Anne Merete Aass

Prevalence of Peri‐Implantitis Related to Severity of the Disease With Different Degrees of Bone Loss

BACKGROUND Several measurements are combined to diagnose peri-implant disease, and different thresholds are used to describe the disease. The purpose of this study was to evaluate the prevalence of peri-implant disease and to apply different diagnostic thresholds to assess its prevalence in relation to severities of peri-implantitis with different degrees of bone loss. METHODS A total of 164 subjects with dental implants inserted at the Institute of Clinical Odontology, University of Oslo, between 1990 and 2005, were invited to join the project, and 109 subjects attended the examination (mean age: 43.8 years; range: 18 to 80 years). The mean functional loading time was 8.4 years (SD: 4.6 years). The participants were examined clinically and radiographically. The following aspects of disease were assessed to describe the peri-implant condition: detectable radiographic peri-implant bone loss and inflammation, the presence of bleeding on probing at a probing depth >or=4 or >or=6 mm, and radiographic peri-implant bone loss assessed at >or=2.0 and >or=3.0 mm. RESULTS Assessing peri-implantitis at different levels of severity yielded a substantial variance in prevalence (11.3% to 47.1%) in the present study population. CONCLUSION Peri-implant inflammation was a frequent finding with and without peri-implant bone loss.

Primary prevention of peri-implantitis: managing peri-implant mucositis

AIMS Over the past decades, the placement of dental implants has become a routine procedure in the oral rehabilitation of fully and partially edentulous patients. However, the number of patients/implants affected by peri-implant diseases is increasing. As there are--in contrast to periodontitis--at present no established and predictable concepts for the treatment of peri-implantitis, primary prevention is of key importance. The management of peri-implant mucositis is considered as a preventive measure for the onset of peri-implantitis. Therefore, the remit of this working group was to assess the prevalence of peri-implant diseases, as well as risks for peri-implant mucositis and to evaluate measures for the management of peri-implant mucositis. METHODS Discussions were informed by four systematic reviews on the current epidemiology of peri-implant diseases, on potential risks contributing to the development of peri-implant mucositis, and on the effect of patient and of professionally administered measures to manage peri-implant mucositis. This consensus report is based on the outcomes of these systematic reviews and on the expert opinion of the participants. RESULTS Key findings included: (i) meta-analysis estimated a weighted mean prevalence for peri-implant mucositis of 43% (CI: 32-54%) and for peri-implantitis of 22% (CI: 14-30%); (ii) bleeding on probing is considered as key clinical measure to distinguish between peri-implant health and disease; (iii) lack of regular supportive therapy in patients with peri-implant mucositis was associated with increased risk for onset of peri-implantitis; (iv) whereas plaque accumulation has been established as aetiological factor, smoking was identified as modifiable patient-related and excess cement as local risk indicator for the development of peri-implant mucositis; (v) patient-administered mechanical plaque control (with manual or powered toothbrushes) has been shown to be an effective preventive measure; (vi) professional intervention comprising oral hygiene instructions and mechanical debridement revealed a reduction in clinical signs of inflammation; (vii) adjunctive measures (antiseptics, local and systemic antibiotics, air-abrasive devices) were not found to improve the efficacy of professionally administered plaque removal in reducing clinical signs of inflammation. CONCLUSIONS Consensus was reached on recommendations for patients with dental implants and oral health care professionals with regard to the efficacy of measures to manage peri-implant mucositis. It was particularly emphasized that implant placement and prosthetic reconstructions need to allow proper personal cleaning, diagnosis by probing and professional plaque removal.

The association between selected risk indicators and severity of peri-implantitis using mixed model analyses.

AIM The aim of the study was to assess possible risk indicators for peri-implantitis at different levels of severity using multi-level analyses. MATERIAL AND METHODS One hundred and nine subjects attended the examination, 69 females and 40 males. Mean time of implants in function was 8.4 years (standard deviation 4.6) (subject level). The participants were examined clinically and radiographically. Information regarding general health and habits was gathered, with special emphasis on smoking, oral hygiene and susceptibility to periodontitis. The relation between possible risk indicators and the following features were assessed: • Detectable peri-implantitis: detectable radiographic bone loss (>0.4 mm) and inflammation • Overt peri-implantitis: radiographic peri-implant bone loss 2.0 mm and bleeding on probing /suppuration at pocket probing depth 4 mm. RESULTS Multi-level statistical analyses identified location in the maxilla as risk indicator for detectable peri-implantitis. Regarding overt peri-implantitis, gender (male) and history of periodontitis were identified as risk indicators. CONCLUSION Individuals with a history of periodontitis were prone to peri-implantitis, peri-implant bone loss ≥ 2.0 mm and overt in the present study. No association was found between smoking and peri-implant disease in the present study population.

