Comparison of clinical values between cone beam computed tomography and conventional intraoral radiography in periodontal and infrabony defect assessment.

OBJECTIVES: The use of CBCT for periodontal diagnosis and treatment plan is limited. The aim of this study is to compare the assessment of periodontal conditions and infrabony defects between conventional intraoral radiography (IOR) and CBCT. METHODS: The study included 25 subjects who had periodontitis and at least two infrabony defects. All subjects received clinical periodontal examination, IOR and CBCT. Three periodontists assigned periodontal diagnosis and prognosis of each tooth. For teeth with infrabony defects, the number of defect walls and treatment was determined. IOR and CBCT assessment was compared. RESULTS: There were 666 teeth and 123 infrabony defects. The overall concordance between IOR and CBCT for periodontal diagnosis, prognosis, infrabony defect type and infrabony defect treatment were 79.3%, 69.5%, 44.7% and 64.2%, respectively. IOR underestimated diagnosis, prognosis and the number of infrabony defect walls at 16.4%, 24% and 37.4%, respectively. IOR and CBCT had poor concordance for periodontal regeneration (43.3%). Tooth extraction was more prevalent when assessed by CBCT (35.0% vs 22.7%). CBCT had excellent interexaminer agreement (Fleiss' kappa 0.87-0.94) and higher percentage of complete agreement among examiners than IOR for all assessments. CONCLUSIONS: IOR underestimated the severity and prognosis of periodontal disease. CBCT was superior to IOR for evaluation of infrabony defect morphology and treatment. CBCT provides excellent agreement among examiners on periodontal and infrabony defect assessment.

The influence of peri-implant mucosal level on the satisfaction with anterior maxillary implants.

OBJECTIVES: The aim of this study was to determine variables associated with implant satisfaction and to evaluate the influence of peri-implant mucosal level on implant satisfaction. MATERIALS AND METHODS: Forty patients restored with single-tooth anterior maxillary implants were recruited for the study. The facial and inter-proximal mucosal level of implants was measured. The patients and clinicians were asked to rate their satisfaction with dental implants on various aspects, using the visual analog scale (VAS). The VAS scores of patients and clinicians were compared and correlated. Variables associated with implant satisfaction as well as the influence of peri-implant mucosal level on implant satisfaction were determined. RESULTS: The patients showed high overall esthetic satisfaction (84.5%) with their implants. However, their satisfaction on the harmonization of gingiva (67.4%) was relatively low. The patient's overall esthetic satisfaction was significantly associated with crown color, crown shape, and confidence when smiling, but not the harmonization of gingival margin. The patient's satisfaction with the worth for expense was significantly associated with overall esthetic satisfaction, confidence when smiling, and speaking well. The presence of facial mucosal level ≥ 1 mm (compared with the contralateral tooth) and less than half papilla fill had no significant effect on the overall esthetic satisfaction assessed by patients. However, the presence of less than half papilla fill affected the patient's satisfaction on speech. CONCLUSIONS: Peri-implant mucosal level is not a significant factor for the patient's esthetic satisfaction with their anterior maxillary implants. Papillary recession, however, appeared to affect their satisfaction on speech.

Cone-beam computed tomographic evidence of the association between periodontal bone loss and mucosal thickening of the maxillary sinus.

BACKGROUND: The aim of the present study is to determine the relationship between dental findings and mucosal abnormalities of the maxillary sinus among dental patients, using cone-beam computed tomography (CBCT). METHODS: Two hundred fifty CBCT scans of dental patients were studied. Dental findings of the upper posterior teeth, including periodontal bone loss, periapical lesions, and root canal fillings, were assessed. The presence of mucosal thickening and mucosal cysts of the maxillary sinus was recorded. Logistic regression analysis was used to determine the influence of periodontal bone loss, periapical lesions, and root canal fillings on these sinus mucosal abnormalities. RESULTS: Mucosal thickening was present in 42% of patients and in 29.2% of sinuses studied. Mucosal cysts were observed in 16.4% of patients and in 10% of sinuses studied. Both abnormalities were present more frequently among males than females. Severe periodontal bone loss was significantly associated with mucosal thickening (odds ratio: 3.02, P <0.001), whereas periapical lesions and root canal fillings were not. There was no association between dental findings and mucosal cysts. CONCLUSIONS: Severe periodontal bone loss was significantly associated with mucosal thickening of the maxillary sinus. Sinuses with severe periodontal bone loss were three times more likely to have mucosal thickening. Mucosal cysts were not associated with any dental findings.

Factors affecting soft tissue level around anterior maxillary single-tooth implants.

BACKGROUND: Peri-implant soft tissue recession is a major esthetic concern for the anterior implants. The aim of this study was to determine the factors that affected the facial marginal mucosal level and papilla level around single-tooth implants in the anterior maxilla. METHODS: Forty single-tooth implants in the anterior maxilla were studied. Variables possibly associated with the soft tissue level were obtained from clinical measurements, study models, peri-apical radiographs, and computerized tomograms. Fisher's exact test, analysis of variance, and binary logistic regression analysis were used to determine the influence of each factor on the facial marginal mucosal level and papilla level. RESULTS: The majority of the implants (75%) replaced the upper central incisors. The facial mucosal margin of the implant was 0.5+/-0.9 mm more apical than that of the contralateral tooth. Half or more of papilla fill was observed in 89% of the samples. More apical level of the facial mucosal margin at the implant sites was significantly influenced by many factors including a thin peri-implant biotype, a proclined implant fixture angle, more apical level of the facial bone crest, increased distance from the contact point to the bone crest, contact point to the platform, and contact point to implant bone. A thin biotype was the most significant factor in determining the facial marginal mucosal level. Increased distance from the contact point to the bone crest was the only factor significantly associated with less papilla fill. CONCLUSIONS: The papilla level around single-tooth implants in the anterior maxilla was mainly influenced by the interproximal bone crest level of the adjacent tooth. Facial marginal mucosal level, on the other hand, was affected by multiple factors including the peri-implant biotype, the facial bone crest level, the implant fixture angle, the interproximal bone crest level, the depth of implant platform, and the level of first bone to implant contact.

