Eli E. Machtei

Cigarette Smoking Increases the Risk for Subgingival Infection With Periodontal Pathogens

Cigarette smoking has been found to increase the risk for periodontitis. The present study examined the association between cigarette smoking and subgingival infection with periodontal pathogens to determine if smokers are more likely to be infected with certain periodontal pathogens than non-smokers. Self-reported data on 1,426 subjects, aged 25 to 74, from the Erie County Study were obtained including data on 798 subjects who were current or former smokers. Mean clinical attachment loss was used to estimate the severity of periodontal destruction. Subgingival infection with target periodontal pathogens was determined by indirect immunofluorescence microscopy. Smokers harbored significantly higher levels and were at significantly greater risk of infection with Bacteroides forsythus than non-smokers. Adjusting for disease severity, the risk of subgingival infection with B. forsythus in current smokers was 2.3 times that of former smokers or non-smokers. The relative risk of B. forsythus infection also increased 1.18 times for every category of smoking as the amount of smoking measured in packyears increased from very light to heavy. Adjusting for disease severity, Porphyromonas gingivalis was also more likely to subgingivally infect smokers than non-smokers; however, there was not a significantly higher relative risk for infection with this bacterium. The data from this study indicate that cigarette smoking increases the likelihood of subgingival infection with certain periodontal pathogens. This may partly explain the increased risk for periodontitis seen in smokers. J Periodontol 1996;67:1050-1054.

Exploratory Case‐Control Analysis of Psychosocial Factors and Adult Periodontitis

We explored the association between social factors and adult periodontitis by comparing self-reported information for daily strains and symptoms of depression in 71 cases and 77 controls. Cases and controls were selected from among 1,426 participants in the Erie County Risk Factor Study. We found differences among those who scored higher than their peers on measures of social strain. The odds ratio (OR) and 95% confidence interval (95% CI) for the association between case status and Role Strain score of 2.27 or more was 2.84, 95% CI = 1.08 to 7.46. We also examined serum antibody, dichotomized at the median, for three periodontal pathogens (Bacteroides forsythus [IgG Bf], Porphyromonas gingivalis [IgG Pg], Actinobacillus actinomycetemcomitans [IgG Aa]), and assessed interaction between antibody levels and a Depression score derived from the Brief Symptom Inventory. IgG Pg and IgG Aa were both strongly associated with case status (OR = 4.52, 95% CI = 1.99 to 10.3 and OR = 5.29, 95% CI = 2.34 to 12.0, respectively). IgG Bf was associated with periodontal disease but only among individuals who had higher scores for Depression (OR = 6.75, 95% CI = 1.25 to 36.5). Smoking status was associated with case status (OR = 4.95, 95% CI = 1.86 to 13.2). We assessed these findings prospectively by examining factors associated with more extensive disease among the 71 case subjects after 1 year of follow-up. We found baseline smoking status and IgG Bf among individuals scoring high on Depression at baseline to be associated with more extensive disease (8.1% or more of the sites showing further breakdown). In this population an elevated Depression score may be a marker for social isolation, which could play a role in immune function during periods of social strain. This exploratory analysis has served to identify specific lines of inquiry concerning psychosocial measures as important environmental factors in adult periodontitis. J Periodontol 1996;67:1060-1069.

Serum Cotinine Levels, Smoking, and Periodontal Attachment Loss:

Cigarette smoking and tobacco use have been the subjects of numerous studies for many years. Smoking has also been associated with periodontal disease. However, no relationship between a reliable biochemical marker and increased severity of the periodontal condition has yet been described. It was thus the aim of this study to apply the measurement of cotinine, the major metabolite of nicotine, as a quantitative method to assess levels of smoking, and to correlate serum levels of cotinine with severity of periodontal disease. The degree of association between smoking and periodontal attachment loss was investigated in a study including 79 patients 25 to 64 years old suffering from periodontitis. Patients were examined and the following parameters recorded: Gingival Assessment (GA), Probing Pocket Depth (PPD), Clinical Attachment Level (CAL), and Bone Crest Height (BCH). In addition, self-reported histories of tobacco use as well as blood samples for quantitative analysis of serum levels of cotinine were taken. The serum samples were analyzed for cotinine content by means of a competitive-inhibition ELISA technique. The differences in mean cotinine levels were statistically significant (p = 0.0001) between smokers and non-smokers, showing no overlap between the groups. Severity of periodontal attachment loss was positively correlated with serum levels of cotinine for both measures of periodontal disease (CAL p = 0.005; BCH p = 0.008). Results from the present study indicate that serum cotinine levels used as a biochemical marker of smoking status are correlated with severity of periodontal attachment loss.

