Treatment of residual pockets with photodynamic therapy, diode laser, or deep scaling. A randomized, split-mouth controlled clinical trial

The objective of this work was to compare the effects of antimicrobial photodynamic therapy (PDT), diode soft laser therapy (DSL), and thorough deep scaling and root planing (SRP) for treatment of residual pockets. Thirty-two subjects with a history of non-surgical treatment for chronic periodontitis were included. Residual pockets >4mm and bleeding upon probing were debrided with an ultrasonic device and then subjected to either PDT, DSL, or SRP. Pocket probing depth (PPD), bleeding on probing (BOP), and gingival recession were monitored over 6months. Counts of four microorganisms were determined by direct hybridization with RNA probes. PPD decreased from 5.6 ± 1.0 to 3.8 ± 1.1 in 6months (p 4mm with BOP depended on initial PPD (p = 0.036) and was higher if treated with DSL (p = 0.034). Frequencies of three microorganisms were significantly lower in PDT- and SRP-treated than in DSL-treated quadrants (p = 0.02) after 14days, but not at months 2 and 6. All three treatments resulted in a significant clinical improvement. PDT and SRP suppressed Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola stronger, and resulted in fewer persisting pockets after 6months, than DSL applicatio

Cost savings in the Swiss healthcare system resulting from professional periodontal care

More than 740 million people worldwide are affected by periodontal disease and are at higher risk of secondary damage such as cardiovascular disease and type 2 diabetes, which place a considerable financial burden on healthcare systems. The aim of this study was to use a computer simulation to estimate the direct and indirect costs of prevention and treatment of gingivitis, periodontitis and related secondary damage in the Swiss population, paid both out of pocket (OOP) and from social welfare (SW). For three different scenarios, iterations with 200,000 simulated individuals over their assumed life span of 35 to 100 years corresponded to a period of four months in which an individual could move from one periodontal condition to the next, each associated with presumed direct and indirect treatment costs. Appropriate diagnosis and adherence to professional periodontal care had a strong benefit saving up to CHF 5.94 billion OOP and CHF 1.03 billion SW costs for the current Swiss population. Considering direct and indirect health care costs, the total expected costs for a 35-year-old individual until death were CHF 17'310 with minimal care and CHF 15'606 with optimal care, resulting in savings of CHF 1'704. In conclusion, early detection and appropriate treatment of periodontitis can help to reduce both overall costs of treating periodontitis and associated secondary damage, especially in the second half of life. These cost savings may further pay off on an individual level through regular supportive periodontal care, both for treatments paid out-of-pocket and those covered by social welfare

Effect of periodontal treatment on peak serum levels of inflammatory markers

Background and objective: Some subjects with untreated periodontitis exhibit elevated levels of distinct inflammatory markers in serum. The aim of the study was to assess whether nonsurgical periodontal therapy changes the levels of these markers and lowers these peaks. Methods: Forty periodontally diseased subjects received nonsurgical periodontal therapy (full-mouth scaling and root planing within 48h) with either adjunctive systemic amoxicillin and metronidazole (n = 19) or placebo (n = 21). Serum samples, obtained at baseline (BL) and 3months after treatment (M3), were evaluated for 15 cytokines and 9 acute-phase proteins using the Bio-Plex bead array multianalyte detection system. For each analyte, peak values were defined as greater than the mean + 2 standard deviations (SD) of measurements found in 40 periodontally healthy persons. Proportions were compared using Fisher's exact test. Results: At M3, a significantly better primary clinical outcome (persisting pockets of >4mm with bleeding on probing) was obtained in patients treated with scaling and root planing plus antibiotics compared to those receiving placebo (3.3 ± 5.1 vs. 6.8 ± 7.8 pockets per patient, p < 0.05). The levels of cytokines and acute-phase proteins of periodontitis patients were usually below the mean + 2 SD threshold of healthy persons. However, values above threshold were found in some individuals. Eleven patients showed a peak value of one analyte, and seven patients showed two peaks. In the remaining 12 patients, between three and ten analytes showed peak values. Therapy greatly reduced the number of subjects with four or more peaks (BL, 11 subjects; M3, 1 subject, p = 0.003). With regards to the reduction of peaks, no specific benefit of adjunctive antibiotics could be seen. Conclusion: Subjects with untreated periodontitis may show high peaks for several inflammatory markers in serum simultaneously. Nonsurgical periodontal treatment with or without antibiotics reduced most of these peak levels

Amoxicilline et métronidazole en association au traitement non chirurgical de la parodontite chronique

Le but de cette étude clinique était d'évaluer le bénéfice obtenu suite à l'administration d'amoxicilline et de métronidazole immédiatement après le traitement non chirurgical de patients atteints de parodontite chronique. Ce fut une étude longitudinale, randomisée, en double aveugle, avec un groupe contrôle. 51 patients furent traités par surfaçages sur une période de 48h. 25 sujets avaient reçu 500 mg de métronidazole et 375 mg d'amoxicilline trois fois par jour durant 7 jours, et 26 avaient reçu un placebo. Les patients ont été suivis à une semaine, 3 mois et 6 mois. Conclusions : L'administration par voie systémique d'amoxicilline et de métronidazole améliore significativement à 6 mois les résultats cliniques d'un traitement non chirurgical d'une parodontite chronique, réduisant ainsi les besoins en thérapie additionnelle

Le titane : son potentiel allergique est-il lié à sa corrosion ?

