty of periodontology? A strong component of periodontal residency programs is extracting teeth and preserving or building bony ridges for the eventual placement of implants. Has the discipline of periodontology moved away from retaining and treating the natural dentition? By the use of a rank‐order survey, the practice of periodontology was defined by periodontists and other dental professionals. Methods: In a pilot study, respondents were asked to list the answers to the question, “What is a periodontist?” The results were consolidated into eight statements. The eight statements were placed into an anonymous rank‐order survey, and more than 1,200 responses were returned. The responses primarily came from periodontists, hygienists, general practitioners, dental students, and dental hygiene students. Results: “Periodontists surgically treat advanced gum and bone infection problems” was considered the most important statement in all of the cohorts. The least important statement considered by all was, “Periodontists are educators promoting health.” Non‐periodontist dentists (NPDs) ranked the statement, “Periodontists perform dental implants and related procedures” less importantly (P <0.001) than the periodontists. The non‐periodontist cohort (NPC), which includes NPDs and dental hygienists, ranked the statement, “Periodontists’ treatments help general dentists and other specialists increase successful therapeutic outcomes” as second most important. Conclusions: The results of this survey indicate that periodontists ranked the placement of implants and their related procedures higher than the NPC. NPDs appear to value periodontists in treating the natural dentition for their patients. The NPC appreciates that periodontal therapy done by periodontists increases their therapeutic success for their patients.     

Economics of periodontal care: market trends,competitive forces and incentives

The adoption of new technologies for the treatment of periodontitis and the replacement of teeth has changed the delivery of periodontal care. The objective of this review was to conduct an economic analysis of a mature periodontal service market with a well‐developed workforce, including general dentists, dental hygienists and periodontists. Publicly available information about the delivery of periodontal care in the USA was used. A strong trend toward increased utilization of nonsurgical therapy and decreased utilization of surgical periodontal therapy was observed. Although periodontal surgery remained the domain of periodontists, general dentists had taken over most of the nonsurgical periodontal care. The decline in surgical periodontal therapy was associated with an increased utilization of implant‐supported prosthesis. Approximately equal numbers of implants were surgically placed by periodontists, oral and maxillofacial surgeons, and general dentists. Porter’s framework of the forces driving industry competition was used to analyze the role of patients, dental insurances, general dentists, competitors, entrants, substitutes and suppliers in the periodontal service market. Estimates of out‐of‐pocket payments of self‐pay and insured patients, reimbursement by dental insurances and providers’ earnings for various periodontal procedures and alternative treatments were calculated. Economic incentives for providers may explain some of the observed shifts in the periodontal service market. Given the inherent uncertainty about treatment outcomes in dentistry, which makes clinical judgment critical, providers may yield to economic incentives without jeopardizing their ethical standards and professional norms. Although the economic analysis pertains to the USA, some considerations may also apply to other periodontal service markets.     

Surgical pocket reduction

It is not possible within the scope of this paper to describe in any detail each of the aforementioned procedures. These can be found in the various textbooks and journals on clinical periodontology. Instead, the objectives of treatment, the spectrum of techniques available, and the rationale for their use have been described. Periodontal surgery should be performed only under certain conditions: the patient must be physically and mentally competent to undergo any type of surgery, and should understand and agree to the procedure and to postoperative management. Finally, periodontal surgery should only be considered when nonsurgical therapy will not accomplish the desired result. When periodontal surgery for pocket elimination is performed for selected defects that have been properly evaluated after a debridement and healing period, and is executed with technical competence and proper postoperative care, it can preserve the dentition affected by periodontal disease.     