Prevalence of Implant Loss and the Influence of Associated Factors

BACKGROUND The objective of this study was to assess the outcome of dental implants inserted at the Institute of Clinical Odontology, University of Oslo, between 1990 and 2005. The prevalence of implant loss and the factors associated with the outcome were studied. METHODS A total of 164 subjects were invited to participate in this cross-sectional project, of whom 55 were unable, leaving 109 volunteers available for examination. The study population included 69 females and 40 males with a mean age of 43.8 years at the time of implant insertion (range, 18 to 80 years). At the subject level, the mean time from implant loading to the present examination was 8.4 years (range, 1.1 to 16.0 years). The participants were examined clinically and radiographically and interviewed regarding general health and habits. RESULTS The 109 examined subjects had been treated with 374 implants. Eighteen implants (4.8%) were lost in 10 subjects (9.2%). Eleven implants were lost before loading, three were lost during the first 5 years after loading, and four were lost 5 to 10 years after loading. No implants were lost after >10 years of loading. The loss of oral implants was significantly associated with a history of smoking and periodontitis (P <0.05). CONCLUSIONS The inserted implants showed a high survival rate, especially after the first year of insertion, even though the subjects were not maintained by specialists. All late implant losses were preceded by an early loss. Implant loss was significantly associated with smoking and periodontitis.

Porous titanium granules promote bone healing and growth in rabbit tibia peri-implant osseous defects

OBJECTIVES The aim of this study was to investigate the osteoconductive properties and biological performance of porous titanium granules used in osseous defects adjacent to titanium implants. MATERIAL AND METHODS In this animal experimental study, calibrated defects were prepared in the tibias of 24 New Zealand rabbits. The defects were randomized into two tests and one control group. The test defects were grafted with either metallic or oxidized porous titanium granules (PTG or WPTG, respectively), whereas control defects were left empty (sham). The defects were closed with a submerged coin shaped titanium implant. Defects were left for healing for 4 weeks. After healing, the implants were removed and the new bone tissue formed onto the implant surface was analyzed for run x 2, osteocalcin, collagen-I, tartrate-resistant acid phosphatase, H(+)-ATPase, tumor necrosis factor-alpha, interleukin (IL)-6 and IL-10 gene expression using reverse transcriptase polymerase chain reaction. Wound fluid from the healed defects was analyzed for lactate dehydrogenase and alkaline phosphatase activity. Finally osteoconductivity was analyzed by micro-computed tomography and histology. RESULTS Significantly more new bone formed in PTG and WPTG grafted defects compared with sham. The new bone grew both through the porosities of the granules and onto the implant surfaces. The WPTG group showed significantly less expression of key inflammation markers, but with no significant difference in a marker for necrosis. The WPTG also showed a significant increase in collagen-I mRNA expression compared with PTG. CONCLUSION The results suggest that PTG and WPTG are both osteoconductive materials that can be used to promote bone formation in osseous defects adjacent to titanium implants without hampering implant osseointegration.

Comparison of oral hygiene efficacy of one manual and two electric toothbrushes.

The purpose of the study was to compare the efficacy of two electric toothbrushes (Philips HP555 and the Philips Jordan 2-action Plaque Remover HP510). A manual toothbrush (Jordan V-shaped, medium) served as control. Fifty subjects, aged 18±60 years, participated in a randomized, single-blind, 3 x 3 weeks crossover study. Plaque was assessed according to the Turesky modification of the Quigley-Hein index (P.I.), while the Løe-Silness index was used for assessing gingivitis. Adverse effects were assessed according to the ADA specifications. Compliance and preference were assessed through questionnaires and interviews, respectively. All periods mean P.I. (all surfaces) were 2.79, 3.01, and 2.86 for the manual, the HP555, and the HP510 electric brushes and the corresponding gingivitis values were 1.19, 1.22, and 1.21. For both indices, only the difference between the manual and the HP555 yielded significance (P = 0.04 and P = 0.02). Most subjects (28/50) preferred the HP510 brush, as it felt more practical to use and was perceived to have better cleaning ability. In conclusion. no clinically relevant differences in plaque reducing and gingivitis controlling ability were observed.