The dimensions of keratinized mucosa around implants affect clinical and immunological parameters

OBJECTIVES To investigate the association between keratinized mucosa (KM) width and mucosal thickness (MTh) with clinical and immunological parameters around dental implants. METHODS Sixty-three functioning dental implants (3I osseotite) were examined. Clinical examinations included plaque index (PI), probing depth (PD), bleeding on probing (BOP), KM width, MTh and buccal mucosal recession (MR). Peri-implant crevicular fluid (PICF) samples were collected for PgE2 assay. RESULTS KM width ranged from 0 to 7 mm (mean 2.5+/-2), MTh ranged from 0.38 to 2.46 mm (mean 1.11+/-0.4) and the mean MR was 0.62 mm, ranging from 0 to 3 mm. A negative correlation was found between MTh and MR (r=-0.32, P=0.01); Likewise, KM width showed a negative correlation with MR, periodontal attachment level (PAL) and PgE2 levels (r=-0.41, P<0.001; r=-0.26, P=0.04; r=-0.26, P=0.04, respectively). In contrast, a positive correlation was found between KM width and PD (r=0.27, P=0.03). When data were dichotomized by KM width, a wider mucosal band (>1 mm) was associated with less MR compared with narrow (<or=1 mm) band (0.27 and 0.9 mm, respectively, P=0.001). A wider KM band was also associated with a greater PD (3.13 mm) compared with a narrow band (2.66 mm, P=0.04). Similarly, a thick mucosa (>or=1 mm) was associated with lesser recession compared with a thin (<1 mm) mucosa (0.45 and 0.9 mm, respectively, P=0.04). CONCLUSION The KM around dental implants affects both the clinical and the immunological parameters at these sites. These findings are of special importance in the esthetic zone, where thin and narrow KM may lead to a greater MR.

Anti-Tumor Necrosis Factor-Alpha Therapy and Periodontal Parameters in Patients With Rheumatoid Arthritis

BACKGROUND The aim of this study was to evaluate the influence of anti-tumor necrosis factor-alpha (TNF-alpha) therapy on the clinical and immunologic parameters of the periodontium. METHODS Ten patients with rheumatoid arthritis (RA) who routinely received infusions of infliximab, 200 mg (RA+), 10 patients with RA without anti-TNF-alpha therapy (RA-), and 10 healthy controls (C) were included. Clinical parameters, including the plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment loss (AL), and bleeding on probing (BOP), were assessed, and total gingival crevicular fluid (GCF) TNF-alpha level was determined using enzyme-linked immunosorbent assay. Analysis of variance with Scheffe modification and the Pearson correlation test were used for statistical analysis. RESULTS The ages of the patients ranged from 22 to 76 years (mean, 50.73 +/- 9.1 years). The mean PI was similar among the groups. However, mean inflammatory parameters in the three groups varied significantly; GI was greater in the RA- group compared to RA+ and C groups (P = 0.0042). The RA+ group exhibited less BOP than RA- and C groups (21.1% +/- 3.0%, 45.9% +/- 6.2%, and 39.1% +/- 7.2%, respectively; P = 0.0146). The mean PD in the RA+ group was shallower than in RA- and C groups (3.22 +/- 0.13 mm, 3.85 +/- 0.22 mm, and 3.77 +/- 0.20 mm, respectively; P = 0.055). Clinical AL in the RA+ group was lower than in RA- and C groups (3.68 +/- 0.11 mm, 4.52 +/- 0.26 mm, and 4.35 +/- 0.24 mm, respectively; P = 0.0273). TNF-alpha levels in the GCF of the RA+ group were the lowest compared to RA- and C groups (0.663, 1.23, and 0.949 ng/site, respectively; P = 0.0401). A significant positive correlation was found between TNF-alpha levels in the GCF and clinical AL (r = 0.448; P = 0.0283). CONCLUSIONS Patients with RA receiving anti-TNF-alpha medication had lower periodontal indices and GCF TNF-alpha levels. Thus, suppression of proinflammatory cytokines might prove beneficial in suppressing periodontal diseases.

Fracture of dental implants: literature review and report of a case.

Fracture of dental implants is a rare phenomenon with severe clinical results. In this article, the literature is reviewed and various causative factors that may lead to fracture are presented. Galvanic activity has not been mentioned before as a possible cause for implant fracture, yet, it can occur at the level of contact with the superstructure. This is illustrated by the case of a titanium implant restored with a nonprecious porcelain-fused-to-metal cemented crown that fractured 4 years after loading. The radiographs show alveolar bone resorption around the fixture. Metallurgical analysis of the implant indicated that the fracture was caused by metal fatigue and that the crown metal, a nickel-chromium-molybdenum alloy, exhibited corrosion. These findings suggest a new explanation for implant fractures; cytotoxic nickel ions, leaching from the base metal alloy may cause bone resorption. This in turn leads to increased mobility, facilitating washout of the luting cement. Contact of the base metal with titanium in the presence of oral fluids produces galvanic currents that hasten corrosion and leaching out of nickel ions, thus leading to further bone resorption. Loss of bone support allows lateral bending moments that cause metal fatigue, eventually leading to fracture. Therefore, good treatment planning and appropriate case selection might have prevented this fracture. Furthermore, the use of nonprecious metal alloy for the crown’s infrastructure had further contribution to the chain of events that led to the implant’s fracture.

