Stability and marginal bone loss in implants placed using piezoelectric osteotomy versus conventional drilling: systematic review and meta-analysis / Estabilidad y pérdida de hueso marginal en implantes colocados mediante piezoeléctrico osteotomía versus perforación convencional: revisión sistemática y metanálisis

Background: The main objective of this systematic review was to compare primary and secondary implant stabil-ity between placement with piezoelectric osteotomy and conventional drilling, comparing marginal bone lossesas a secondary objective.Material and Methods: An electronic search was conducted using PubMed (MEDLINE), Scopus, and CochraneLibrary (Wiley) databases, besides a manual search.Results: A total of 153 articles were retrieved, 39 from Pubmed, 44 from Scopus, and 70 from the CochraneLibrary. After removing duplicates, 112 articles (1 from the manual search) were screened, and 9 were finallyselected for qualitative and statistical analyses.Conclusions: Piezoelectric surgery is a predictable alternative to conventional drilling for dental implant place-ment. Medium/long-term survival rates and marginal bone losses are similar between piezoelectric osteotomy andconventional drilling, and there is no difference in ISQ values for primary stability. However, implants placed withultrasound showed a lower decrease in implant stability quotient (ISQ) during the osseointegration period and ahigher ISQ value for secondary stability. This study contributes further information on peri-implant bone tissueat 3 and 6 months after implant placement with piezoelectric osteotomy or conventional drilling and provides anupdated meta-analysis of comparative studies.(AU)

Efficacy of dental floss with ellipsoidal knots vs conventional dental floss for plaque removal: A split-mouth randomized trial.

OBJECTIVES: To compare clinical efficacy for plaque removal between dental floss with soft ellipsoidal knots and conventional floss. MATERIALS AND METHODS: We studied 33 university students (29 females and 4 males, 13 of them undergraduate/postgraduate students of dentistry), including regular and sporadic (less once/wk) users of dental floss, with interproximal spaces ≤1 mm, who used floss with and without knots in a randomized manner following a split-mouth design. The Modified Navy Plaque Index (RMNPI) by Rustogi et al. was applied to determine the total removed plaque (TPI) and that removed in the gingival area (GPI) and interproximal spaces (IPI). RESULTS: The reduction in GPI was greater with the knotted vs conventional floss in all cases (14.77 ± 12.38; 64.79% vs 17.38 ± 13.66; 57.51%) and especially among no floss users (12.469 ± 10.98; 68.02% vs 15.833 ± 11.88; 58.55%). No statistically significant difference between floss types was found in TPI and IPI (globally or by floss utilization frequency) or in the mean GPI of floss users. CONCLUSION: Floss with ellipsoidal knots showed similar efficacy to remove plaque in patients with less experience of flossing (but without statistically significant differences) compared with flossing themselves with conventional floss, and it may be an optimal solution for patients starting to use dental floss and for those with a lesser or only sporadic history of floss utilization.

Periodontal status during pregnancy and postpartum.

OBJECTIVES: Different studies have documented an association between periodontal disease and low birth-weight delivery. Hence, knowledge of periodontal status during pregnancy and postpartum is important in order to reduce the risks of both diseases. This study aimed to analyze periodontal status at successive stages of pregnancy and 3-6 weeks postpartum in women with initial periodontal alterations. MATERIALS AND METHODS: Ninety-six pregnant women were examined at 8-10 weeks (pregnancy diagnosis, baseline), 21-23 weeks and 34-36 weeks of gestation and at 40 days postpartum to record plaque scores, clinically assessed gingival inflammation and probing depth (mean depth and % sites with depth >3 mm). Bivariate and multivariate analyses were performed. Type 1 (α) error was established at 0.05. RESULTS: Plaque Index increased (p = 0.043) throughout pregnancy (baseline, 42%±0.18); 21-23 weeks, 42.6%±0.14; 34-36 weeks, 45.6%±0.13 and decreased postpartum (44.8%±0-13). Gingival Index increased (p<0.001) throughout pregnancy (baseline, 56.7%±0.20; 21-23 weeks, 66.36%±0.17; 34-36 weeks, 74.5%±0.18) and decreased postpartum (59.3%±0.21). Probing Depth increased (p<0.001) throughout pregnancy (baseline, 2.51±0.05; 21-23 weeks, 2.63±0.053; 34-36 weeks 2.81±0.055) and decreased postpartum (2.54±0.049). Percentage of sites with Probing Depth >3 mm increased (p<0.001) throughout pregnancy (baseline, 17.6%±0.16; 21-23 weeks, 23.9%±0.17; 34-36 weeks, 31.1%±0.17) and decreased postpartum (21.2%±0.17) but remained significantly (p<0.02) higher than at baseline. CONCLUSION: Periodontal status deteriorates during gestation but improves postpartum.

