Rutger Persson

Differences in salivary flow rates in elderly subjects using xerostomatic medications

Stimulated whole salivary flow rate (SWSFR) was measured in a group of elderly subjects who were examined for the use of xerostomia-inducing medications. SWSFR was significantly reduced in elderly subjects using one of these medications when compared with control subjects (0.94 vs 1.52 ml/min). Increasing use of up to four different xerostomia-inducing medications did not result in additional significant reduction of stimulated salivary flow rate. Psychotropic and diuretic agents were the most commonly used xerostomatic medications, and these were almost equally potent in reducing mean flow rate (0.79 vs 0.84 ml/min). The use of potentially xerostomatic medications did not affect decayed, missing, or filled surface scores or unstimulated whole saliva pH values. A weak, statistically significant, positive correlation (r = 0.39, p less than 0.01) was found between subject age and salivary flow rate in this population of elderly subjects, and this suggests that SWSRF is influenced more by factors such as medication than by aging.

Improved General and Oral Health in Diabetic Patients by an Okinawan-Based Nordic Diet: A Pilot Study

Periodontal disease, periodontitis as well as the preceding gingivitis, has been associated with both obesity and diabetes. Studies have shown that diet changes can lead to a lower incidence of such inflammation. The aim of the present case series over four weeks was to study the effects on medical and dental conditions in patients with type 2 diabetes of the consumption of the Okinawan-based Nordic Diet (OBND®). Medical and dental examinations were performed to estimate the general health and gingivitis/periodontitis. Serum cytokine levels were assessed using Luminex technology. Eight of ten study participants completed the study. All participants lost weight (p = 0.012). Six out of seven that were treated with insulin could reduce their insulin intake after two weeks with OBND®. The reduction was about 16 units which corresponds to a 34% relative reduction compared to the starting point (range 15–63%). Fasting blood glucose values fell (p = 0.035). Hemoglobin A1c (HbA1c) (p = 0.01), triglycerides (p = 0.05), and low-density lipoprotein (LDL) (p = 0.05) were also reduced. Bleeding on probing changed from ~28% before any dietary changes to ~13% after two weeks with OBND® (p = 0.01). The reduction in gingival bleeding was as substantial as might be expected from one session of professional tooth cleaning. Markers of inflammation were also reduced. The OBND® thus showed significant promise in alleviating the impact of diabetes on dental as well as general health.

Long-term follow-up of single turned Brånemark implants after 16–22 years: microbiological findings