Effect of instruction and motivation in the use of electric and manual toothbrushes in periodontal patients: a comparative study

O objetivo do presente estudo foi avaliar a eficacia de escovas dentais manual e eletrica no controle de placa em pacientes periodontais apos instrucoes apropriadas. Trinta e seis pacientes periodontais (media de idade de 49 anos, 21 mulheres e 15 homens) foram incluidos e completaram o estudo (100% de adesao). Um delineamento de ensaio clinico randomizado controlado cego e cruzado foi adotado, com pacientes usando durante 2 periodos de 14 dias cada escovas manuais e/ou eletricas. Quatro subgrupos de 9 individuos foram estudados: A1 - utilizou escova manual em ambos os periodos experimentais; A2 - utilizou a escova manual durante o primeiro, e a escova eletrica, no segundo periodo; B1 - usou escova eletrica em ambos os periodos; B2 - iniciou com escova eletrica e utilizou escova manual no segundo periodo. A escovacao foi realizada durante 14 dias e, nos dias 14 e 28, essa foi realizada na clinica, e o tempo de escovacao foi cronometrado sem que os pacientes soubessem. O Indice de Placa (Silness, Loe, 1964) foi utilizado. Comparacoes intragrupo foram realizadas por teste t pareado e intergrupo por teste t para amostras independentes, com um nivel alfa de 0,05. Os resultados nao identificaram diferencas entre as escovas testadas em relacao a placa ou ao tempo utilizado. Entretanto, reinstrucao foi detectada como um fator importante, uma vez que, para todos os grupos, o segundo periodo, apos reinstrucao, demonstrou menores escores de placa. Conclui-se que aconselhamento profissional e instrucao e reinstrucao parecem mais importantes para se obter um bom controle de placa do que a escolha da escova em pacientes com doenca periodontal.The aim of the present study was to evaluate the efficacy of manual and electric toothbrushes in plaque control in periodontal patients after proper instructions. Thirty six periodontal patients (mean age of 49 years, 21 females and 15 males) were included and completed the study (100% compliance). A single-blinded, randomized, controlled, cross-over clinical design was adopted, with the patients using during 2 periods of 14 days each the manual and/or electric toothbrush. Four subgroups of 9 individuals were studied: A1--used manual toothbrush in both experimental periods; A2--used the manual toothbrush during the first period and the electrical toothbrush during the second period; B1--used electrical toothbrush during both periods; B2--used the electrical toothbrush in the first period and the manual one in the second period. Brushing was performed during 14 days and at day 14 and 28 it was performed in the clinic, and timing of brushing was recorded without patients being aware. The Plaque Index (Silness, Löe, 1964) was used. Intra-group comparisons were performed by paired t-test and inter-group comparisons by independent sample t-test, with an alpha level of 0.05. The results showed no difference between the tested brushes neither for plaque nor for timing. However, re-instruction was detected as an important factor, since for all groups the second period, after reinstruction, showed lower plaque scores. It is concluded that professional advice and instruction and re-instruction seem more important in order to obtain good plaque control than the choice of toothbrush in subjects with periodontal disease.

