Non-surgical therapy of peri-implant mucositis—Mechanical/physical approaches: A systematic review

Aim To study in humans with peri-implant mucositis the efficacy of (Q1) mechanical/physical instrumentation over oral hygiene instructions alone; (Q2) any single mode of mechanical/physical instrumentation over others; (Q3) combinations of mechanical/physical instrumentation over single modes; and (Q4) repetitions of mechanical/physical instrumentation over single administration. Materials and Methods Randomized clinical trials (RCTs) fulfilling specific inclusion criteria established to answer the four PICOS questions were included. A single search strategy encompassing the four questions was applied to four electronic databases. Two review authors independently screened the titles and abstracts, carried out full-text analysis, extracted the data from the published reports and performed the risk of bias assessment through the RoB2 tool of the Cochrane Collaboration. In case of disagreement, a third review author took the final decision. Treatment success (i.e., absence of bleeding on probing [BoP]), BoP extent and BoP severity were considered as the implant-level outcomes of critical importance for the present review. Results A total of five papers reporting on five RCTs, involving 364 participants and 383 implants, were included. Overall, treatment success rates after mechanical/physical instrumentation ranged from 30.9% to 34.5% at 3 months and from 8.3% to 16.7% at 6 months. Reduction in BoP extent was 19.4%–28.6% at 3 months, 27.2%–30.5% at 6 months and 31.8%–35.1% at 12 months. Reduction in BoP severity was 0.3–0.5 at 3 months and 0.6–0.8 at 6 months. Q2 was addressed in two RCTs, which reported no differences between glycine powder air-polishing and ultrasonic cleaning, as well as between chitosan rotating brush and titanium curettes. Q3 was addressed by three RCTs, which showed no added effect of glycine powder air-polishing over the use of ultrasonic and of diode laser over ultrasonic/curettes. No RCTs were identified that answered Q1 and Q4. Conclusions Several mechanical/physical instrumentation procedures including curettes, ultrasonics, lasers, rotating brushes and air-polishing are documented; however, a beneficial effect over oral hygiene instructions alone or superiority over other procedures could not be demonstrated. Moreover, it remains unclear whether combinations of different procedures or their repetition over time may provide additional benefits.publishedVersio

Prevention and treatment of peri-implant diseases—The EFP S3 level clinical practice guideline

Background: The recently published Clinical Practice Guidelines (CPGs) for the treatment of stages I–IV periodontitis provided evidence-based recommendations for treating periodontitis patients, defined according to the 2018 classification. Peri-implant diseases were also re-defined in the 2018 classification. It is well established that both peri-implant mucositis and peri-implantitis are highly prevalent. In addition, peri-implantitis is particularly challenging to manage and is accompanied by significant morbidity. Aim: To develop an S3 level CPG for the prevention and treatment of peri-implant diseases, focusing on the implementation of interdisciplinary approaches required to prevent the development of peri-implant diseases or their recurrence, and to treat/rehabilitate patients with dental implants following the development of peri-implant diseases. Materials and Methods: This S3 level CPG was developed by the European Federation of Periodontology, following methodological guidance from the Association of Scientific Medical Societies in Germany and the Grading of Recommendations Assessment, Development and Evaluation process. A rigorous and transparent process included synthesis of relevant research in 13 specifically commissioned systematic reviews, evaluation of the quality and strength of evidence, formulation of specific recommendations, and a structured consensus process involving leading experts and a broad base of stakeholders. Results: The S3 level CPG for the prevention and treatment of peri-implant diseases culminated in the recommendation for implementation of various different interventions before, during and after implant placement/loading. Prevention of peri-implant diseases should commence when dental implants are planned, surgically placed and prosthetically loaded. Once the implants are loaded and in function, a supportive peri-implant care programme should be structured, including periodical assessment of peri-implant tissue health. If peri-implant mucositis or peri-implantitis are detected, appropriate treatments for their management must be rendered. Conclusion: The present S3 level CPG informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to maintain healthy peri-implant tissues, and to manage peri-implant diseases, according to the available evidence at the time of publication

Bone grafts: which is the ideal biomaterial?

