Low Level Laser Therapy With an 810-nm Diode Laser Affects the Proliferation and Differentiation of Premature Osteoblasts and Human Gingival Fibroblasts In Vitro.

Introduction: Photomodulation is a promising strategy for optimizing tissue healing, but its photomodulatory effects on the synergistic cellular metabolism of gingival and bony tissues remain largely unknown. The aim of the present study was to evaluate the photomodulatory effects of a diode laser (810 nm) on osteoblasts, HGFs and their co-cultures in vitro. Methods: Primary cultures of HGFs, cultures of immature osteoblastic cells (MG63) and their co-cultures were irradiated with a diode laser (810 nm), 15 J/cm2. Cell cultures were examined for cellular proliferation (MTT assay), viability (FDA/PI staining) after 24, 48 and 72 hours and cell differentiation (qPCR of collagen type 1a - COL1a and alkaline phosphatase expressions - ALP) after 7 days. Results: Photomodulation with an 810-nm diode laser increased cell proliferation at all time points. COL1a gene expression increased both in HGF and co-cultures. ALP expression was up-regulated in osteoblastic cultures, but co-cultures with fibroblasts negated this response. Conclusion: The 810-nm diode laser positively affected cell proliferation and viability in all experimental groups. The statistically significant increased COL1a gene expression at 7 days after irradiation both in the irradiated HGF and co-cultures suggests that low-level laser therapy (LLLT) stimulated extracellular matrix (ECM) formation signaling in both cell types.

General genetic and acquired risk factors, and prevalence of peri-implant diseases - Consensus report of working group 1.

For decades, oral implants have been used successfully for the replacement of missing teeth. Nevertheless, peri-implant diseases have become an increasingly important issue in daily practice. In this working group, the prevalence of peri-implant mucositis and peri-implantitis, as well as different general risk factors and their impact on the onset and progression of peri-implant diseases, were discussed based on reviews reflecting the current state of evidence. The influence of smoking on the peri-implant bone-healing process and its association with peri-implantitis has been explored in the current literature, demonstrating that smoking is an important risk indicator for the development of peri-implantitis and implant loss. Compared with non-smokers, smokers have a higher potential for pathological peri-implant bone loss, which is also influenced by poor oral hygiene. Despite the fact that a growing number of genetic polymorphisms have been identified and related to periodontal diseases, there are still no genetic patterns that could act as adjuncts to clinical diagnostics in order to identify patients at higher risk of peri-implant diseases. Long-term medications, such as bisphosphonate therapy (> 3 years), may have an impact on implant loss. A higher incidence of implant failure was reported in patients using selective serotonin reuptake inhibitors in anti-depression therapy. Alcoholism (defined as more than 5 units a day) has been associated with implant loss in retrospective and case-control studies, as well as in animal studies.

Genetic Risk Factors for the Development of Periimplantitis.

INTRODUCTION: Periimplantitis etiology is multifactorial. The aim of this review is to identify the available data so far concerning the association between genetic polymorphisms and periimplantitis risk. MATERIALS AND METHODS: A literature search was performed in MEDLINE using the PubMed database of the US National Library of Medicine for articles published until March 2018. In addition, a manual search was performed. Our search and application of eligibility criteria provided 23 articles. Genes in these 23 studies could be divided into 3 overlapping categories: genes associated with (a) immune function, (b) bone growth, and (c) regulation of gene expression. DISCUSSION: The pathogenesis of periimplantitis is not currently well understood. There are some polymorphisms, for which different studies state consistent results. However, there are many polymorphisms with conflicting results, which could be attributed to differences in study design. CONCLUSION: The identification of genetic biomarkers associated with periimplantitis risk could be valuable in daily clinical practice. However, no robust conclusions could be drawn from the current literature. The inequality of these studies' design necessitates the conduction of further studies using larger population samples and from different ethnic groups.

Spongiotic Gingival Hyperplasia Synchronously Involving Multiple Sites: Case Report and Review of the Literature.

