Ceramic anterior veneer restorations in periodontally compromised patients: A retrospective study.

BACKGROUND: Successful periodontal therapy can lead to poor esthetic results, especially in the anterior region, for which there are treatment options such as direct composite or indirect veneer restorations. Until now, there are no data describing the long-term results of veneer restorations in periodontally treated patients. The aim of this retrospective study was to evaluate the outcome of anterior porcelain veneer restorations in periodontally compromised and noncompromised patients. METHODS: Periodontally healthy and periodontally compromised patients, who had received anterior veneer restorations at least 5 years ago, were invited to a follow-up examination. Groups were divided according to their periodontal diagnosis (periodontally healthy, stage I/II, stage III/IV). Tooth loss, veneer loss, biologic parameters, and complication rates were examined. Also, veneers were evaluated according to modified United States Public Health Service criteria. RESULTS: A total of 68 patients with 312 veneers were examined with a mean follow-up time of 8 years. Veneered teeth in patients with periodontitis stage III/IV showed no difference regarding tooth-specific, overall, and functional veneer survival when compared to periodontally healthy patients (Kaplan-Meier analyses). In Cox regression analysis, follow-up time had an impact on complications and veneer loss, whereas periodontal diagnosis showed no significant influence on the survival of restorations. Comparative tests showed that patients with severe periodontitis at baseline have slightly lower veneer survival rates after 8 years and slightly higher complication rates after 13 years. CONCLUSION: Long-term results and complication rates of veneer restorations in periodontally compromised patients are comparable to periodontally healthy patients over a mean follow-up of 8 years.

Patient satisfaction and oral health-related quality of life 10 years after implant placement.

BACKGROUND: Implant survival and implant success (freedom of biologic complications) are important factors in assessing the success of implant therapy. However, these factors are not the only determinants. Patients' satisfaction also plays a very important role in daily practice. Therefore, the aim of this study was to assess patients' satisfaction regarding function (phonetics, chewing comfort, stability, cleanability) and aesthetics in patients treated with XiVE and Frialite implants in a private periodontal practice ten years after implant placement. Furthermore, oral health-related quality of life (OHRQoL) was evaluated. METHODS: Patient-reported outcome measures (PROMs) regarding overall satisfaction, phonetics, chewing comfort, stability, cleanability, and aesthetics were examined on a Visual Analog Scale (VAS) 10 years ± 6 months after implant placement in a cross-sectional survey. OHRQoL and psychological impact were assessed via the Oral Health Impact Profile (OHIP) and Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ). Potential influence of patient-related factors (age, gender, smoking, peri-implantitis, implant position, type of restoration) on VAS, OHRQoL and PIDAQ were investigated using regression analyses. RESULTS: High satisfaction with implant-supported restorations was seen in all 95 patients ten years after implant placement. Mean VAS-score for general satisfaction with implant-supported restoration was 93.0% (SD ± 9.4, median: 96.3%, range 50.0-100%). Mean OHIP score was 11.3 (SD ± 10.8, median: 9.0, range 0-45), mean PIDAQ score 20.5 (SD ± 11.37, median: 17.0, range 0-52). A slight tendency that presence of a moderate/severe peri-implantitis lowers satisfaction could be detected (overall satisfaction: ordinal, p = 0.012, VAS, p = 0.026). Also, the factors age, implant position and type of restoration might have an impact on patient's satisfaction. CONCLUSIONS: Patients restored with mostly fixed implant-supported restorations showed a very high patient satisfaction regarding function and aesthetics 10-year after implant placement. The presence of a moderate/severe peri-implantitis showed a slight tendency for influencing patient satisfaction. Due to the cross-sectional design results have to be interpreted with care.

Tooth-related factors for tooth loss 20 years after active periodontal therapy-A partially prospective study.