A practical approach to the diagnosis and treatment of periodontal disease

BACKGROUND: Both nonsurgical and surgical periodontal therapies are important in the control of most forms of periodontal disease. Sometimes, nonsurgical therapy is adequate to control the disease in mild cases and to slow progression and maintain periodontal stability in more advanced cases. Other times, both therapies may be indicated to obtain satisfactory results. The author presents treatment guidelines and recommendations for periodontal therapy. METHODS: The author searched the dental literature for information pertaining to periodontal therapy. RESULTS: The author found evidence-based data to support the effectiveness of nonsurgical and surgical periodontal therapy in controlling periodontal disease. Nonsurgical periodontal therapy requires time, effort, and good diagnostic and clinical skills to obtain satisfactory results. The results are determined by evaluating the patient's periodontal disease after active therapy, at which time additional surgical or nonsurgical treatment may be recommended. Evaluation should continue throughout the lifelong supportive phase of periodontal therapy. CONCLUSION: Clinicians should continue to develop and enhance their diagnostic skills, assess factors that affect diagnosis and prognosis, formulate a comprehensive treatment plan, render appropriate treatment, evaluate the outcome and determine when periodontal care is indicated. CLINICAL IMPLICATION: Failure to comply with monitoring the patient's periodontal status may lead to uncontrolled disease and eventually premature tooth loss. Premature tooth loss can be prevented through patient education and application of evidence-based nonsurgical and surgical therapy.     

Factors influencing periodontal therapy for the geriatric patient

Anatomic changes in the periodontium occur with aging. There is no indication that these changes predispose to periodontal breakdown. In the United States, there is evidence that older individuals are retaining more teeth and that these teeth have less periodontal disease than previous generations of seniors. Studies comparing the healing of older and younger patients have clearly demonstrated that both groups of patients respond equally well to therapy. Proven methods of periodontal therapy include modified Widman surgery, pocket elimination surgery, or nonsurgical scaling and root planing. Surgical treatment may be used with confidence unless there are medical contraindications. In these cases, nonsurgical therapy may be preferred. If there are physical or mental disabilities that make effective home care difficult, antimicrobial agents, such as the extensively tested chlorhexidine rinse, may be valuable adjuncts. In the future, senior adults can look forward to the benefits of regenerative periodontal procedures that seek to regain lost periodontal support. Age alone should not diminish an individual's right to care because the practitioner has qualms about his or her longevity. Successful treatment of periodontitis by surgical and nonsurgical methods has been extensively documented. Senior patients can benefit from these treatments as much as younger patients, and age is not a barrier to effective periodontal therapy.     

Surgical and nonsurgical periodontal therapy. Learned and unlearned concepts

This review aims to highlight concepts relating to nonsurgical and surgical periodontal therapy, which have been learned and unlearned over the past few decades. A number of treatment procedures, such as gingival curettage and aggressive removal of contaminated root cementum, have been unlearned. Advances in technology have resulted in the introduction of a range of new methods for use in nonsurgical periodontal therapy, including machine‐driven instruments, lasers, antimicrobial photodynamic therapy and local antimicrobial‐delivery devices. However, these methods have not been shown to offer significant benefits over and above nonsurgical debridement using hand instruments. The method of debridement is therefore largely dependent on the preferences of the operator and the patient. Recent evidence indicates that specific systemic antimicrobials may be indicated for use as adjuncts to nonsurgical debridement in patients with advanced disease. Full‐mouth disinfection protocols have been proven to be a relevant treatment option. We have learned that while nonsurgical and surgical methods result in similar long‐term treatment outcomes, surgical therapy results in greater probing‐depth reduction and clinical attachment gain in initially deep pockets. The surgical technique chosen seems to have limited influence upon changes in clinical attachment gain. What has not changed is the importance of thorough mechanical debridement and optimal plaque control for successful nonsurgical and surgical periodontal therapy.     

