Nico C. Geurs

American Academy of Periodontology Task Force report on the update to the 1999 classification of periodontal diseases and conditions

In 2014, the American Academy of Periodontology Board of Trustees charged a Task Force to develop a clinical interpretation of the 1999 Classification of Periodontal Diseases and Conditions to address concerns expressed by the education community, the American Board of Periodontology, and the practicing community that the current Classification presents challenges for the education of dental students and implementation in clinical practice. The Academy announced that an update to the 1999 Classification would commence in 2017. The present focused update addresses three specific areas of concern with the current classification: attachment level, chronic versus aggressive periodontitis, and localized versus generalized periodontitis.

Influence of surface characteristics on survival rates of mini-implants.

OBJECTIVE To compare the clinical performance and the survival rate of two mini-implant systems with different surface characteristics under immediate orthodontic loading. MATERIALS AND METHODS Seventeen machined titanium (MT) mini-implants and 15 sandblasted, large grit, acid-etched (SLA) mini-implants were placed in 10 patients. The mini-implants were immediately loaded and the patients seen at 7, 14, 30, 60, and 150 days. Clinical parameters such as anatomical location, character of the soft tissue at the screw head emergence, type of mini-implant system, diameter, and length were analyzed. In addition, the insertion torque recorded at the time of insertion was also assessed. Survival rate and clinical parameters were evaluated by the chi-square exact tests using the SAS version 9.1. RESULTS The overall survival rate was 87.5%. Over the four failing mini-implants, three were MT and one SLA resulting in an individual survival rate of 82.4% and 93.4%, respectively. In the failure group, all the fixtures had their screw emergence at the oral mucosa and recorded a torque range of less than 15 Ncm. The insertion torque statistically influenced the survival rate of the mini-implants (P < .05). Surface treatment, anatomical location, as well as soft tissue emergence were not statistically significant. CONCLUSION Surface characteristics did not appear to influence survival rates of immediately loaded mini-implants.

Periodontal health of older men: the MrOS dental study.

OBJECTIVE The purpose of this study was to evaluate the prevalence and severity of periodontitis in men of 65+ years and identify demographic and lifestyle factors associated with its presence. METHODS Participants were recruited from the Osteoporotic Fractures in Men Study, a longitudinal study of risk factors for fractures in older men. Dental measures included clinical attachment loss (CAL), pocket depth (PD), calculus, plaque and bleeding on a random half-mouth, plus a questionnaire regarding access to care, symptoms and previous diagnosis. RESULTS 1210 dentate men completed the dental visit. Average age was 75 years, 39% reported some graduate school education, 32% smoked 20 + pack years and 88% reported their overall health as excellent/good. In terms of periodontal health, 38% had sub-gingival calculus, 53% gingival bleeding, 82% CAL > or =5 mm and 34% PD > or =6 mm. The prevalence of severe periodontitis was 38%. Significant demographic and lifestyle factors associated with severe periodontitis in multivariate analyses included age > or =75 (OR 1.4, 95% CI 1.1-1.7) non-white race (OR 1.9, 95% CI 1.3-2.8), less than an annual dental visit (OR 1.5, 95% CI 1.1-2.0), and 20 + pack years (OR 2.1, 95% CI 1.6-2.7). CONCLUSION A high proportion of healthy older men have evidence of periodontal destruction which could, given the growing ageing population, have a significant impact on the dental professions ability to provide preventive and therapeutic care. The population at highest risk of periodontitis in MrOS is older minority men who smoke and do not have annual dental visits.

Clinical Assessment of Bone Quality of Human Extraction Sockets After Conversion with Growth Factors

PURPOSE The study was conducted to evaluate the effect of mineralized freeze-dried bone allograft (FDBA), alone or in combination with growth factors in extraction sockets, on subjective assessment of bone quality during implant placement. MATERIALS AND METHODS Forty-one patients whose treatment plan involved extraction of anterior or premolar teeth were randomized into four groups: Group 1, collagen plug (control); Group 2, FDBA/β-tricalcium phosphate (β-TCP)/collagen plug; Group 3, FDBA/β-TCP/platelet-rich plasma (PRP)/collagen plug; Group 4, FDBA/β-TCP/recombinant human platelet-derived growth factor BB (rhPDGF-BB)/collagen plug. After 8 weeks of healing, implants were placed. The clinicians assessed bone quality according to the Misch classification. A benchtop calibration exercise test was conducted to evaluate agreement and accuracy of operators in recognizing different bone qualities. Differences were analyzed using one-way analysis of variance (ANOVA) or chi-square tests for continuous and categorical data. Pairwise comparisons were tested using least squares means (LS means). Spearman correlation coefficients were used to evaluate the relationship of bone growth with potential confounders. P < .05 was considered statistically significant. A simple (not weighted) kappa statistic was used to assess the agreement between raters. To assess accuracy in identifying bone quality, a chi-square test was used to compare the percent correct for each rater. RESULTS The benchtop calibration exercise test demonstrated agreement among clinicians (0.75 and 0.92 between raters 1 and 2 and raters 1 and 3, respectively). Raters were more likely to identify the correct bone quality (P > .05). Inclusion of bone grafting is associated with a shift from D4 quality to D3 quality bone. Inclusion of PRP in bone grafting eliminates the incidence of D4 bone, establishing D3 and D2 quality bone as prevalent (56% vs. 42%, respectively). Inclusion of rhPDGF-BB and β-TCP in combination with the bone grafting has the same effect, although D2 quality is less prevalent. When compared to sockets grafted with FDBA/β-TCP/collagen plug alone, the sockets with growth factors demonstrated fewer residual bone graft particles. CONCLUSION (1) Inclusion of bone grafting enhanced bone quality as assessed during implant placement. (2) Overall inclusion of PRP and rhPDGF-BB enhanced subjective bone quality, eliminating incidence of D4 quality in human extraction sockets. (3) The use of PRP or rhPDGF-BB may enhance healing within extraction sockets and decrease the healing time prior to dental implant placement.