Microbiologic results after non-surgical erbium-doped:yttrium, aluminum, and garnet laser or air-abrasive treatment of peri-implantitis: a randomized clinical trial

Background: The purpose of this study is to assess clinical and microbiologic effects of the non‐surgical treatment of peri‐implantitis lesions using either an erbium‐doped:yttrium, aluminum, and garnet (Er:YAG) laser or an air‐abrasive subgingival polishing method. Methods: In a 6‐month clinical trial, 42 patients with peri‐implantitis were treated at one time with an Er:YAG laser or an air‐abrasive device. Routine clinical methods were used to monitor clinical conditions. Baseline and 6‐month intraoral radiographs were assessed with a software program. The checkerboard DNA–DNA hybridization method was used to assess 74 bacterial species from the site with the deepest probing depth (PD) at the implant. Non‐parametric tests were applied to microbiology data. Results: PD reductions (mean ± SD) were 0.9 ± 0.8 mm and 0.8 ± 0.5 mm in the laser and air‐abrasive groups, respectively (not significant). No baseline differences in bacterial counts between groups were found. In the air‐abrasive group, Pseudomonas aeruginosa, Staphylococcus aureus, and Staphylococcus anaerobius were found at lower counts at 1 month after therapy (P <0.001) and with lower counts in the laser group for Fusobacterium nucleatum naviforme (P = 0.002), and Fusobacterium nucleatum nucleatum (P = 0.002). Both treatments failed to reduce bacterial counts at 6 months. Porphyromonas gingivalis counts were higher in cases with progressive peri‐implantitis (P <0.001). Conclusions: At 1 month, P. aeruginosa, S. aureus, and S. anaerobius were reduced in the air‐abrasive group, and Fusobacterium spp. were reduced in the laser group. Six‐month data demonstrated that both methods failed to reduce bacterial counts. Clinical improvements were limited.     

Ingredients in dentifrices and their effect on plaque, gingivitis and mutans streptococci

Objective: The aim of this study was to investigate attitudes and opinions of old, independently living people about their oral health and how it has affected them through life. Material and methods: A random selection of 12 individuals was made in a group of 79 individuals who earlier participated in a study about self‐reported oral health. The average age was 78.4 years. An interview guide was used as support to focus on oral health. The respondents themselves decided what was important within the topics. The respondents were encouraged to speak freely about their childhood, family, social relations, memories from early dental care, general health situation, experience from health care, life and their future. The interviews were recorded and extended from 60 to 90 min. All of them were transcribed and analysed with phenomenological method inspired by Giogi. The analysis was made by two researchers independently. After 11 interviews, no new information was found; similar opinions, answers and stories recurred. Results: Seven of 11 respondents were born and grown up in the countryside and had moved to Stockholm in the forties. Awareness about dental care was generally low. Many of them have terrible memories from early dental visits, and the dentist was authoritarian and rough. Many had no memories of brushing their teeth as a child. Most of the respondents went to dentists as adults and when they could afford to pay by themselves. After retirement, all have continuous dental care and have visited a dental hygienist during the last 20 years. Nine of 11 have regular contact with a dental hygienist. Most of them are satisfied with their oral health and want to continue being clean and healthy in the mouth. Conclusions: Most of the respondents experienced an improved oral health, information and instructions from the dental hygienist have affected their self‐care. Many tell that they have become more aware and carry out the oral hygiene more carefully after retirement. All of them experience that oral health affects the quality of life.     

Quantification of Periodontal Pathogens in Vascular,Blood, and Subgingival Samples From Patients With Peripheral Arterial Disease or Abdominal Aortic Aneurysms

Background: The aim of this investigation is to quantify periodontal pathogens (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Campylobacter rectus, and Tannerella forsythia) in vascular, blood, and subgingival samples. As a secondary objective, two molecular bacterial identification methods (nested polymerase chain reaction [PCR] and quantitative PCR [qPCR]) are compared. Methods: Seventy consecutive patients provided a vascular lesion, a blood sample, and 36 subgingival samples. Bacterial DNA was extracted, and qPCR was used to determine the prevalence and amounts of the target pathogens in each sample. Nested PCR was performed only in the samples from vascular lesions. Periodontal examination was performed in 42 patients. Mann‐Whitney U or χ² tests were used to compare microbiologic results according to periodontal diagnosis. Results: All targeted periodontal pathogens (A. actinomycetemcomitans, P. gingivalis, T. forsythia, or C. rectus) were detected in subgingival samples, with a prevalence rate of 72.2%, 47.2%, 74.3%, and 82.9%, respectively. In 7.1% and 11.4% of vascular and blood samples, bacterial DNA was detected. One patient was positive for A. actinomycetemcomitans in the three types of samples. No differences were found in the levels of targeted bacteria when comparing patients with and without periodontitis. Prevalence rates obtained with nested PCR were significantly higher than those obtained with qPCR. Conclusions: The presence of A. actinomycetemcomitans was demonstrated in vascular, blood, and subgingival samples in one of 36 patients. These results, although with a very low frequency, may support the hypothesis of a translocation of periodontal pathogens from subgingival microbiota to the bloodstream and then to atheromatous plaques in carotid or other peripheral arteries. Nested PCR is not an adequate method for identifying DNA of periodontal pathogens in low quantities because of the high number of false‐negative results.     