Prevalence of periimplant disease in partially edentulous patients: a practice-based cross-sectional study

Objectives: Evaluation of the prevalence rates of periimplant mucositis and periimplantitis in partially edentulous patients in a private dental practice. Material and methods: The data of 89 patients were collected (52 female, 37 male, age at time of implant placement: 51.8±10.3 years). All patients had been treated with dental implants of the same type and fixed superstructures between January 1999 and June 2006 (observational period: 68.2±24.8 months). Results: The patient‐related prevalence rate of periimplant mucositis (probing depth ≥4 mm and bleeding on probing [BOP]) was over all 44.9%. The respective rates in non‐smokers without periodontal history were 30.4% and in smokers with periodontal history 80%. The multiple logistic regression analysis identified a significant association of mucositis with the independent variable “smoker” (odds ratio [OR] 3.77; P=0.023). The patient‐related prevalence rate of periimplantitis (probing depth ≥5 mm, BOP/pus, radiographic bone loss) was 11.2% (smokers with periodontal history: 53.3%, non‐smokers: 2.8%). No periimplant disease was diagnosed in non‐smoking patients without periodontal history and with a good compliance after treatment. Statistical analysis identified a significant association of periimplantitis with “smoker” (OR: 31.58; P<0.001) and “compliance” (OR: 0.09; P=0.011). Periodontal history in general showed no significant association with periimplantitis. Conclusions: Smoking and compliance are important risk factors for periimplant inflammations in partially edentulous patients. To cite this article:
Rinke S, Ohl S, Ziebolz D, Lange K, Eickholz P. Prevalence of periimplant disease in partially edentulous patients: a practice‐based cross‐sectional study.
Clin. Oral Impl. Res. 22 , 2011; 826–833
doi: 10.1111/j.1600‐0501.2010.02061.x     

Quo vadis: what is the future of periodontics? How will we get there?

Approximately 40 years ago periodontists began systematically developing the evidence to treat predictably and prevent gingivitis and periodontitis. More recently, periodontists have been among a small group of skilled dental‐implant surgeons leading that revolution in dentistry. Today, much of the mild/localized moderate periodontitis is not treated by periodontists, and an increasing number of implants are placed by dentists with limited surgical training. The current field of periodontics includes a broad range of surgical skills and technologies to regenerate predictably destroyed tissues and manage complex interdisciplinary treatment that may, in some way, involve the tissues that support teeth and implants. In addition, periodontal researchers have shown that moderate‐to‐severe periodontitis increases the systemic inflammatory burden and transient bacteremias that result in a significant independent role for periodontitis in multiple systemic diseases. Although many periodontists have very advanced practices that incorporate certain aspects of the current and near‐future dimensions of periodontics, the innovations and technologies have not yet fully integrated throughout the specialty. It is an appropriate time to ask the question: Quo vadis? Which paths have the potential to deliver great value to our patients and to the health‐care system? And who will be our patients in the near future? We propose some key capabilities, knowledge and clinical applications. Perhaps most importantly, we propose new partnerships. Much of the vision centers around the application of special diagnostic technologies and surgical skills to help our dental colleagues better manage complex dental and periodontal cases and to deliver on the promise of reducing systemic inflammation sufficiently to enhance medical management of certain chronic diseases and reduce preterm births. The specialty has always been about retaining teeth in good health and in recent years has focused on controlling oral inflammation to enhance systemic health. We already have several of the key principles, concepts and technologies that are likely to define the role of periodontics in the evolving health‐care delivery system. Perhaps it is time to define the mission and start moving toward the future periodontics.     

Effects of nonsurgical periodontal therapy on C-reactive protein and serum lipids in Jordanian adults with advanced periodontitis

