Histological and histomorphometric evaluation of alveolar ridge preservation using an allograft and nonresorbable membrane with and without primary closure: A pilot randomized controlled clinical trial.

The aim of this article is to assess the formation of new vital bone (VB) using histomorphometric analysis in alveolar ridge preservation (ARP), with and without primary closure. Eight patients needed bilateral tooth extraction and planned for ARP. All patients had a nonresorbable membrane with freeze-dried bone allograft after the extractions. Biopsies were obtained 6 months after ARP and were evaluated using histomorphometric analysis. The study included 6 males and 2 females, with an average age of 54.2 years (standard deviation, 9.7). The teeth requiring extraction included a bilateral canine (1 case), premolars (5 cases), and molars (2 cases). Histomorphometric values of new VB, residual bone (RB) substitute particles, and marrow tissue formation were 71.1 %, 16.2%, and 9.69% for closed flap and 50.9%, 15.3%, and 8.19 for open flap. P values were 0.066, 0.878, and 0.326, respectively. The present findings indicate that leaving the flap without primary closure did not have any effect on new VB, RB particles, and immature bone marrow compared with closed flap. However, the results favored the closed-flap technique.

A Comparison between Primary and Secondary Flap Coverage in Ridge Preservation Procedures: A Pilot Randomized Controlled Clinical Trial.

AIMS: To assess the bone dimensional changes after extraction and alveolar ridge preservation (ARP) using primary coverage (closed flap technique, CFT) or healing by secondary intention (open flap technique, OFT). MATERIALS AND METHODS: Ten patients (split mouth design) were planned for extraction and ARP. All sites received ARP with freeze-dried bone allograft (FDBA) and nonresorbable membrane after extraction. Clinical standardized measurements were used to assess the dimensional alterations of the alveolar ridge. RESULTS: All patients completed the study, and a total of 20 sites were randomized to CFT or OFT group. Center height (mean difference of 8.1 mm, SD =1.9 CFT, and 7.5 mm, SD= 1.8 OFT) and buccal height (mean difference of 0.8 mm, SD =1.0 CFT, and 0.3 mm, SD= 1.1 OFT) were significantly different within the same group. However, there was no statistically significant difference between groups. In the OFT group, the keratinized tissue width was higher and the pain VAS scores at 24 hours were lower compared with the CFT (p = 0.004 and p = 0.006, respectively). CONCLUSIONS: Leaving the flap open did not have any effects on the dimensional changes of bone height or width. However, there was a wider band of keratinized tissue and less pain with the CFT compared with the OFT. The study protocol was registered at ClinicalTrials.gov, Identifier NCT03136913.

Is there a relationship between periodontal conditions and number of medications among the elderly?

OBJECTIVE: To investigate possible correlations of clinical attachment level and pocket depth with number of medications in elderly individuals. METHODS: Intra-oral examinations for 139 patients visiting Tufts dental clinic were done. Periodontal assessments were performed with a manual UNC-15 periodontal probe to measure probing depth (PD) and clinical attachment level (CAL) at 6 sites. Complete lists of patients' medications were obtained during the examinations. Statistical analysis involved Kruskal-Wallis, chi square and multivariate logistic regression analyses. RESULTS: Age and health status attained statistical significance (p< 0.05), in contingency table analysis with number of medications. Number of medications had an effect on CAL: increased attachment loss was observed when 4 or more medications were being taken by the patient. Number of medications did not have any effect on periodontal PD. In multivariate logistic regression analysis, 6 or more medications had a higher risk of attachment loss (>3mm) when compared to the no-medication group, in crude OR (1.20, 95% CI:0.22-6.64), and age adjusted (OR=1.16, 95% CI:0.21-6.45), but not with the multivariate model (OR=0.71, 95% CI:0.11-4.39). CONCLUSION: CAL seems to be more sensitive to the number of medications taken, when compared to PD. However, it is not possible to discriminate at exactly what number of drug combinations the breakdown in CAL will happen. We need to do further analysis, including more subjects, to understand the possible synergistic mechanisms for different drug and periodontal responses.

Comfort Levels Among Predoctoral Dental and Dental Hygiene Students in Treating Patients at High-Risk for HIV/AIDS.