Localized juvenile spongiotic gingival hyperplasia (LJSGH) is a gingival lesion with unique clinicopathologic features that may involve synchronously multiple sites. We present a case with lesions clinically consistent with LJSGH in four jaw quadrants, confirmed by biopsy and review the English literature on multifocal LJSGH cases. A 19 year-old woman presented with circumscribed, erythematous overgrowths on the right and left maxillary and mandibular gingiva. With the provisional diagnosis of multifocal LJSGH, total excision of four maxillary lesions was performed. Clinical, microscopic and immunohistochemical examination with cytokeratin 19 confirmed the diagnosis of LJSGH in multiple sites. The excised lesions showed partial to complete recurrence after 4 months, while spontaneous regression of all but one lesion was observed after 15 months. Twenty cases with synchronous involvement of the gingiva of at least two teeth were previously reported. Their clinical features were comparable to that of solitary LJSGH. Only one case involved all four jaw quadrants. Spontaneous remission has not been documented before. The recognition of multiple lesions with clinicopathologic features diagnostic of LJSGH in the same adult patient argue against the designations "localized" and "juvenile". Recurrences are common, while remission might occur.

Xenogenic collagen matrix or autologous connective tissue graft as adjunct to coronally advanced flaps for coverage of multiple adjacent gingival recession: Randomized trial assessing non-inferiority in root coverage and superiority in oral health-related quality of life.

AIM: To evaluate the non-inferiority of the adjunct of a xenogeneic collagen matrix (CMX) or connective tissue graft (CTG) to coronally advanced flaps (CAF) for coverage of multiple adjacent recessions and compare superiority in patient-reported outcomes (PROM). MATERIAL AND METHODS: One hundred and eighty-seven subjects (92 CMX) with 485 recessions in 14 centres were randomized and followed up for 6 months. Patients filled daily diaries for 15 days to monitor patient-reported experience. The primary outcome was changed in position of the gingival margin. Multilevel analysis used centre, subject and tooth as levels and baseline parameters as covariates. RESULTS: Average baseline recession was 2.5 ± 1.0 mm. The surgery was 15.7 min shorter (95%CI from 11.9 to 19.6, p < .0001) and perceived lighter (11.9 VAS units, 95%CI from 4.6 to 19.1, p = .0014) in CMX subjects. Time to recovery was 1.8 days shorter in CMX. Six-month root coverage was 1.7 ± 1.1 mm for CMX and 2.1 ± 1.0 mm for CTG (difference of 0.44 mm, 95%CI from 0.25 to 0.63 mm). The upper limit of the confidence interval was over the non-inferiority margin of 0.25 mm. Odds of complete root coverage were significantly higher for CTG (OR = 4.0, 95% CI 1.8-8.8). CONCLUSION: Replacing CTG with CMX shortens time to recovery and decreases morbidity, but the tested generation of devices is probably inferior to autologous CTG in terms of root coverage. Significant variability in PROMs was observed among centres.

Effects of a single topical doxycycline administration adjunctive to mechanical debridement in patients with persistent/recurrent periodontitis but acceptable oral hygiene during supportive periodontal therapy.

OBJECTIVES: To evaluate the efficacy of a slow release doxycycline gel (SRD) adjunctively administered to non-surgical therapy in subjects with recurrent or persistent periodontitis but acceptable oral hygiene during supportive periodontal care. MATERIAL & METHODS: In this single blind, parallel group, multicentre study, 202 of 203 recruited periodontal maintenance subjects with recurrent or persistent periodontitis were randomly assigned to subgingival ultrasonic/sonic instrumentation (USI) with (test) or without (control) subsequent administration of SRD in all residual periodontal pockets ≥4 mm. Intergroup differences in probing depth, BOP reductions, treatment time, probing attachment levels were evaluated at 3, 6 and 12 months. The primary outcome was the inter-group difference in absolute change of probing pocket depth (PPD) 3, 6 and 12 months after intervention. RESULTS: At baseline, the two groups were comparable. At 3 months, the test group showed a significantly higher decrease in mean probing depth than the control group at 3 months (mean difference = 0.11 mm, 95% CI 0.03-0.19 mm, p = 0.003). Administration of SRD resulted in significantly greater odds of transition of bleeding pockets ≥5 mm to a category of non bleeding sites with PPD ≤4 mm at 3 and 6 months (O.R. = 1.4, 95% CI 1.2-1.8 at 3 months). At 6 months, SRD benefit was observed only in the deeper pockets. 7.5% of subjects (no significant difference between test and control) showed disease progression (attachment loss ≥2 mm) and were exited from the study. No difference in the incidence of adverse events was observed between groups. CONCLUSION: The trial results show that topically administered SRD may provide short-term benefit in controlling inflammation and deep pockets in treated periodontal patients participating in a secondary prevention programme and able to maintain a satisfactory level of oral hygiene.

