Characteristics and frequency distribution of bone defect configurations in peri-implantitis lesions : A series of 193 cases

Background: Knowledge on peri‐implantitis bone defect characteristics and predictors is still limited. Purpose: To describe peri‐implantitis bone defect characteristics and identify possible predictors. Methods: Various parameters at patient‐ (age, gender, smoking, and supra‐structure), implant‐ (surface, type, connection, platform, and misfit), and site level (region, alveolar ridge position, defect characteristics, neighboring structure) were recorded retrospectively. Results: Among 193 implants, the most prevalent defects were class Ic (25.4%), and Id (23.8%); a previously non‐described category “class Id with only one bone wall” was frequently observed (11.9%). Mean intrabony defect depth and width ranged from 4.5 to 6.2 mm and from 2.7 to 2.9 mm, respectively; mean dehiscence extent ranged from 2.8 to 7.0 mm. A total of 37.8% of the defects presented horizontal bone loss and an intrabony component; in 52.7% of the implants, total defect extent was >6 mm. Jaw region, implant position within the alveolar ridge, and implant/abutment misfit showed significant associations either to defect configuration and/or defect extent. Conclusion: (a) Most common peri‐implantitis defects exhibited a combination of intrabony component and a buccal/oral dehiscence, while purely circumferential defects were relatively seldom; (b) implants with defects with bone dehiscence were placed more frequently closer to the lateral aspect of the ridge harboring the dehiscence; (c) implants placed in the lower anterior region had the highest risk for more severe peri‐implant bone loss; and (d) peri‐implant bone defects with only a single bone wall appropriate for regenerative procedure were relatively frequent

Effect of Enamel Matrix Derivatives on Osteoclast Formation from PBMC of Periodontitis Patients and Healthy Individuals after Interaction with Activated Endothelial Cells

Background and objectives: Enamel matrix derivative (EMD) is produced from developing porcine tooth buds and represents a complex of low-molecular-weight hydrophobic enamel proteins. EMD is widely applied in periodontal regeneration. Osteoclasts are multinuclear cells, which are responsible for bone resorption. The precursors of osteoclasts, hematopoietic cells, undergo in vivo the process of transendothelial migration before differentiation. EMD is known to affect the process of osteoclastogenesis, but its effect on human osteoclasts precursors after the interaction with activated endothelium was never studied. Materials and Methods: Human umbilical vein endothelial cells (HUVECs)s were seeded in transwell inserts with a pore size of 8 µm and pre-activated by TNF-α and IL-1β for 18 h. Peripheral blood mononuclear cells (PBMCs), freshly isolated from 16 periodontitis patients and 16 healthy individuals, were added to pre-activated HUVECs. Adherent, non-adherent and transmigrated cells were collected and differentiated to osteoclasts by the standard protocol in the presence or absence of EMD. The number of osteoclasts was determined by tartrate-resistant acid phosphatase staining. Results: PBMCs isolated from periodontitis patients have formed a significantly higher osteoclast number compared to PBMCs isolated from healthy individuals (p < 0.05). EMD induced concentration-dependent inhibition of osteoclast formation from PBMCs. This was true for the different PBMC fractions isolated from both healthy individuals and periodontitis patients. Conclusions: Our data show that EMD inhibits the formation and activity of osteoclasts differentiated from the progenitor cells after the interaction with activated endothelium. This might be associated with bone resorption inhibition and supporting bone regeneration in the frame of periodontal therapy

Inter- and intra-observer agreement on Miller's classification of gingival tissue recessions

Purpose Miller's is the most commonly used classification of gingival tissue recessions. However, data on the reliability of this classification are missing so far, although reliability, which reflects the consistency of repeated measurements, is regarded as a prerequisite for judging the utility of a classification. The primary aim of the present study was to determine inter- and intra-observer agreement on Miller’s classification. Second, 3 additional parameters, associated with gingival tissue recessions, were evaluated. Methods Two hundred photographs (50 of each region: maxillary/mandibular anterior/posterior teeth) of gingival tissue recessions were evaluated twice (interval of one month) by 4 observers in Miller's classification (classes I to IV), gingival phenotype (thin&high or thick&low scalloping), tooth shape (long-narrow or short-wide), and identifiability of the cemento-enamel junction (CEJ). The level of agreement was assessed according to a 6-level nomenclature: poor <0.0, slight 0.0-0.2, fair 0.21-0.4, moderate 0.41-0.6, substantial 0.61-0.8, almost perfect 0.81-1.0. Results The inter- and intra-observer agreements on the assessed parameters are summarised in the table. The inter-observer agreement on Miller's classification was substantial, with the highest values for anterior teeth. The intra-observer agreement was substantial to almost perfect, with the highest values for maxillary anterior teeth. The differences between the first and second ratings as well as among the different observers were mainly among Miller’s classes I, II, and III, but never between classes I and IV. The inter-observer agreement on the gingival phenotype was slight to moderate, with higher values for anterior mandibular teeth. Similar results were seen for intra-observer agreements. In general, the intra-observer agreements for all regions were moderate for each observer. The inter-observer agreement on tooth shape was fair to moderate, with higher values for the anterior mandibular teeth. Similar results are presented for intra-observer agreement. In general, intra-observer agreement for all regions was moderate for each observer. Inter-observer agreement on the identifiability of the CEJ was slight to fair, with values just slightly higher for anterior teeth. Intra-observer agreement was poor to almost perfect. The anterior mandibular teeth presented slightly higher values. Gingival phenotype (thin-high scalloping) significantly correlated with tooth shape (long-narrow) (rho=0.662, p<0.001). Anterior teeth presented a higher correlation, with the mandibular anterior teeth presenting an almost perfect correlation (rho=0.954). Conclusions Miller’s classification of gingival tissue recessions was evaluated by 4 examiners using 200 photographs and yielded substantial to almost perfect agreement, with higher agreement for anterior teeth. The present study offers the so far missing proof on the sufficient inter- and intra-observer agreement of this classification

