The use of Lactobacillus reuteri DSM 17938 and ATCC PTA 5289 on oral health indexes in a school population: A pilot randomized clinical trial.

To assess the effects of a probiotic upon oral health indices in adolescents and to establish relationships between these indices and dietary habits and oral hygiene. Twenty-seven adolescents between 12 and 18 years of age were randomized into two groups. The study group received tablets containing Lactobacillus reuteri DSM 17938/ATCC 5289 for 28 days, while the control group received tablets without any bacteria. Streptococcus mutans, Lactobacillus sp., and salivary pH were assessed at baseline and at 7, 14, 21, 28, and 45 days. The plaque, gingivitis, and bleeding indices were recorded at baseline and at 14, 28, and 45 days. Dietary and oral hygiene habits were also evaluated by means of a questionnaire. A less marked rise in S. mutans was recorded in the study group. Improvements were observed in terms of plaque, gingivitis, and bleeding, though statistical significance was not reached. Oral pH increased in the study group, though not to a significant degree. Poorer eating habits were significantly correlated to increased plaque. The study parameters decreased with the two strains of L. reuteri DSM 17938 and ATCC PTA 5289, though the results failed to reach statistical.

Impact of heavy smoking on the clinical, microbiological and immunological parameters of patients with dental implants: a prospective cross-sectional study.

AIM: The aim of the present study was to investigate how heavy smoking influences the clinical, microbiological, and host-response characteristics in peri-implant sulcus fluid of patients with healthy dental implants. METHODS: A total of 29 individuals with 74 dental implants were included in the present study; 20 implants were in heavy smokers and 54 were in non-smokers. The modified gingival index, modified plaque index, and probing pocket depth were evaluated. Periodontopathogenic bacteria Tannerella forsythia, Treponema denticola, and Porphyromonas gingivalis were evaluated, together with the total bacterial load. Peri-implant sulcus fluid samples were analyzed for the quantification of interleukin-8, interleukin-1ß, interleukin-6, interleukin-10, and tumor necrosis factor-α. RESULTS: No significant differences in the clinical parameters evaluated were found between the groups, although smokers had poorer peri-implant parameters. Among the smokers, subgingival microbiota was composed of a greater number of periodontal pathogens; these differences were not statistically significant. Smokers showed a greater expression of interleukin-1ß, interleukin-6, interleukin-10, and tumor necrosis factor-α, but interleukin-8 was slightly higher among non-smokers, but not significantly. CONCLUSIONS: Although smokers presented deeper probing depths, bleeding on probing, and peri-implant microbiota composed of a greater number of periodontal pathogens than in non-smoking patients, these data did not show significant differences. In the present study, and in relation to the samples analyzed, smoking alone did not influence the immunological and microbiological parameters in dental implants with healthy peri-implant tissues. Further studies with larger samples are required to better evaluate the influence of smoking on dental implants.

Clinical, microbiological, and immunological aspects of healthy versus peri-implantitis tissue in full arch reconstruction patients: a prospective cross-sectional study.

BACKGROUND: Due to the world-wide increase in treatments involving implant placement, the incidence of peri-implant disease is increasing. Late implant failure is the result of the inability to maintain osseointegration, whose most important cause is peri-implantitis. The aim of this study was to analyze the clinical, microbiological, and immunological aspects in the peri-implant sulcus fluid (PISF) of patients with healthy dental implants and patients with peri-implantitis. METHODS: PISF samples were obtained from 24 peri-implantitis sites and 54 healthy peri-implant sites in this prospective cross-sectional study. The clinical parameters recorded were: modified gingival index (mGI), modified plaque index (mPI) and probing pocket depth (PPD). The periodontopathogenic bacteria Tannerella forsythia, Treponema denticola and Porphyromonas gingivalis were evaluated, together with the total bacterial load (TBL). PISF samples were analyzed for the quantification of Interleukin (IL)-8, IL-1ß, IL-6, IL-10 and Tumor Necrosis Factor (TNF)-α using flow cytometry (FACS). RESULTS: The mGI and PPD scores in the peri-implantitis group were significantly higher than the healthy group (p < 0.001). A total of 61.5% of the patients with peri-implantitis had both arches rehabilitated, compared with 22.7% of patients with healthy peri-implant tissues; there was no implant with peri-implantitis in cases that received mandibular treatment exclusively (p < 0.05). Concentrations of Porphyromonas gingivalis (p < 0.01), association with bacteria Porphyromonas gingivalis and Treponema denticola (p < 0.05), as well as the TBL (p < 0.05) are significantly higher in the peri-implantitis group. IL-1ß (p < 0.01), IL-6 (p < 0.01), IL-10 (p < 0.05) and TNF-α (p < 0.01) are significantly higher at the sites with peri-implantitis compared to healthy peri-implant tissue, while IL-8 did not increase significantly. CONCLUSION: The results of the present study involving a limited patient sample suggest that the peri-implant microbiota and which dental arch was rehabilitated involved could contribute to bone loss in peri-implantitis. A significant relationship is observed between the concentration of cytokines (interleukins 1ß, 6 and 10 and TNF-α) and the inflammatory response in peri-implantitis tissue.

