Predictive Periodontitis: The Most Promising Salivary Biomarkers for Early Diagnosis of Periodontitis.

The primary cause of tooth loss in the industrialized world is periodontitis, a bacterial anaerobic infection whose pathogenesis is characterized by composite immune response. At present, the diagnose of periodontitis is made by a complete status check of the patient's periodontal health; full-mouth plaque score, full-mouth bleeding score, probing depth, clinical attachment level, bleeding on probing, recessions, mobility, and migration are evaluated in order to provides a clear picture of the periodontal conditions of a single patient. Chair-side diagnostic tests based on whole saliva could be routinely used by periodontists for a very early diagnosis of periodontitis, monitoring, prognosis, and management of periodontal patients by biomarker detection, whose diagnostic validity is related to sensitivity and specificity. Recent paper reviews and meta-analyses have focused on five promising host derived biomarkers as candidate for early diagnosis of periodontitis: MMP-8 (Metalloproteinase-8), MIP-1α (Macrophage inflammatory protein-1 alpha), IL-1 ß (Interleukin-1 beta), IL-6 (Interleukin-6), and HB (Hemoglobin), and their combinations. Chair-side Lab-on-a-chip (LOC) technology may soon become an important part of efforts to detect such biomarkers in saliva medium to improve worldwide periodontal health in developed nations as well as in underserved communities and poor countries. Their applications in preventive and predictive medicine is now fundamental, and is aimed at the early detection of risk factors or the presence or evolution of the disease, and in personalized medicine, which aims to identify tailor-made treatments for individual patients. The aim of the present paper is to be informative about host derived periodontal biomarkers and, in particular, we intend to report information about the most important immune response derived biomarkers and Hemoglobin as candidates to be routinely utilized in order to obtain a chair-side early diagnosis of periodontal disease.

Antibiotic's effectiveness after erupted tooth extractions: A retrospective study.

OBJECTIVE: The purpose of this retrospective study was to assess the influence of antibiotics on the development of alveolitis after tooth extractions. MATERIALS AND METHODS: The study population consisted of patients who had erupted tooth extractions in 3 centers. The patients' medical records were collected for several parameters. Moreover, use of antibiotics was evaluated. The primary outcome was the development of alveolitis during the postoperative period. The secondary outcome measure was the possible associations between alveolitis and other patients' characteristics. RESULTS: A total of 1579 patient charts were screened. The patients enrolled in the study were 418 (159 males and 259 females). Alveolitis was reported for 12 extraction sites (2.87%). Six were in the group of patients that received antibiotics (2.14% out of 280 patients treated with antibiotics), and six were in the group of patients that did not receive antibiotics (4.35% out of 138 patients not receiving antibiotics). None of patient-level parameters showed any significant association with the development of alveolitis. CONCLUSION: In conclusion, this study showed that the use of antibiotics after erupted tooth extractions is not useful in preventing alveolitis. Larger, prospective, and randomized studies are needed before incorporating these findings into the daily clinical practice.

A methodological approach to standardize and control the quality of the position and alignment of lamina implants on two-dimensional radiographs.

OBJECTIVES: We sought to validate a new method to detect the degree of correlation between simulated and real tilted blade implants as they appear on a single two-dimensional radiograph. METHODS: The angular correction factor (CF^) was defined as the coupling of two subsequent angle transformations, a set of five angular values describing the theoretical radiographic appearance of the blade implant: (1) three consecutive rotations about the axes of the blade ([Formula: see text], θ, and ψ, standing for pitch, roll, and yaw, respectively) to represent the polarization directions; (2) a two-dimensional projection defined by two angles (λ and [Formula: see text], respectively, longitude and latitude) to represent the vector of the X-ray beam intersecting the detector plate. Data of patients who received fixed prostheses supported by blade-form implants were employed to calculate a dimensional correction factor (CF°), a specific length through the major axis. The simulation of a distorted radiograph of a blade positioned in space was compared with the real radiograph. Differences in the angular measurements served as an initial test to assess the effectiveness of the method. RESULTS: In the acquired sets of periapical radiographs, mean misalignments of + 3.58° in longitude and - 0.04° in latitude were registered. The following variations were detected during the accuracy testing: the absolute error was 0.1 ± 7.5° for angle [Formula: see text]; 2.4 ± 6.7° for angle θ; - 1.0 ± 3.7° for angle ψ; 4.5 ± 8.6° for angle λ; and 2.0 ± 9.3° for angle [Formula: see text]. The linear dependence between CF° and CF^ was estimated by a robust linear regression: slope + 0.991, intercept + 0.007, and adjusted R2 0.992. CONCLUSIONS: This a posteriori analysis introduces the explicit trigonometric equations of the theoretical standard (CF^) used to describe the blade implant radiographic position and misalignment on two-dimensional radiographs.