Inter- and intra-observer agreement on Miller's classification of gingival tissue recessions (San Francisco)

PurposeMiller's is the most commonly used classification of gingival tissue recessions. However, data on the reliability of this classification are missing so far, although reliability, which reflects the consistency of repeated measurements, is regarded as a prerequisite for judging the utility of a classification. The primary aim of the present study was to determine inter- and intra-observer agreement on Miller’s classification. Second, 3 additional parameters, associated with gingival tissue recessions, were evaluated.MethodsTwo hundred photographs (50 of each region: maxillary/mandibular anterior/posterior teeth) of gingival tissue recessions were evaluated twice (interval of one month) by 4 observers in Miller's classification (classes I to IV), gingival phenotype (thin&high or thick&low scalloping), tooth shape (long-narrow or short-wide), and identifiability of the cemento-enamel junction (CEJ). The level of agreement was assessed according to a 6-level nomenclature: poor <0.0, slight 0.0-0.2, fair 0.21-0.4, moderate 0.41-0.6, substantial 0.61-0.8, almost perfect 0.81-1.0.ResultsThe inter- and intra-observer agreements on the assessed parameters are summarised in the table. The inter-observer agreement on Miller's classification was substantial, with the highest values for anterior teeth. The intra-observer agreement was substantial to almost perfect, with the highest values for maxillary anterior teeth. The differences between the first and second ratings as well as among the different observers were mainly among Miller’s classes I, II, and III, but never between classes I and IV. The inter-observer agreement on the gingival phenotype was slight to moderate, with higher values for anterior mandibular teeth. Similar results were seen for intra-observer agreements. In general, the intra-observer agreements for all regions were moderate for each observer.The inter-observer agreement on tooth shape was fair to moderate, with higher values for the anterior mandibular teeth. Similar results are presented for intra-observer agreement. In general, intra-observer agreement for all regions was moderate for each observer.Inter-observer agreement on the identifiability of the CEJ was slight to fair, with values just slightly higher for anterior teeth. Intra-observer agreement was poor to almost perfect. The anterior mandibular teeth presented slightly higher values.Gingival phenotype (thin-high scalloping) significantly correlated with tooth shape (long-narrow) (rho=0.662, p<0.001). Anterior teeth presented a higher correlation, with the mandibular anterior teeth presenting an almost perfect correlation (rho=0.954).ConclusionsMiller’s classification of gingival tissue recessions was evaluated by 4 examiners using 200 photographs and yielded substantial to almost perfect agreement, with higher agreement for anterior teeth. The present study offers the so far missing proof on the sufficient inter- and intra-observer agreement of this classification

Inter- and intra-observer agreement on Miller's classification of gingival tissue recessions (San Francisco)

PurposeMiller's is the most commonly used classification of gingival tissue recessions. However, data on the reliability of this classification are missing so far, although reliability, which reflects the consistency of repeated measurements, is regarded as a prerequisite for judging the utility of a classification. The primary aim of the present study was to determine inter- and intra-observer agreement on Miller’s classification. Second, 3 additional parameters, associated with gingival tissue recessions, were evaluated.MethodsTwo hundred photographs (50 of each region: maxillary/mandibular anterior/posterior teeth) of gingival tissue recessions were evaluated twice (interval of one month) by 4 observers in Miller's classification (classes I to IV), gingival phenotype (thin&high or thick&low scalloping), tooth shape (long-narrow or short-wide), and identifiability of the cemento-enamel junction (CEJ). The level of agreement was assessed according to a 6-level nomenclature: poor <0.0, slight 0.0-0.2, fair 0.21-0.4, moderate 0.41-0.6, substantial 0.61-0.8, almost perfect 0.81-1.0.ResultsThe inter- and intra-observer agreements on the assessed parameters are summarised in the table. The inter-observer agreement on Miller's classification was substantial, with the highest values for anterior teeth. The intra-observer agreement was substantial to almost perfect, with the highest values for maxillary anterior teeth. The differences between the first and second ratings as well as among the different observers were mainly among Miller’s classes I, II, and III, but never between classes I and IV. The inter-observer agreement on the gingival phenotype was slight to moderate, with higher values for anterior mandibular teeth. Similar results were seen for intra-observer agreements. In general, the intra-observer agreements for all regions were moderate for each observer.The inter-observer agreement on tooth shape was fair to moderate, with higher values for the anterior mandibular teeth. Similar results are presented for intra-observer agreement. In general, intra-observer agreement for all regions was moderate for each observer.Inter-observer agreement on the identifiability of the CEJ was slight to fair, with values just slightly higher for anterior teeth. Intra-observer agreement was poor to almost perfect. The anterior mandibular teeth presented slightly higher values.Gingival phenotype (thin-high scalloping) significantly correlated with tooth shape (long-narrow) (rho=0.662, p<0.001). Anterior teeth presented a higher correlation, with the mandibular anterior teeth presenting an almost perfect correlation (rho=0.954).ConclusionsMiller’s classification of gingival tissue recessions was evaluated by 4 examiners using 200 photographs and yielded substantial to almost perfect agreement, with higher agreement for anterior teeth. The present study offers the so far missing proof on the sufficient inter- and intra-observer agreement of this classification