A randomized, single‐blind, parallel‐group clinical study to evaluate the effect of soluble β‐1,3/1,6‐glucan on experimental gingivitis in man

BACKGROUND Gingivitis is an inflammatory disorder of the periodontium induced by dental plaque bacteria. Soluble beta-1,3/1,6-glucan (SBG) is known to enhance infection defense by preventing excessive inflammatory responses caused by bacterial endotoxins. AIM The aim of the present study was to investigate the effect of SBG on experimental gingivitis in man. MATERIAL AND METHODS Experimental gingivitis was induced over a period of 24 days in 30 healthy volunteers who were simultaneously treated with SBG. Two groups (n=10/group) rinsed twice daily with an SBG mouthwash that was either swallowed or expectorated. A third group (n=10) received a water rinse as a control. Plaque index (Pl.I), gingival index (GI), and amount of gingival crevicular fluid (GCF) were assessed at baseline and at six times during the study. RESULTS The results showed that in the SBG groups, GCF decreased significantly during the study. The swallow group experienced a significant increase in GCF during the first week. The control group followed the expected pattern of experimental gingivitis, with a significant increase in the gingival fluid secretion during the test period. There was a significant increase in GI and Pl.I during the study for all groups, with no significant differences between them. No adverse effects of SBG were recorded. CONCLUSIONS In this 24-day experimental gingivitis study of subjects who used either a SBG or a control mouthrinse: (1) all subjects had increased plaque and gingivitis, (2) GCF increased in control-rinse subjects and GCF decreased in SBG-rinse subjects. The only statistically significant difference between the SBG-rinse and control-rinse subjects was an increase in GCF at day 7 for subjects who rinsed and swallowed SBG.

Porous Titanium Granules in the Treatment of Mandibular Class II Furcation Defects: A Consecutive Case Series

BACKGROUND The osteoconductive potential of titanium is interesting from the perspective of periodontal surgery and reconstitution of osseous defects. The aim of the present consecutive case series is to evaluate a surgical strategy based on the use of porous titanium granules (PTG) in the treatment of Class II buccal furcation defects in mandibular molars in humans. METHODS Surgical intervention with PTG used as a bone graft substitute was performed in 10 patients with 10 mandibular Class II buccal furcation defects. Clinical parameters (probing depth (PD), clinical attachment level (CAL), gingival recession (GR), gingival index (GI), bleeding on probing (BOP), and horizontal and vertical bone sounding) and radiographic measurements of vertical furcation height were compared among baseline (presurgery), 6, and 12 months (post-surgery). The significance level (α) was set at 0.05. RESULTS With respect to vertical and horizontal bone sounding measurements, CAL, and GR, no significant improvements between baseline and the 12-month examination were seen. Both PD and radiographic vertical furcation height were significantly reduced between baseline and 12 months. When comparing the baseline to 12-month data, a significantly lower GI score was seen but the BOP score was unchanged. None of the treated teeth showed radiographic signs of root resorption. CONCLUSION This study suggests that PTG is safe to use in close proximity to root surfaces, but no significant improvements in clinical endpoints of defect resolution were observed.

Microcomputed Tomographic and Histologic Analysis of Animal Experimental Degree II Furcation Defects Treated With Porous Titanium Granules or Deproteinized Bovine Bone

BACKGROUND Titanium is an interesting material for osseous reconstruction given its thrombogenic properties. The aim of this study is to compare the potential of porous titanium granules (PTGs) with sham and deproteinized bovine bone mineral (DBBM) in the reconstructive treatment of surgically created buccal, degree II furcation defects in mini-pigs. METHODS Buccal degree II furcation defects were surgically created in maxillary premolar teeth in adult, female, mini-pigs and filled with PTG or DBBM or were left empty (sham). After 6 weeks of healing, pigs were euthanized. Teeth with defects were excised en bloc and analyzed by microcomputed tomography (microCT) and histology. RESULTS The histologic analysis showed significantly more vertical bone formation in both PTG and sham groups compared to DBBM-treated defects (P <0.01). The microCT analysis showed significantly more bucco-palatal bone formation in furcations treated with PTG compared to the DBBM and sham (P <0.05). Bucco-palatal cylindrical microCT cores demonstrated a median defect fill of 96.8% for PTG-implanted defects, which was significantly greater than sham (72.2%) and DBBM (62.0%) (P <0.001) treatments. Significantly more regenerated periodontal ligament was seen for sham than DBBM-treated defects (P <0.05). Root resorption lacunae were small and infrequent and did not differ among groups. CONCLUSIONS The results of this study in mini-pigs suggest that PTG may integrate well in alveolar bone and supports osseous regrowth in degree II furcation defects. Moreover, PTG seems safe to use in close proximity to root surfaces. Clinical studies will be necessary to further explore these experimental animal findings.