Diagnosis of peri-implant status after peri-implantitis surgical treatment: Proposal of a new classification.

BACKGROUND: The 2017 World Workshop classified peri-implant diseases into health, peri-implant mucositis, and peri-implantitis. The aim of this article is to build upon this recent classification and propose a framework for the diagnosis of peri-implant status after surgical treatment for peri-implantitis. METHODS: A literature review was conducted to discuss the relevant diagnostic, clinical, and radiographic parameters, including probing depth, bleeding on probing, visual inspection, and radiographic bone loss. Case definitions of possible treatment outcomes were discussed, and a flowchart was constructed to guide post-treatment diagnosis according to the possible clinical scenarios which can be encountered in daily practice. RESULTS: Three possible treatment outcomes were identified after resective treatment of peri-implantitis: 1) peri-implant health with a reduced support, 2) peri-implant mucositis with a reduced support, and 3) recurrent/refractory peri-implantitis. After regenerative treatment for peri-implantitis, the peri-implant condition was classified according to the same diagnoses with the addition of peri-implant health or peri-implant mucositis after complete regeneration for cases where complete regeneration was attained. Criteria for successful treatment of peri-implantitis were proposed. After resective therapy, a successful treatment outcome was defined as peri-implant health with a reduced support, whereas, after regenerative therapy, a successful outcome was described as either peri-implant health after complete regeneration or peri-implant health with a reduced support. CONCLUSIONS: The proposed classification system of peri-implant status after surgical treatment for peri-implantitis provides a framework for diagnosing the various forms of peri-implant stability or disease to guide clinical decision-making post-treatment.

Feline chronic gingivostomatitis is more prevalent in shared households and its risk correlates with the number of cohabiting cats.

OBJECTIVES: The aim of this study was to determine whether feline chronic gingivostomatitis (FCGS) is more prevalent in shared vs single-cat households, whether the number of cohabiting cats or outdoor access represent risk factors for FCGS and whether the number of cohabiting cats is a useful prognostic indicator for standard surgical treatment. METHODS: Cats diagnosed with FCGS (study group) in the past 5 years at a referral institution were identified. The number of cohabiting cats, outdoor access, number of other cohabiting cats diagnosed with FCGS, ⩾6 month surgical outcome, when applicable, and historical signs of upper respiratory disease among any of the cohabiting cats, as well as patient demographic information, were recorded. Data were collected from medical records and by means of a telephone interview with the owners. The same information was collected from a group of cats of similar demographic characteristics diagnosed with periodontal disease but free of FCGS (control group). RESULTS: Seventy-six cats were included, of which 36 (47%) had FCGS and 40 (53%) served as controls. Bivariate analysis showed that cats with FCGS were significantly more likely to come from shared households, and had significantly more total cats per household compared with controls. Multivariate analysis also showed that cats in shared households had a significantly increased odds of FCGS compared with those from single-cat households. Historical signs of upper respiratory disease and outdoor access among cats within the same household were not associated with FCGS. The number of cohabiting cats was not associated with surgical outcome. CONCLUSIONS AND RELEVANCE: Cats with FCGS are more likely to live in shared households. The risk of FCGS correlates with the number of cohabiting cats. The epidemiological features of FCGS may support an infectious etiology. The number of cohabiting cats within a household is not a useful prognostic indicator for standard surgical treatment of FCGS.

Preliminary study in a new protocol for the treatment of oral mucositis in pediatric patients undergoing hematopoietic stem cell transplantation (HSCT) and chemotherapy (CT).

Oral mucositis (OM) is a debilitating and serious side effect in patients undergoing hematopoietic stem cell transplantation (HSCT) and chemotherapy (CT). Laser therapy is becoming a promising treatment option in these patients, avoiding the necessity of enteral/parenteral nutrition. The aim of this study was to evaluate the efficacy of laser therapy in patients affected by oral mucositis induced by chemotherapy and HSCT. Sixteen onco-hematological pediatric patients receiving chemotherapy and hematopoietic stem cell transplantation, affected by oral mucositis, were enrolled in this study. They were divided in two randomized groups: the laser group and the placebo-control group. Patients in the laser group were treated with HPLT (970 ± 15 nm, 3.2 W (50%), 35-6000 Hz, 240 s) for four consecutive days, once a day; and placebo group underwent sham treatment. The assessment of mucositis was recorded through WHO Oral Mucositis Grading Objective Scale, and pain was evaluated through Visual Analogue Scale (VAS). Patients were monitored and evaluated 3, 7, and 11 days after the first day of laser therapy. Once OM was diagnosed, the patients had mucositis grading assessments before laser or sham application at day 3, 7, and 11 after first application. All patients of laser group demonstrated improvement in pain sensation from day 3 after first application of laser (p < 0.05), ulcerations reduced their dimensions and erythema disappeared. The patients of placebo group had improvement from day 7. In laser group, all mucositis were fully resolved from day 7 (p < 0.05). Oral mucositis negatively impacts on nutritional intake, oral hygiene, and quality of life. Laser therapy appears to be a safe and innovative approach in the management of oral mucositis. In this preliminary study, HPLT encourages to consider laser therapy as a part of onco-hematological protocol, providing to decrease pain and duration of OM induced by CT and HSCT. Further researches will be needed, especially randomized, controlled clinical trials with a large number of enrolled patients and a long term of follow-up to confirm the efficacy of laser therapy in prevention and control of OM in onco-hematological pediatric patients.