Periodontal and biochemical bone metabolism assessment on a chronic oral anticoagulation population treated with dicoumarins

BACKGROUND: The aim is to evaluate periodontal alteration and biochemical markers associated with bone turnover in chronic oral with dicoumarins anticoagulant treatment patients. MATERIAL AND METHODS: 80 patients treated with oral anticoagulants were divided into 2 cohort: Group A (n = 36) 6 month to 1 year with anticoagulant treatment and Group B (n = 44) > 2 years with anticoagulant treatment. Clinical evaluation included: Clinical attachment level (CAL), plaque index (PI) and gingival index (GI). Analytically biochemical parameters of bone remodeling (calcium and phosphorus), formation (total acid phosphatase, alkaline phosphatase and osteocalcin) and resorption (tartrate-resistant acid phosphatase and beta-crosslaps) were evaluated. RESULTS: High values of PI (67-100%) especially in men and in Group B were observed. Men with anticoagulation treatment length showed an increased GI (49.167 vs 78.083) while Group B women showed a decreased GI in comparison with Group A (59.389 vs 42.120). Women presented a greater average CAL than men as well as Group B vs Group A but without statistical significance. All biochemical markers were decreased respect to values of general population. Osteocalcin in Group B women showed a statistically significant outcome vs Group A (p = 0.004). Acid phosphatase (total and tartrate-resistant) has a slight increase in Group B women versus Group A, and Beta-crosslap showed lower values in Group A men than Group B and slightly lower in Group A women versus Group B, without statistical significance. CONCLUSIONS: Patients showed a slight to moderate degree of periodontal affectation, especially gingivitis related to bacterial plaque. Periodontal disorders tended to be more severe in Group B. While bone remodeling showed an overall decrease with greater affectation of bone neoformation phenomena, bone destruction tended to recover and normalize in time

Bisphosphonates, vitamin D, parathyroid hormone, and osteonecrosis of the jaw. Could there be a missing link?

BACKGROUND: It is estimated that over 190 million bisphosphonates have been prescribed worldwide. But this drug can produce adverse effects, of which osteonecrosis of the jaw and severe hypocalcemia are the most serious. It is evident that bisphosphonate administration affects multiple and diverse biochemical mediators related to bone metabolism. MATERIAL AND METHODS: This review of literature investigates four basic parameters in patients treated with bisphosphonates - parathyroid hormone (PTH), bisphosphonates, vitamin D, calcium, and jaw osteonecrosis - which are fundamental for assessing bone metabolism and so the efficacy and correct use of the drug. The imbalances generated by vitamin D and calcium deficiencies, together with their multiple systemic repercussions, have been widely researched but the outcomes of these imbalances in relation to bisphosphonate administration are not well known, and some research has indicated that they may be associated with osteonecrosis of the jaw (ONJ). RESULTS: The present review set out to explain the functioning of bone metabolism, the importance of different chemical mediators, the imbalances produced by incorrect use of this drug, in order to forewarn against the possible relation of these parameters with ONJ, whose physiopathology remains unknown. CONCLUSIONS: Medical and dental clinics should keep detailed anamneses of the use of vitamin D and calcium supplements, as it is of vital importance to maintain their correct levels in blood, given that these are related to ONJ as well as other adverse effects; this procedure is also necessary in order to ensure the correct use of the drug

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Bisphosphonates, vitamin D, parathyroid hormone, and osteonecrosis of the jaw. Could there be a missing link?