AIM: To assess factors contributing to tooth loss 20 years after active periodontal therapy (APT) on tooth level. MATERIALS AND METHODS: After an initial retrospective analysis 10 years after APT, patients were monitored for 10 more years. At clinical re-evaluation 20 years after APT, tooth-related factors (tooth type, location, bone loss, furcation involvement, abutment status) and patient-related factors (gender, smoking, adherence) were investigated. Descriptive statistical analysis and a mixed logistic regression analysis were performed with tooth loss as primary outcome variable. RESULTS: The study included 69 patients (42 female/27 male). 39 patients were non-adherent (56.5%), and 11 were active smokers (15.9%). A total of 198 out of 1611 teeth were lost. Tooth loss was significantly highest (p < .01) in molars (21.1%), multi-rooted teeth with furcation involvement (23.5%) and abutment teeth (fixed: 27.6%, removable: 36.4%). 37.6% of teeth with initial bone loss >60% were lost during 20 years. Adherent patients showed less frequent tooth loss than non-adherent patients (OR 0.371; p <  .01). CONCLUSION: Even teeth with an initial bone loss over 60% could be retained in approximately two thirds for 20 years. This should be kept in mind when assigning prognosis and establishing a treatment plan.

Survival and success of implants in a private periodontal practice: a 10 year retrospective study.

BACKGROUND: To assess long-term results of implants (XiVE/Frialit-2 Synchro) in a private periodontal practice according to survival and success rates (biological and technical complications) and to detect possible influencing factors, retrospectively. METHODS: Implant placement of at least one implant took place 10 years ±6 months before clinical and radiographic re-examination. Incidence of implant loss as main and incidence of mucositis/ peri-implantitis as secondary outcome were detected. Also, patient-related and implant-related influencing factors were determined by regression analyses. RESULTS: 100 patients (59.0% female) with 242 implants were included into analysis. Survival rate was 94.0% (XiVE: 97.7%; Frialit-2-Synchro: 66.7%). Mucositis was found in 77.6% of all patients, moderate/severe peri-implantitis in 16.3%. In logistic regression analyses statistically significant influencing factors for implant loss was implant type (p < 0.001), for mucositis a wider implant diameter (p = 0.0438) and a high modified Plaque Index (p = 0.0253), for peri-implantits number of implants per patient (p = 0.0075) and a wider implant diameter (p = 0.0079). Technical complications were found in 47 implants (19.4%). CONCLUSIONS: XiVE implants showed a high survival rate over a 10-year follow-up, on the other hand Frialit-2 Synchro implants had worse survival rates. Success rates regarding biological complications are in line with other implant systems.

Tooth loss in aggressive periodontitis: Results 25 years after active periodontal therapy in a private practice.

AIM: To assess tooth loss in patients with aggressive periodontitis (AgP) 10-35 years after active periodontal therapy (APT) in a private practice and to detect possible factors influencing tooth loss. MATERIAL AND METHODS: In 100 patients with AgP, tooth loss was recorded over a median follow-up period of 25.5 years after APT, retrospectively. Patient- and tooth-level factors were assessed with a Cox frailty regression model. RESULTS: Of 2,380 teeth, 227 were lost during a median follow-up time of 25.5 years (2.3 ± 3.6 teeth/patient, range 0-17 teeth), resulting in a mean tooth loss rate of 0.09 teeth/patient/year. At patient-level, statistically significant factors for tooth loss were smoking (p = .039) and the baseline diagnosis generalized AgP (p < .001). Influencing factors at tooth-level were location in the maxilla (p = .003), baseline bone loss (p < .001), molars (p < .001) and premolars (p < .001) as well as abutment teeth (p = .009). CONCLUSION: Tooth loss occurred rarely in patients with AgP treated in a private practice over a long-time period. Annual tooth loss rates are comparable with those described in university settings. Smoking, generalized form of AgP, location/type of tooth, baseline bone loss and abutment status could be detected as factors impacting upon tooth loss.

Oral health-related quality of life and standard of treatment in aggressive periodontitis patients more than 5 years after therapy.