Cement-associated peri-implant mucositis. A 1-year follow-up after excess cement removal on the peri-implant tissue of dental implants.

BACKGROUND: Methacrylate-based cements seem to promote peri-implant tissue inflammation even in the absence of excess cement. PURPOSE: The present study deals with the question of whether the removal of methacrylate cement from the peri-implant sulcus will lead to peri-implant tissues free of inflammation on a 1-year follow-up basis. MATERIAL AND METHODS: Implant supported suprastructures that had been in the mouth for at least 3.5 years either cemented with methacrylate (premier implant cement [PIC]) or zinc eugenol (temp bond [TB]) cement were compared. All superstructures in 33 patients with a total of 61 implants (35 with PIC and 26 with TB) were removed and excess cement, bleeding on probing (BOP), suppurationen and probing depth were documented. Excess cement found was removed, and in all cases the suprastructure was recemented with TB. Patients were followed up after 4 weeks (F1) and 1 year (F2). RESULTS: Excess cement was found around 60% of the implants with PIC. No excess cement was found around implants with TB. At the time of revision therapy, BOP was found around 100% of the implants with PIC and excess cement (PIC+), 93% around implants with PIC but no excess cement (PIC-), and around 42% of the TB-cemented implants (Chi-squared P < .01). Suppuration was observed in 86% of the PIC+ implants, in 14% of the PIC- implants and in 0% of the TB implants (Chi-squared P < .01). At the time of both F1 and F2, the inflammation parameters, that is BOP and suppuration, on implant level were significantly reduced in the PIC+ cases (McNemar's test P < .01). For PIC-, BOP was significantly reduced at both points in time (P < .05). For TB no differences were found. Probing depth at F2 had significantly decreased in all groups (t test P < .05). CONCLUSION: The removal of excess cement and recementation with TB had an anti-inflammatory effect on the peri-implant tissues after 1 year.

[Lesions of the oral mucosa : Differential diagnostic approach from the maxillofacial surgeon's perspective]. / Schleimhauterkrankungen : Differenzialdiagnostischer Zugang aus kieferchirurgischer Sicht.

A detailed medical history and a careful clinical examination are the basis for developing a list of possible differential diagnoses in lesions of the oral mucosa. On this basis, it can be decided whether a lesion can be observed for 14 days after removal of possible causes or the start of a trial treatment, or whether a biopsy for histological examination must be taken immediately. An excisional biopsy is performed for small and presumably benign lesions, an incisional biopsy for large and presumably malignant lesions. If an autoimmune blistering disease is suspected, a second sample for examination by immunofluorescence is taken. Depending on the results of the histological examination further treatment steps are planned or regular appointments for follow-up are arranged.

A Hemophagocytic Lymphohistiocytosis Case with Newly Defined UNC13D (c.175G>C; p.Ala59Pro) Mutation and a Rare Complication.

Hemophagocytic lymphohistiocytosis (HLH) represents a severe hyperinflammatory condition with cardinal symptoms of prolonged fever, cytopenias, hepatosplenomegaly, and hemophagocytosis by activated, morphologically benign macrophages with impaired function of natural killer cells and cytotoxic T lymphocytes. A 2-month-old girl, who was admitted with fever, was diagnosed with HLH and her genetic examination revealed a newly defined mutation in the UNC13D (c.175G>C; p.Ala59Pro) gene. She was treated with dexamethasone, etoposide, and intrathecal methotrexate. During the second week of treatment, after three doses of etoposide, it was noticed that there was a necrotic plaque lesion on the soft palate. Pathologic examination of debrided material in PAS and Grocott staining revealed lots of septated hyphae, which was consistent with aspergillosis infection. Etoposide was stopped and amphotericin B treatment was given for six weeks. HLH 2004 protocol was completed to eight weeks with cyclosporine A orally. There was no patient with invasive aspergillosis infection as severe as causing palate and nasal septum perforation during HLH therapy. In immunocompromised patients, fungal infections may cause nasal septum perforation and treatment could be achieved by antifungal therapy and debridement of necrotic tissue.