A systematic review and meta-analysis on the effect of implant length on the survival of rough-surface dental implants.

BACKGROUND: A meta-analysis on the survival of short implants compared to conventional implants has never been performed. Therefore, the aim of this study was to address the focused question "Is there a significant difference in survival between short (or=10 mm) rough-surface dental implants placed in 1) totally or 2) partially edentulous patients?" by conducting a systematic review and meta-analysis of prospective studies published in the dental literature in the English language up to and including August 2007. METHODS: PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were scanned electronically, and seven journals were searched manually. In the first phase of selection, titles and abstracts, and in the second phase, full texts, were evaluated autonomously and in duplicate by two reviewers. Extensive contact with authors was carried out in search of missing, unclear, or unpublished data. RESULTS: The electronic and manual search provided, respectively, 1,056 and 14,417 titles and abstracts. In the second phase of selection, the complete text of 300 articles was examined, and 37 articles reporting on 22 patient cohorts were selected. Meta-analyses revealed no statistically significant difference in survival between short (or=10 mm) rough-surface implants placed in totally or partially edentulous patients. CONCLUSIONS: Within the limitations of this systematic review, the placement of short rough-surface implants is not a less efficacious treatment modality compared to the placement of conventional rough-surface implants for the replacement of missing teeth in either totally or partially edentulous patients.

Therapy of peri-implantitis: a systematic review.

AIM: The objective of this study was to provide a systematic review of randomized controlled and/or comparative clinical trials published in the international peer-reviewed literature in the English language, up to and including July 2007, concerning the efficacy of all treatment modalities implemented for the therapy of peri-implantitis. MATERIAL AND METHODS: PubMed and The Cochrane Library databases were searched electronically and numerous journals were examined manually. In the first phase of selection, the titles and abstracts, and in the second phase, complete papers were screened independently and in duplicate by three reviewers (S. K., I. K. K. and M. T.). RESULTS: The search yielded 1304 possibly relevant titles and abstracts. After the first phase of selection, 13 publications were singled out for a rigorous evaluation. Following the second phase, five studies were selected. CONCLUSIONS: The selected studies are too limited in number and exhibit small sample sizes and short follow-up periods. Therefore, there is a definite need for more well-designed, preferably longitudinal, randomized controlled clinical trials. Within the limitations of the selected studies, mechanical debridement combined with antiseptic/antibiotic therapy, the Er:YAG laser or regenerative techniques may be used for treating peri-implantitis, but the indications for each of these techniques have not been delineated clearly.

A comprehensive and critical review of dental implant prognosis in periodontally compromised partially edentulous patients.