Abstract Bovine xenograft materials, followed by synthetic biomaterials, which unfortunately still lack documented predictability and clinical performance, dominate the market for the cranio‐maxillofacial area. In Europe, new stringent regulations are expected to further limit the allograft market in the future Aim Within this narrative review, we discuss possible future biomaterials for bone replacement. Scientific Rationale for Study Although the bone graft (BG) literature is overflooded, only a handful of new BG substitutes are clinically available. Laboratory studies tend to focus on advanced production methods and novel biomaterial features, which can be costly to produce. Practical Implications In this review, we ask why such a limited number of BGs are clinically available when compared to extensive laboratory studies. We also discuss what features are needed for an ideal BG. Results We have identified the key properties of current bone substitutes and have provided important information to guide clinical decision‐making and generate new perspectives on bone substitutes. Our results indicated that different mechanical and biological properties are needed despite each having a broad spectrum of variations. Conclusions We foresee bone replacement composite materials with higher levels of bioactivity, providing an appropriate balance between bioabsorption and volume maintenance for achieving ideal bone remodelling

Developing a novel protocol for testing decontamination of TiO2 dental implant surfaces- an in vitro experimental study

Vi ha i denne oppgaven brukt 30 prefabrikerte halvsylindriske titanimplantater. Alle ble inkubert med kalveserum før forsøket begynte. 10 ble brukt til en kontrollgruppe mens 20 ble renset, 10 med titanbørste og 10 med titancyrette. Samtlige implantater ble så analysert i spektroskopi (FTIR). På de tyve rensede ble også resterene proteinmengde etter rensing undersøkt ved hjelp av proteinassay og ELISA. Resultatene ble til slutt analysert ved hjelp av statisikkprogra

The combined association of musculoskeletal pain, physical activity, and BMI on the risk of disability pension. - Prospective data from the HUNT-study.

Many in the working population today obtain disability pension and a significant part of the population receive sick leave compensation or other kinds of public support in shorter or longer periods of time. In our society today, one of the most frequent reasons of sick leave and disability pension is pain in neck and/or back. This study will examine the association between musculoskeletal pain in relation to risk of disability pension, and include lifestyle factors, such as physical activity and BMI, to examine if these factors can modify the association. We ran cox regression analyses on a HUNT population including 45654 individuals to estimate RRs of disability pension with 95% CI. The results show that musculoskeletal pain in neck/shoulder/back increases the risk of disability pension (RR 2,57, CI 2,44 – 2,72). A combined analysis including musculoskeletal pain and different levels of BMI showed that the risk of disability pension increases from normal weight (RR 2,67, CI 2,46 – 2,94) to obese (RR 4,02, CI 3,64 – 4,45) among people with musculoskeletal pain, compared to normal weight without pain. High BMI also gives an increased risk of disability pension among people without pain (RR 1,55, CI 1,37 – 1,75). Physical activity is also showing to be a contributing factor. People with pain, already have a risk of disability pension, but it can be reduced from the inactive (RR 2,54, CI 2,11 – 3,05) to the highly active (RR 1,48, CI 1,25 – 1,75), when compared to inactive people without pain. A similar preventive effect can be seen among people without pain, where the risk of disability pension descends to RR 0,55 (CI 0,47 – 0,66) with high activity, compared to the inactive without pain. Our main findings are the relation between musculoskeletal pain in the neck, shoulders and back towards risk of disability pension. This study also found that physical activity and BMI may affect the relation between musculoskeletal pain and risk of disability pension, where increased physical activity reduce the risk of disability pension and increased BMI has the opposite effect. In conclusion, it seems that physical activity and achieving normal weight may reduce the unfortunate effects of musculoskeletal pain when it comes to risk of disability pension

Quality of life assessment and screening tool development for endometriosis

The thesis is based on three papers on endometriosis, a relatively common chronic inflammatory gynecological disease which can cause significant pain and infertility. All three papers are based on cross-sectional data from postal surveys conducted among a randomly selected sample of women residing in Oslo and members of the Norwegian Endometriosis Association and the Oslo Rheumatoid Arthritis Registry. The main weakness of all three papers is possible selection bias. The aim of the first paper was to evaluate the measurement properties of the Norwegian version of the disease-specific quality of life questionnaire Endometriosis Health Profile-30. The scale self-image of the Norwegian version EHP-30 does not seem to measure the construct self-image appropriately. Thus, for Norwegian quality of life studies on women with endometriosis, the EHP-30 must be used with caution. The aim of the second paper was to compare quality of life in women with endometriosis and women with rheumatoid arthritis using the generic quality of life questionnaire Short form-36. Women with endometriosis seemed to have poorer mental quality of life compared with women with rheumatoid arthritis, despite similar pain scores. The aim of the third paper was to identify predictors of endometriosis among factors commonly associated with endometriosis and available to physicians through medical interview. Further, if successful, to combine these to develop and internally validate a prediction model to aid primary care physicians in early identification of women at high risk of developing endometriosis. The predictors absenteeism from school due to dysmenorrhea and family history of endometriosis demonstrated the strongest association with disease. A prediction model based on these two predictors appears to be a relatively efficient screening tool for endometriosis