BACKGROUND: It is estimated that over 190 million bisphosphonates have been prescribed worldwide. But this drug can produce adverse effects, of which osteonecrosis of the jaw and severe hypocalcemia are the most serious. It is evident that bisphosphonate administration affects multiple and diverse biochemical mediators related to bone metabolism. MATERIAL AND METHODS: This review of literature investigates four basic parameters in patients treated with bisphosphonates - parathyroid hormone (PTH), bisphosphonates, vitamin D, calcium, and jaw osteonecrosis - which are fundamental for assessing bone metabolism and so the efficacy and correct use of the drug. The imbalances generated by vitamin D and calcium deficiencies, together with their multiple systemic repercussions, have been widely researched but the outcomes of these imbalances in relation to bisphosphonate administration are not well known, and some research has indicated that they may be associated with osteonecrosis of the jaw (ONJ). RESULTS: The present review set out to explain the functioning of bone metabolism, the importance of different chemical mediators, the imbalances produced by incorrect use of this drug, in order to forewarn against the possible relation of these parameters with ONJ, whose physiopathology remains unknown. CONCLUSIONS: Medical and dental clinics should keep detailed anamneses of the use of vitamin D and calcium supplements, as it is of vital importance to maintain their correct levels in blood, given that these are related to ONJ as well as other adverse effects; this procedure is also necessary in order to ensure the correct use of the drug.

Bacterial influence on consolidation of bone grafts in maxillary sinus elevation.

OBJECTIVES: The aim of this study was to identify microorganisms present on the maxillary sinus floor at the moment of sinus elevation surgery and, using tomography, to investigate the repercussions these might have for regenerated bone 9 months after the procedure. MATERIALS AND METHODS: 174 patients (90 women and 84 men) with a mean age of 55.92 years underwent 227 sinus elevations (120 left sinus, 107 right sinus). As the membrane was lifted, a sample of the maxillary sinus floor was collected with a cotton swab, and placed on a blood agar and chocolate agar culture to incubate for 48 h at 37°C; the samples then underwent microbiological analysis. Orthopantomographs and computerized tomographs were made immediately after the sinus grafting and after 9 months to measure the amount of remaining and regenerated bone in vertical and transversal direction. RESULTS: 18.1% of 227 cultures were bacteria-positive. 45% of the germs were of the Streptococcus genus, most of which belonged to the S. viridans group (61.1%). Patients presenting negative cultures had 5% more regenerated bone than patients with bacteria-positive cultures, which represents an additional 2.28 mmof vertical bone (with a confidence interval between 0.83 mm and 3.73 mm). CONCLUSIONS: Patients with bacteria-positive cultures obtained previously to the sinus grafting procedure have greater risk of bone height loss after 9 months, which indicates that bacterial contamination may influence bone graft regeneration.

Peri-implant evaluation of immediately loaded implants placed in esthetic zone in patients with diabetes mellitus type 2: a two-year study.

