Identification of microbiota in peri-implantitis pockets by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry.

The purpose of this study was to identify the microbial communities that colonize peri-implantitis pockets using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Subjects having at least one implant with peri-implantitis, no diabetes, and not taking antibiotics in the previous 3 months were selected. Peri-implantitis was defined when surrounding bone loss ≥0.5 mm and bleeding on probing was found. Microbial samples were collected from peri-implantitis pockets using paper points. After incubation and isolation, the colonies were analyzed by MALDI-TOF MS. A total of 126 isolates were cultivated and identified from 12 samples, in identification rates of 82.5% at the species level and 12.72% at the genus level. Although the compositions were highly variable, major habitants in different peri-implant pockets could be identified. Among them the most distinguished were Neisseria flavescens (87%), Streptococcus constellatus (56%), Slackia exigua (46%), Streptococcus intermedius (45%), Fusobacterium nucleatum (45%) and Gemella morbillorum (43%). This preliminary study provides comprehensive and reliable data for future study designs involving MALDI-TOF MS and peri-implantitis in a more specific, easy, rapid and economical way. MALDI-TOF MS could be a new clinical method to evaluate and monitor oral microbiota associated with the disease.

Assessment of pain perception following periodontal and implant surgeries.

OBJECTIVE: To evaluate patients' pain perception following periodontal or implant surgery and to explore risk factors associated with post-surgical pain. MATERIALS AND METHODS: Patients undergoing periodontal or implant surgery were recruited. Post-surgical pain perception was evaluated by a numeric rating scale (NRS, 1-10) after 1 week. Self-reported durations of pain (DOP) and of swelling (DOS), and consumption of prescriptions were also recorded. Demographic and surgical variables were compared between the groups of mild (MP) and moderate-to-severe post-surgical pain (SP). Factors associated with SP were analysed statistically. RESULTS: Ten surgical types in three categories, comprising 330 surgeries in 253 patients, were included. Overall, 70.3% of the subjects experienced MP, 25.5% experienced moderate pain and 4.2% experienced severe pain. The highest median NRS score was found in subjects having advanced implant surgery [4.0, interquartile range (IQR) 4.00] and the lowest in open flap debridement surgery (1.0, IQR 1.00). The median DOP was 2.0 days (IQR 2.00). Analgesic need (median = 2.0 days, IQR 4.00) was correlated with the DOP (r = 0.406, p < 0.01) and the NRS score (r = 0.358, p < 0.01). Subjects receiving periodontal plastic surgery (OR = 3.20, 95% CI = 1.06-9.71), complex surgery (OR = 2.63, 95% CI = 1.31-5.25), increased surgical extension (OR = 1.78, 95% CI = 1.21-2.62) and increased anaesthesia (OR = 2.32, 95% CI = 1.13-4.76) were more likely to experience SP. CONCLUSIONS: The majority of patients perceived mild post-surgical pain, but the pain level varied among different surgical procedures. Periodontal plastic surgery, complex surgery, surgical extension and anaesthetic volume were associated with more pain.

Association between patients' chief complaints and their compliance with periodontal therapy.

AIM: To evaluate the association between patients' chief complaints (CCs) and their compliance with basic periodontal therapy. MATERIALS AND METHODS: Data on CCs and periodontal diseases were obtained from patients attending a periodontal clinic. Patient compliance with basic periodontal therapy was studied in relation to their CCs. RESULTS: The mean age of the 1196 subjects was 47.7±11.6 years. Among them, 36.9% of the subjects had chronic symptomatic CCs; 22.4%, acute symptomatic CCs; and 40.7%, asymptomatic CCs. Four hundred eighty subjects completed basic periodontal therapy; 209, incomplete treatment; and 507, no treatment. The subjects with acute symptomatic CCs were 60% more likely to receive periodontal treatment [odds ratio (OR)=1.661; 95% confidence interval (CI): 1.203-2.293] than chronic symptomatic subjects, as did the asymptomatic subjects (OR=1.669; 95% CI: 1.252-2.223). However, subjects with acute symptomatic CCs were 60% less likely to complete periodontal treatment (OR=0.420; 95% CI: 0.267-0.660). The OR of completing treatment for the copayment requirement was 1.944, while that for being treated by an experienced periodontist was 1.695. CONCLUSIONS: Patients' CCs were associated with their compliance to basic periodontal therapy. Acute symptomatic CCs may be a positive predictor to initiate periodontal treatment but a negative predictor to complete the treatment.

Guided bone regeneration for fenestration defects in dental implants.

Guided bone regeneration has been applied in implant dentistry for increasing the width and height of the alveolar ridge in areas with insufficient bone. Various materials and techniques have been used for this purpose. It refers to a surgical procedure by which utilizing a mechanical barrier to create a secluded space around the defect to permit bone regeneration without the competition of other tissues. This report presents a case with buccal fenestrations on maxillary implant sites observed during a surgical procedure. An allograft and a non-resorbable membrane were concomitantly used to increase the width of the alveolar ridge. Hard tissue regeneration was evident clinically. The implants were restored for functioning and followed for 2 years. Factors affecting outcomes are also discussed. Membrane stability and the space-making effect remain the keys to success.

Complications of mandibulotomy: midline versus paramidline.

OBJECTIVE: Mandibulotomy is an important surgical approach to oral cavity and oropharynx. The objective of this study was to evaluate the related complications of 2 common mandibulotomies: midline (osteotomy between 2 central incisors) and paramidline (osteotomy between lateral incisor and canine). STUDY DESIGN: Ninety-six patients who had cancer in the oral cavity or oropharynx had preoperative evaluation of the mandible with panoramic films. Among them, 42 patients underwent mandibulotomies: midline for 19 patients and paramidline for 23. RESULTS: Twenty (47.6%) of 42 patients had mandibulotomy-related complications, including 9 (21.4%) minor complications and 11 (26.2%) major complications. There were 6 (31.6%) major and 4 (21.1%) minor complications in the midline mandibulotomy and both 5 (21.7%) major and minor complications in the paramidline mandibulotomy. CONCLUSION: There was no significant difference in the mandibulotomy-related complication rate between midline and paramidline mandibulotomies. Paramidline mandibulotomy, which preserves the geniohyoid and genioglossus muscles, should be a better function-preserving operation than midline mandibulotomy.