Common oral manifestations during pregnancy: a review.

Pregnancy has far-reaching systemic effects extending beyond the reproductive system. Oral and masticatory changes during pregnancy have been documented for many years; however, their magnitude and frequency have not been stressed. This review highlights the major oral complications during pregnancy. Pregnancy gingivitis and pregnancy tumor are described and presented, and possible preventive strategies are suggested. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader will be able to summarize the major oral complications during pregnancy, to outline the etiologic factors associated with each of these conditions, and to explain the role of dental treatment during pregnancy.

Dental Implants in Patients With Type 2 Diabetes Mellitus: A Clinical Study

PurposeSystemic factors, such as diabetes mellitus, can influence the success rate of dental implants. The authors describe their experience using the MIS implant system (Medical Implant System, Shlomi, Israel) for retention of overdentures in patients with type 2 diabetes mellitus and provide data regarding the level of satisfaction of the patients, the improvement of function, mucosal and periimplant health, and bone level around implants in this group. MethodsThe study group consisted of 41 patients with type 2 diabetes mellitus who received 141 implants for retention of overdentures. ResultsThe success rate was 97.3% and 94.4% 1 and 5 years following implantation, respectively. The majority of patients reported improvement of function following the new treatment. A high correlation was observed between mucosal health and improvement of function. No correlation was found between failed implants and glucose level. ConclusionThe clinical outcome of dental implants in a selected group of patients with well-controlled type 2 diabetes mellitus is satisfying and encouraging. Further investigations and clinical trials over a longer period of time are needed to determine the long-term survival of implants in diverse groups of patients with diabetes mellitus.

Accuracy of a computerized tomography-guided template-assisted implant placement system: an in vitro study

OBJECTIVES To evaluate the accuracy of computer-assisted 3D planning and implant insertion using computerized tomography (CT). MATERIALS AND METHODS Nine implants were planned on pre-operative CTs of six resin models, which were acquired with radiographic templates, using a planning software (E implants). Each resin model contained three pre-existing control implants (C implants). Radiographic templates were converted into operative guides containing 4.8-mm-diameter titanium sleeves. A single set of insertable sleeves was used for consecutively drilling the six models, followed by implant insertion through the guide sleeves. Models were further divided into group A (the first three models) and group B (the last three models). Post-operative CTs were used to compare implant positions with pre-operative planned positions. Statistical analysis included the Mann-Whitney U test for E and C implants and the Wilcoxons signed ranks test for groups A and B. RESULTS The mean apex depth deviations for E and C implants [0.49 mm+/-0.36 standard deviation (SD) and 0.32 mm+/-0.21 SD, respectively], and the mean apex radial deviations (0.63 mm+/-0.38 SD and 0.49 mm+/-0.17 SD, respectively) were similar (P>0.05). The mean angulation deviations for E and C implants were 2.17+/-1.06 degrees SD and 1.33+/-0.69 degrees SD, P<0.05. E implant deviations of all the parameters in group A were significantly smaller than E implant deviations in group B. CONCLUSIONS Computer-assisted implant planning and insertion provides good accuracy. Deviations are mainly related to system and reproducibility errors. Multiple use of drills and titanium sleeves significantly reduces system accuracy.

Dental implants placed in previously failed sites: survival rate and factors affecting the outcome

OBJECTIVES The purpose of the present study was to evaluate the survival rate of dental implants in previously failed implant sites. In addition, factors that might affect the outcome of these redo procedures were also explored. MATERIAL AND METHODS Patients that had failed dental implants, which were replaced with the same implant type at the same site, were included. Data on the failed implants were collected. The same parameters, along with the interval between retrieval and re-implantation, were collected for the second set of implants. Descriptive statistics were used to describe the patients and implants. Life table analysis of these implants was tabulated for both implant sets. The effect of systemic, environmental and local factors on the survival of the redo dental implants was evaluated. RESULTS Fifty-six patients with a total of 79 redo implants were included in this study. Implants were followed for 7-78 months (mean 29.9+/-2). Thirteen implants failed that resulted in an overall survival rate of 83.5%. Successful implants had greater diameter (4.05+/-0.52 mm) than failed implants (3.72+/-0.56 mm); however, these differences were only marginal (P=0.06). Conversely, smoking habits, implants length and location, mode of placement and spontaneous exposure did not have a significant effect on the outcome of this procedure. CONCLUSION Redo of dental implants has a lesser survival rate compared with previous reports for implants in pristine sites. These results were not associated with most implant- and/or patient-related factors. Thus, a possible negative effect that is associated with the specific implants site might account for this phenomenon.