Kamil W, Al Habashneh R, Khader Y, Al Bayati L, Taani D. Effects of nonsurgical periodontal therapy on C‐reactive protein and serum lipids in Jordanian adults with advanced periodontitis. J Periodont Res 2011; 46: 616–621. © 2011 John Wiley & Sons A/S Background and Objective: Data on whether periodontal therapy affects serum CRP levels are inconclusive. The aim of this study was to determine if nonsurgical periodontal therapy has any effect on CRP and serum lipid levels in patients with advanced periodontitis. Material and Methods: Thirty‐six systemically healthy patients, ≥ 40 years of age and with advanced periodontitis, were recruited for the study. Patients were randomized consecutively to one of two groups: the treatment group (n = 18) or the control group (n = 18). Treated subjects received nonsurgical periodontal therapy, which included oral hygiene instructions and subgingival scaling and root planing. Systemic levels of inflammatory markers [C‐reactive protein (CRP) and the lipid profile] were measured at baseline and 3 mo after periodontal therapy. Results: Nonsurgical periodontal therapy in the treatment group resulted in a significant reduction in the serum CRP level. The average CRP level decreased from 2.3 mg/dL at baseline to 1.8 mg/dL (p < 0.005) after 3 mo of periodontal therapy. The average reduction (95% confidence interval) in CRP was 0.498 (95% confidence interval = 0.265–0.731). In the treatment group, the reduction in CRP was significantly, linearly and directly correlated with the reduction in the plaque index, the gingival index and the percentage of sites with pocket depth ≥ 7 mm (Pearson correlation coefficient = 0.746, 0.425 and 0.621, respectively). Nonsurgical periodontal therapy had no effect on the lipid parameters. Conclusion: This study demonstrated that nonsurgical periodontal therapy results in a significant reduction in the serum CRP level. The effect of this outcome on systemic disease is still unknown.     

Nonsurgical therapy for teeth and implants—When and why?

As periodontal and peri‐implant diseases represent opportunistic infections, antiinfective therapy is the method of choice. Correctly performed, the treatment outcomes will include resolution of the inflammation concomitant with shrinkage of the tissues, reflected in reduced probing depths. Depending on the patient data obtained after initial antiinfective therapy, further – mostly surgical – treatment may be rendered to reach the goals of a healthy periodontium and peri‐implant tissues. Patient compliance is as important as operator skills for optimal treatment outcomes. Regenerative therapy may be applied in compliant patients and for appropriate defects. This article depicts the historical development of periodontal therapy during the 20th century and addresses the various outcome parameters to be used in daily decision making. Obviously, nonsurgical therapy has gained clinical relevance, resulting in highly satisfactory treatment outcomes in many cases. The critical probing depth above which positive attachment gain is registered varies from one treatment modality to another. It is a concept that helps facilitate decision making for additional therapeutic measures after initial therapy. Treatment of peri‐implant mucositis prevents development of peri‐implantitis. Hence, nonsurgical treatment of mucositis is frequently performed during the continuous monitoring of oral implants. This chapter of Periodontology 2000 presents evidence for the prevention and therapy of peri‐implant diseases.     

The periodontal pocket

Periodontal disease is synonymous with the presence of periodontal pockets, and very often the clinical success of periodontal therapy is based on periodontal pocket depth reduction. Therefore, in the fields of periodontology and implant dentistry, significant research effort has been placed on the etiopathogenesis, diagnosis and treatment of periodontal/peri‐implant disease and as a consequence on pocket pathology. In this volume of Periodontology 2000, the in‐depth reviews include topics ranging from preclinical models, anatomy and structure of tissues, and molecular and bacterial components, to treatments of pockets around teeth and implants. These reviews aim to provide the readers with current and future perspectives on the different areas of research into the periodontal pocket.     

A public health perspective on personalized periodontics

In this paper, we consider personalized periodontics from a public health perspective. Periodontitis is an under‐acknowledged and important public health problem, and there has long been interest in identifying and treating those who are at high risk of developing this disease. Although susceptibility/risk‐assessment tools in periodontology are currently in their early stages of development, personalized periodontics is increasingly becoming a realistic approach. At the population level, however, personalized periodontics is not an effective way of improving periodontal health because it would target only those who seek help or are able to access care. The occurrence of periodontitis in populations is socially patterned, with those of lower socio‐economic position having poorer periodontal health and being far less likely to seek care. There is the potential for social inequalities actually to worsen as a result of personalized periodontics. In most health systems, personalized periodontics is likely to be accessible only to the social strata for whom it is affordable, and those with the greatest need for such an intervention will remain the least likely to be able to get it. Thus, personalized periodontics is likely to be a niche service for a small proportion of the adult population. This is at odds with the public health approach.     