OBJECTIVES: The outcome of implant treatment in periodontally compromised partially edentulous patients has not been completely clarified. Therefore, the aim of the present study was to perform, applying a systematic methodology, a comprehensive and critical review of the prospective studies published in English up to and including August 2006, regarding the short-term (<5 years) and long-term (>or=5 years) prognosis of osseointegrated implants placed in periodontally compromised partially edentulous patients. MATERIAL AND METHODS: Using The National Library Of Medicine and Cochrane Oral Health Group databases, a literature search for articles published up to and including August 2006 was performed. At the first phase of selection the titles and abstracts and at the second phase full papers were screened independently and in duplicate by the three reviewers (I. K. K., S. K., I. F.). RESULTS: The search provided 2987 potentially relevant titles and abstracts. At the first phase of evaluation, 2956 publications were rejected based on title and abstract. At the second phase, the full text of the remaining 31 publications was retrieved for more detailed evaluation. Finally, 15 prospective studies were selected, including seven short-term and eight long-term studies. Because of considerable discrepancies among these studies, meta-analysis was not performed. CONCLUSIONS: No statistically significant differences in both short-term and long-term implant survival exist between patients with a history of chronic periodontitis and periodontally healthy individuals. Patients with a history of chronic periodontitis may exhibit significantly greater long-term probing pocket depth, peri-implant marginal bone loss and incidence of peri-implantitis compared with periodontally healthy subjects. Even though the short-term implant prognosis for patients treated for aggressive periodontitis is acceptable, on a long-term basis the matter is open to question. Alterations in clinical parameters around implants and teeth in aggressive periodontitis patients may not follow the same pattern, in contrast to what has been reported for chronic periodontitis patients. However, as only three studies comprising patients treated for aggressive periodontitis were selected, more studies, specially designed, are required to evaluate implant prognosis in this subtype of periodontitis. As the selected publications exhibited considerable discrepancies, more studies, uniformly designed, preferably longitudinal, prospective and controlled, would be important.

Immediate implant placement with transmucosal healing in areas of aesthetic priority. A multicentre randomized-controlled clinical trial I. Surgical outcomes.

OBJECTIVES: To compare the clinical outcomes of standard, cylindrical, screw-shaped to novel tapered, transmucosal (Straumann Dental implants immediately placed into extraction sockets. MATERIAL AND METHODS: In this randomized-controlled clinical trial, outcomes were evaluated over a 3-year observation period. This report deals with the need for bone augmentation, healing events, implant stability and patient-centred outcomes up to 3 months only. Nine centres contributed a total of 208 immediate implant placements. All surgical and post-surgical procedures and the evaluation parameters were discussed with representatives of all centres during a calibration meeting. Following careful luxation of the designated tooth, allocation of the devices was randomly performed by a central study registrar. The allocated SLA titanium implant was installed at the bottom or in the palatal wall of the extraction socket until primary stability was reached. If the extraction socket was >or=1 mm larger than the implant, guided bone regeneration was performed simultaneously (Bio Oss and BioGide. The flaps were then sutured. During non-submerged transmucosal healing, everything was done to prevent infection. At surgery, the need for augmentation and the degree of wound closure was verified. Implant stability was assessed clinically and by means of resonance frequency analysis (RFA) at surgery and after 3 months. Wound healing was evaluated after 1, 2, 6 and 12 weeks post-operatively. RESULTS: The demographic data did not show any differences between the patients receiving either standard cylindrical or tapered implants. All implants yielded uneventful healing with 15% wound dehiscences after 1 week. After 2 weeks, 93%, after 6 weeks 96%, and after 12 weeks 100% of the flaps were closed. Ninety percent of both implant designs required bone augmentation. Immediately after implantation, RFA values were 55.8 and 56.7 and at 3 months 59.4 and 61.1 for cylindrical and tapered implants, respectively. Patient-centred outcomes did not differ between the two implant designs. However, a clear preference of the surgeon's perception for the appropriateness of the novel-tapered implant was evident. CONCLUSIONS: This RCT has demonstrated that tapered or standard cylindrical implants yielded clinically equivalent short-term outcomes after immediate implant placement into the extraction socket.

A comprehensive and critical review of dental implant placement in diabetic animals and patients.