Microbes of the tonsils in PFAPA (Periodic Fever, Aphtous stomatitis, Pharyngitis and Adenitis) syndrome - a possible trigger of febrile episodes.

Periodic Fever, Aphtous stomatitis, Pharyngitis, and Adenitis (PFAPA) is a childhood febrile syndrome that is often cured by tonsillectomy (TE). We hypothesized that microbes present in the tonsils may act as a trigger for the activation of inflammasomes and investigated the microbiology of the tonsils in PFAPA patients and controls. We recruited 31 consecutive children who underwent TE due to PFAPA; 24 children who underwent TE due to other reasons served as controls. We cultured all the samples for bacteria, mycobacteria, yeasts, and viruses and used PCR for 15 viruses. Also biofilm formation and histologic findings were identified. The samples of the patients yielded Candida albicans more often than did the controls (16 vs 0%, p = 0.003). Staphylococcus aureus occurred in only 10% of the patients, but in 38% of the controls (p = 0.01). Varicella zoster and Herpes simplex viruses occurred less often in patients than in controls. Biofilm was present in 55% of PFAPA tonsils, but in only 24% of the controls (p = 0.03). The microbes found in the tonsils of PFAPA patients showed significant differences from those of controls. This may in part explain the efficacy of TE in PFAPA.

Chemotherapy-induced oral mucositis: effect of LED and laser phototherapy treatment protocols.

BACKGROUND AND OBJECTIVE: Over the last few decades, many studies have focused on the effect of lasers on the management of oral mucositis in oncologic patients treated with chemotherapy and/or radiotherapy. However, the effect of light-emitting diode (LED) has been poorly studied, and was not compared with that of laser phototherapy (LPT). For this reason, the aim of the present study was to clinically compare the effect of these two therapies on chemotherapy-induced oral mucositis (CIOM) and pain. METHODS: Forty patients with CIOM were divided into two groups: G1, patients treated with LPT; G2, patients treated with LED. The treatment was administered during 10 consecutive days, with exception of weekends. LPT was applied using an InGaAlP laser (660 nm/40 mW/6.6 J cm-(2)/0.24 J per point/0.036 cm(2) of spot size). LED phototherapy was applied using 0.24 J per point/80 mW/630 nm/1 cm(2) of spot size. CIOM was assessed during each session in accordance to the World Health Organization (WHO) score. The patient self-assessed pain was scored on a visual analog scale (VAS). RESULTS: The mean VAS and WHO scores were significantly smaller in the LED group (p<0.05). However, both groups required the same number of days to reach score zero for mucositis and pain (p>0.05). Moreover, in the group with severe mucositis (score III), there was a lower frequency of patients with complete healing and pain relief, with the exception of analgesia in G2, in which almost all patients were completely relieved from pain. CONCLUSIONS: These findings suggest that LED therapy is more effective than LPT in the treatment of COIM, with the parameters used in the present study.

Effects of bone marrow or mesenchymal stem cell transplantation on oral mucositis (mouse) induced by fractionated irradiation.

BACKGROUND AND PURPOSE: Oral mucositis is a severe and dose limiting early side effect of radiotherapy for head-and-neck tumors. This study was initiated to determine the effect of bone marrow- and mesenchymal stem cell transplantation on oral mucositis (mouse tongue model) induced by fractionated irradiation. MATERIAL AND METHODS: Daily fractionated irradiation (5 × 3 Gy/week) was given over 1 (days 0-4) or 3 weeks (days 0-4, 7-11, 14-18). Each protocol was terminated (day 7 or 21) by graded test doses (5 dose groups, 10 animals each) in order to generate complete dose-effect curves. The incidence of mucosal ulceration, corresponding to confluent mucositis grade 3 (RTOG/EORTC), was analyzed as the primary, clinically relevant endpoint. Bone marrow or mesenchymal stem cells were transplanted intravenously at various time points within these fractionation protocols. RESULTS: Transplantation of 6 × 10(6), but not of 3 × 10(6) bone marrow stem cells on day - 1, + 4, + 8, + 11 or + 15 significantly increased the ED50 values (dose, at which an ulcer is expected in 50 % of the mice); transplantation on day + 2, in contrast, was ineffective. Mesenchymal stem cell transplantation on day - 1, 2 or + 8 significantly, and on day + 4 marginally increased the ED50 values. CONCLUSION: Transplantation of bone marrow or mesenchymal stem cells has the potential to modulate radiation-induced oral mucositis during fractionated radiotherapy. The effect is dependent on the timing of the transplantation. The mechanisms require further investigation.