Background: Achieving high esthetic results in the pontic sites of fixed implant-supported restorations is a challenging task for the clinician and requires appropriate surgical and prosthodontic management of the soft tissues. In order to obtain an esthetic soft tissue frame, the underlying alveolar bone must be present to support it. Socket preservation and soft tissue augmentation techniques have been suggested to maintain the ridge contour at the pontic site. The root submergence is another technique that has been proposed instead of the commonly used bone and soft tissue augmentation procedures. The root is sectioned at the level of the bone and covered with a buccal or buccolingual flap. The attachment apparatus of the natural root maintains the contour of the alveolar ridge and prevents bone resorption and soft tissue collapse that are observed after extraction of a tooth. Aim: The aim of this poster is to present a clinical procedure that can obtain high esthetic results in the pontic sites of fixed implant restorations, utilizing the root submergence technique. Methods: A 71 years old male with a severely compromised dentition presented for treatment. The patient had high esthetic demands and desired fixed restorations. Thesuggested treatment included fabrication of cement retained Fixed Dental Prostheses supported by six implants in the maxilla and a screw retained hybrid bridge supported by five implants in the mandible. The upper canines and central incisors, despite their poor prognosis, were maintained temporarily in order to support a fixed transitional restoration for the osseointegration period. All implants osseointegrated successfully and a screw-retained implant-supported transitional restoration was fabricated in the maxilla. The crowns of the canines were sectioned at the level of the bone and the roots were submerged. The central incisors were extracted due to excessive root caries. Selective pressure was applied at the soft tissues of the pontic sites with the provisional restoration. A natural scallop of the soft tissues was formed and the fabrication of the definitive Fixed Dental Prostheses with ovate pontics was followed. Results: After 3 years in function, no biologic complications on the natural submerged roots were observed. The esthetic appearance of the restorations at the pontic sites was excellent. Conclusions and clinical implications: The utilization of the root submergence technique in the pontic sites of fixed implant restorations is a predictable clinical procedure, which maintains the alveolar ridge contour and enhances the final esthetic result.Immediate placement is defined as implant placement in conjunction with tooth extraction and offers several benefits for the patient and the clinician. It reduces the treatment time with several months since implant osseointegration coincide with soft tissue healing after extraction. Today immediate implantation combined with immediate provisionalisation further enhances socket and soft tissue preservation, cost-benefits and patient comfort. The first-generation dental implants resulted in unacceptably high failure rates. The introduction of rougher surfaces, however, has improved survival in such a way that comparable results to implants placed in a delayed manner have been obtained. A brief overview of evidence-based literature will be given pointing to the prerequisites needed for an optimal clinical implant survival. On the other hand, implant placement in the aesthetic zone is more critical and more demanding. It is imperative that after implant placement the hard and soft tissues are in perfect harmony with the neighbouring natural teeth. The process of healing and tissue preservation seems to benefit from immediate provisionalisation but is affected by the patient’s biotype. The clinical results of a prospective clinical trial will be presented whereby single implants were placed in the anterior maxilla in either healed bone or in extraction sockets. The discussion will focus on bone and soft tissue healing and patient-centered aesthetic outcome. Clinical guidelines for this treatment option will be given regarding the surgical as well as prosthetic approach in order to obtain predictability.Background: The good long-term clinical results of dental implants are well established, under the scope of osseointegration and function. Esthetics, especially in the anterior maxilla, is another factor gaining importance nowadays. Thus, customized zirconia abutments are replacing the standardized titanium ones at these sites, since they have also very good physical properties and biocompability. However, in the clinical practice we are often dealing with failures of such ceramic abutments. These failures could be related to the type of the customized abutment, as well as other factors. High stresses at the abutment-screw- nut interface could be generated as a result of the limited degree of rotational freedom in combination with a slight misfit. This may lead to the loosening of the assembled components and eventually to fracture, at two-material zirconia abutments (e.g. Procera Zr). In the case of two-component abutments (prefabricated titanium post and custom-made zirconia coping cemented on top of that) the weak link is the cement. The failure usually involves separation of the components, without any observed fractures. Other reasons of failure are considered to be defects in the fabrication process, fractures in the green structure, sintering prestresses, or handling errors. Aim: The purpose of this poster is to present the use and the technical complications of customized zirconia abutments, through a series of clinical cases. Methods: Three customized zirconia abutments were used in three different patients, in the esthetic zone, to achieve optimal esthetics. In two cases, a two-piece abutment with internal connection (Procera Zirconia) was utilized. In the third patient, a two-component abutment with cement retention was used. Results: Failure in all three cases of customized zirconia abutments was observed because of technical complications. Consequently, there was a need to modify the treatment plan. Conclusions and clinical implications: Customized zirconia abutments exhibit good esthetic, biological and technical outcomes, and they are considered to be a widespread and viable treatment option. However, their use in different clinical cases must be carefully selected. Additionally, great attention has to be given in their manufacturing procedure and adjustment in the laboratory.implants after 16–22 years: Microbiological findings Presenter: Dierens M University of Ghent, Gent, Belgium Co-authors: Dierens M1, Vandeweghe S1,2, Cosyn J1, Kisch J3, Persson R4, De Bruyn H1,2 1University of Ghent, Ghent, Belgium, 2Malmo ̈ University, Malmo ̈, Sweden, 3Centre of Dental Specialist Care, Malmo ̈, Sweden, 4University of Berne, Bern, Switzerland Background: Research on long-term outcome of single dental implants is scarce. Microbiological data around single implants have been described after short-term follow-up only. Aim: The primary objective of this study was to evaluate the microbiota around single turned Bra°nemarkTM implants after 16–22 years of follow-up. Secondary objectives were to compare the microbiota around teeth and implants and to correlate microbiological findings and clinical parameters. Methods: Fifty patients with 59 single implants were invited after a mean follow-up of 18.4 years (range 16–22). Paper point samples were retrieved from the deepest implant pocket (I, n1⁄459), the deepest pocket of the contralateral tooth (C, n1⁄448), and of the deepest pocket on natural teeth in each quadrant (P, n1⁄450). Checkerboard DNA-DNA hybridization was performed evaluating 40 species as well as the total DNA count. Bacterial counts were standardized according to the number of paper points used. Overall differences between implants, contralaterals and the pooled samples were analyzed using the Friedman test. Comparison between implants and contralateral teeth was made by means of the Wilcoxon Signed Ranks test. Correlations between microbiological and clinical parameters were performed using the Spearman correlation coefficient. Results: The species with the highest mean bacterial counts around implants were C. showae (1.07 _ 2.32). Significant differences in bacterial counts between an implant and the contralateral tooth were found for P. micra (P1⁄40.049), P. gingivalis (P1⁄40.025), P. intermedia (P1⁄40.006), T. forsythia (P1⁄40.014) and T. denticola (P1⁄40.003). The mean counts of these species were higher around implants than around teeth. Spearman correlations of the total bacterial counts were weak but significant for mean interproximal probing depth around the implant (r1⁄40.352; P1⁄40.006) and mean interproximal bleeding index (r1⁄40.381; P1⁄40.003). The species with the highest correlation coefficients for mean interproximal probing depth were S. haemolyticus (r1⁄40.405), S. anginosus (r1⁄40.421) and S. mitis (r1⁄40.401). Conclusions and clinical implications: Periodontal pathogens are present in higher numbers around implants after 16–22 years of function than around contralateral teeth. This, however, is not correlated to the clinicalmeasurements of probing depth, bleeding index, plaque index or marginal bone level. The overall count of bacteria seems to be weakly correlated to mean interproximal probing depth and bleeding indices.