OBJECTIVES: A thorough and exhaustive analysis of the available studies concerning placement of endosseous dental implants in diabetic subjects has not been previously published. The aim of the present study was to perform a comprehensive and critical review of experimental and clinical studies published in the international peer-reviewed literature in the English language regarding endosseous implant installation in diabetic subjects and to draw evidence-based conclusions on the effectiveness and predictability of dental implant therapy in diabetic patients. MATERIAL AND METHODS: Literature search for articles published up to and including March 2005 in the English language was performed with a personal computer (PC) using The National Library Of Medicine (http://www.ncbi.nlm.nih.gov/PubMed) and Cochrane Oral Health Group databases. Search strategy included a specific series of terms and key words. The reference lists of identified publications, relevant texts and previous workshops were also scanned. Data sources also included several hand-searched journals and contact with experts, when it was considered appropriate. Search was conducted independently by the three reviewers (S. K., I. K. K., I. F.). At the first phase of selection the titles and abstracts and at the second phase full papers were screened independently by the three reviewers. Disagreement regarding inclusion of full papers was resolved by discussion among the reviewers. RESULTS: The search provided 227 potentially relevant titles and abstracts. At the first phase of evaluation, 199 publications were rejected based on title and abstract. At the second phase, the full text of the remaining 28 publications was retrieved for more detailed evaluation. These publications included 11 experimental studies and 16 clinical studies (one clinical study corresponded to two publications). Finally, 11 experimental and eight clinical studies were accepted. Clinical studies included four prospective and four retrospective studies. Because of the limited number of available studies and their heterogeneity, focusing on a specific predefined question to be answered by a systematic review was not feasible and therefore no meta-analysis was planned. CONCLUSION: Within the limits of the existing investigations, experimental studies seem to reveal an impaired bone healing response to implant placement in diabetic animals compared with non-diabetic controls, both quantitatively and qualitatively. The majority of clinical studies tend to indicate that diabetes is no contraindication for implant placement, on condition that it remains under metabolic control. However, definitive guidelines with objective criteria, such as type and duration of diabetes and glucosylated hemoglobin levels, need to be established in the future.

Healing, post-operative morbidity and patient perception of outcomes following regenerative therapy of deep intrabony defects.

AIM: This prospective multicenter randomized controlled clinical trial was designed to compare the clinical outcomes of papilla preservation flap surgery with or without the application of enamel matrix derivatives (EMD). This article reports on early healing events, post-operative morbidity and patient perceptions of the surgical outcomes. MATERIAL AND METHODS: One hundred and seventy-two patients with advanced chronic periodontitis and at least one intrabony defect of > or =3 mm were recruited in 12 centres in seven countries (European Research Group on Periodontology (ERGOPERIO)). Papilla preservation flaps were used to obtain access and primary closure. After debridement, and root conditioning, EMD was applied in the test subjects, and omitted in the controls. Healing was monitored 1, 2, 3, 4, 6 and 12 weeks after surgery. During the first 12 weeks of healing, supracrestal soft-tissue density was evaluated with a computer-assisted densitometric image analysis system (CADIA) using underexposed radiographs taken on a subset of 34 patients. Patient perceptions were evaluated with a questionnaire immediately after the procedure, at suture removal 1 week later and at 1 year. RESULTS: Subjects reported little intraoperative or post-operative pain or discomfort for both test and controls. Twenty-four percent of controls and 30% of tests (p=0.64) reported a degree of interference with daily activities for an average of 3 and 3.5 days, respectively. Post-surgical edema was noted in 25% of tests and 28% of controls. Wound dehiscence in the interdental portion of the flap was uncommon (14% of tests and 12% of controls at week 1) and of limited size. Root sensitivity was the most frequent post-operative adverse event: it affected 45% of test and 35% of controls (p=0.55). Up to 6 weeks post-operatively, soft-tissue densities were significantly higher in subjects treated with EMD with respect to controls. One year after completion of the surgery, patients reported high levels of satisfaction with the outcomes. The most frequently reported benefits included the ability to preserve a tooth/dentition and to maintain/improve chewing ability. The cost and need for frequent follow-ups were cited as significant drawbacks. CONCLUSIONS: This study portrayed the early healing events, pain, discomfort and adverse events of papilla preservation flap surgery and the 1-year patient perceptions of the benefits and disadvantages of periodontal surgery in intrabony defects. Earlier gains in soft-tissue density were observed following application of EMD. In terms of patient-centered outcomes, however, both procedures performed in a similar manner.