Computed tomography-aided descriptive analysis of maxillary and mandibular atrophies.

INTRODUCTION: The aim of the present retrospective chart review was to analyze by Computed Tomography (CT) scan technique the degree of maxillomandibular atrophies, searching for differences between totally- and partially-edentulous subjects, and possibly identify and classify maxillomandibular atrophy staged patterns for implant planning in both totally- and partially- edentulous jaws. MATERIAL AND METHODS: CT scans of 89 mandibles and 77 maxillae from 111 patients were classified according to six different patterns of residual ridge resorption and to two different groups of edentulism (totally- and partially-edentulous). Maxillomandibular absolute linear dimensions were calculated and results compared for statistically significant differences by Wilcoxon tests. RESULTS: Maxillomandibular CT cross-section interpretation showed different patterns of linear bone remodelling (height values) between the two groups of edentulism joined with specific positions in the maxilla or mandible. The judgment of the investigator was uncertain in the analysis of the mandibular posterior areas with similar percentages for both totally- and partially-edentulous groups (12.5% and 11.5%, respectively). DISCUSSION: The 3D analysis is self-explanatory and easy to apply, aided by CT scans. The measurements between the referring planes and inviolable anatomical structures (nasal floor NFD, lower border of mandible LBD, inferior alveolar nerve AND, and sinus floor SFD), showed that class III may not guarantee an optimal implant placement, especially in the totally-edentulous group, due to a major degree of pneumatisation.

Pose determination of a blade implant in three dimensions from a single two-dimensional radiograph.

The aim of the study was to introduce a mathematical method to estimate the correct pose of a blade by evaluating the radiographic features obtained from a single two-dimensional image. Blade-form implant bed preparation was performed using the piezosurgery device, and placement was attained with the use of magnetic mallet. The pose determination of the blade was described by means of three consecutive rotations defined by three angles of orientation (triplet φ, θ and ψ). Retrospective analysis on periapical radiographs was performed. This method was used to compare implant (axial length along the marker, i.e. the implant structure) vs angular correction factor (a trigonometric function of the triplet). The accuracy of the method was tested by generating two-dimensional radiographic simulations of the blades, which were then compared with the images of the implants as appearing on the real radiographs. Two patients had to be excluded from further evaluation because the values of the estimated pose angles showed a too-wide range to be effective for a good standardization of serial radiographs: intrapatient range from baseline to 1-year survey was > of a threshold determined by the clinicians (30°). The linear dependence between implant (CF°) and angular correction factor (CF^) was estimated by a robust linear regression, yielding the following coefficients: slope, 0.908; intercept, -0.092; and coefficient of determination, 0.924. The absolute error in accuracy was -0.29 ± 4.35, 0.23 ± 3.81 and 0.64 ± 1.18°, respectively, for the angles φ, θ and ψ. The present theoretical and experimental study established the possibility of determining, a posteriori, a unique triplet of angles (φ, θ and ψ) which described the pose of a blade upon a single two-dimensional radiograph, and of suggesting a method to detect cases in which the standardized geometric projection failed. The angular correction of the bone level yielded results very close to those obtained with an internal marker related to the implant length.

Evaluation of volumetric dimensional changes in posterior extraction sites with and without ARP using a novel imaging device.

BACKGROUND: Alveolar ridge volume loss may be minimized when postextraction sockets are filled by bone substitutes. PURPOSE: The aim of the study was to measure the effect of alveolar ridge preservation (ARP) in maintaining the external contour of the ridge after fresh socket grafting with or without particulate anorganic bovine bone mineral (BBM) and resorbable barrier covering. MATERIALS AND METHODS: In the present controlled study, patients subjected to single-tooth extraction were allocated to 2 groups: postextraction sockets grafted with bovine bone mineral (bbm), and naturally healing sockets (nat). Before and at 5 months following tooth extraction, plaster cast contours of the sockets were acquired by means of an optical scanner; the 2 contours of each patient underwent voxelization and fusion using a matrix elaborator. Outcome variables at 5 months (volumetric, surface, and linear changes) were measured in digital fused plaster casts with a dental scan software analyzing a volume of interest ranging from residual papilla to 10 mm toward the apical point. Intra- and inter-group pair-wise variables' comparisons were conducted. Level of significance was set at 0.05. RESULTS: Twenty-four sites were enrolled: 12 ARP and 12 naturally healed. Five-month percentage of volume loss of the bbm-group (21.7% ± 7.4%) was significantly lower (Ps < .0003) than that of the naturally healing group (38.8% ± 7.9%). When tooth position was investigated, volume loss in percentage registered a significantly better (P values ≤ .0485) behavior in molars (ΔV% = -19.1% ± 6.5% and ΔV% = -35.6% ± 7.6%, respectively, for bbm and nat) than that in premolars (ΔV% = -26.9% ± 7.2% and ΔV% = -45.1% ± 4.2%, respectively, for bbm and nat), in both the preserved and naturally healing groups. CONCLUSION: The dimensional loss in postextraction sockets grafted with anorganic bovine bone substitute and covered by a resorbable collagen barrier was lower than that of the naturally healing sites. However, ridge preservation was able to maintain almost 80% of the pristine bone.