Clinical, microbiologic, and host response characteristics in patients with peri-implant mucositis.

PURPOSE: To analyze the clinical, microbiologic, and host response characteristics (interleukins 1ß and 6) in the peri-implant sulcus fluid (PISF) of patients with healthy dental implants and with peri-implant mucositis. MATERIALS AND METHODS: Clinical parameters (modified Gingival Index [mGI], modified Plaque Index [mPI], probing pocket depth [PPD], and absence or presence of radiologic bone loss) were recorded, and PISF samples were obtained from peri-implant sites showing mucositis as well as healthy sites. The periodontopathogenic bacteria Tannerella forsythia (Tf), Treponema denticola (Td), and Porphyromonas gingivalis (Pg) were evaluated, together with the total bacterial load (TBL) and the interleukin (IL) 1ß and IL-6 values. RESULTS: The study population consisted of 34 individuals, and 77 dental implants were evaluated during the study (23 mucositis and 54 healthy peri-implant sites). The mGI, mPI, and PPD scores of the peri-implant mucositis group were significantly greater than in the healthy group. No differences in detection frequency were found for putative periodontal pathogens and TBL between the healthy peri-implant sites and mucositis sites. The mucositis group showed a significantly greater expression of IL-6 than the healthy group (P < .05). Although IL-1ß was increased in the mucositis group, there was no statistically significant difference versus the healthy implant group. CONCLUSIONS: An analysis was made of the clinical, microbiologic, and host response characteristics in implants with peri-implant mucositis, establishing comparisons with healthy implants. In the patients studied, bacterial plaque induced an inflammatory response that can lead to the development of peri-implant mucositis. Adequate plaque control is therefore able to increase peri-implant health, avoiding the risk of future complications. No specific association to the studied bacterial species was established.

Study of serum CTX in 50 oral surgical patients treated with oral bisphosphonates

Objectives: To determine whether there is a relationship between the total BP dose administered and the variations in serum CTX concentration. Study design: The study included 50 patients requiring dental implant surgery and treated with oral BPs, seen in an Oral Surgery and Implantology Unit between January 2007 and June 2009. The patients were divided into two groups: those in which the medication was not suspended before obtaining the laboratory test sample, and those patients referred from other dental clinics in which BPs was suspended before reporting to our Unit. The total drug dosage administered and the total dose per kilogram body weight were evaluated for comparison with serum CTX. The data obtained were correlated to the osteonecrosis risk table developed by Marx et al. in 2007.Results: There were no significant differences between the two groups in relation to the total administered dose and the dose in mg/kg b.w. Likewise, in both groups no relationship was observed between the serum CTX value and the total administered dose or the dose in mg/kg b.w. No differences were found between the two patient groups regarding chemical osteonecrosis risk based on the criteria of Marx et al Conclusions: No relationship was observed between the oral BP dose administered (total dose or expressed in mg/kg b.w.) and serum CTX concentration, and suspension of the medication did not influence the serum CTX levels (AU)

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Study of serum CTX in 50 oral surgical patients treated with oral bisphosphonates.

OBJECTIVES: To determine whether there is a relationship between the total BP dose administered and the variations in serum CTX concentration. STUDY DESIGN: The study included 50 patients requiring dental implant surgery and treated with oral BPs, seen in an Oral Surgery and Implantology Unit between January 2007 and June 2009. The patients were divided into two groups: those in which the medication was not suspended before obtaining the laboratory test sample, and those patients referred from other dental clinics in which BPs was suspended before reporting to our Unit. The total drug dosage administered and the total dose per kilogram body weight were evaluated for comparison with serum CTX. The data obtained were correlated to the osteonecrosis risk table developed by Marx et al. in 2007. RESULTS: There were no significant differences between the two groups in relation to the total administered dose and the dose in mg/kg b.w. Likewise, in both groups no relationship was observed between the serum CTX value and the total administered dose or the dose in mg/kg b.w. No differences were found between the two patient groups regarding chemical osteonecrosis risk based on the criteria of Marx et al. CONCLUSIONS: No relationship was observed between the oral BP dose administered (total dose or expressed in mg/kg b.w.) and serum CTX concentration, and suspension of the medication did not influence the serum CTX levels.