Associations between clinical parameters assessed around implants and teeth

The aim of the present study was to clinically assess the peri-implant and periodontal conditions 1 year after placement of oral implants (ITI® Dental Implant System) in partially edentulous patients. In all, 127 patients (median age 50 years, range 17 to 79) were examined. They were all treated according to a concept of comprehensive dental care and had received fixed partial dentures (FPD). Significant differences were observed between implants and contralateral control teeth with respect to mean pocket probing depth (PPD)(2.55 mm at implants/2.02 mm at teeth), mean probing attachment level (PAL)(2.97 mm/253 mm) and bleeding on probing (BOP)(24%/12%)(Wilcoxon matched pairs sign rank test, P≥0.0l), whereas mean modified plaque index (0.22/0.30), mean modified bleeding index (0.351 0.44) and mean recession (?0.42 mm/?0.51mm) did not significantly differ between implants and teeth. Compared to control teeth, the width of keratinized mucosa at implants was significantly smaller at lingual, but not at buccal aspects. Regression analyses showed no significant association between the amount of keratinized mucosa and degree of inflammation. Recession, PPD and PAL were slightly influenced by the amount of keratinized mucosa indicating greater resistance to probing. Grouping the implants according to various lengths, type of fixation of the FPD or combination with natural teeth did not result in statistically significant different clinical parameters, whereas grouping according to different localization within the oral cavity did. For example, the mean PAL in 83 anterior implants was 2.52mm, whereas 175 posterior implants had a mean PAL of 3.18mm (Mann-Whitney U-test, P≤0.01). Regression analyses between the mean PAL for all implants in each patient and the mean PAL of the corresponding dentition revealed an r² of 0.23 (P≤0.01). Using multiple regression analysis, the mean PAL of the implants showed to be significantly influenced by the combined factors “fullmouth” PII, “fullmouth” BOP and mean PAL of all teeth. The resuhs of this study suggest that in partially edentulous patients the overall periodontal condition may influence the clinical condition around implants and thus reinforces the importance of periodontal treatment prior to and supportive periodontal therapy after the incorporation of osseointegrated oral implants.     

Postoperative discomfort associated with surgical and nonsurgical endodontic retreatment

Abstract – Endodontic retreatment decision‐making must include an appraisal of the costs of the different strategies proposed. In addition to direct costs, postoperative discomfort may have other consequences in terms of time off work, unscheduled visits and suffering. To establish a foundation for the appraisal of such indirect and intangible costs the present study was set up in which patients' assessments of pain and swelling after surgical and nonsurgical retreatment procedures were recorded. Ninety‐two patients with 95 root‐filled incisors and canine teeth exhibiting apical periodontitis were included in the study. The mode of retreatment was randomly assigned. Each day during the first post‐treatment week patients assessed their degree of swelling and pain on horizontal 100‐mm visual analog scales (VAS). The scales ranged from “no swelling” to “very severe swelling” and “no pain” to “intolerable pain”, respectively. Consumption of self‐prescribed analgesics and time off work were also recorded. Significantly more patients reported discomfort after surgical retreatment than after nonsurgical procedures. High pain scores were most frequent on the operative day while swelling reached its maximum on the first postoperative day followed by progressive decrease both in frequency and magnitude. Postoperative symptoms associated with nonsurgical retreatment were less frequent but reached high VAS values in single cases. Analgesics were significantly more often consumed after periapical surgery. Patients reported absence from work mainly due to swelling and discoloration of the skin. This was found to occur only after surgical retreatment. Conclusively, surgical retreatment resulted in more discomfort and tended to bring about greater indirect costs than nonsurgical retreatment.     

