Host response modulation in the management of periodontal diseases

Objective: To review the biological mechanisms and clinical utility of therapeutic modulation of the host response in the management of periodontal diseases. Material and methods: A search of MEDLINE-PubMed was performed up to and including December 2004. The search was limited to in vitro, experimental animal and clinical studies published in English. The selection criteria included all levels of available evidence: systematic reviews, randomised-controlled clinical trials, controlled clinical trials, prospective and retrospective cohort studies and case reports of human and experimental animal studies. Results: Six targets for non-microbial chemotherapeutic intervention were identified. Clinical trials have demonstrated the ability of non-steroidal anti-inflammatory drugs to slow periodontal disease progression. However, recently reported serious adverse effects preclude the use of cyclooxygenase-2 inhibitors as an adjunct to periodontal therapy. Adjunctive use of subantimicrobial dose doxycycline to non-surgical periodontal therapy is beneficial in the management of chronic periodontitis over 12 months. Controversial data exist on the effects of bisphosphonate administration as an adjunct to periodontal therapy. Evidence on modulation of other host mediators including lipoxins, cytokines and nitric oxide synthase is limited to animal research. Conclusion: After validation in long-term clinical trials, adjunctive host modulation therapy may prove advantageous in the management of periodontal diseases. © Blackwell Munksgaard 2005.link_to_subscribed_fulltex

Diagnostic parameters for monitoring peri-implant conditions

Purpose: To review the literature on clinical, radiographic, and biochemical parameters used for monitoring peri-implant conditions. Materials and Methods: A MEDLINE search was conducted that included articles published in English until the end of August 2003, Results from human and experimental animal studies are presented. Results: The parameters that may be used to assess the presence of peri-implant health and the severity of peri-implant disease include plaque assessment, mucosal conditions, peri-implant probing depth, width of the peri-implant keratinized mucosa, periimplant sulcus fluid analysis, suppuration, implant mobility and discomfort, resonance frequency analysis, and radiographic evaluation. Discussion: Based on the analysis of the available evidence, it appears reasonable to use a number of clinical and radiographic parameters to discriminate between peri-implant health and disease. Conclusions: Systematic and continuous monitoring of peri-implant tissues during maintenance care is recommended for the early diagnosis of peri-implant disease.link_to_subscribed_fulltex

The effects of non-steroidal anti-inflammatory drugs (selective and non-selective) on the treatment of periodontal diseases

The objective was to review the literature on the effects of selective and non-selective non-steroidal anti-inflammatory drugs (NSAIDs) on the treatment of periodontal diseases. A search of MEDLINE was conducted and articles published in English until December 2003 were included. The results from in vitro and animal experiments as well as from human clinical trials are presented. Non-selective cyclooxygenase-1 (COX-1) inhibitors used in periodontal research include compounds such as aspirin, flurbiprofen, ibuprofen, naproxen and piroxicam. Selective cyclooxygenase-2 (COX-2) inhibitors represent a new group of pharmaceutical products termed "coxibs" that include meloxicam, nimesulide, etodolac and celecoxib. Evidence from animal experiments and clinical trials documents that selective and non-selective NSAIDs are mainly responsible for the stabilization of periodontal conditions by reducing the rate of alveolar bone resorption. This is achieved through local inhibition of both enzymes (e.g. COX-1 and COX-2) responsible for the synthesis of arachidonic acid metabolites. Evidence shows that the effects of NSAIDs drop off rapidly after drugwithdrawal. One of the major advantages of selective COX-2 inhibition is the reduction of adverse systemic effects. Although some studies present promising results, no data from long-term, multicenter prospective clinical trials are yet available for determining whether these therapeutic effects can be retained on a long-term basis. Many of these compounds, such as flurbiprofen, are readily absorbed through the gingival tissues. Therefore, the development of topical NSAIDs formulations (e.g. gels, toothpastes, rinses) with a daily application seems to be of particular interest. This may help to further reduce adverse systemic effects of non-selective NSAIDs in the long-term host modulation of periodontitis-susceptible patients. © 2005 Bentham Science Publishers Ltd.link_to_subscribed_fulltex