Peri-implantitis: Associated microbiota and treatment

Introduction: Peri-implantitis is a late complication of dental implant treatment, induced by microbiological changes. Since the disorder is frequent, a review is indicated of the microorganisms that influence it and of the existing treatment options.Objective: To conduct a literature review of the microbiota associated to peri-implantitis and the existing treatmentoptions.Material and Method: A PubMed literature search was made of the studies on the microbiota associated to dental implants in healthy patients and patients with peri-implantitis, as well as of the latest treatment developments,using the following key words: “peri-implantitis AND microbiota”, “periimplantitis AND microbiota”, “periimplantitis AND treatment”, and “periimplantitis AND treatment”. Only clinical studies in humans were considered.The following criteria were applied for including articles in the analysis: a) for the peri-implant microbiota,the search limits were human studies after the year 2000; and b) for the treatment of peri-implantitis, the search limits were randomized and controlled clinical trials (RCTs) in humans, with a minimum follow-up of 4 months,and publication after the year 2000.Results: A total of 18 articles were selected in relation to peri-implant microbiota, and 13 in relation to the treatment of peri-implantitis (8 involving nonsurgical mechanical treatments and 5 surgical procedures).Conclusions: Evaluation of the literature has shown the microbiota associated to peri-implantitis to be more complex than that found under healthy peri-implant conditions – the main flora consisting of anaerobic gramnegative bacteria. No clear criteria have been identified for the diagnosis and treatment of peri-implantitis (AU)

Analysis of the peri-implant microbiota in 90 dental implants and itsr elationship to crevicular fluid volume

Objective: To evaluate the presence within the peri-implant sulcus of Tannerela forsythia (Tf), Porphyromonasgingivales (Pg), Treponema denticola (Td) and Aggregatibacter actinomycetemcomitans (Aa), and relate these bacteria to the peri-implant crevicular fluid volume (PICFV).Material and Method: A prospective and cross-sectional clinical case series study was made. For the measurement of crevicular fluid, use was made of the Periotron® 8000 (Proflow Incorporated. New York, USA), measuring the volume in Periotron units (PU). For the detection of period ontopathogenic bacteria we used the IAI-PadoTest 4.5 (IAI Inc., IAI Institute, Zuchwil, Switzerland) – a system for the detection of Tf, Pg, Td and Aa based on the use of RNA arrays.Results: We included 34 patients (19 females and 15 males) with a mean age of 56.4 years. Of these subjects, 30.8%were smokers and 69.2% non-smokers. Out of a total series of 213 implants, we analyzed the crevicular fluid and microbiota in 90 implants. A total of 16.5% of the implants presented mucositis, while 83.5% were in healthy peri implantconditions. The microbiological study revealed the presence of Tf in 17.1% of the implants, Pg in 9.3%, Tdin 13.6%, in Aa in none of the implants. The mean Periotron reading was 93.4 PU (range 12-198 PU). A statistically significant (p<0.05) relationship was observed between PICFV and the total percentage bacteria (Tf, Pg andTd) – with a strong association between the Td levels and smoking (p<0.01). In the implants with mucositis, the concentration of Pg and Td was greater.Conclusions: In the implants studied, the subgingival peri-implant microbiota was characterized by low levels ofPg, Tf, Td, and none of the patients proved positive for Aa. These bacteria showed a positive correlation to crevicular fluid volume, and a statistically significant relationship was observed between Td and smoking (AU)

Peri-implantitis: associated microbiota and treatment.

