Discomfort/pain due to peri-implant probing at titanium and zirconium implants: A cross-sectional study.

OBJECTIVE: This study was designed to compare discomfort/pain after periodontal and peri-implant probing in patients with titanium compared with zirconium implants. METHODS: One examiner recruited and examined 70 patients, each of whom had a dental implant with a contralateral tooth; 37 patients had titanium implants of various types and 33 patients had zirconium implants; one implant was analyzed for each patient. Periodontal and peri-implant probing pocket depth (PPD) and clinical attachment level (CAL) were assessed. Immediately after probing, patients rated their discomfort/pain with a visual analog scale (VAS). The emergence profiles of implant crowns were assessed on periapical radiographs of the implants. RESULTS: Seventy patients with a median age of 55 years (interquartile range [IQR]: 42-65 years), including 43 females and 16 current smokers, were examined. The mean PPD and bleeding on probing (BOP) were higher around implants than around teeth (p < .001). CAL and suppuration were well-balanced between implants and teeth. Peri-implant probing caused significantly more discomfort/pain than periodontal probing [median VAS score: 12.5 (IQR 4-22) vs. 9 (2-15); p < .001]. Logistic regression revealed that discomfort/pain after peri-implant probing was less intense in patients who had taken analgesic medication (p = .021) and around titanium implants (p = .037). CONCLUSIONS: Peri-implant probing caused significantly more discomfort/pain than periodontal probing. Patients who had taken analgesic medication experienced less discomfort and pain with peri-implant probing than those who had not; furthermore, titanium implants were associated with less pain than zirconium implants.

Bacterial growth on titanium versus zirconia healing caps. An In vitro study.

Objectives To evaluate and compare bacterial growth on zirconia versus titanium healing caps. Material and methods S. sanguinis (Ss) and F. nucleatum (Fn) were grown on titanium and zirconia healing caps that were fixed to the cover of a 96-well microtiter plate. A drop (10 µL) of bacterial suspension was placed on each healing cap and allowed to dry for 1h at 37°C. After this time, the cover was replaced on the plate such that the caps were completely immersed in fresh liquid medium. Each plate contained only one bacterial strain, with 2 control groups. Bacterial growth was monitored over 18h by following the optical density at 650nm. A one-way ANOVA comparison test was used for statistical analysis. Scanning electron microscope (SEM) images of healing caps of each material were taken after a 48h incubation with Ss or Fn to assess bacterial attachment and with no bacteria as control. Results Ss growth was similar in both types of healing cap with no significant differences between these groups and the control (P=0.990). However, there was significantly less growth of Fn on the zirconia caps than on the titanium samples (P<0.0001) or the control (P<0.0001). SEM imaging revealed obvious differences in the surface characteristics of the titanium and zirconia caps. The number of bacteria attached to the rough apical area was particularly high. Conclusions The use of zirconia healing caps may reduce the growth of some bacterial species compared to that seen on titanium healing caps.

Computer-assisted periodontal classification vs manual classification among dental students: a comparative pilot study.

OBJECTIVE: The objective of the study was to assess whether computer-assisted periodontal diagnosis can improve the accuracy and homogeneity of classification results obtained by dental students using the 2017 classification of periodontal diseases. METHOD AND MATERIALS: All final year predoctoral dental students from two dental schools were invited to participate in the study. Participants who volunteered for the study were randomly divided into two groups for digital or manual diagnosis, and each participant classified 48 cases. A group of three experienced periodontists provided the reference or gold standard diagnosis. RESULTS: Overall, 27 students completed the evaluation of all cases; 14 students comprised the digital application group and 13 the manual group. The accuracy of the classification results compared with the gold standard committee was 82% for the digital group compared to 50% of the manual group in terms of the extent of gingivitis; 71% vs 56% for the stage of periodontitis; 67% vs 62% for grade of periodontitis; 76% vs 63% for extent of periodontitis; and 43% vs 30% for overall diagnosis accuracy of periodontitis cases respectively. CONCLUSIONS: Computer-assisted classification using newly developed software, within the boundaries of this study, was shown to be a sensible support tool for dental practitioners to use when diagnosing periodontal disease. This digital tool can the clinicians' accuracy of diagnosis primarily in the extent and staging of periodontitis.