Nine- to fourteen-year follow-up of implant treatment. Part I: implant loss and associations to various factors

Objectives: The aim of the present study was to evaluate the long‐term result of implant therapy, using implant loss as outcome variable. Material and Method: Two hundred and ninty‐four patients had received implant therapy (Brånemark System^®) during the years of 1988–1992 in Kristianstad County, Sweden. The patients were recalled to the speciality clinic 1 and 5 years after placement of the suprastructure. Between 2000 and 2002, 9–14 years after implant placements, the patients were again called in for a complete clinical and radiographic examination. Results: Two hundred and eighteen patients treated with 1057 implants were examined. Twenty‐two patients had lost 46 implants and 12 implants were considered “sleeping implants”. The overall survival rate was 95.7%. Implant loss appeared in a cluster in a few patients and early failures were most common. Eight patients lost more than one fixture. A significant relationship was observed between implant loss and periodontal bone loss of the remaining teeth at implant placement. Maxillary, as opposed to mandibulary implants, showed more implant loss if many implants were placed in the jaw. A significant relationship between smoking habits and implant loss was not found. Conclusion: A history of periodontitis seems to be related to implant loss.     

Implant-Supported Fixed Prostheses for the Rehabilitation of Periodontally Compromised Dentitions: A 3-Year Prospective Clinical Study

Background: The application of a strict hygiene maintenance care protocol following rehabilitation of periodontally compromised dentitions by means of tooth‐supported fixed partial dentures has demonstrated excellent long‐term treatment outcome. Purpose: A clinical and radiographic study was performed to document and evaluate the short‐ and medium‐term result of occlusal rehabilitation by means of implant‐supported fixed prostheses (ISFPs) in patients treated for advanced peri‐odontal disease. Materials and Methods: Forty‐three consecutive patients were included. All patients were referred because of advanced periodontal disease. Before the implant therapy was initiated, periodontal treatment was performed and the outcome evaluated during at least a 6‐month period. An individual maintenance care program was designed for each patient. All 125 implants were placed using a two‐stage surgical approach. Following installation of the ISFPs, all patients underwent a baseline examination including evaluation of oral hygiene, periodontal or peri‐implant conditions, and radiographs. These examinations were repeated annually during the 3‐year observation period. Results: No single implant was lost during the 3‐year follow‐up period. The percentages of plaque‐harboring surfaces and bleeding units on probing were found to be low (< 10%), and no soft‐tissue complications were recorded. The mean marginal bone resorption during the observation period amounted to 0.21 mm. In a few patients, apposition of marginal bone was observed. Bone loss amounting to 0.5 mm or less was found around 81% of the implants (101/125 implants). The amount of bone loss around the remaining 24 implants (19%) varied between 0.5 and 2.0 mm. Conclusions: The present clinical trial demonstrates that, at least during a 3‐year period, the ISFP is an acceptable and predictable treatment option for rehabilitation in patients who have lost their teeth because of periodontal disease. This observation seems to be valid in edentulous and partially dentate jaws. A prerequisite to reach such a favorable treatment outcome is possibly the combination of the strict maintenance care program and the careful design of the ISFPs.     