Retrospective volume analysis of bone remodeling after tooth extraction with and without deproteinized bovine bone mineral insertion.

OBJECTIVES: The aim of the study was to analyze volume changes of post-extractive sockets grafted with or without deproteinized bovine bone mineral (DBBM) and a resorbable barrier. MATERIALS AND METHODS: This retrospective analysis utilized patients who had undergone tooth extraction. Sites, one per patient, were allocated to two groups: post-extractive non-grafted sockets (NG) and post-extractive grafted sockets with DBBM and resorbable barrier insertion (G). Maximal primary soft tissue closure was sought for both procedures. Before extraction and 6 months later, three-dimensional features of the sockets (linear indexes, areas, and volumes) and outcome variables at 6 months (volume- and surface changes) were acquired through computer tomography scans. Intra- and inter-group comparisons of the outcome variables were performed. Nonparametric tests were applied with a level of significance set at P < 0.01. RESULTS: Twenty-four sites, 9 grafted and 15 ungrafted, were enrolled. Between baseline and the 6-month evaluation, significant bone volume loss, superior surface shrinkage, and height reduction were registered for the G (72 mm(3) , 76 mm(2) , and 0.5 mm, respectively) and the NG group (274 mm(3) , 87 mm(2) , and 1.8 mm, respectively) with all P-values ≤ 0.0039. A significant difference, regarding the percentage of the volume change, was registered between the two procedures with a volume loss of 9.9% for the grafted sockets and 34.8% for the ungrafted ones (P-value = 0.0073). CONCLUSION: Grafting of the sockets with DBBM and a resorbable barrier insertion seemed to reduce negative osseous remodeling in the short term when compared to that of the ungrafted sockets.

A 5-Year Implant Follow-Up in Maxillary and Mandibular Horizontal Osseous Onlay Grafts and Native Bone.

The purpose of this study is to analyze marginal bone levels (MBLs) around dental implants positioned in the upper and lower jaw with or without horizontal onlay grafting procedures, and to survey implant survival with a follow-up of 5 years. Seventeen patients were surveyed in the present retrospective chart review. A total of 27 dental implants positioned in pristine bone and 21 in horizontally grafted bone were enrolled. MBLs were recorded for 4 aspects during a radiologic survey of 5 years. Significant differences were searched for among times and surgical procedures with paired and unpaired comparison tests, respectively, and survival rates were calculated for the 2 groups. In the maxilla, no statistically-significant differences between pristine and augmented groups were obtained; the time comparisons for pristine implants showed an affection of palatal, mesial, and distal sides, whereas the resorption around implants placed into horizontally grafted bone of anterior maxilla seemed to be limited just to buccal and distal aspects. Comparisons with the pristine horizontal procedure revealed that just the buccal sides were involved. The analysis of time comparisons attested to a continuous alveolar bone remodeling during the entire time of the survey for the pristine group. Given the extremely unfavorable resorption at the buccal aspect of the augmented areas, clinicians should reserve dental implant positioning into horizontal bone graft to selected patients, in whom it may represent one of the last opportunities of rehabilitation with a fixed prosthesis.

Implant angulation: 2-year retrospective analysis on the influence of dental implant angle insertion on marginal bone resorption in maxillary and mandibular osseous onlay grafts.