OBJECTIVES: The aim of this study was to evaluate implant survival and primary stability parameters in patients with diabetes with different levels of glycosylated hemoglobin Alc (HbA1c) treated with immediate placement and provisionalization of implant-supported, single-tooth replacements over 2 years. MATERIALS AND METHODS: Eighty-five patients were divided into three groups according to their HbA1c levels: 33 patients in Group 1 (<6, control group); 30 patients in Group 2 (6.1-8); and 22 patients in Group 3 (8.1-10). Each patient received one-one-piece implant in the anterior zone of the upper maxillary. The implant survival rate was analyzed for each group, together with three variables to evaluate the general state of peri-implant health: probe depth, bleeding on probing, marginal bone loss. RESULTS: Marginal bone loss increased in relation with higher HbA1c levels. For marginal bone loss in Group 1, mean resorption values ranged from 0.51 after 6 months to 0.72 after 2 years in comparison with respective values of 1.33 and 1.92 in Group 3. This pattern was repeated for bleeding on probing, both parameters showing significant differences between groups. For bleeding on probing, mean bleeding levels varied from 0.36 in Group I at 6 months after implant placement, to 0.59 in Group 3 (P = 0.041 between the three groups). Peri-implant pocket depth showed the same tendency to increase in relation to HbA1C but differences between groups did not reach statistical significance. CONCLUSIONS: Patients with diabetes can receive implant-based treatments with immediate loading safely, providing they present moderate HbA1c values.

Dental extraction in patients receiving dual antiplatelet therapy

BACKGROUND: Dual antiplatelet therapy consists of administering antiplatelet (antiaggregant) drugs (clopidogrel and aspirin) to prevent thrombotic processes, as a preventative measure in patients with acute coronary disease, or in patients subjected to percutaneous coronary intervention. OBJECTIVE: The purpose of this study was to evaluate the efficacy of a protocol for performing dental extraction in patients receiving dual antiplatelet therapy. Material and Methods Thirty-tow patients undergoing dental extractions were included in the study. The variables evaluated were: collagen-epinephrine fraction, collagen- adenosine diphosphate fraction, surgical surface, post-surgical measures, and adverse effects. Alveolar sutures and gauzes impregnated with an antifibrinolytic agent (tranexamic acid), which the patient pressed in place for 30 minutes, were applied to all patients as postsurgical measures. Descriptive statistics were calculated and analyzed with Student's t-test to compare pairs of quantitative variables; simple regression analysis was performed using Pearson's correlation coefficient. Statistical significance was set at p < 0.05. RESULTS: Collagen/epinephrine fraction was 264.53±55.624 seconds with a range of 135 to 300 seconds, and collagen/ADP fraction was 119.41±44.216 seconds, both values being higher than normal. As a result of the postsurgical measures taken, no patients presented post-operative bleeding, hematoma or infection. CONCLUSIONS: Dental extraction was safe for patients receiving dual anti-platelet therapy when using sutures and gauze impregnated with tranexamic acid, which the patient pressed in place for 30 minutes

Dental extraction in patients receiving dual antiplatelet therapy.

BACKGROUND: Dual antiplatelet therapy consists of administering antiplatelet (antiaggregant) drugs (clopidogrel and aspirin) to prevent thrombotic processes, as a preventative measure in patients with acute coronary disease, or in patients subjected to percutaneous coronary intervention. OBJECTIVE: The purpose of this study was to evaluate the efficacy of a protocol for performing dental extraction in patients receiving dual antiplatelet therapy. MATERIAL AND METHODS: Thirty-two patients undergoing dental extractions were included in the study. The variables evaluated were: collagen-epinephrine fraction, collagen- adenosine diphosphate fraction, surgical surface, post-surgical measures, and adverse effects. Alveolar sutures and gauzes impregnated with an antifibrinolytic agent (tranexamic acid), which the patient pressed in place for 30 minutes, were applied to all patients as post-surgical measures. Descriptive statistics were calculated and analyzed with Student's t-test to compare pairs of quantitative variables; simple regression analysis was performed using Pearson's correlation coefficient. Statistical significance was set at p<0.05. RESULTS: Collagen/epinephrine fraction was 264.53±55.624 seconds with a range of 135 to 300 seconds, and collagen/ADP fraction was 119.41±44.216 seconds, both values being higher than normal. As a result of the post-surgical measures taken, no patients presented post-operative bleeding, hematoma or infection. CONCLUSIONS: Dental extraction was safe for patients receiving dual anti-platelet therapy when using sutures and gauze impregnated with tranexamic acid, which the patient pressed in place for 30 minutes.