Periodontal and peri‐implant wound healing following laser therapy

Laser irradiation has numerous favorable characteristics, such as ablation or vaporization, hemostasis, biostimulation (photobiomodulation) and microbial inhibition and destruction, which induce various beneficial therapeutic effects and biological responses. Therefore, the use of lasers is considered effective and suitable for treating a variety of inflammatory and infectious oral conditions. The CO₂, neodymium‐doped yttrium‐aluminium‐garnet (Nd:YAG) and diode lasers have mainly been used for periodontal soft‐tissue management. With development of the erbium‐doped yttrium‐aluminium‐garnet (Er:YAG) and erbium, chromium‐doped yttrium‐scandium‐gallium‐garnet (Er,Cr:YSGG) lasers, which can be applied not only on soft tissues but also on dental hard tissues, the application of lasers dramatically expanded from periodontal soft‐tissue management to hard‐tissue treatment. Currently, various periodontal tissues (such as gingiva, tooth roots and bone tissue), as well as titanium implant surfaces, can be treated with lasers, and a variety of dental laser systems are being employed for the management of periodontal and peri‐implant diseases. In periodontics, mechanical therapy has conventionally been the mainstream of treatment; however, complete bacterial eradication and/or optimal wound healing may not be necessarily achieved with conventional mechanical therapy alone. Consequently, in addition to chemotherapy consisting of antibiotics and anti‐inflammatory agents, phototherapy using lasers and light‐emitting diodes has been gradually integrated with mechanical therapy to enhance subsequent wound healing by achieving thorough debridement, decontamination and tissue stimulation. With increasing evidence of benefits, therapies with low‐ and high‐level lasers play an important role in wound healing/tissue regeneration in the treatment of periodontal and peri‐implant diseases. This article discusses the outcomes of laser therapy in soft‐tissue management, periodontal nonsurgical and surgical treatment, osseous surgery and peri‐implant treatment, focusing on postoperative wound healing of periodontal and peri‐implant tissues, based on scientific evidence from currently available basic and clinical studies, as well as on case reports.     

Long-term follow-up of osseointegrated titanium implants using clinical, radiographic and microbiological parameters

Abstract: The aim of this study was to longitudinally follow up osseointegrated titanium implants in partially dentate patients by clinical, radiographic and microbiological parameters in order to evaluate possible changes in the peri‐implant health over time. Fifteen individuals treated with titanium implants, ad modum Brånemark, and followed for ten years were included in the study. Before implant placement ten years previously, the individuals had been treated for advanced periodontal disease and thereafter been included in a maintenance care program. The survival rate of the implants after ten years was 94.7%. The bone loss was 1.7 mm when using the abutment‐fixture junction as a reference point. Of the individuals, 50% were positive for plaque at the implants. Bleeding on sulcus probing was present at 61% of the implant surfaces. Ten years previously, the individuals had been carriers of putative periodontal pathogens, such as Porphyromonas gingivalis, Prevotella intermedia, Actinobacillus actinomycetemcomitans, Capnocytophaga spp. and Campylobacter rectus, and were also carriers of these species at the current examination. The results of the present study suggest that the presence of these putative periodontal pathogens at implants may not be associated with an impaired implant treatment. These species are most likely part of the normal resident microbiota of most individuals and may therefore be found at random at both stable and progressing peri‐implant sites.     

Understanding peri-implantitis: a strategic review

The high survival rate of osseointegrated dental implants is well documented, but it is becoming increasingly clear that successfully integrated implants are susceptible to disease conditions that may lead to loss of the implant. Although placement and restoration usually are included in the domain of the periodontal, oral and maxillofacial surgery, or prosthetic specialist, given the increasing numbers of patients treated with osseointegrated fixtures, it is increasingly likely that maintenance of these implants by the general dentist will become much more common. However, the surrounding tissues may be subject to inflammatory conditions similar to periodontal disease and so require maintenance. This article discusses the background, cause, and diagnosis of peri-implant disease, as well as the maintenance, care, and treatment of peri-implant infection in osseointegrated implants.     

Regenerative periodontal therapy

Regenerative periodontal therapy comprises procedures which are specially designed to restore parts of the tooth supporting apparatus which have been lost due to periodontitis. A procedure must fulfill certain criteria to be considered a therapy which encourages regeneration. This paper discusses a variety of surgical approaches including root surface conditioning, the placement of bone garfts or bone substitute implants and the use of organic or synthetic barrier membranes (GTR). Evidence is presented that regenerative surgery utilising the GTR principle fulfills all the criteria required of a surgical procedure to be considered a procedure leading to periodontal regeneration.