OBJECTIVES: To assess OHRQoL in patients with aggressive periodontitis (AgP) after periodontal treatment using the Oral Health Impact Profile-49 (OHIP-49) and compare to patients' dental status. MATERIAL AND METHODS: More than 5 years after therapy, 71 patients were examined and answered the OHIP-questionnaire. The dental and periodontal status were assessed according to the SSO (Swiss Dental Society) criteria. Descriptive statistics were performed with SPSS, correlation analysis and tests for differences using R 3.2.2. RESULTS: More than 90% of all patients showed no probing depths (PD) >5 mm, a bleeding on probing (BOP) index below 35%, and a sufficient function. Four patients showed no visible plaque, PDs ≤ 3 mm, a BOP below 10%, and an optimum function. Non-smoking and compliant patients exhibited a more favourable status. The OHIP-49 added up to 24.9 points, representing a comparatively high satisfaction of AgP-patients with their oral status. The subscale which most patients reported impairment in was "functional limitation." A correlation between quality standard and the OHIP-49G could only be shown in the psychological disability subscale. CONCLUSION: After treatment, a moderate to high quality level can be retained over more than 5 years. Most patients are satisfied with their oral health. Correlations between the objective and subjective view could not be found, apart from the subscale "psychological disability."

Tooth loss in periodontally compromised patients: Results 20 years after active periodontal therapy.

AIM: To assess tooth loss in periodontally compromised patients 20 years after active periodontal therapy (APT) and to detect potential influencing factors for tooth loss on patient level. MATERIAL AND METHODS: From a total of 100 patients, who were re-evaluated ten years after APT, 70 could be re-examined 20 years ± 12 months after APT. Tooth loss during 20 years was detected and based on regression analyses the impact of patient-levelled factors was estimated. RESULTS: Of 1.639 teeth, 201 were lost (mean 2.87 teeth/patient, range 0-19 teeth, SD 3.49), resulting in a mean tooth loss rate of 0.14 teeth/patient/year during 20 years. Mean tooth loss per patient was higher during the second ten years of supportive periodontal therapy (SPT) compared to the first (1.20 vs. 1.67 teeth/patient). As influencing factors age (p < 0.001), smoking (p < 0.001), compliance to SPT (p < 0.001), marital status (p < 0.001), presence of diabetes (p < 0.001) and heart diseases (p = 0.001) could be detected. CONCLUSION: Over 20 years of follow-up, a low number of teeth were lost in mostly severely compromised periodontal patients. Smoking, non-compliance to SPT, age, living as a single and systemic diseases like diabetes or cardiovascular diseases negatively influence tooth loss on the long run.

Effect of professional mechanical plaque removal on secondary prevention of periodontitis and the complications of gingival and periodontal preventive measures: consensus report of group 4 of the 11th European Workshop on Periodontology on effective prevention of periodontal and peri-implant diseases.

BACKGROUND AND AIMS: The scope of this working group was to review: (1) the effect of professional mechanical plaque removal (PMPR) on secondary prevention of periodontitis; (2) the occurrence of gingival recessions and non-carious cervical lesions (NCCL) secondary to traumatic tooth brushing; (3) the management of hypersensitivity, through professionally and self administered agents and (4) the management of oral malodour, through mechanical and/or chemical agents. RESULTS AND CONCLUSIONS: Patients undergoing supportive periodontal therapy including PMPR showed mean tooth loss rates of 0.15 ± 0.14 teeth/year for 5-year follow-up and 0.09 ± 0.08 teeth/year (corresponding to a mean number of teeth lost ranging between 1.1 and 1.3) for 12-14 year follow-up. There is no direct evidence to confirm tooth brushing as the sole factor causing gingival recession or NCCLs. Similarly, there is no conclusive evidence from intervention studies regarding the impact of manual versus powered toothbrushes on development of gingival recession or NCCLs, or on the treatment of gingival recessions. Local and patient-related factors can be highly relevant in the development and progression of these lesions. Two modes of action are used in the treatment of dentine hypersensitivity: dentine tubule occlusion and/or modification or blocking of pulpal nerve response. Dentifrices containing arginine, calcium sodium phosphosilicate, stannous fluoride and strontium have shown an effect on pain reduction. Similarly, professionally applied prophylaxis pastes containing arginine and calcium sodium phosphosilicate have shown efficacy. There is currently evidence from short-term studies that tongue cleaning has an effect in reducing intra-oral halitosis caused by tongue coating. Similarly, mouthrinses and dentifrices with active ingredients based on Chlorhexidine, Cetylpyridinium chloride and Zinc combinations have a significant beneficial effect.

Periodontal pathogens and associated factors in aggressive periodontitis: results 5-17 years after active periodontal therapy.