Indoleamine 2,3-dioxygenase expression and regulation in chronic periodontitis.

BACKGROUND: Indoleamine 2,3-dioxygenase (IDO) is an intracellular tryptophan-oxidizing enzyme with immunosuppressive characteristics. Its expression and regulation in periodontal tissues are unknown. The aim of this study was to determine IDO expression in healthy gingiva and chronic periodontitis lesions. In addition, the effect of inflammatory cytokines and bacterial products on the expression and activity of DOI in human gingival fibroblasts (HGFs) was assessed. METHODS: Human gingival tissue samples were obtained from patients who underwent periodontal surgery. IDO expression in healthy gingiva and periodontitis lesions was determined by immunohistochemistry. HGF cells were treated with interferon-gamma (IFN-gamma), interleukin (IL)-1beta, tumor necrosis factor-alpha (TNF-alpha), and lipopolysaccharides from Porphyromonas gingivalis (PgLPS). IDO mRNA expression was determined by reverse transcription-polymerase chain reaction. The IDO enzymatic activity was determined by measuring the kynurenine level using a colorimetric method. RESULTS: In gingival tissues, IDO expression was detected in epithelial cells, fibroblasts, endothelial cells, and inflammatory mononuclear cells. IDO expression was higher in periodontitis lesions than in healthy gingiva. HGFs did not constitutively express IDO. IFN-gamma strongly induced IDO expression and activity in HGFs, in a dose-dependent manner. IL-1beta, TNF-alpha, and PgLPS were also able to induce IDO expression in HGF cells. IFN-gamma in combination with IL-1beta, TNF-alpha, or PgLPS showed enhanced IDO expression. CONCLUSIONS: IDO was expressed in human gingiva, and the expression was upregulated in chronic periodontitis. The increased IDO expression in periodontitis lesions may be due, in part, to the activation of HGFs by inflammatory cytokines and bacterial products.

Risk indicators of periodontal disease in older Thai adults.

BACKGROUND: The aim of this study was to identify risk indicators for periodontitis using cross-sectional data from a group of older Thai adults. METHODS: The study group consisted of 2,005 individuals, aged 50 to 73 years old. They received detailed medical examinations and periodontal examinations including plaque score, probing depth, and clinical attachment level. These individuals were categorized into mild, moderate, or severe periodontitis if mean clinical attachment level was <2.5 mm, 2.5 to 3.9 mm, or > or = 4.0 mm, respectively. The degree of association between the severity of periodontitis and various independent variables was investigated using multinomial logistic regression analysis. RESULTS: The percentage of subjects classified as mild, moderate, and severe periodontitis was 30.5, 53.6, and 15.9, respectively. The prevalence of severe periodontitis was higher in males and increased with age. In univariate analysis, older subjects, males, less educated persons, persons with lower income, persons with higher plaque score, smokers, drinkers, and diabetics were more likely to have both moderate and severe periodontitis. In multivariate analysis, males, less educated persons, persons with higher plaque score, and current smokers were more likely to have moderate periodontitis. Three additional factors including older age, former smokers, and diabetes significantly increased the odds for having severe periodontitis. Income, alcohol consumption, body mass index, and waist circumference had no significant effects on periodontal disease severity in the multivariate model. CONCLUSIONS: Our data suggest that age, gender, education, oral hygiene status, smoking, and diabetes are significantly associated with periodontal disease severity in this study group. Longitudinal studies will establish whether these variables are true risk factors.

The effect of cigarette smoking on the severity of periodontal disease among older Thai adults.

BACKGROUND: The aim of this study is to determine the effect of cigarette smoking on the severity of periodontitis in a cross-sectional study of older Thai adults. METHODS: The study population consisted of 1,960 subjects (age 50 to 73 years old). All subjects received both medical and dental examinations. Periodontal examinations, including plaque score, probing depth, and clinical attachment level, were done on all teeth present in two diagonal quadrants. Sociodemographic characteristics and smoking status were obtained by questionnaires. Multinomial logistic regression was used to address the association between cigarette consumption and mean clinical attachment level. RESULTS: In this study population, 48.7% were non-smokers, 14.4% were current smokers, and 36.9% were former smokers. Current smokers had higher percentage of sites with plaque, deeper mean probing depth, and greater mean clinical attachment level than former smokers and non-smokers. The odds of having moderate and severe periodontitis for current smokers were 1.7 and 4.8 times greater than non-smokers, respectively. Former smokers were 1.8 times more likely than non-smokers to have severe periodontitis. Quitting smoking reduced the odds of having periodontitis. For light smokers (<15 packyear), the odds for severe periodontitis reverted to the level of non-smokers when they had quit smoking for > or =10 years. For moderate and heavy smokers (> or =15 packyear), the odds of having severe periodontitis did not differ from those of non-smokers when they had quit smoking for > or =20 years. CONCLUSIONS: There was a strong association between cigarette smoking and the risk of periodontitis among older Thai adults. Quitting smoking appears to be beneficial to periodontal health.