Since decades, implantology is predominantly dominated by titanium thanks to its mechanical and biological properties. However, questions related to its ageing and its resistance to corrosion have rarely been asked. A phenomenon named tribocorrosion was reported in the recent literature resulting in the release of titanium particles into the soft tissues and the bone. The scientific evidence has shown particles could interact with osteoclasts, affect the cellular homeostasis of fibroblasts and promote inflammatory reactions. Regarding any allergic reactions to titanium, data remained limited and subject to controversy in their interpretation. Nowadays, titanium dioxide is commonly used by the food, cosmetic and pharmaceutic industry

A comprehensive review of peri-implantitis risk factors

Purpose of Review: This is a comprehensive narrative review aimed at identifying relevant risk factors associated with peri-implantitis. Recent Findings: Recent studies suggest that water pipes and electronic cigarettes present potentially significant risk factors for peri-implantitis. In addition, we have recently appreciated that the release of titanium particles into the peri-implant tissues is associated with inflammation and disease progression. Yet the question remains as to whether these factors could be sole or major causes of peri-implantitis, or merely additional factors contributing to the aggravation of the disease. Furthermore, the use of zirconia implants does not prevent the development of peri-implantitis, but it has been associated with lower inflammation and marginal bone resorption. Summary: Established peri-implantitis risk factors include periodontal disease, lack of maintenance, cigarette and smokeless tobacco use, hyperglycaemia and obesity. Local risk factors include inadequate plaque control, mucositis, implant’s malposition and poorly designed prostheses or presence of excess cement. Potential risk factors requiring additional research include genetic and systemic conditions, high doses of bisphosphonates and hormonal replacement therapy. Occlusal overload, lack of keratinised tissue and local presence of titanium particles seem to aggravate peri-implant disease, but studies are still required prior to drawing definitive conclusions

Two-piece zirconia implants supporting all-ceramic crowns: A prospective clinical study

Objectives: The aim of this prospective clinical study is to evaluate the safety and efficacy of a new all-ceramic implant system to replace missing teeth in partially edentulous patients. Material and methods: Thirty-two partially edentulous, systemically healthy patients were treated with 49 two-piece zirconia implants (ZERAMEX" T Implant System). Zirconia abutments were connected with adhesive resin cement. Single-unit full-ceramic crowns were cemented. The cases have been followed for 588`174 days after loading (range 369–889 days). All patients have been re-evaluated 1 year after loading. Results: The cumulative survival rate 1 year after loading was 87% implants. All failures were the result of aseptic loosening, and no implants were lost after the first year. The results of the other cases were good, and the patients were very satisfied. The cumulative soft tissue complication rate was 0%, the cumulative technical complication rate was 4% implants, the cumulative complication rate for bone loss >2 mm was 0%, and the cumulative esthetic complication rate was 0%. Including the data from 20 patients treated with an earlier version of the system, an over-all 2-year cumulative survival rate of 86% was calculated for a total of 76 two-piece zirconia implants supporting all-ceramic crowns in 52 patients. Conclusions: Replacement of single teeth in the posterior area was possible with this new full- ceramic implant system. Failures were due to aseptic loosening

The epidemiology of peri-implantitis

Aim: To review the literature on the prevalence and incidence of peri-implantitis. Methods: Out of 322 potentially relevant publications we identified 29 articles concerning 23 studies, with information on the presence of signs of peri-implantitis in populations of at least 20 cases. Results and conclusions: All studies provided data from convenience samples, typically from patients who were treated in a clinical center during a certain period, and most data were cross- sectional or collected retrospectively. Based on the reviewed papers one may state that the prevalence of peri-implantitis seems to be in the order of 10% implants and 20% patients during 5 –10 years after implant placement but the individual reported figures are rather variable, not easily comparable and not suitable for meta-analysis. Factors that should be considered to affect prevalence figures are the disease definition, the differential diagnosis, the chosen thresholds for probing depths and bone loss, differences in treatment methods and aftercare of patients, and dissimilarities in the composition of study populations. Smoking and a history of periodontitis have been associated with a higher prevalence of peri-implantitis

What is the impact of titanium particles and biocorrosion on implant survival and complications? A critical review

OBJECTIVES: To compile the current evidence regarding the association between the release of titanium particles and biologic complications of dental implants. MATERIAL AND METHODS: This is a critical review. We searched the literature using the terms "corrosion," "allergy," "hypersensitivity," or "particles" together with "titanium," "Ti," "TiO2. " The bibliographies of identified publications and previously published review articles were scanned to find additional related articles. We included clinical studies, in vivo and in vitro experiments. RESULTS: Titanium particles and degradation products of titanium have been detected in oral and nonoral tissues. Particles are released from surfaces of dental implants because of material degradation in a process called tribocorrosion. It involves mechanical wear and environmental factors, notably contact to chemical agents and interaction with substances produced by adherent biofilm and inflammatory cells. In vitro, titanium particles can interfere with cell function and promote inflammation. A temporal association between exposure to titanium and occurrence of tissue reactions suggested hypersensitivity in a limited number of cases. However, there is poor specificity as the observed reactions could be initiated by other factors associated with the placement of implants. Titanium particles are commonly detected in healthy and diseased peri-implant mucosa alike, at low levels even in gingiva of individuals without titanium implants. Rather than being the trigger of disease, higher concentrations of titanium in peri-implantitis lesions could be the consequence of the presence of biofilms and inflammation. CONCLUSION: There is an association between biocorrosion, presence of titanium particles, and biological implant complications, but there is insufficient evidence to prove a unidirectional causal relationship