Effect of class IV laser therapy on chemotherapy-induced oral mucositis: a clinical and experimental study.

Oral mucositis (OM) is a serious and acute side effect in patients with cancer who receive chemotherapy or radiotherapy, often leading to the suspension of therapy and a need for opioid analgesic and enteral/parenteral nutrition, with an effect on patient survival. Among the various interventions proposed in OM management, laser therapy is becoming a recommended treatment option but has limitations due to its heterogeneous laser parameters. Here, we report on our successful clinical experience on the use of class IV laser therapy to treat OM induced by different chemotherapy regimens. To shed light on the mechanisms of action of laser therapy in improving OM resolution, we have developed an animal model of chemotherapy-induced OM, in which we compare the efficacy of the standard low-power laser therapy protocol with an innovative protocol, defined as high-power laser therapy. We show that high-power laser therapy is more effective than low-power laser therapy in improving OM lesion healing, reducing the inflammatory burden, and preserving tissue integrity. In addition, high-power laser therapy has been particularly effective in promoting the formation of new arterioles within the granulation tissue. Our results provide important insights into the mechanism of action of biostimulating laser therapy on OM in vivo and pave a way for clinical experimentation with the use of high-power laser therapy.

Ailing and failing oral implants: initial therapy and surgical management.

The distinction between ailing and failing implants is clinically important. Changes in the peri-implant soft or hard tissues will indicate whether the implant is ailing, failing, or has failed. This article discusses these clinical situations and provides an overview and description of peri-implant diseases and their treatment alternatives.

Treatment outcome in patients with peri-implantitis in a periodontal clinic: a retrospective study.

BACKGROUND: The number of placed implants has grown during the past decade, and the prevalence of peri-implantitis has increased. The purpose of the present study is to investigate the treatment outcome of peri-implantitis and to identify factors influencing the treatment success rate. METHODS: The study was conducted as a retrospective longitudinal study on a referral population. The material included 382 implants with peri-implantitis in 150 patients. Peri-implantitis was defined as presence of pocket depths ≥5 mm, bleeding at probing and/or suppuration, and the presence of implant radiographic bone loss ≥3 mm or bone loss comprising at least three threads of the implant. Variance analyses, χ(2) analyses, and logistic regression analysis were used for data analyses. RESULTS: The mean age of the participants at baseline was found to be 64 years (range: 22 to 87 years). The mean ± SD follow-up time was 26 ± 20 months, and the mean time between implant installation and baseline was 6.4 years (range: 1 to 20 years). Periodontal flap surgery with osteoplasty was the most common type of therapy (47%), and regenerative surgery procedures with bone substitute materials were chosen in 20% of the cases. The mean success rate at patient level was 69%. The results of the logistic regression analyses showed that the success rate was significantly lower for individuals with the diagnosis of severe periodontitis, severe marginal bone loss around the implants, poor oral hygiene, and low compliance. CONCLUSION: The effectiveness of the peri-implantitis therapy was impaired by severe periodontitis, severe marginal bone loss around the implants, poor oral hygiene, and low compliance.

[Use of erbium laser for treatment of dental implant complications].

The paper presents the results of the use of Er:YAG laser for surgical treatment of 48 patients aged 25-73 years with early and late dental implant complications were presented. Among all lasers used in the field of dentistry, the Er:YAG laser seems to possess characteristics most suitable for oral treatment, due to its ability to ablate both soft and hard tissues as well as bacterial biofilms and calculus without causing major thermal damage to the adjacent tissue.

Therapy of peri-implant diseases. Where is the evidence?

Peri-implant diseases are a common problem in dentistry today and no definitive treatment protocol exists for their treatment. The purpose of this review was to examine the evidence concerning the management of these diseases. The evidence provided suggests that peri-mucositis can be managed with use of mechanical nonsurgical therapy. Peri-implantitis does not respond to nonsurgical therapy. Various surgical methods have been proposed for management of peri-implantitis with some success; however, no single method can be promoted based on the current evidence.