OBJECTIVES: To assess the association between presence of periodontal pathogens and recurrence of disease in patients with aggressive periodontitis (AgP) after active periodontal therapy (APT) and further influencing factors. MATERIAL & METHODS: Microbiological samples were taken from 73 patients with AgP 5-17 years after APT at 292 sites (deepest site per quadrant). Real-time polymerase chain reactions were used to detect the periodontal pathogens Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola. Uni- and multivariate analyses evaluated the associations between pathogens and recurrence of disease, smoking and adjunctive antibiotic therapy. RESULTS: At re-examination A. actinomycetemcomitans could be detected in six patients (8.2%), P. gingivalis in 24 (32.9%), T. forsythia in 31 (42.5%) and T. denticola in 35 (48.0%). Increased levels of T. forsythia and T. denticola at re-examination were significantly associated with recurrence of disease in multivariate analyses (OR: 12.72, p < 0.001; OR 5.55, p = 0.002 respectively). Furthermore, high counts of T. denticola were found in patients with increased percentage of sites with clinical attachment levels (CAL) ≥ 6 mm compared to those with low counts (13.8% versus 3.2%, p = 0.005). CONCLUSION: In patients with recurrence of disease T. forsythia and T. denticola were detected more frequently and in higher counts. Furthermore, T. denticola was found more frequently in patients with increased CAL.

Caries experience after periodontal treatment in aggressive and chronic periodontitis: results of a 10-year follow-up.

OBJECTIVE: To compare the increase of DMF-T and DMF-S in patients with aggressive periodontitis (AgP) and chronic periodontitis (ChP) after active periodontal therapy. MATERIALS AND METHODS: One hundred and thirty-six periodontally treated patients were re-examined after 10 years. Dental and periodontal status was assessed and patients' charts were screened for diagnosis, compliance to supportive periodontal treatment (SPT) and DMF-T/-S at baseline and re-examination. δDMF-T/-S was calculated and multi-level regression analyses were performed to identify factors contributing to increase of DMF-T/-S. RESULTS: Thirty patients with AgP, 37 with moderate ChP and 69 with severe ChP could be included. δDMF-T between first visit and re-examination was 2.07 (SD = 2.51, range = 0-14 teeth), mean δDMF-S = 14.66 (SD = 14.54, range = 0-83 surfaces). Patients with AgP showed a similar increase in DMF-T/-S to those with ChP. Regression analysis identified compliance as the only factor significantly accounting for preventing an increase of DMF-S (p = 0.017). No factor had a significant impact on DMF-T. CONCLUSIONS: DMF-T and DMF-S developed similarly in periodontally-treated patients with AgP and ChP during a follow-up of 10 years. SPT showed a positive influence on avoiding decline in DMF-S in periodontally compromised patients. No significant impact was detected for all other studied factors.

Use of 8-mm and 9-mm implants in atrophic alveolar ridges: 10-year results.

PURPOSE: The use of short implants can reduce the need for augmentative procedures prior to implant placement and, thus, morbidity and treatment time for patients with severely atrophied alveolar ridges. However, the inevitably less favorable crown-to-implant ratio is often associated with higher implant failure rates and greater marginal bone loss. The aim of this study was to evaluate the long-term survival and success rates of short implants in severely atrophic alveolar ridges retaining restorations on these short implants only. MATERIALS AND METHODS: In this study, 8-mm and 9-mm implants were inserted in atrophic alveolar ridges according to the manufacturer's protocol for the respective bone quality and loaded after 3 months of healing. Prosthetic restorations were supported only by short implants (not in combination with longer implants). After a mean observation period of 10.1 years (±1.9 years), all patients were re-examined clinically and radiographically. RESULTS: In this study, fifty-two 8-mm and 9-mm implants were placed in 14 patients. After 10.1 years, no implants and suprastructures had been lost. A mean marginal bone loss of 0.3 mm (±0.4 mm) was recorded. According to the Albrektsson criteria, all implants were successful; with respect to the more rigorous Karoussis et al criteria, four implants failed. CONCLUSIONS: The results of this long-term study suggest that the use of short implants results in marginal bone resorption and failure rates similar to those for longer implants. The higher crown-to-implant ratio did not seem to have any negative influence on implant success in this study.

Prognostic value of the periodontal risk assessment in patients with aggressive periodontitis.