OBJECTIVES: The purpose of this study was to determine the existence of correlations between marginal peri-implant linear bone loss and the angulation of implants in maxillary and mandibular augmented areas over the course of a 2-year survey. MATERIALS AND METHODS: Dependent variables described the sample of the present retrospective chart review. By using three-dimensional radiographs, input variables, describing the implant angulation (buccal-lingual angle [φ] and mesial-distal angle [θ]) were measured; outcome variables described survival rate and marginal bone resorption (MBR) around dental implants in autogenous grafts (10 maxillae and 14 mandibles). Pairwise comparisons and linear correlation coefficient were computed. RESULTS: The peri-implant MBR in maxillary buccal and palatal areas appeared less intensive in the presence of an increased angulation of an implant towards the palatal side. Minor MBR was recorded around mandibular dental implants positioned at a right angle and slightly angulated towards the mesial. CONCLUSIONS: Resorption in buccal areas may be less intensive as the angulation of placed implants increases towards the palatal area in the maxilla, whereas for the mandible, a greater inclination towards the lingual area could be negative. In the mandibular group, when the implant was slightly angulated in the direction of the distal area, bone resorption seemed to be more marked in the buccal area. CLINICAL RELEVANCE: In the planning of dental implant placement in reconstructed alveolar bone with autograft, the extremely unfavourable resorption at the buccal aspect should be considered; this marginal bone loss seemed to be very sensitive to the angulation of the dental implant.

Marginal masticatory mucosa dimensional changes in immediate post-extractive implants: a 2 year prospective cohort study.

OBJECTIVES: The present two-year prospective cohort study was undertaken to evaluate marginal masticatory mucosa dimensional changes around immediate post-extractive implants positioned transgingivally with a non-submerged healing screw. MATERIAL AND METHODS: Twenty-one immediate post-extractive implants from 21 patients were enrolled, peri-implant gap was filled with bovine bone mineral, and soft tissue was allowed to heal around a non-submerged healing screw. Post-extractive socket dimension was recorded. Intraoperative (T0) vertical distances: bone margin level (BML) from the bone margin to the implant platform and mucosal margin height (MMH) from marginal mucosa to implant platform were taken; MMH measurement was repeated 4 months later (T4). Horizontal mucosal level (HML): from customized stent to marginal mucosa at 0, 4, 12, and 24 months postoperatively (T0, T4, T12, T24) and vertical mucosal level (VML): from the stent to marginal mucosa at T4, T12, T24 were registered. RESULTS: One implant failed at 3 weeks; in the remaining 20 cases the MMH, coronally positioned with respect to the BML ≅2 mm at T0, showed a statistically significant vertical contraction of the mucosa at T4. Other vertical mucosal measurements (VML) did not show further changes over time. HML measures showed a, statistically significant, shrinkage of the mucosa on the transverse plane between T0/T12 and T0/T24 and between T4/T12 and T4/T24. CONCLUSIONS: Immediate post-extractive implant inserted transgingivally with a non-submerged healing screw and internal peri-implant gap filled with bovine bone mineral may favor an early and stable peri-implant soft tissue healing over 2 years.

A 5-year clinical and computerized tomographic implant follow-up in sinus-lifted maxillae and native bone.

OBJECTIVES: The present study analysed apical and marginal bone remodelling around dental implants placed in both maxillary (sinus elevated with particulated autogenous osseous graft) and corresponding native bone areas, with a follow-up of 5 years. The clinical survival of implants was also observed. MATERIALS AND METHODS: In this retrospective chart review, 27 patients were enrolled, with 55 dental implants inserted from 2000 to 2006, 26 of which were followed (one implant per patient); if required, patients were treated via sinus lift with autogenous bone and particulate technique. The internal controls were implants positioned in native areas beneath the sinus. Radiologic survey was assessed via computerized tomographic analysis measuring apical bone level (ABL) and marginal bone level (MBL), at 1- (T1 ), 3- (T2 ) and 5 years (T3 ), around implants (buccal, b; palatal, p; mesial, m; and distal sides, d). Clinical probing depth (CPD) and clinical attachment level (CAL) for all the four peri-implant aspects were measured. Cumulative survival rate (CSR) and survival rate (SR) of implants were calculated. Significances for paired and unpaired comparisons were searched for. RESULTS: A significant degree of apical resorption was recorded between T1 and T3 for the mesial particulate group; again, a significant difference was discovered between the native and particulate procedures for mABL. A further feature was discovered for the particulate procedure, for which ABLs resulted negative at least for three of the aspects. Regarding MBL measurements, similar behaviours were revealed using time-comparison analysis for the two procedures at the buccal aspect. Comparisons among diameters, irrespective of the procedure, showed that resorption times for the bMBL were shorter as the diameter of the implant became wider. The implant CSR was 92% in native areas (two failures/25 implants) and 93.3% in sinuses lifted with particulate bone (two failures/30 implants). CONCLUSIONS: The results suggest that a protrusion of the implant apices into augmented sinus lift occurred, whereas the bone remodelling of the coronal areas was not influenced by the events in the maxillary sinus. A diameter ranging from 4 to 5 mm might better guarantee a conservation of marginal peri-implant bone level compared with implants with smaller diameters.

Gene clustering analysis in human osteoporosis disease and modifications of the jawbone.