Changing paradigms in implant dentistry

This review focuses on five paradigms of implant dentistry which have undergone considerable modifications in recent years. An attempt was made to select and include all the relevant citations of the past 10 years. These five paradigms document the debate in the clinical and scientific community and include the aspects of (1) smooth vs. rough implant surfaces, (2) submerged vs. non-submerged implant installation techniques, (3) mixed tooth-implant vs. solely implant-supported reconstructions, (4) morse-taper abutment fixation vs. butt-joint interfaces, and (5) titanium abutments vs. esthetic abutments in clinical situations where esthetics is of primary concern.link_to_subscribed_fulltex

Reconstruction of a periodontally compromised dentition | Rekonstruktion eines parodontal geschädigten Gebisses.

The presented case report describes a systematic treatment concept, the treatment sequence and the maintenance care of a sixty-seven-year old female patient suffering from generalized chronic periodontitis with advanced attachment loss. Due to a pretherapeutic risk assessment, several teeth were classified as "irrational to treat" or "doubtful". Therefore, a comprehensive reconstructive rehabilitation after active periodontal therapy was necessary. The restoration of a periodontally compromised dentition represents various difficulties. The patient wished to have fixed reconstructions. Depending upon anatomical conditions several different reconstructions were used: conventional bridges, partly using a resected molar root, a solely implant-retained bridge and a combined implant-tooth-retained bridge.link_to_subscribed_fulltex

Early loading (2 or 6 weeks) of sandblasted and acid-etched (SLA) ITI® implants in the posterior mandible. A 1-year randomized controlled clinical trial

The aim of this 1-year prospective controlled clinical trial was to evaluate the effect of early loading of ITI® solid screw titanium implants with a sandblasted and acid-etched (SLA) surface on clinical and radiographic parameters. Material and methods: Twenty-seven consecutively admitted patients presenting bilateral edentulous posterior mandibular areas and in need of prosthetic reconstruction were recruited. Sixty-seven ITI® standard solid screw implants with an SLA surface, a diameter of 4.1 mm and a length of 8, 10 or 12mm were installed bilaterally in molar and premolar areas according to a one-stage surgical protocol. One week (test) and 5 weeks (control) after implant placement, solid ITI® prosthetic abutments were connected using a torque of 35 N cm. No provisional restoration was fabricated. Two weeks (test) and 6 weeks (control) after implant placement, porcelain-fused-to-metal single-tooth crowns were cemented. Clinical measurements were obtained at day O and 2, 6, 12, 24 and 52 weeks thereafter. Periapical radiographs were taken immediately after implant placement, after 6 weeks and at the 1-year examination. Results: After 1 year, implant survival was 100%. Two test and one control implants rotated at the time of abutment connection and were left unloaded for 12 additional weeks. At the 1-year examination, no statistically significant differences were found between the test and control sites with respect to pocket probing depths (2.6 mm ± 0.5 vs. 2.7 mm ± 0.5), mean clinical attachment levels (3.1 mm ± 0.4 vs. 3.2 mm ± 0.5), mean percentages of sites bleeding on probing (9.7% vs. 8.3%), mean widths of keratinized mucosa (1.8 mm ± 0.4 vs. 1.9 mm ± 0.5), mean PerioTest® values (- 1.4 PTV ± 0.9 vs. - 1.6 PTV ± 0.8) or mean crestal bone loss measurements (0.57 mm ± 0.49 vs. 0.72 mm ± 0.50). Conclusion: Based on these results, loading of titanium implants with an SLA surface as early as 2 weeks did not appear to jeopardize the osseointegration healing process in the posterior mandible. Furthermore, implants rotating at 35 N cm, if left unloaded for additional 12 weeks, did not negatively affect clinical and radiographic outcomes.link_to_subscribed_fulltex