D.E. Slot

Alveolar bone dimensional changes of post-extraction sockets in humans: a systematic review

OBJECTIVE To review the literature to assess the amount of change in height and width of the residual ridge after tooth extraction. MATERIAL AND METHODS MEDLINE-PubMed and the Cochrane Central register of controlled trials (CENTRAL) were searched through up to March 2009. Appropriate studies which data reported concerning the dimensional changes in alveolar height and width after tooth extraction were included. Approximal height change, mid-buccal change, mid-crestal change, mid-lingual change, Alveolar width change and socket fill were selected as outcome variables. Mean values and if available standard deviations were extracted. Weighted mean changes were calculated. RESULTS Independent screening of the titles and abstracts of 1244 MEDLINE-PubMed and 106 Cochrane papers resulted in 12 publications that met the eligibility criteria. The reduction in width of the alveolar ridges was 3.87 mm. The mean clinical mid-buccal height loss was 1.67 mm. The mean crestal height change as assessed on the radiographs was 1.53 mm. Socket fill in height as measured relative to the original socket floor was on an average 2.57 mm. CONCLUSION During the post-extraction healing period, the weighted mean changes as based on the data derived from the individual selected studies show the clinical loss in width to be greater than the loss in height, assessed both clinically as well as radiographically.

Effect of socket preservation therapies following tooth extraction in non-molar regions in humans: a systematic review

OBJECTIVE To assess, based on the existing literature, the benefit of socket preservation therapies in patients with a tooth extraction in the anterior or premolar region as compared with no additional treatment with respect to bone level. MATERIAL AND METHODS MEDLINE-PubMed and the Cochrane Central Register of controlled trials (CENTRAL) were searched till June 2010 for appropriate studies, which reported data concerning the dimensional changes in alveolar height and width after tooth extraction with or without additional treatment like bonefillers, collagen, growth factors or membranes. RESULTS Independent screening of the titles and abstracts of 1918 MEDLINE-PubMed and 163 Cochrane papers resulted in nine publications that met the eligibility criteria. In natural healing after extraction, a reduction in width ranging between 2.6 and 4.6 mm and in height between 0.4 and 3.9 mm was observed. With respect to socket preservation, the freeze-dried bone allograft group performed best with a gain in height, however, concurrent with a loss in width of 1.2 mm. CONCLUSION Data concerning socket preservation therapies in humans are scarce, which does not allow any firm conclusions. Socket preservation may aid in reducing the bone dimensional changes following tooth extraction. However, they do not prevent bone resorption because, depending on the technique, on the basis of the included papers one may still expect a loss in width and in height.

Treatment of periodontitis improves the atherosclerotic profile: a systematic review and meta‐analysis

AIM Systematic review and meta-analyses to study the robustness of observations that treatment of periodontitis improves the atherosclerotic profile. MATERIAL AND METHODS Literature was searched in Medline-PubMed, Cochrane CENTRAL and EMBASE, based on controlled periodontal intervention trials, including also a non-intervention group. Data were extracted and meta-analyses were performed. RESULTS From 3928 screened studies, 25 trials met the eligibility criteria. These trials enrolled 1748 periodontitis patients. Seven trials enrolled periodontitis patients that were otherwise healthy, 18 trials recruited periodontal patients with various co-morbidities, such as CVD or diabetes. None of the trials used hard clinical endpoints of CVD. However, improvement of endothelial function has been consistently reported. Meta-analyses demonstrated significant weighted mean difference (WMD) for hsCRP (-0.50 mg/l, 95% CI:-0.78; -0.22), IL-6 (-0.48 ng/l, 95% CI: -0.90; -0.06), TNF-α (-0.75 pg/ml, 95% CI: -1.34; -0.17), fibrinogen (-0.47 g/l, 95% CI: -0.76; -0.17), total cholesterol (-0.11 mmol/l, 95% CI: -0.21; -0.01) and HDL-C (0.04 mmol/l, 95% CI: 0.03; 0.06) favouring periodontal intervention. Importantly, periodontitis patients with co-morbidity benefitted most from periodontal therapy; significant WMD were observed for levels of hsCRP (-0.71 mg/l, 95% CI: -1.05; -0.36), IL-6 (-0.87 ng/l, 95% CI: -0.97; -0.78), triglycerides (-0.24 mmol/l, 95% CI: -0.26; -0.22), total cholesterol (-0.15 mmol/l, 95% CI: -0.29; -0.01), HDL-C (0.05 mmol/l, 95% CI: 0.03; 0.06) and HbA1c (-0.43%, 95% CI: -0.60; -0.25). CONCLUSIONS This systematic review and meta-analyses demonstrate that periodontal treatment improves endothelial function and reduces biomarkers of atherosclerotic disease, especially in those already suffering from CVD and/or diabetes.