Patient and professional use of the root coverage esthetic score (RES) and how it relates to patient satisfaction following periodontal plastic surgery

Abstract Background Following periodontal plastic surgery in the treatment of recession defects, previous studies have reported that patients rate the esthetic outcomes more favorable than dental professionals. The root coverage esthetic score has been developed and suggested to serve as a comprehensive assessment instrument as it addresses several esthetic outcomes following root coverage procedures. However, no study has yet reported on patient use of this instrument. In the present study clinical, esthetic and patient-reported outcomes following periodontal plastic surgery were assessed. The primary objective was to compare the esthetic/clinical outcome as judged by the patient and by one dentist by using the root coverage esthetic score. The secondary objective was to evaluate the correlation between patient-reported outcomes, root coverage esthetic score and clinical parameters following treatment of recession defects. Materials and methods Subjects that had undergone periodontal plastic surgery were invited to score the treatment outcome according to the root coverage esthetic score, which subsequently also was professionally scored by a dentist. Thereafter, the subjects answered a questionnaire on patient satisfaction. All types of surgical root coverage procedures in canine or incisor teeth were included. Results A total of 34 subjects were included, presenting 46 treated recessions. No statistically significant different score was found comparing the root coverage esthetic score by the patient and the professional. The majority of subjects was satisfied with the treatment outcome, and most would have undergone the treatment again. Conclusion The root coverage esthetic score assessment can be conducted by patients and was not statistically significant different to that of the professional. Patient satisfaction is not always dependent on complete root coverage or the other clinical parameters included in the root coverage esthetic score

Implantoplasty- provoking or reducing inflammation? – a systematic scoping review

Objectives To evaluate clinical parameters associated with inflammation after adjunctive implantoplasty in conjunction with surgical treatment of peri-implantitis. Materials and methods A systematic literature search was performed in 2 databases until 29. December 2020 to find publications that report on clinical parameters after surgical peri-implantitis treatment which included adjunctive implantoplasty. Clinical studies on implantoplasty reporting on BoP as outcome were included, but other clinical or radiographic outcomes were also considered. Results The search resulted in 18 articles that fulfilled the inclusion criteria. The results indicated improvements of BoP and clinical parameters following surgical peri-implantitis treatment with adjunctive implantoplasty. Conclusions Within its limits, the findings of the present scoping review indicated that BoP is reduced following surgical peri-implantitis treatment with adjunctive implantoplasty, and that this improvement is in line with surgical peri-implantitis treatment without adjunctive implantoplasty

Alginate hydrogel enriched with enamel matrix derivative to target osteogenic cell differentiation in TiO2 scaffolds

The purpose of bone tissue engineering is to employ scaffolds, cells, and growth factors to facilitate healing of bone defects. The aim of this study was to assess the viability and osteogenic differentiation of primary human osteoblasts and adipose tissue–derived mesenchymal stem cells from various donors on titanium dioxide (TiO2) scaffolds coated with an alginate hydrogel enriched with enamel matrix derivative. Cells were harvested for quantitative reverse transcription polymerase chain reaction on days 14 and 21, and medium was collected on days 2, 14, and 21 for protein analyses. Neither coating with alginate hydrogel nor alginate hydrogel enriched with enamel matrix derivative induced a cytotoxic response. Enamel matrix derivative–enriched alginate hydrogel significantly increased the expression of osteoblast markers COL1A1, TNFRSF11B, and BGLAP and secretion of osteopontin in human osteoblasts, whereas osteogenic differentiation of human adipose tissue–derived mesenchymal stem cells seemed unaffected by enamel matrix derivative. The alginate hydrogel coating procedure may have potential for local delivery of enamel matrix derivative and other stimulatory factors for use in bone tissue engineering