The comparison of two techniques to increase the amount of peri-implant attached mucosa: free gingival grafts versus vestibuloplasty. One-year results from a randomised controlled trial.

AIMS: The objective of this randomised controlled trial was to compare the efficacy of two techniques for increasing the amount of keratinised mucosa around implants: free gingival grafts versus classic vestibuloplasty. MATERIALS AND METHODS: Sixty-four patients with 64 implants presenting keratinised mucosa <1.5 mm and showing signs of peri-implant mucositis were randomly assigned to two groups. Thirty-two implants received free gingival grafts (FGG group) while 32 implants were treated via vestibuloplasty (VP group). Plaque Index (PI), Gingival Index (GI), probing depth (PD) and the width of attached mucosa (WAM) were measured at baseline and 1, 3, 6 and 12 months following surgery. RESULTS: WAM in the FGG group was significantly greater than the VP group at 3, 6 and 12 months (P = 0.000). In the FGG group, the final gain in WAM was greater (2.36 mm in FGG group, 1.15 mm in VP group) (P = 0.000) and the postoperative relapse was smaller (2.00 mm in FGG group, 3.06 mm in VP group) (P = 0.000). The VP group had higher PD values at 3, 6 and 12 months (P = 0.02, P = 0.024, P = 0.000, respectively). CONCLUSIONS: The application of FGG is a more predictable method for enhancing the width of attached mucosa in the vicinity of implants compared with classic vestibuloplasty.

Long-term outcome of radiofrequency ablation for intraoral microcystic lymphatic malformation.

OBJECTIVE: To determine long-term outcome of radiofrequency (RF) ablation of microcystic lymphatic malformation (LM) of the oral cavity for control of recurrent infection and bleeding. DESIGN: Institutional review board-approved retrospective study, SETTING: Tertiary pediatric medical center, PATIENTS: Twenty-six patients with intraoral microcystic LM were treated with RF ablation from August 2002 through August 2010. INTERVENTION: Radiofrequency ablation of intraoral LM. MAIN OUTCOME MEASURES: Postoperative stay, diet, pain; control of bleeding and/or infection; recurrence; and indication for retreatment. RESULTS: The most common complaints necessitating initial RF ablation were recurrent infection (n=10 [37%]) and bleeding (n=9 [33%]). The most common problems requiring further ablation were bleeding (n=11 [41%]) and cosmetic deformity not affecting function (n=8 [31%]). Fourteen patients (55%) were discharged home on postoperative day (POD) 3; the remaining 11 (45%) were discharged home on POD 4. Thirteen patients (52%) resumed oral diet immediately on the day of the procedure. Ten patients (38%) began eating on POD 1, and virtually every patient was on full oral intake at discharge. Fourteen patients (55%) required only acetaminophen for pain control, 11 (41%) required acetaminophen with codeine, and 1 (4%) required oxycodone. The mean follow-up time was 47 months after treatment. At the most recent clinic evaluation, 13 patients (50%) were symptom free, 8 (31%) were stable and improved without need for future treatment, and 5 (19%) required further treatment. One-half of patients in the study group underwent more than 1 RF procedure for recurrence. The number of RF ablations in this series were 1 procedure (n = 13), 2 procedures (n = 7), 3 procedures (n = 2), 4 procedures (n = 2), and 6 or 7 procedures (n = 2). CONCLUSIONS: Radiofrequency ablation is an effective treatment for localized, superficial microcystic LM in the oral cavity. Pediatric patients tolerate the treatment with rapid postoperative recovery and minimal complications. The majority of patients required a short hospital stay for observation of the airway. Virtually every patient resumed oral diet by the time of discharge. Radiofrequency ablation is the treatment of choice at Children's Hospital Boston (CHB) for patients who present with symptomatic, superficial, and localized intraoral microcystic LM. For lesions involving deeper structures, multimodal treatments including surgical and sclerotherapy may be necessary.

Maxillary osteomyelitis in two Scottish terrier dogs with chronic ulcerative paradental stomatitis.

Two Scottish terrier dogs were presented for recurrent oral problems. They were diagnosed with refractory chronic ulcerative paradental stomatitis and necrosis of the incisive and maxillary bones. Both dogs were treated with a combination of bilateral rostral maxillectomy and tooth extractions. The ostectomy was performed with a specific cutting device using piezoelectric bone surgery technology. These two cases show that a precise evaluation of dogs is essential for the diagnose of chronic ulcerative paradental stomatitis and its differentiation from mucocutaneous autoimmune diseases.