Mechanical non-surgical treatment of peri-implantitis: a double-blind randomized longitudinal clinical study. I: clinical results

Background: Peri-implantitis is a frequent finding in patients with dental implants. The present study compared two non-surgical mechanical debridement methods of peri-implantitis.
Material and Methods: Thirty-seven subjects (mean age 61.5; S.D±12.4), with one implant each, demonstrating peri-implantitis were randomized, and those treated either with titanium hand-instruments or with an ultrasonic device were enrolled. Data were obtained before treatment, and at 1, 3, and 6 months. Parametric and non-parametric statistics were used.
Results: Thirty-one subjects completed the study. The mean bone loss at implants in both groups was 1.5 mm (SD ±1.2 mm). No group differences for plaque or gingival indices were found at any time point. Baseline and 6-month mean probing pocket depths (PPD) at implants were 5.1 and 4.9 mm ( p =0.30) in both groups. Plaque scores at treated implants decreased from 73% to 53% ( p <0.01). Bleeding scores also decreased ( p <0.01), with no group differences. No differences in the total bacterial counts were found over time. Higher total bacterial counts were found immediately after treatment ( p <0.01) and at 1 week for ultrasonic-treated implants ( p <0.05).
Conclusions: No group differences were found in the treatment outcomes. While plaque and bleeding scores improved, no effects on PPD were identified.     

Surgical treatment of peri-implantitis

Objectives: To review the literature on surgical treatment of peri-implantitis.
Material and Methods: A search of PubMed and as well as a hand search of articles were conducted. Publications and articles accepted for publication up to November 2007 were included.
Results: A total of 43 studies were selected for the review. Only 13 of these were studies in humans and only one study directly addressed disease resolution. Thus the available evidence for surgical treatment of peri-implantitis is extremely limited.
Animal studies: Re-osseointegration can occur on previously contaminated surfaces. The surface characteristics are decisive for regeneration and re-osseointegration. No single surface decontamination method appears to be distinctly superior. Open debridement with surface decontamination can achieve resolution.
Human studies: Access surgery has been investigated in one study demonstrating that resolution occurred in 58% of the lesions. No single method of surface decontamination (chemical agents, air abrasives and lasers) was found to be superior. The use of regenerative procedures such as bone graft techniques with or without the use of barrier membranes has been reported with various degrees of success. However, it must be stressed that such techniques do not address disease resolution but rather merely attempt to fill the osseous defect.     

Significance of probing force for evaluation of healing following periodontal therapy

The present report compares pre- and postoperative probing pocket depths and probing attachment levels in deep pockets treated non-surgically as well as surgically using probing forces at 0.25 N, 0.50 N and 0.75 N. The results demonstrated that the recorded mean pre- and postoperative probing depths were deeper with increasing probing force. In deep preoperative pockets, the difference amounted to as much as 2.0 mm comparing measurements at 0.25 N and 0.75 N. The use of 0.25 N for evaluation of therapy showed less mean pocket reduction and probing attachment gain than the use of 0.50 N or 0.75 N. Selection of a higher probing force before therapy (i.e. 0.75 N) and a lower force after therapy (i.e. 0.25 N) resulted in increased values for pocket reduction and probing attachment gain compared to use of the same probing force for both pre- and postoperative recordings. The findings emphasize the significance of using a known and standardized probing force for evaluation of results following periodontal therapy.     

Re-osseointegration on rough implant surfaces previously coated with bacterial biofilm: an experimental study in the dog

OBJECTIVE: The purpose of the study was to investigate whether osseointegration can occur on rough implant surfaces that previously had been coated with bacterial biofilm. MATERIALS AND METHODS: The premolars on both sides of the mandible in four beagle dogs were extracted. Following 3 months healing, three titanium implants Ti-Unite, Nobel Biocare were partially inserted in the left side of each mandible. Some threads protruded from the tissues into the oral cavity. Plaque accumulated on the exposed part of the implant. Following a 5-week healing period, the contaminated parts of each implant were treated using three different techniques: (1) swabbing with citric acid for 30 s followed by rinsing with physiological saline, (2) cleansing with a toothbrush and physiological saline for 1 min, and (3) swabbing with 10% hydrogen peroxide for 1 min followed by rinsing with physiological saline. The treated implants and one pristine implant (control) were installed to the full implant length on the contralateral sides of the mandibles. Following 11 weeks of healing, the dogs were sacrificed and biopsies were obtained. Ground sections were prepared for histomorphometric analysis. RESULTS: All treatment modalities were associated with direct bone-to-implant contact on the portion of implant surface previously exposed to the oral environment. CONCLUSIONS: The results demonstrate that rough surfaces, which were plaque contaminated and cleaned by different methods, can re-osseointegrate.     

Healing after treatment of periodontal intraosseous defects

2 regenerative surgical approaches using citric acid conditioning, were compared in the treatment of deep intraosseous periodontal defects. The first approach was non-resective in that no osseous tissue was removed. The second, a partially resective approach, involved reduction of the osseous defect depth by removal of some supporting bone. 16 patients and a total of 26 defects, with probing pocket depth greater than or equal to 7 mm, were included in the study. The depths of the corresponding osseous defect, as revealed during surgery were greater than or equal to 5 mm. The results demonstrated mean gains in probing attachment level of 0.7 mm for the partially resected group and 1.1 mm for the non-resected group. Corresponding gains in probing bone levels were recorded in the defect sites for each group. Probing pocket depth was reduced from 7.5 mm to 4.0 mm in the partially resected group and from 7.9 mm to 5.3 mm in the non-resected group. Both procedures caused loss of attachment and bony support from adjacent tooth surfaces involved by the surgical procedure. Slightly more loss of attachment and bone was experienced by the partially resected group (range 1.2-1.5 mm) than by the non-resective group (range 0.1-0.9 mm).