The Clinical Effect of Scaling and Root Planing and the Concomitant Administration of Systemic Amoxicillin and Metronidazole: A Systematic Review

BACKGROUND The treatment of periodontitis frequently begins with a non-surgical phase that includes scaling and root planing (SRP) and, on occasion, the use of systemic antibiotics. The goal of this review is to systematically evaluate the data concerning the effect of the concomitant administration of amoxicillin and metronidazole adjunctive to SRP in adults who are otherwise healthy. METHODS The PubMed-MEDLINE, Cochrane-Central, and EMBASE databases were searched to April 1, 2012, to identify appropriate studies. Probing depth (PD), clinical attachment level (CAL), bleeding on probing, and plaque index were selected as outcome variables. Based on the extracted mean values and number of individuals, changes in weighted means were calculated and a meta-analysis conducted. RESULTS The search yielded 526 unique titles and abstracts. Ultimately, 35 studies were selected, describing 28 clinical trials meeting the eligibility criteria. The full-mouth weighted mean change for PD showed an improvement of 1.41 mm. The full-mouth weighted mean change for CAL showed a gain of 0.94 mm. CONCLUSION Systemic antimicrobial therapy using a combination of amoxicillin and metronidazole as an adjunct to SRP can enhance the clinical benefits of non-surgical periodontal therapy in adults who are otherwise healthy.

The Effect of Chlorhexidine Varnish on Root Caries: A Systematic Review

Objective: The aim of this study was to systematically review the present literature on the effect of chlorhexidine varnish (CHX-V) on root caries. Materials and Methods: The MEDLINE-PubMed, the Cochrane-CENTRAL and EMBASE databases were searched through December 2010 to identify any appropriate studies. Root caries incidence and root caries activity were selected as outcome variables. Results: An independent screening of the unique titles and abstracts of 24 MEDLINE-PubMed, 14 Cochrane-CENTRAL and 18 EMBASE papers resulted in 6 publications that met the eligibility criteria. Data extraction provided no conclusive evidence that the application of CHX-V is effective in patients when regular professional oral prophylaxis is performed. If effective, the 40% CHX-V was found to provide a benefit over a control or fluoride varnish. CHX-V at lower concentrations (1 and 10%) may provide protection against root caries in high-risk patients (such as geriatric and xerostomia patients) in the absence of regular professional oral prophylaxis. Conclusion: Within the limitations of this review, it may be concluded that in the absence of regular professional tooth cleaning and oral hygiene instructions, CHX-V may provide a beneficial effect in patients in need of special care. The strength of this recommendation is graded as ‘weak’.

The efficacy of powered toothbrushes following a brushing exercise: a systematic review

AIM The primary objective was to determine, based on the available published evidence, the efficacy of powered toothbrushing following a brushing exercise and secondary to what magnitude this effect is dependent on the plaque index score, power supply and mode of action. MATERIAL AND METHODS The PubMed-MEDLINE and Cochrane CENTRAL databases were searched through and up to August 2014 to identify appropriate studies. The outcome measurement was the weighted mean (WM) percentage plaque score reduction of a full-mouth assessment following subject brushing. RESULTS The search yielded 2420 titles and abstracts. Ultimately, 58 articles with 146 brushing exercises as separate legs were selected. The overall effect of a powered brushing exercise provides a 46% WM plaque score reduction. One hundred and six experiments provided data as assessed according to the Quigley and Hein plaque index. The WM reduction from baseline in plaque scores was 36%. A WM plaque score reduction of 65% was observed in 39 experiments using the Navy plaque index. Subanalysis on power supply and mode of action showed WM plaque score reductions ranging from 33% up to 71% depending on plaque index score. CONCLUSION The efficacy in plaque removal following a brushing exercise using a powered toothbrush provides a WM plaque score reduction of 46% on average, with a range of 36-65% dependent on the index scale to score plaque. The available evidence indicates that the power supply (rechargeable or replaceable battery), mode of action, as well as brushing duration and type of instructions are factors which contribute to the variation in the observed efficacy.

Efficacy of inter‐dental mechanical plaque control in managing gingivitis – a meta‐review

FOCUSED QUESTION What is the effect of mechanical inter-dental plaque removal in addition to toothbrushing, on managing gingivitis using various formats of inter-dental self-care in adults based on evidence gathered from existing systematic reviews? MATERIAL & METHODS Three Internet sources were searched by a strategy designed to include systematic reviews on inter-dental cleaning devices. Plaque and gingivitis scores were the primary parameters of interest. Characteristics of selected papers were extracted. The potential risk of bias was estimated and the acquired evidence was graded. RESULTS Screening of 395 papers resulted in six systematic reviews. Two papers evaluated the efficacy of dental floss, two of inter-dental brushes (IDB), one of woodsticks and one of the oral irrigator. Weak evidence of unclear or small magnitude was retrieved that supported dental floss, woodsticks and the oral irrigator to reduce gingivitis in addition to toothbrushing. No concomitant evidence for an effect on plaque emerged. There is moderate evidence that IDBs in combination with toothbrushing reduce both plaque and gingivitis. CONCLUSION Evidence suggests that inter-dental cleaning with IDBs is the most effective method for inter-dental plaque removal. The majority of available studies fail to demonstrate that flossing is generally effective in plaque removal. All investigated devices for inter-dental self-care seem to support the management of gingivitis, however, to a varying extend.