INTRODUCTION: Peri-implantitis is a late complication of dental implant treatment, induced by microbiological changes. Since the disorder is frequent, a review is indicated of the microorganisms that influence it and of the existing treatment options. OBJECTIVE: To conduct a literature review of the microbiota associated to peri-implantitis and the existing treatment options. MATERIAL AND METHOD: A PubMed literature search was made of the studies on the microbiota associated to dental implants in healthy patients and patients with peri-implantitis, as well as of the latest treatment developments, using the following key words: "peri-implantitis AND microbiota", "periimplantitis AND microbiota", "peri-implantitis AND treatment", and "periimplantitis AND treatment". Only clinical studies in humans were considered. The following criteria were applied for including articles in the analysis: a) for the peri-implant microbiota, the search limits were human studies after the year 2000; and b) for the treatment of peri-implantitis, the search limits were randomized and controlled clinical trials (RCTs) in humans, with a minimum follow-up of 4 months, and publication after the year 2000. RESULTS: A total of 18 articles were selected in relation to peri-implant microbiota, and 13 in relation to the treatment of peri-implantitis (8 involving nonsurgical mechanical treatments and 5 surgical procedures). CONCLUSIONS: Evaluation of the literature has shown the microbiota associated to peri-implantitis to be more complex than that found under healthy peri-implant conditions - the main flora consisting of anaerobic gramnegative bacteria. No clear criteria have been identified for the diagnosis and treatment of peri-implantitis.

Interleukins IL-6, IL-8, IL-10, IL-12 and periimplant disease. An update

Introduction: A study is made of the usefulness of cytokines (such as interleukin-6 (IL-6), interleukin-8 (IL-8),interleukin-10 (IL-10) and interleukin-12 (IL-12)) as markers of periimplant disease (mucositis and periimplantitis).An increase in the levels of these cytokines in dental implant crevicular fluid may give rise to a lack of osteointegration,bone loss or implant failure.Objective: To review the literature relating IL-6, IL-8, IL-10 and IL-12 levels to dental implant surgery and periimplantitis.Material and Method: A PubMed literature search was made of articles in English and Spanish, using the keywords “cytokine and dental implants”, cytokine and periimplantitis”, “IL-6, IL-8, IL-10, IL-12 and dental implants”,“IL-6, IL-8, IL-10, IL-12 and periimplantitis”. Fourteen articles were found and classified into two groupsrelating interleukin levels to: a) periimplant disease; and b) their influence upon dental implant osteointegrationwithout periimplant disease.Conclusions: An increase in interleukin levels is observed in patients with periimplant disease, though there iscontroversy over the effect of interleukins in crevicular fluid and periimplantitis in relation to implant failure orthe development of periimplant disease (AU)

Interleukins IL-6, IL-8, IL-10, IL-12 and periimplant disease. An update.

INTRODUCTION: A study is made of the usefulness of cytokines (such as interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10) and interleukin-12 (IL-12)) as markers of periimplant disease (mucositis and periimplantitis). An increase in the levels of these cytokines in dental implant crevicular fluid may give rise to a lack of osteointegration, bone loss or implant failure. OBJECTIVE: To review the literature relating IL-6, IL-8, IL-10 and IL-12 levels to dental implant surgery and periimplantitis. MATERIAL AND METHOD: A PubMed literature search was made of articles in English and Spanish, using the key words "cytokine and dental implants", cytokine and periimplantitis", "IL-6, IL-8, IL-10, IL-12 and dental implants", "IL-6, IL-8, IL-10, IL-12 and periimplantitis". Fourteen articles were found and classified into two groups relating interleukin levels to: a) periimplant disease; and b) their influence upon dental implant osteointegration without periimplant disease. CONCLUSIONS: An increase in interleukin levels is observed in patients with periimplant disease, though there is controversy over the effect of interleukins in crevicular fluid and periimplantitis in relation to implant failure or the development of periimplant disease.

Probiotic treatment in the oral cavity: An update

Probiotics have been found to be beneficial to host health. Their primary use in medicine has been for the management of intestinal tract problems.In recent years, probiotics have been used as a treatment to promote oral health. The aim of the present study was to review published studies regarding probiotics and their effects on the oral cavity. Studies reporting the anticariogenic effects of probiotics, their use in the treatment of periodontal disease, a reduced crevicular fluid volume and cytokine content, as well as their use in the treatment of halitosis and Candida albicans were identified. Studies assessing residence time of probiotics in the oral cavity were also selected for retrieval. Most authors concluded that the use of oral probiotics was associated with an improvement in oral health, including a significantly reduced level of cariogenic and periodontal pathogens and a lower crevicular fluid volume and cytokine concentration (AU)

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Probiotic treatment in the oral cavity: an update.