OBJECTIVES: Aim of the study was to evaluate the predictive value of the modified periodontal risk assessment (PRA) in patients with aggressive periodontitis (AgP) for the first time. MATERIAL AND METHODS: A total of 86 Patients with AgP were re-examined 5-17 years after active periodontal treatment. Risk profile according to the modified PRA was assigned and regularity of maintenance monitored. Tooth loss, bone loss and recurrence of periodontitis were analysed in association with gender, diagnosis, compliance and risk profile using uni- and multivariate parametric regression and Cox proportional hazards models. RESULTS: A total of 14 patients showed a localized AgP, 60 a high-risk-profile and 19 were compliant with the proposed maintenance-interval. Of 2202 teeth 98 were lost. Multivariate analysis could not assign a statistically significant impact to risk-profile. By excluding Interleukin-1 composite genotype from the modified PRA a significant influence (p = 0.003, HR 2.74) was detected. The impact of compliance was shown to be nearly significant (p = 0.059, HR 2.0). In patients with generalized AgP a tendency for increased tooth loss was found. CONCLUSION: The prognostic value of the modified PRA could not be confirmed in patients with AgP. However, exclusion of Interleukin-1 composite genotype led to a model with significant influence on tooth loss.

Fixed implant-retained rehabilitation of the edentulous maxilla: 11-year results of a prospective study.

OBJECTIVES: The aim of the present study was to assess long-term survival and success rates of implants in the edentulous maxilla restored with an implant-supported fixed prosthesis. MATERIALS AND METHODS: Seventeen edentulous patients received six to eight implants and implant-supported fixed prostheses by one surgeon. Yearly recalls were conducted by two examiners over a period of 11 years. Survival and success rates (biological complications) were determined; marginal bone loss was examined radiographically. Furthermore, microbiological tests as well as test for interleukin-1 composite genotype were assessed and potential risk factors were evaluated. RESULTS: After a mean time of 11.26 years, 15 patients of 17 could be reexamined. Out of 94 implants, three were lost in one patient. Mean marginal bone loss reached 0.88 mm, two patients (at seven implants) showed bone loss of ≥3.2 mm. Survival rate of implants reached 96.8%. Success rates on implant level hit 92.6% according to the criteria of Albrektsson and colleagues and 83.0% in accordance with Karoussis and colleagues. One prosthesis had to be renewed. CONCLUSION: Within the limitation of this study, restoration of the edentulous maxilla with an implant-supported fixed prosthesis represents an effective tool for rehabilitation over a period of 11 years.

IL-1-polymorphism and severity of periodontal disease.

OBJECTIVE: To determine the association between the interleukin (IL)-1-polymorphism and the severity of periodontal disease prior to active periodontal therapy. MATERIALS AND METHODS: Two hundred and six patients with obtained baseline x-rays were tested for IL-1-polymorphism. Relative bone loss before active periodontal treatment was measured with a Schei ruler and classified in five groups. Descriptive statistics and backward stepwise linear regression analyses were performed. RESULTS: Forty-nine patients with moderate (mChP), 79 with severe chronic (sChP) and 78 with aggressive periodontitis (AgP) were included. Age correlated significantly with bone loss and number of teeth at baseline. Gender, smoking and IL-1-polymorphism were neither associated with bone loss nor with number of teeth prior to treatment. After adjusting for age as well as gender, AgP was significantly associated with more severe bone loss in untreated periodontal disease (p = 0.036). In non-smokers, mean number of teeth prior to active periodontal therapy correlated significantly with presence of IL-1 polymorphism. CONCLUSION: The IL-1-polymorphism is associated with lower number of teeth in non-smokers with untreated periodontal disease. Untreated AgP is associated with more severe bone loss than untreated ChP.

Tooth loss in aggressive periodontitis after active periodontal therapy: patient-related and tooth-related prognostic factors.

