Tooth Loss and Periodontitis in Older Individuals: Results From the Swedish National Study on Aging and Care

Background: Due to the increasing number of older people, there is a need for studies focused on this population. The aims of the present study are to assess oral and systemic conditions in individuals aged 60 to 95 years with access to dental insurance. Methods: Probing depths (PDs), tooth loss, alveolar bone levels, and systemic health were studied among a representative cohort of older individuals. Results: A total of 1,147 individuals in young‐old (aged 60 or 67 years), old (aged 72 or 78 years), and old‐old (aged ≥81 years) age groups were enrolled, including 200 individuals who were edentulous, in this study. Annual dental care was received by 82% of dentate individuals. Systemic diseases were common (diabetes: 5.8%; cardiovascular diseases: 20.7%; obesity: 71.2%; elevated C‐reactive protein [CRP]: 98.4%). Serum CRP values were unrelated to periodontal conditions. Rates of periodontitis, defined as ≥30% of sites with a distance from cemento‐enamel junction to bone of ≥5 mm, were 11.2% in women in the young‐old age group and 44.9% in men in the old‐old age group. Individuals in older age groups had a higher likelihood of periodontitis defined by bone loss and cutoff levels of PD ≥5 mm (odds ratio: 1.8; 95% confidence interval: 1.2 to 2.5; P <0.01). A total of 7% of individuals in the old‐old age group had ≥20 teeth and no periodontitis. Systemic diseases, dental use, or smoking were not explanatory, whereas age and sex were explanatory for periodontitis. Conclusions: The prevalence of periodontitis increased with age. Sex seems to be the dominant explanatory factor for periodontitis in older individuals. Despite frequent dental visits, overall oral health in the oldest age cohort was poor.     

Long‐Term Follow‐Up of Turned Single Implants Placed in Periodontally Healthy Patients After 16 to 22 Years: Microbiologic Outcome

Background: Survival rates in implant dentistry today are high, although late failures do occur for many reasons, including peri‐implant infections. The primary objective of this study is to investigate microbiota around single turned implants after 16 to 22 years. Secondary objectives are to compare teeth and implants and to correlate microbiologic, radiographic, and clinical parameters. Methods: A total of 46 patients with single implants were invited for a clinical examination. Clinical data were collected from implants and contralateral natural teeth. Radiographic bone level was measured around implants. Microbiologic samples were taken from implants, contralateral teeth, and the deepest pocket per quadrant. Samples were analyzed with DNA‐DNA hybridization including 40 species. Statistical analysis was performed using Wilcoxon signed‐rank tests, McNemar tests, and Spearman correlation coefficients with a 0.05 significance level. Results: Mean follow‐up was 18.5 years (range 16 to 22 years). Tannerella forsythia (1.5 × 10⁵) and Veillonella parvula (1.02 × 10⁵) showed the highest concentrations around implants and teeth, respectively. Porphyromonas gingivalis, Prevotella intermedia, and T. forsythia were significantly more present around implants than teeth. Mean counts were significantly higher around implants than teeth for Parvimonas micra, P. gingivalis, P. intermedia, T. forsythia, and Treponema denticola. Total DNA count was correlated to interproximal bleeding index (r = 0.409) and interproximal probing depth (r = 0.307). No correlations were present with plaque index or radiographic bone level. Conclusions: In the present study, bacterial counts around single implants in periodontally healthy patients are rather low. Although pathogenic bacteria are present, some in higher numbers around implants than teeth (five of 40), the majority of implants present with healthy peri‐implant tissues without progressive bone loss.     

Bisphosphonate-associated osteonecrosis of the auditory canal

Only rare cases of osteonecrosis of the auditory canal associated with bisphosphonates, have been published. Our results confirm that similar reports can also be encountered in databases of adverse drug reactions.     

Long‐Term Clinical,Microbiological, and Radiographic Outcomes of Brånemark™ Implants Installed in Augmented Maxillary Bone for Fixed Full‐Arch Rehabilitation

Purpose: The purpose of this study was to document the long‐term outcome of Brånemark implants installed in augmented maxillary bone and to identify parameters that are associated with peri‐implant bone level. Material and Methods: Patients of a periodontal practice who had been referred to a maxillofacial surgeon for iliac crest bone grafting in the atrophic maxilla were retrospectively recruited. Five months following grafting, they received 7–8 turned Brånemark implants. Following submerged healing of another 5 months, implants were uncovered and restorative procedures for fixed rehabilitation were initiated 2–3 months thereafter. The primary outcome variable was bone level defined as the distance from the implant‐abutment interface to the first visible bone‐to‐implant contact. Secondary outcome variables included plaque index, bleeding index, probing depth, and levels of 40 species in subgingival plaque samples as identified by means of checkerboard DNA–DNA hybridization. Results: Nine out of 16 patients (eight females, one male; mean age 59) with 71 implants agreed to come in for evaluation after on average 9 years (SD 4; range 3–13) of function. One implant was deemed mobile at the time of inspection. Clinical conditions were acceptable with 11% of the implants showing pockets ≥ 5 mm. Periodontopathogens were encountered frequently and in high numbers. Clinical parameters and bacterial levels were highly patient dependent. The mean bone level was 2.30 mm (SD 1.53; range 0.00–6.95), with 23% of the implants demonstrating advanced resorption (bone level > 3 mm). Regression analysis showed a significant association of the patient (p < .001) and plaque index (p = .007) with bone level. Conclusions: The long‐term outcome of Brånemark implants installed in iliac crest‐augmented maxillary bone is acceptable; however, advanced peri‐implant bone loss is rather common and indicative of graft resorption. This phenomenon is patient dependent and seems also associated with oral hygiene.     

