Prevalence and risk factors for peri-implant disease in Belgian adults.

OBJECTIVES: This study aimed to evaluate in a Belgian population the frequence of mucositis and peri-implantitis in patients with implants of at least 5 years of function. Another outcome was to access implants/patients characteristics as possible risk indicators for peri-implantitis. MATERIAL AND METHODS: One hundred and three patients (38 males/65 females) with a total of 266 implants were examined. Implants had been inserted in university hospitals as well as in private clinics and the mean time of implants in function was 8.5 years (±3.2). The average patients' age within the population was 62 years (±13.4). General health informations were recorded as well as habits regarding smoking, maintenance visits and oral hygiene. Full mouth clinical parameters (PlI, BoP, PPD) were assessed and radiographs taken to determine the periodontal status and implants diagnosis. RESULTS: Prevalences of mucositis and peri-implantitis at the patient's level were respectively 31% and 37%. They were 38% and 23% at the implant's level. Subjects older than 65 years (OR = 1.39) and those with active periodontitis (OR = 1.98) were prone to peri-implantitis. The association was stronger for hepatitis (OR = 2.92) and totally edentulous patients (OR = 5.56). Finally, at the implant's level, a significant correlation was found in the multi-level analyses between rough surfaces, overdentures and peri-implantitis. CONCLUSION: After 8.5 years an important proportion (±60%) of implants presented biological complications. Furthermore, a positive correlation was showed between age, periodontitis, absence of teeth, rough surfaces and peri-implantitis. Consequently, patients with such characteristics should be informed before implant placement and frequently re-called after for maintenance visits.

Susceptibility to various oral antiseptics of Porphyromonas gingivalis W83 within a biofilm.

The origin of chronic periodontal disease is strongly related to the nature and physiology of the subgingival bacterial biofilm, of which Porphyromonas gingivalis is a main protagonist. This study was conducted in vitro, to test the susceptibility of the W83 strain of P gingivalis to several oral antiseptics, bearing in mind its mode of growth as biofilm. To this end, the investigators inoculated a brain-heart infusion broth with Streptococcus gordonii, to which P gingivalis was added before perfusion for 7 d via a closed circuit containing a modified Robbins device. Then, various antiseptics were perfused through the circuit over 30 min, and their bactericidal effects were evaluated after culture by comparison of the mean proportion of bacteria killed. The average proportion of P gingivalis W83 killed after 15 min of contact with antiseptics was 90.51% (+/-4.78) for chlorhexidine 0.2%, 89.87% (+/-6.58) for povidone-iodine 1%, and 98.6% (+/-0.86) for Listerine (McNeil-PPC, Inc., Morris Plains, NJ). After 30 min of contact, survival of P gingivalis was nil, irrespective of the antimicrobial agent used. Preliminary results show that antiseptic mouth rinses, when used in pure concentrations in the traditional way, are effective in killing P gingivalis W83 within a biofilm. Furthermore, in light of these experiments, it appears that the best results are obtained when Listerine is used; however, new trials should be conducted to confirm this observation.

Improving patients' compliance with the treatment of periodontitis: a controlled study of behavioural intervention.

OBJECTIVES: This clinical trial study investigates whether a behavioural educational intervention based on the autoregulation theory can improve periodontitis patients' compliance with proper dental care at a 1-month follow-up. MATERIAL AND METHODS: Thirty patients matched for gender (20 men), age (mean age=39 years) and education were randomly assigned to a control or an experimental treatment condition. In the control condition, patients received the regular treatment based on instruction of the proper prophylactic dental care. In the experimental treatment condition, patients received information about the symptoms of periodontitis, the causes, consequences and temporal course, and the types of effective strategy and they were requested to keep daily records of the effects of applying prophylactic dental care on their periodontitis symptoms. In both groups, plaque indices (PIs) (Silness & Löe 1964) were measured prior to treatment and at a 1-month follow-up. A self-report questionnaire also assessed the representation of periodontitis in all patients. RESULTS: A 2 (time of measurement: baseline versus follow-up) x 3 (PI localization) x 2 (experimental group) mixed-design anova computed on the PI reports a large effect of time, F(1, 28)=267.10, p<0.000, indicating that both groups improved from baseline (mean=1.73, SD=0.08) to the 1-month follow-up (mean=0.56, SD=0.06). It is important to point out that this analysis also revealed the expected Group x Time interaction, F(1, 28)=7.09, p<0.02, partial eta(2)=0.19, indicating that smaller PI were observed in the experimental group (mean=0.24, SD=0.14) than in the control group (mean=0.88, SD=0.38) at follow-up. Post hoc analyses showed that this pattern applies to the proximal and lingual PI but not to the vestibular PI. CONCLUSIONS: The present data show that the behavioural education intervention is (a) more effective than a classical intervention based on information and training about prophylactic techniques and (b) that it is effective in bringing most patients to normal levels of PI. For clinical practice, it suggests that better results can be obtained if (a) patients are taught a correct representation about periodontitis and (b) patients' sense of self-efficacy is developed through their own direct experience, by observing the effects of their behaviour on periodontitis symptoms.