Common practices of dental implants maintenance among dental hygiene professionals in Israel and Germany.

OBJECTIVE: The aim of this study was to assess the common practices of dental implant maintenance among dental hygiene professionals (DHP) in Israel (IL) and Germany (GE). METHODS: An online questionnaire was developed by the Periodontology Departments of Tel Aviv (IL) and Frankfurt University (GE) to address demographics, training, prevention and treatment of peri-implant diseases. The questionnaire was distributed by DHP associations via social media. RESULTS: The responses of 376 DHPs (IL: 169; GE: 207) were analysed. Most participants were female (IL: 168/99%; GE: 203/98%), had received education (IL: 179/97%; GE: 207/97%) and were working in their home countries (IL: 182/99%; GE: 211/99%). Peri-implant probing was not performed by 22% of DHPs in IL and 5% in GE. Of the DHPs who used probes, 49% used metal probes in IL, while 40% used plastic probes in GE (p < 0.001). A majority of DHPs performed peri-implant instrumentation (IL: 168/99%; GE: 190/92%). Most DHPs from IL did not use devices other than hand and/or sonic/ultrasonic instruments for peri-implant cleaning (IL: 130/77%; GE 5/2%); in GE, the use of airflow (IL: 31/18%; GE: 199/96%) is popular (p < 0.001). CONCLUSIONS: Most DHPs in IL and GE perform peri-implant probing and debridement. However, there are some distinct differences between the two countries regarding the choice of instruments and treatment regimens.

Positive relationship between the dimensions of clinical gingival recessions and associated alveolar bone dehiscences: a biometric study.

OBJECTIVES: To analyze the relationships between the dimension of clinical gingival recession and of the actual bone dehiscence. METHOD AND MATERIALS: Data included measurements taken before and during root coverage surgical procedures. General health, smoking status, previous orthodontic treatment, probing depth, clinical measurements taken on gingival recessions, and the exposed alveolar bone dehiscences were recorded. Data were analyzed using descriptive statistics and linear regression model. RESULTS: Twenty-three patient files were available. The mean age was 31.3 ± 12.1 years (range 13 to 51 years). Eight patients had previous orthodontic treatment. Incisor, canine, and premolar recessions amounted to 9, 8, and 6 teeth, respectively. The deepest recession per patient was recorded. The mean alveolar bone dehiscence depth was 6.78 ± 1.2 mm (range 5 to 9 mm). Patient-related or systemic findings, preceding orthodontic treatment, and tooth type were not correlated with alveolar bone dehiscence dimensions. A significant association was found between clinical recession and the alveolar bone dehiscence depths (P < .001, Fisher exact test). On average, each 1 mm increase in clinical recession depth involved an increase of 1.45 mm in alveolar bone dehiscence depth (P < .001, linear regression). The ratio between the clinical recession depth and width was significantly associated with the depth of the bone dehiscence (P = .007, Fisher exact test). CONCLUSION: Within the limitations of the size of this study, clinical recession depth and width dimensions may help to predict the underling bone dehiscence magnitude. Gingival recession is associated with deformities of the underlying alveolar bone; this may be revealed during mucogingival procedures associated with full-thickness flaps. The association between the two may be of particular value to the operator as it may significantly affect the outcome of treatment. Furthermore, this relationship is of utmost importance in minimally invasive procedures that avoid flap elevation. A significant association was found between the depth of the clinical gingival recession and that of alveolar bone dehiscence. In addition, the ratio between the clinical recession depth and width was significantly associated with the depth of the bone dehiscence. Clinical recession depth and width dimensions may serve as an assessment predictor for the underling bone dehiscence magnitude.

Incidence and nature of claims against dental practitioners for dental implant treatment in Israel between 2005 and 2015.