Probiotics have been found to be beneficial to host health. Their primary use in medicine has been for the management of intestinal tract problems. In recent years, probiotics have been used as a treatment to promote oral health. The aim of the present study was to review published studies regarding probiotics and their effects on the oral cavity. Studies reporting the anticariogenic effects of probiotics, their use in the treatment of periodontal disease, a reduced crevicular fluid volume and cytokine content, as well as their use in the treatment of halitosis and Candida albicans were identified. Studies assessing residence time of probiotics in the oral cavity were also selected for retrieval. Most authors concluded that the use of oral probiotics was associated with an improvement in oral health, including a significantly reduced level of cariogenic and periodontal pathogens and a lower crevicular fluid volume and cytokine concentration.

Bisphosphonates and dental implants: Current problems

Osteonecrosis of the jaw has been described in patients taking bisphosphonates after oral surgery procedures, including the placement of dental implants. This review is an update of the relationship between bisphosphonates and dental implants.
Results obtained by different authors are compared, contrasting earlier studies where an improvement in implant osseointegration using bisphosphonates was observed, with ones where statistically significant differences were found, and more recent studies disagreeing with the use of bisphosphonates for causing necrosis of the jaw. The differing results obtained between animal studies and the situation observed in humans may be due to a short medication and follow-up period, as well as to the existence of few research studies where dental implants are placed in the oral cavity. Currently, dental implants are contraindicated in patients being treated with intravenous bisphosphonates. In 2007, the American Association of Oral and Maxillofacial Surgeons suggested guidelines for patients treated with oral bisphosphonates, based on the clinical situation of the patient and the length of treatment with the drug, and that greater caution prior and subsequent to surgery should be taken for three years after treatment. All patients treated with bisphosphonates must have the risk of possible loss of implants and the risk of suffering a bony necrosis of the operated jaw explained to them, and give their informed consent prior to dental implant surgery (AU)

Bisphosphonates and dental implants: current problems.

Osteonecrosis of the jaw has been described in patients taking bisphosphonates after oral surgery procedures, including the placement of dental implants. This review is an update of the relationship between bisphosphonates and dental implants. Results obtained by different authors are compared, contrasting earlier studies where an improvement in implant osseointegration using bisphosphonates was observed, with ones where statistically significant differences were found, and more recent studies disagreeing with the use of bisphosphonates for causing necrosis of the jaw. The differing results obtained between animal studies and the situation observed in humans may be due to a short medication and follow-up period, as well as to the existence of few research studies where dental implants are placed in the oral cavity. Currently, dental implants are contraindicated in patients being treated with intravenous bisphosphonates. In 2007, the American Association of Oral and Maxillofacial Surgeons suggested guidelines for patients treated with oral bisphosphonates, based on the clinical situation of the patient and the length of treatment with the drug, and that greater caution prior and subsequent to surgery should be taken for three years after treatment. All patients treated with bisphosphonates must have the risk of possible loss of implants and the risk of suffering a bony necrosis of the operated jaw explained to them, and give their informed consent prior to dental implant surgery.

Dentinal sensitivity: Concept and methodology for its objective evaluation

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Dentinal sensitivity is a clinical condition of some importance, particularly in periodontal patients. Symptoms appear on applying a triggering stimulus to the exposed dentine - the particularity being that the pain is similar to that of other dental disorders of different etiology and treatment. Hence the importance of a correct differential diagnosis. The main problem not only in clinical practice when treating the disorder, but also in designing studies for the objectiveevaluation of dentinal sensitivity, is the difficulty of standardizing, evaluating and interpreting the clinical condition in its different degrees. Thus, consensus in designing and evaluating studies of dentinal sensitivity would facilitate our understanding of its etiology, and the assessment of possible treatments. Such studies may center their methodology on individual patient response or on the nature of the triggering stimulus. The present study provides an updated and global view of the disorder, and reviews the basic protocol for the objective assessment of dentinal sensitivity

Dentinal sensitivity: concept and methodology for its objective evaluation.

Dentinal sensitivity is a clinical condition of some importance, particularly in periodontal patients. Symptoms appear on applying a triggering stimulus to the exposed dentine - the particularity being that the pain is similar to that of other dental disorders of different etiology and treatment. Hence the importance of a correct differential diagnosis. The main problem not only in clinical practice when treating the disorder, but also in designing studies for the objective evaluation of dentinal sensitivity, is the difficulty of standardizing, evaluating and interpreting the clinical condition in its different degrees. Thus, consensus in designing and evaluating studies of dentinal sensitivity would facilitate our understanding of its etiology, and the assessment of possible treatments. Such studies may center their methodology on individual patient response or on the nature of the triggering stimulus. The present study provides an updated and global view of the disorder, and reviews the basic protocol for the objective assessment of dentinal sensitivity.