One-year results of a prospective randomized, evaluator-blinded, multicenter study comparing TVT and TVT Secur

Introduction and hypothesis

The aim of this prospective randomized multicenter study was to compare retropubic tension-free vaginal tape (TVT) with TVT Secur in terms of efficacy and safety.

Methods

We set out to enrol 280 stress urinary incontinent (SUI) women with a half-time interim analysis of short-term cure and adverse events. The short-term results have previously been published. Of the133 randomized women, 125 underwent surgery, and 121 (TVT n?=?61, TVT Secur n?=?60) were available for follow-up 1 year postsurgery.

Results

No significant differences were found between groups regarding demographics or incontinence grade. One year after surgery, both subjective and objective cure rates were significantly lower for TVT Secur than for TVT (subjective cure: TVT 98 %, TVT Secur 80 %, p?=?0.03; objective cure: TVT 94 %, TVT Secur 71 % for cough test, p?=?0.01; TVT 76 %, TVT Secur 58 % for pad test, p?=?0.05 ). Three major complications occurred in the TVT Secur group: one tape erosion into the urethra, one tape inadvertently placed into the bladder, and one immediate postoperative bleeding due to injury to the corona mortis. No major complications occurred in the TVT group. No significant differences were found between groups regarding peroperative bleeding, hospital stay, urge symptoms, residual urinary volume, subjective bladder emptying problems, postoperative urinary tract infections, and minor complications. The TVT Secur group used more antimuscarine medication after surgery than the TVT group (p?=?0.03). Median time for surgery was 13 and 22 min for TVT Secur and TVT, respectively (p?<?0.0001).

Conclusion

The TVT Secur procedure had significantly inferior subjective and objective cure rates compared with the retropubic TVT procedure. Three serious adverse events occurred in the TVT Secur group. We therefore discourage further use of TVT Secur.     

Perceptual analysis of speech and the activity in the lateral pharyngeal walls before and after velopharyngeal flap surgery

The purpose of this study was to investigate the effects of velopharyngeal flap surgery on speech and its relation with the activity in the lateral pharyngeal wall. Videofluoroscopic recordings made before and after operation were used in this retrospective study, which comprised 28 patients who had pharyngeal flap surgery between 5:5 and 14:3 (mean 8:6) years:months of age at the Sahlgrenska University Hospital, Göteborg, Sweden. Twenty-four patients had different types of clefts and four had velopharyngeal impairment (VPI) without a cleft palate. Eleven had additional malformations. Speech and activity in the lateral pharyngeal walls were rated perceptually preoperatively and postoperatively. The study confirmed that patients with VPI can be helped by a velopharyngeal flap operation. There seemed to be a relation with the activity in the lateral pharyngeal wall and speech. The later the postoperative assessment, the better the speech, but the age at operation did not affect the result. The impact of additional anomalies and syndromes should be investigated further.     

Neuropathy‐associated NaV1.7 variant I228M impairs integrity of dorsal root ganglion neuron axons

Small‐fiber neuropathy (SFN) is characterized by injury to small‐diameter peripheral nerve axons and intraepidermal nerve fibers (IENF). Although mechanisms underlying loss of IENF in SFN are poorly understood, available data suggest that it results from axonal degeneration and reduced regenerative capacity. Gain‐of‐function variants in sodium channel Na_V1.7 that increase firing frequency and spontaneous firing of dorsal root ganglion (DRG) neurons have recently been identified in ～30% of patients with idiopathic SFN. In the present study, to determine whether these channel variants can impair axonal integrity, we developed an in vitro assay of DRG neurite length, and examined the effect of 3 SFN‐associated variant Na_V1.7 channels, I228M, M932L/V991L (ML/VL), and I720K, on DRG neurites in vitro. At 3 days after culturing, DRG neurons transfected with I228M channels exhibited ～20% reduced neurite length compared to wild‐type channels; DRG neurons transfected with ML/VL and I720K variants displayed a trend toward reduced neurite length. I228M‐induced reduction in neurite length was ameliorated by the use‐dependent sodium channel blocker carbamazepine and by a blocker of reverse Na‐Ca exchange. These in vitro observations provide evidence supporting a contribution of the I228M variant Na_V1.7 channel to impaired regeneration and/or degeneration of sensory axons in idiopathic SFN, and suggest that enhanced sodium channel activity and reverse Na‐Ca exchange can contribute to a decrease in length of peripheral sensory axons. Ann Neurol 2012     

Radixin expression in microglia after cortical stroke lesion

Stroke induces extensive tissue remodeling, resulting in the activation of several cell types in the brain as well as recruitment of blood‐borne leucocytes. Radixin is part of a cytoskeleton linker protein family with the ability to connect transmembrane proteins to the actin cytoskeleton, promoting cell functions involving a dynamic cytoskeleton such as morphological changes, cell division and migration which are common events of different cell types after stroke. In the healthy adult brain radixin is expressed in Olig2⁺ cells throughout the brain and in neural progenitor cells in the subventricular zone. In the current study, we detected a 2.5 fold increase in the number of radixin positive cells in the peri‐infarct cortex two weeks after the induction of cortical stroke by photothrombosis. Similarly, the number of Olig2⁺ cells increased in the peri‐infarct area after stroke; however, the number of radixin⁺/Olig2⁺ cells was unchanged. Neural progenitor cells maintained radixin expression on their route to the infarct. More surprising however, was the expression of radixin in activated microglia in the peri‐infarct cortex. Seventy percent of Iba1⁺ cells expressed radixin after stroke, a population which was not present in the control brain. Furthermore, activation of radixin was predominantly detected in the peri‐infarct region of oligodendrocyte progenitors and microglia. The specific location of radixin⁺ cells in the peri‐infarct region and in microglia suggests a role for radixin in microglial activation after stroke.