Clinical outcomes following treatment of human intrabony defects with GTR/bone replacement material or access flap alone. A multicenter randomized controlled clinical trial.

AIM: This prospective multicenter randomized controlled clinical trial was designed to compare the clinical outcomes of papilla preservation flap surgery with or without the application of a guided tissue regeneration (GTR)/bone replacement material. MATERIALS AND METHODS: One hundred and twenty-four patients with advanced chronic periodontitis were recruited in 10 centers in seven countries. All patients had at least one intrabony defect of > or = 3 mm. The surgical procedures included access for root instrumentation using either the simplified or the modified papilla preservation flap in order to obtain optimal tissue adaptation and primary closure. After debridement, the regenerative material was applied in the test subjects, and omitted in the controls. At baseline and 1 year following the interventions, clinical attachment levels (CALs), probing pocket depths (PPDs), recession, full-mouth plaque scores and full-mouth bleeding scores (FMBS) were assessed. RESULTS: One year after treatment, the test defects gained 3.3 +/- 1.7 mm of CAL, while the control defects yielded a significantly lower CAL gain of 2.5 +/- 1.5 mm. Pocket reduction was also significantly higher in the test group (3.7 +/- 1.8 mm) when compared with the controls (3.2 +/- 1.5 mm). A multivariate analysis indicated that the treatment, the clinical centers, baseline PPD and baseline FMBS significantly influenced CAL gains. Odds ratios (ORs) of achieving above-median CAL gains were significantly improved by the test procedure (OR = 2.6, 95% CI 1.2-5.4) and by starting with deeper PPD (OR = 1.7, 1.3-2.2) but were decreased by receiving treatment at the worst-performing clinical center (OR = 0.9, 0.76-0.99). CONCLUSIONS: The results of this trial indicated that regenerative periodontal surgery with a GTR/bone replacement material offers an additional benefit in terms of CAL gains, PPD reductions and predictability of outcomes with respect to papilla preservation flaps alone.

Enamel matrix proteins in the regenerative therapy of deep intrabony defects.

AIM: This prospective multicentre randomized controlled clinical trial was designed to compare the clinical outcomes of papilla preservation flap surgery with or without the application of enamel matrix proteins (EMD). MATERIAL AND METHODS: 172 patients with advanced chronic periodontitis were recruited in 12 centers in 7 countries. All patients had at least one intrabony defect of > or =3mm. Heavy smokers (> or =20 cigarettes/day) were excluded. The surgical procedures included access for root instrumentation using either the simplified or the modified papilla preservation flap in order to obtain optimal tissue adaptation and primary closure. After debridement, roots were conditioned for 2 min with a gel containing 24% EDTA. EMD was applied in the test subjects, and omitted in the controls. Postsurgically, a strict plaque control protocol was followed. At baseline and 1 year following the interventions, clinical attachment levels (CAL), pocket probing depths (PPD), recession (REC), full-mouth plaque scores and full-mouth bleeding scores were assessed. A total of 166 patients were available for the 1-year follow-up. RESULTS: At baseline, 86 test and 86 control patients presented with similar subject and defect characteristics. On average, the test defects gained 3.1+/-1.5 mm of CAL, while the control defects yielded a significantly lower CAL gain of 2.5+/-1.5 mm. Pocket reduction was also significantly higher in the test group (3.9+/-1.7 mm) when compared to the controls (3.3+/-1.7 mm). A multivariate analysis indicated that the treatment, the clinical centers, cigarette smoking, baseline PPD, and defect corticalisation significantly influenced CAL gains. A frequency distribution analysis of the studied outcomes indicated that EMD increased the predictability of clinically significant results (CAL gains > or =4 mm) and decreased the probability of obtaining negligible or no gains in CAL (CAL gains <2 mm). CONCLUSIONS: The results of this trial indicated that regenerative periodontal surgery with EMD offers an additional benefit in terms of CAL gains, PPD reductions and predictability of outcomes with respect to papilla preservation flaps alone.