PURPOSE: The purpose of this article is to discuss the impact of the training program for predoctoral dental and hygiene students at Loma Linda University School of Dentistry (LLUSD) with regard to issues related to treating patients with a high risk of having HIV/AIDS. METHODS: LLUSD offers a training program for fourth-year dental hygiene and predoctoral dental students that addresses the oral health care needs of persons with HIV disease. The training occurs in small groups 2 days per week at a community clinic serving HIV-positive individuals. Three academic quarters are required to train all fourth-year students each year. Evaluation of program effectiveness is conducted by means of pre- and post-session surveys. Dental hygiene and dental students completed the pre-survey during the spring quarter of their third year in public health dentistry courses. The same students completed the post-session survey at the end of their weekly training sessions during the fourth year. RESULTS: The overall change in all areas related to the students' comfort level in treating patients in the 3 defined categories is in a positive direction (p-value<0.0001). The change was much higher among dental hygiene students compared with predoctoral dental students. CONCLUSION: A comparison of pre- and post-session surveys reveals a significant improvement in students' perception of and comfort level with treating patients who are homosexual/bisexual or intravenous drug users, or who have a history of blood transfusion in both student groups upon completion of the HIV and the Dentist training program at LLUSD.

Comparison of the efficacy of different types of lasers for the treatment of peri-implantitis: a systematic review.

PURPOSE: To evaluate the efficacy of various types of lasers (neodymium-doped yttrium-aluminum-garnet [Nd:YAG], carbon dioxide [CO2], diode, erbium/chromium-doped yttrium-scandium-gallium-garnet [Er,Cr:YSGG], and erbium-doped yttrium-aluminum-garnet [Er:YAG]) in the treatment of peri-implantitis and their use in surgical and nonsurgical procedures. MATERIALS AND METHODS: Human studies for the treatment of peri-implantitis with laser therapy, published between 2002 and January 2014, were collected utilizing the electronic databases PubMed, Ovid, MEDLINE, Cochrane, and Google Scholar. Two reviewers conducted the study selection, data collection, and validity assessment. RESULTS: Eight hundred twelve studies were selected in the initial title search; 13 studies were then chosen for this review. No human studies evaluated the effect of the Nd:YAG laser on peri-implantitis. The CO2 laser is reported to be safe and able to enhance bone regeneration. The diode laser (980 nm) seems to be effective in its bactericidal effect without changing the implant surface pattern. The Er,Cr:YSGG laser was reported to obtain bone regeneration around a failing implant in one case, while the Er:YAG laser exhibits a strong bactericidal effect against periodontopathic bacteria at a low energy level. CONCLUSION: Although lasers have shown promising results in reducing clinical signs of peri-implantitis, because of the limited sample sizes and short follow-up periods, no firm conclusion can be drawn at this moment. Hence, there is a need for more well-designed, longitudinal, randomized controlled clinical trials.

Is there a relationship between periodontal disease and causes of death? A cross sectional study.

The aim of this study was to evaluate whether there is any correlation between periodontal disease and mortality contributing factors, such as cardiovascular disease and diabetes mellitus in the elderly population. A dental evaluation was performed by a single examiner at Tufts University dental clinics for 284 patients. Periodontal assessments were performed by probing with a manual UNC-15 periodontal probe to measure pocket depth and clinical attachment level (CAL) at 6 sites. Causes of death abstracted from death certificate. Statistical analysis involved ANOVA, chi-square and multivariate logistic regression analysis. The demographics of the population sample indicated that, most were females (except for diabetes mellitus), white, married, completed 13 years of education and were 83 years old on average. CAL (continuous or dichotomous) and marital status attained statistical significance (p<0.05) in contingency table analysis (Chi-square for independence). Individuals with increased CAL were 2.16 times more likely (OR=2.16, 95% CI=1.47-3.17) to die due to CVD and this effect persisted even after control for age, marital status, gender, race, years of education (OR=2.03, 95% CI=1.35-3.03). CAL (continuous or dichotomous) was much higher among those who died due to diabetes mellitus or out of state of Massachusetts. However, these results were not statistically significant. The same pattern was observed with pocket depth (continuous or dichotomous), but these results were not statistically significant either. CAL seems to be more sensitive to chronic diseases than pocket depth. Among those conditions, cardiovascular disease has the strongest effect.