PURPOSE: In recent years, dental malpractice claims have increased dramatically worldwide. The present study aimed to categorise and analyse claims related to implant dentistry that resulted in legal decisions in Israel, seeking to contribute to dental risk management and improve patient safety. MATERIALS AND METHODS: This study analysed legal claims registered by Medical Consultants International between 2005 and 2015. Only closed cases in which a decision was made were included. The parameters studied included patient age and sex, date of the complaint, treatment setting (private/public clinic), description of the adverse event and type of negligence claimed. RESULTS: The cohort included 709 settled claims out of a total of 1066 that were litigated against dental practitioners in Israel during the study period. Of the patients included, 60.0% were women and 63.9% were aged 40 to 59 years. The most common treatment-related damage was neural injury in 133 patients (18.7% of the cohort). Unplanned changes in the treatment plan and violation of autonomy were the most frequent documentation-/information-related claims (66.3% and 32.7%, respectively). The legal responsibility of the dental practitioner was acknowledged in 89.0% of cases. Dental practitioners working in the private sector were more likely to be sued due to violation of autonomy than those working in public clinics. CONCLUSIONS: Although the main cause for lawsuits was actual bodily injury, the high percentage of documentation-/information-related malpractice claims calls for increased awareness of patients' autonomy and rights. Practitioners should dedicate a significant part of the entire treatment time to preoperative diagnosis and planning.

Discomfort/pain due to periodontal and peri-implant probing with/without platform switching.

OBJECTIVE: To compare discomfort/pain following periodontal probing around teeth and peri-implant probing around implants with or without platform switching. METHODS: Two dentists recruited and examined 65 patients, each of them exhibiting a dental implant with a contralateral tooth. Only two types of implants were included: one with and one without platform switching. Periodontal and peri-implant probing depths (PPD) and probing attachment level (PAL) were assessed. Whether implant or tooth was measured first was randomly assigned. Immediately after probing, patients scored discomfort/pain using a visual analogue scale (VAS). The emergence profiles of implant crowns were assessed as angles between interproximal surfaces on radiographs. RESULTS: Sixty-five patients (age 69; 63/76 years [median; lower/upper quartile]; 38 females, 11 smokers) were examined. With the exception of mean PPD and PAL (p < .05) clinical parameters (PPD, PAL, bleeding on probing, suppuration) were well balanced between implants and teeth. Peri-implant probing (VAS: 10; 0.75/16.25) caused significantly (p < .001) more discomfort/pain than periodontal probing (4; 0/10). Logistic regression analysis identified a larger difference between discomfort/pain for peri-implant and periodontal probing in the maxilla than the mandible (p = .003). Comparing discomfort/pain between implants maxilla (p = .006) and emergence profile (p = .015) were associated with discomfort/pain. Type of implant (with/without platform switching) had no significant effect on discomfort/pain. CONCLUSIONS: Peri-implant probing caused significantly more discomfort/pain than periodontal probing. Implant design with/without platform switching failed to have a significant effect on discomfort/pain.

Periodontal Disease and Dental Caries among children and Adolescents Suffering from Endocrine Disorders - A Literature Review.

BACKGROUND: Dental caries and periodontal disease are the most common oral diseases. Their link to disorders of endocrine system is of high interest. Most of the available data relates to the adult population, though its importance among children and adolescents is paramount. OBJECTIVE: To review the existing evidence examining the link between these clinical conditions among children and adolescents. DATA SOURCES: Electronic bibliographic databases and hand searches of relevant publications, based on prepared list of relevant key-words was performed. RESULTS: Paucity of existing data leaves the question of association between most endocrine disorders of the youth with dental caries and periodontal disease, inconclusive, apart from obesity and diabetes mellitus, where it seems to be elucidated. CONCLUSION: A profound research should be done in order to amend our understanding to what extent, if at all, exists the link between these oral maladies and different pediatric endocrine disorders.

The association between dental proximal restorations and periodontal disease: A retrospective 10-18 years longitudinal study.