Titanium surface alterations following the use of different mechanical instruments: a systematic review

OBJECTIVE To systematically collect and evaluate existing evidence on the effects of different mechanical instruments on the surface characteristics of smooth and rough titanium surfaces. MATERIALS AND METHODS PubMed-MEDLINE, Cochrane-CENTRAL and EMBASE databases were searched up to December 2010 to identify appropriate studies. The eligible studies were controlled studies investigating titanium surface alterations following treatment with different mechanical instruments. RESULTS In total, 3275 unique papers were identified. A screening of the titles and abstracts resulted in 34 publications that met all of the eligibility criteria. Surface roughness was evaluated using scanning electron microscopy in most studies and using a profilometer in only 10 studies. The rough surfaces evaluated were titanium plasma sprayed and sandblasted and acid-etched surfaces only. Non-metal instruments were found to cause minimal or no damage to both smooth and rough titanium surfaces. Metal instruments were found to cause major damage to smooth surfaces. Burs seemed to be the instruments of choice, if smoothening of a rough surface was required. CONCLUSION Non-metal instruments and rubber cups seem to be the instruments of choice for the treatment of smooth surfaces. Similarly, for rough implant surfaces, non-metal instruments and air abrasives are the instruments of choice, if surface integrity needs to be maintained. Metal instruments and burs are recommended only in cases requiring the smoothening of the surface roughness. The clinical impact of these findings requires clarification.

The effect of chemotherapeutic agents on contaminated titanium surfaces: a systematic review

OBJECTIVE To systematically collect and evaluate the existing evidence for the abilities of different chemotherapeutic agents to decontaminate biofilm-contaminated titanium surfaces. MATERIAL AND METHODS PubMed-MEDLINE and the Cochrane-CENTRAL databases were searched, covering research published on or before June 2010, to identify appropriate studies. The eligible studies were controlled studies on the effects of chemical treatments on biofilm-contaminated titanium surfaces. RESULTS In total, 2425 unique papers were identified. Independent screening of the titles and abstracts resulted in only four publications that met all of the eligibility criteria. None of the in vivo studies assessed titanium surface decontamination in a controlled fashion. Three studies provided in vitro data, and one used an ex vivo protocol. Citric acid was found to be the most effective treatment in lipopolysaccharide removal as compared with an untreated control, although its effectiveness was equivalent to those of water and saline. In addition, citric acid demonstrated the greatest efficacy in cleaning the contaminated titanium surface, as evidenced by scanning electron microscopy. CONCLUSION The data reported for the efficacy of chemotherapeutic agents in cleaning contaminated titanium surfaces are scarce, which precludes the generation of firm conclusions. Based on the lack of robust data, we cautiously conclude that citric acid is the chemotherapeutic agent with the highest potential for the removal of biofilms from contaminated titanium surfaces in vitro, although it does not achieve complete removal. To date, the killing effect of citric acid against biofilms has not been investigated on titanium surfaces.

Histological responses of the periodontium to MTA: a systematic review.

AIM The purpose of this systematic review was to investigate whether a mineral trioxide aggregate (MTA) restoration of an endodontic-periodontal communication leads to regeneration of the adjacent periodontal tissues. METHODOLOGY The databases MEDLINE-PubMed, Cochrane-CENTRAL, and EMBASE were searched, up to July 2012. In vivo studies that reported on the histological response of the periodontium to MTA were selected. RESULTS The screening of 98 title-abstracts, full-text reading, and hand searches in literature lists yielded 24 papers. All of them involved animals. There were no studies reporting on human histology. Study protocols presented heterogeneity regarding treated lesions, intervention, and reported outcomes. The histological results of the animal studies showed minimal inflammatory reactions, bone healing, periodontal ligament presence, and consistent cementum formation. Time lapse after mixing, bacterial contamination, root canal disinfection, and inflammation influenced MTAs cementoconductive properties. CONCLUSIONS Within the limitations of the selected papers concerning inhomogeneous study protocols and low methodological quality scores, their findings were consistent with regard to MTAs biocompatibility and cementogenic ability. Experimental animal studies show that MTA can promote healing towards regeneration. There is now a distinct need to examine the clinical performance of MTA in well-controlled prospective human cohort studies.