Is There a Relationship Between Periodontal Disease and Causes of Death? A Cross Sectional Study

The aim of this study was to evaluate whether there is any correlation between periodontal disease and mortality contributing factors, such as cardiovascular disease and diabetes mellitus in the elderly population. A dental evaluation was performed by a single examiner at Tufts University dental clinics for 284 patients. Periodontal assessments were performed by probing with a manual UNC-15 periodontal probe to measure pocket depth and clinical attachment level (CAL) at 6 sites. Causes of death abstracted from death certificate. Statistical analysis involved ANOVA, chi-square and multivariate logistic regression analysis. The demographics of the population sample indicated that, most were females (except for diabetes mellitus), white, married, completed 13 years of education and were 83 years old on average. CAL (continuous or dichotomous) and marital status attained statistical significance (p<0.05) in contingency table analysis (Chi-square for independence). Individuals with increased CAL were 2.16 times more likely (OR=2.16, 95% CI=1.47-3.17) to die due to CVD and this effect persisted even after control for age, marital status, gender, race, years of education (OR=2.03, 95% CI=1.35-3.03). CAL (continuous or dichotomous) was much higher among those who died due to diabetes mellitus or out of state of Massachusetts. However, these results were not statistically significant. The same pattern was observed with pocket depth (continuous or dichotomous), but these results were not statistically significant either. CAL seems to be more sensitive to chronic diseases than pocket depth. Among those conditions, cardiovascular disease has the strongest effect.

O objetivo deste estudo foi avaliar se existe relação entre doença periodontal e fatores de mortalidade como, por ex., doenças cardiovasculares e diabetes melitus, numa amostra de pessoas idosas. Um único examinador fez avaliação dentária em 284 pacientes. As avaliações periodontais foram feitas com sonda manual UNC-15 para medir profundidade da bolsa e nível de inserção clínica em 6 pontos. As causas dos óbitos foram obtidas das certidões. Para análise estatística utilizou-se ANOVA, teste do qui-quadrado e análise de regressão logística multivariada. Os dados demográficos indicaram que a maioria era constituída de mulheres (exceto para diabetes melitus), leucodermas, casadas, completaram 13 anos de escolaridade e média de 83 anos de idade. O nível de inserção clínica (contínuo ou dicotomizado) e estado civil tiveram significância estatística (p<0,05) na análise das tabelas de contingência (qui-quadrado para independentes). O nível de inserção clínica foi 2,16 vezes mais provável causa de óbito (OR=2,16; 95%CI 1,47-3,17) por doença cardiovascular que o grupo dos sobreviventes e este efeito persistiu mesmo depois de controlados idade, estado civil, sexo, raça e anos de escolaridade (OR=2,03, 95%CI 1.35-3.03). O nível de inserção clínica (contínuo ou dicotomizado) foi muito maior entre os que morreram por diabetes melitus ou fora do estado de Massachusetts, mas estes resultados não foram estatisticamente significantes. O mesmo ocorreu com a profundidade da bolsa gengival (contínua ou dicotomizada), mas estes resultados também não foram estatisticamente significantes. Aparentemente a inserção clínica é mais afetada pelas doenças crônicas em comparação com a profundidade da bolsa. Entre estas doenças, as cardiovasculares têm efeito mais forte.

Factors contributing to tooth loss among the elderly: A cross sectional study.

BACKGROUND: The present study evaluates the influence of several demographic, health, personal, and clinical factors on the number of missing teeth in old age sample. METHODS: The number of patients included was 259; they received a full mouth examination and answered a questionnaire provided by one examiner. All the variables related to teeth loss based on the literature were included. These variables focused on age, gender, race, marital status, clinical attachment level, pocket depth, year of smoking, number of cigarettes smoked per day, number of medications, root decay, coronal decay, health status, and year of education. Statistical analysis involved stepwise multivariate linear regression. RESULTS: Teeth loss was statistically associated with clinical attachment level (CAL)(p value 0.0001), pocket depth (PD) (0.0007) and education level (0.0048). When smoking was included in the model, age was significantly associated with teeth loss (0.0037). At least one of these four factors was also related to teeth loss in several specific groups such as diabetes mellitus, male, and White. The multiple linear regressions for all the proposed variables showed that they contributed to teeth loss by about 23%. CONCLUSIONS: It can be concluded that less education or increased clinical attachment level loss may increase number of missing teeth. Additionally, age may cause teeth loss in the presence of smoking.