OBJECTIVE: An analysis of the genes involved in both osteoporosis and modifications of the jawbone, through text mining, using a web search tool, of information regarding gene/protein interaction. DESIGN: The final set of genes involved in the present phenomenon was obtained by expansion-filtering loop. Using a web-available software (STRING), interactions among all genes were searched for, and a clustering procedure was performed in which only high-confidence predicted associations were considered. RESULTS: Two hundred forty-two genes potentially involved in osteoporosis and in modifications of the jawbone were recorded. Seven "leader genes" were identified (CTNNB1, IL1B, IL6, JUN, RUNX2, SPP1, TGFB1), while another 10 genes formed the cluster B group (BMP2, BMP7, COL1A1, ICAM1, IGF1, IL10, MMP9, NFKB1, TNFSF11, VEGFA). Ninety-eight genes had no interactions, and were defined as "orphan genes". CONCLUSIONS: The expansion of knowledge regarding the molecular basis causing osteoporotic traits has been brought about with the help of a de novo identification, based on the data mining of genes involved in osteoporosis and in modification of the jawbone. A comparison of the present data, in which no role was verified for 98 genes that had been previously supposed to have a role, with that of the literature, in which another 81 genes, as obtained from GWAS reviews and meta-analyses, appeared to be strongly associated with osteoporosis, probably attests to a lack of information on osteoporotic disease.

Healing of donor defect after mandibular parasymphyseal block harvesting: a 6-year computerized tomographic follow-up.

OBJECTIVES: A long-term survey on the healing potential of large-sized parasymphyseal osseous defects. PATIENTS AND METHODS: Ten patients, subjected to 14 bilateral and 3 unilateral parasymphyseal bone harvesting for alveolar ridge augmentation, were selected for the retrospective chart review. CT scans were performed immediately before bone grafting, before implant insertion, and then once annually for 6 years, and the volumes of the bone defects at the buccal aspect in the healing process were measured using a software program. Volumes from the yearly measurements were then compared statistically. RESULTS: Volumes of both the intrasurgical defects, 0.77 (0.20) cc and of those in the one-year group, 0.60 (0.26) cc were statistically different from volumes of all the other time intervals (from 24 to 72 months) with all p-values less than 0.002 and 0.004, respectively. The healing of osseous defects in the long-term radiographic survey (6 years) resulted in bony infill of 63%. CONCLUSION: For parasymphyseal defects of 0.7 cc, a maximum possible healing of two-thirds can be expected; a re-harvesting procedure could be performed 24 months after early surgery, due to both the formation of a new buccal cortical plate and the achievement of a steady state of osseous remodelling.

Volume changes of grafted autogenous bone in sinus augmentation procedure.

PURPOSE: To evaluate associations between the osseous remodeling and the 3-dimensional features of both the grafted bone and the recipient site, as well as the density of the grafted bone, and to assess the relation between the degree of bone resorption and the type of autogenous bone-grafting procedure or the source (block or particulate bone from iliac crest or block bone from chin). PATIENTS AND METHODS: A retrospective chart review of patients receiving sinus lifting and grafting procedures for implant positioning was conducted: radiographic analysis of the volume and area of both sinuses and autogenous bone grafts was performed, as per Smolka et al and Krennmair et al. The volumetric remodeling--measured at 1 year after implant positioning as the percentage of residual bone (%R)--was correlated, with Spearman analysis, to 3-dimensional features of both graft and recipient sites. All quantities correlated with %R at a statistically significant level were used for 2-dimensional and multidimensional visualizations with scattergrams. RESULTS: Twenty-five iliac crest or chin grafts were inlay positioned in the maxillary sinuses of patients. Computed tomography scans, taken before implant positioning and after 1 year, showed a 1-year negligible volume remodeling for block graft from chin (97.9%) but slightly greater resorption values (%R) for particulate and block grafts from iliac crest (93.8% and 83.3%, respectively). Three- and four-dimensional scattergrams of significant data resulting from Spearman correlation tests (particulate and block grafts both from iliac crest) showed a variation of the remodeling pattern dependent on 3-dimensional features, namely inlay graft thickness, surface area of the graft in contact with basal bone, volume of the recipient site, and surface area of the graft projecting into the sinus cavity. CONCLUSIONS: Retrospective data analysis shows that iliac crest grafts positioned on a small basal bone volume (≤ 2.5 mL) may point to a very favorable remodeling of the volume when the particulate graft is molded to a thickness of less than 4 mm, with a reduced surface area protruding into the sinus (≤ 5 cm(2)). Bone blocks with a reduced contact surface and with basal bone (≤ 4 cm(2)) also display minimal resorption.