Evaluation of the efficacy of a topical sialogogue spray containing malic acid 1% in elderly people with xerostomia: a double-blind, randomized clinical trial.

OBJECTIVE: The aim of this study was to evaluate the clinical efficacy of a topical sialogogue spray containing 1% malic acid for elderly people affected by xerostomia. MATERIAL AND METHODS: This research took the form of a double-blind, randomized clinical trial. Forty-one individuals (mean age: 78.7 years) with xerostomia were divided into two groups: for the first 'intervention group' (21 subjects) a topical sialogogue spray (1% malic acid) was applied, while for the second 'control group' (20 subjects), a placebo spray was applied; for both groups, the sprays were applied on demand during 2 weeks. The Xerostomia Inventory (XI) was used to evaluate xerostomia levels before and after product/placebo application. Unstimulated and stimulated salivary flows rates, before and after spray application, were measured. RESULTS: XI scores decreased significantly (clinically meaningful) from 36.4 ± 7.3 points to 29.1 ± 7.1 (p < 0.05) with an XI difference of 7.2 ± 6.1, after the combination among 1% malic acid with xylitol and fluoride application. After 2 weeks of 1% malic acid application, unstimulated and stimulated salivary flows rates increased significantly (p < 0.05). CONCLUSION: A topical sialogogue spray containing 1% malic acid improved xerostomia in an elderly population and increased unstimulated and stimulated salivary flows rates.

Electron microprobe analysis in guided tissue regeneration: a case report.

OBJECTIVES: Several procedures have been advocated as regenerative procedures in periodontology, but one of the most widely used techniques up to now is guided tissue regeneration (GTR). Likewise, different assessment methods based on clinical, radiographic or histological measurements have been proposed for the evaluation of these regenerative procedures. However, none of the methods used for human material incorporates quantitative X-ray microanalysis to assess the degree of mineralization of the regenerated periodontal hard tissues. The objective of this report was to evaluate, using quantitative X-ray microprobe analysis, the newly-formed hard tissue in a periodontal infrabony defect. METHODS: Electron microprobe analysis was used to study the nature of the newly-formed hard tissue 3 years after treatment with guided tissue regeneration in a patient with localized aggressive periodontitis. RESULTS: Our quantitative analyses, using the peak-to-background method, showed calcium/phosphorus mass ratio of 1.50 +/- 0.38 in the newly-formed hard tissue around the affected tooth root. CONCLUSION: Quantitative X-ray microprobe analysis is a useful tool that may provide an accurate assessment of the degree of mineralization in an extremely small tissue sample.

Relationship between maternal periodontal disease and low-birth-weight pre-term infants.

OBJECTIVES: The purpose of this study was to determine the influence of periodontal status on low-birth-weight pre-term delivery. MATERIAL AND METHODS: Ninety-six pregnant women were examined in their first, second and third trimester to record plaque scores, clinically assessed gingival inflammation and probing depth (mean depth and percentage of sites with depth of >3 mm). Binary logistic regression analyses were performed using SUDAAN 7.5 program. The type 1 (alpha) error established at 0.05 and an (alpha) error of 0.05-0.1 were considered nearly significant. RESULTS: The 96 women delivered 89 newborns: 16 were pre-term and seven of these were of low birth weight. There were seven miscarriages, all in the second trimester. No statistically significant association was found between gestational age and periodontal parameters. No significant relationship was found between low-weight delivery and plaque index measurements, although the association with gingival index was close to significant. A relationship was observed between low-weight birth and probing depth measurements, especially the percentage of sites of >3 mm depth, which was statistically significant (p=0.0038) even when gestational age was controlled for. CONCLUSIONS: According to these results, periodontal disease is a significant risk factor for low birth weight but not for pre-term delivery.