Loss of tooth substance during root planing with various periodontal instruments: an in vitro study.

Ultrasonic and power-driven instrumentation is gaining in significance as an acceptable alternative to manual periodontal root treatment. Some question whether they do not remove too much tooth substance. Various ultrasonic scalers, hand instruments and two power-driven systems were compared by assessing the loss of tooth substance due to root instrumentation. Quantitative analysis of this effect of the instruments used was performed on 20 freshly extracted, non-periodontally involved, large human molars. In the first study, 40 specimens were randomly assigned to four groups of treatment: combined use of ultrasonic scaler and Periopolisher diamond-coated inserts (US-POL), hand instruments (MANUAL), Perioplaner-Periopolisher system (PPL-POL) and Periokit ultrasonic-designed scalers (PERIOKIT). The second study involved two treatment groups, ultrasonic scaler alone and hand instruments, each allocated with 20 teeth (small root fragments). An unpaired two-tailed t test was carried out for both studies to compare the average weight loss of root substance with the modes of instrumentation. The level of significance was set at p

Comparative clinical responses related to the use of various periodontal instrumentation.

AIM: The aim of this study was to evaluate in vivo the effectiveness of scaling and root planing of a power-driven mechanism compared with hand instruments and ultrasonic insert alone with a split-mouth design after 3 and 6 months. METHODS: Healing events after initial periodontal therapy were investigated in 20 patients with moderate-to-severe adult periodontitis. Plaque index (PlI), bleeding on probing (PBI), probing pocket depth (PPD), probing attachment level (PAL) and number of moderate and deep pockets (NMP, NDP) were recorded at baseline and 3 and 6 months after treatment. Oral hygiene instruction was provided for each patient. Randomly assigned quadrants per patient were scaled and root planed with hand instrumentation (curettes, hoes and files), with reciprocating power-driven instruments, with ultrasonic scaler alone and with the combined use of ultrasonic scaler and power-driven inserts. The Friedman test was applied to test the significance of difference between the various methods of root instrumentation. Repeated measures of analysis of variance (manova) were used to analyse the time effect on the different treatments. RESULTS: At the 6-month evaluation, all groups in the scaling and root planing treatment presented with an improvement in the measured clinical parameters, as compared with baseline. No statistical differences (p>0.05) were observed in the assessed periodontal indices among the study sites between the four groups for either treatment. CONCLUSIONS: Under our experimental conditions, this clinical study demonstrates that mechanized root planing with power-driven instruments, as effective as the usual procedures (hand and sonic instruments), represents a satisfactory and alternative means of nonsurgical root therapy.

Patient evaluation of a novel non-injectable anesthetic gel: a multicenter crossover study comparing the gel to infiltration anesthesia during scaling and root planing.

BACKGROUND: Periodontal scaling procedures commonly require some kind of anesthesia. From the patient's perspective, the choice of anesthetic method is a trade-off between the degree of anesthesia and accepting the side effects. The present study evaluates the preferences for a novel non-injection anesthetic product (a gel, containing lidocaine 25 mg/g plus prilocaine 25 mg/g and thermosetting agents) versus injection anesthesia (lidocaine 2% adrenaline) in conjunction with scaling and/or root planing (SRP). METHODS: In a multicenter, crossover, randomized, open study patients were asked, after they had experienced both products, if they preferred anesthetic gel or injection anesthesia. In addition, the adequacy of anesthesia and occurrence of post-procedure problems were assessed. The patients were also asked about their willingness to return if they were offered anesthetic gel at their next visit and their maximum willingness to pay (WTP) for this option. RESULTS: One-hundred seventy (170) patients at eight centers in Belgium were included in the study. There were 157 per protocol (PP) patients. A vast majority of the PP patients (70%) preferred the anesthetic gel to injection anesthesia (22%). The most common reason was less post-procedure numbness. Eighty percent (80%) of the patients expressed satisfactory anesthesia with the gel and 96% with injection anesthesia (P <0.001). Post-procedure problems were significantly less with the gel than with injection (P <0.001): numbness 15% versus 66%, unpleasant sensations such as soreness and pain 44% versus 63%, and problems connected with daily activities 19% versus 69%. The majority of patients (60%) who preferred gel were also willing to pay for it. A conservative estimate of the median WTP was $10.00. Furthermore, anesthetic gel would make almost every second patient (45%) more or much more willing to return for the next treatment. CONCLUSIONS: The data suggest that a somewhat less profound anesthesia with gel is clearly preferred by the patients because of the low incidence of post-procedure problems as compared to conventional injection anesthesia. The median WTP is likely in excess of the acquisition cost of the product, which indicates a favorable cost-benefit ratio for the individual patient.