OBJECTIVES: To assess prognostic factors for tooth loss after active periodontal therapy (APT) in patients with aggressive periodontitis (AgP) at tooth level. MATERIAL AND METHODS: Eighty-four patients with AgP were re-evaluated after a mean period of 10.5 years of supportive periodontal therapy (SPT). Two thousand and fifty-four teeth were entered into the model. The tooth-related factors including baseline bone loss, tooth location and type, furcation involvement (FI), regenerative therapy, and abutment status, as well as time of follow-up and other patient-related factors were tested for their prognostic value at tooth level. Multilevel regression analysis was performed for statistical analysis to identify factors contributing to tooth loss. RESULTS: During SPT, 113 teeth (1.34 teeth per patient) were lost. Baseline bone loss, use as abutment tooth, tooth type, and maxillary location contributed significantly to tooth loss during SPT. Molars showed the highest risk for tooth loss after APT. Moreover, time of follow-up and the patient-related factor "educational status" significantly accounted for tooth loss at tooth level. CONCLUSION: Baseline bone loss, abutment status, tooth location, and type as well as time of follow-up and educational status were detected as prognostic factors for tooth loss during SPT in patients with AgP at tooth level.

Patient-related risk factors for tooth loss in aggressive periodontitis after active periodontal therapy.

OBJECTIVES: Evaluation of patient-related risk factors contributing to tooth loss and recurrence of periodontitis 10.5 years after initial therapy in patients with aggressive periodontitis (AgP). MATERIAL AND METHODS: Eighty-four of 174 patients were included. Re-examination consisted of patient's history, clinical examination and test for interleukin (IL)-1 composite genotype. Patients' charts were searched for regularity of maintenance and initial diagnosis. Statistical analysis was performed using Poisson and logistical regression analysis. RESULTS: The responder rate was 48%. Thirteen of 84 patients presented a localized AgP, 68 were females and 29 smoked. One hundred and thirteen teeth out of 2154 were lost after therapy (1.34 teeth/patient). Age (p=0.0018), absence of IL-1 composite genotype (p=0.0091) and educational status (p=0.0085) were identified as statistically significant risk factors for tooth loss. Twenty patients exhibited recurrence of periodontitis at re-examination. Smoking (p=0.0034) and mean Gingival Bleeding Index (GBI) (p=0.0239) contributed significantly to recurrence of disease. No patient participating regularly in supportive periodontal therapy (SPT) showed disease recurrence. CONCLUSION: Age, absence of IL-1 composite genotype and low social status are detected as risk factors for tooth loss. Smoking and high mean GBI are associated with an increased risk for recurrence of periodontitis, whereas regular SPT acts as a protective factor.

Development and validation of an immunoluminometric assay (ILMA) for fetuin-A-glycoprotein.

BACKGROUND: To identify dialysis patients with low fetuin-A levels, a sensitive immunoluminometric assay (ILMA) was developed. METHODS: For the two-site ILMA, one monoclonal antibody was coated to polystyrene beads and one polyclonal antibody was labelled with acridinium ester. RESULTS: The lower detection threshold was 0.013 g/L, with the normal range 0.20-0.87 g/L (arithmetic mean 0.437 +/- 0.118 g/L). Serum fetuin-A levels in the dialysis patients were significantly lower (arithmetic mean: 0.352 +/- 0.099 g/L, p < 0.0001). CONCLUSION: This ILMA has been proved to be a reliable method for the determination of serum fetuin-A concentrations in dialysis patients.

Comparison of two different microbiological test kits for detection of periodontal pathogens.

OBJECTIVE: The aim of this study was to compare the outcome of two different microbiological tests for detection of Aggregatibacter actinomycetemcomitans (A.a.), Porphyromonas gingivalis (P.g.), Tannerella forsythia (T.f.) and Treponema denticola (T.d.). MATERIAL AND METHODS: A total of 69 adult patients with severe chronic (sCP) or aggressive periodontitis (AgP) participated in the study. Microbiological samples were examined for A.a., P.g., T.f. and T.d. using an RNA probe test (PADO) and a real-time polymerase chain reaction test (MERI). RESULTS: For all periodontal pathogens under investigation, the median bacterial counts detected with PADO were smaller compared to those detected with MERI. P.g., T.f. and T.d. could be found in the majority of all patients with both tests. With MERI, A.a. was detected more often (24.6%) than with PADO (18.8%). Only 10.1% of the patients tested positive for A.a. with both tests. CONCLUSION: Both tests showed a high percentage of agreement for P.g., T.f. and T.d., but exhibited marked differences in the detection of A.a.