OBJECTIVE: Dental restorations may be plaque retentive. The aim of this study was to evaluate the long-term association between proximal restorations and the incidence and progression of periodontal disease in well-maintained patients. METHOD AND MATERIALS: Probing pocket depths (PPD), bleeding on probing (BOP), and radiographic status of proximal restorations were retrospectively retrieved from files of patients attending a specialist periodontal office. Ill-fitting margins were recorded. The association between these parameters was evaluated at baseline examination (T0), after cause-related therapy (T1) and after ≥ 10 years from T0 (T2), during which supportive periodontal therapy (SPT) was administered, using descriptive statistics, ANOVA-Bonferroni, and chi-square analyses. RESULTS: 1,301 teeth were examined. Mean PPD in unrestored surfaces was 3.7 ± 1.7 mm, 3.1 ± 1.3 mm, and 2.8 ± 1 mm at T0, T1, and T2, respectively. Deeper pockets were found in restored surfaces at those time points with PPD values of 4.4 ± 1.8 mm, 3.6 ± 1.4 mm, and 3.2 ± 1.1 mm, respectively (P < .001). Higher PPD values were found in restored surfaces exhibiting inadequate restorations when compared to restored surfaces with adequate restorations at all time points. These values were 4.9 ± 1.9 mm, 4.1 ± 1.5 mm, and 4 ± 1.7 mm vs 4.3 ± 1.8 mm, 3.6 ± 1.4 mm, and 3.1 ± 1.1 mm, respectively (P < .001). CONCLUSION: The present study confirmed that restorations might be detrimental to periodontal health. A significant association between the presence of proximal restorations and the incidence of periodontal disease was observed. This association was more pronounced for inadequate restorations while becoming less significant over time in patients receiving routine SPT.

Intraoperative Measurement of the Distance from the Bottom of Osteotomy to the Mandibular Canal Using a Novel Ultrasonic Device.

BACKGROUND: In our previous study, we found that a novel ultrasound (US) device may serve as a useful intraoperative tool to measure the distance from osteotomy to the inferior alveolar canal (IAC). PURPOSE: To validate our previous results in a larger group of osteotomies in the posterior mandible. METHODS: During dental implant placement surgery, osteotomies were created using a standardized 2-mm-diameter pilot drill. The distance from the bottom of the osteotome to the IAC was assessed using an ultrasonic device and compared with a standard panoramic radiograph used to measure the same residual distance. The total distance from the crestal bone to the IAC was measured on a preoperative computed tomography (CT) and compared with total US measurements by summing the drill depth with residual depth measurements. RESULTS: Mean radiographic and US residual distances were 5.19 ± 1.95 mm, 5.01 ± 1.82 mm, p = 0.79 respectively. These measurements presented strong positive correlations (r = 0.61, p = .01). Mean total CT distance was 13.48 ± 2.66 mm; mean total US calculation was 13.69 ± 2.51 mm. No significant difference was found (p > .05). CONCLUSIONS: The results support our previous pilot study and confirm that the tested US device identifies the IAC and measures the distance from the osteotomy to the roof of the mandibular canal.

Variables affecting tooth survival and changes in probing depth: a long-term follow-up of periodontitis patients.

AIM: To retrospectively assess tooth-survival rate and its association with patient and oral variables in periodontal office patients, followed up to 18 years. MATERIAL AND METHODS: Patients in a private periodontal office whose files included initial examination (T0 ), reevaluation (TRe ) and ≥ 10 years after T0 (TF ) chartings, and received periodontal therapy and supportive periodontal therapy (SPT) after TRe were included. General health, plaque scores (PI), probing depth (PPD), bleeding on probing (BOP) at six points/tooth, tooth extractions, and SPT visits were extracted from patient files at T0 , TRe , and TF . Descriptive statistics and Cox regression analysis were performed. RESULTS: Fifty patients (mean 26 ± 4 teeth/patient, 1301 teeth) fulfilled inclusion criteria. About 20 and 129 teeth respectively were extracted before/after TRe , 96 of them for periodontal causes. PPD>7 mm at TRe (HR = 17.7, 95%CI 8.6, 36.6), age above 60 years (HR = 3.3, 95%CI 1.5, 7.2), multi-rooted teeth (HR = 1.9, 95%CI 1.2, 3.1) and SPT<3 times/year (HR = 1.8, 95%CI 1.1, 2.9), were the best prognostic factors for tooth loss during follow-up. (p < 0.05, Cox regression analysis). A continuous, statistically significant reduction was observed in mean PPD among teeth that survived follow-up [4.3 ± 1.8 mm, 3.5 ± 1.4 mm, 3.2 ± 1.3 mm, at T0 , TRe , TF , respectively. (p < 0.001, Repeated-measures test)]. CONCLUSION: Regular SPT was associated with low tooth-loss rates and continuous reductions in probing depth. PPD after initial therapy, age above 60, multi-rooted teeth and infrequent SPT were strong negative prognostic factors for long-term tooth survival among periodontal patients.