Heel DXA T-scores and panoramic radiographs in the prediciton of hip and hand fractures

Background: Infection and inflammation in tissues adjacent to dental implants are common. There are few controlled studies assessing interventions. We assessed if mechanical debridement with titanium curettes, is equally effective as an ultrasonic device in reducing clinical signs of inflammation and the total bacterial load. Materials and methods: Thrity two subjects (mean age 62.5 S.D ± 11.7) with one implant each demonstrating peri-implantitis were randomized in two intervention groups. Clinical and microbiological data were obtained before and during 6 months. Group one received debridement using titanium hand-instruments and group two received ultrasonic treatment using a coated working end. Results: At the different time-points, data analysis by independent t–test, or Mann–Whitney U tests failed to demonstrate group differences. Comparing baseline data with results at 6 months (merged groups) demonstrated that overall PI scores and at implants decreased (mean diff: 20.2%, S.E ± 6.3, 95%CI: 7.0 to 32.7, P < 0.002) and (mean diff: 27.2% S.E ± 7.9, 95%CI: 11.3 to 43.1, P < 0.001). Bleeding scores at implants improved (P < 0.01). PPD scores at implants did not improve (P = 0.30). Conclusions: No differences in treatment outcomes between the two treatment methods studied were found. While PI and BOP scores improved no effects in PPD were identified.Aims: To assess whether recurrence of acute coronary syndrome (ACS) can be linked to periodontitis in subjects followed over a 3 year period. Methods and results: Consecutive 163 hospital admitted subjects with ACS, and 158 medically healthy matched control subjects were followed through medical records review over 3 years. At baseline, subjects received medical and dental examinations. Periodontitis was defined as alveolar bone loss (ABL) > 2 S.D. above normal mean values. Subgingival bacterial samples were collected and processed by checkerboard DNA–DNA hybridization. ACS recurrence was found in 66/163 (40.5%) subjects, and a first ACS event in 7/158 (4.4%) control subjects. ABL was a risk marker of future ACS with OR: 3.6 (95%CI: 2.0-6.5, P < 0.001). Subject age was also an explanatory factor for a new ACS event (P < 0.001). Significantly higher subgingival bacterial counts for 20/37 species (i.e., Streptococcus anginosus, Streptococcus mitis, Tannerella forsythia) in ACS cases than in healthy controls. None of traditional serum markers (CRP, high and low density lipoprotein, cholesterol, triglycerides) were explanatory. Conclusions: Age, and periodontitis (ABL) are robust markers of risk for future ACS. Subgingival bacterial counts are elevated in subjects with ACS.Background: Periodontal disease affect a large proportion of the adult population and cause an increasein serum levels of C- reactive protein (CRP), and other markers of inflammation. An increased level of CRP reflects an increased risk of cardiovascular disease. The aim of the current randomized clinical trial was to evaluate the short term effect of CRx-102 alone on the levels of hs-CRP, pro-inflammatory markers in blood and clinical signs of periodontal disease. Methods: Fifty seven patients with at least 10 pockets, with a probing depth of 5 mm or more, were randomized into two groups either CRx-102 (n = 28) or placebo (n = 29) in this blinded single-centre placebo controlled study. High sensitivity CRP (Hs-CRP) levels, inflammatory markers (IL-6, Il-1b, TNFa, IL12, IL-8, IFN c), bleeding on probing (BOP) and change in probing depths were evaluated. After 42 days the subjects received mechanical non-surgical therapy and the study was completed after 49 days. Results: At day 42 the difference in hs-CRP and IFN c levels between the two groups was statistically significant (P = 0.02 and P = 0.03, respectively) whereas no difference was found for the other inflammatory markers. There was no change in periodontal probing depth or BOP between the two groups. Conclusion: The current study demonstrated that the administration of CRx-102, resulted in significant decreases in hs- CRP and IFN c, but did not significantly change BOP or probing depths. 10:15–10:30 Ref no: EUABS065318 Anti TNF-a therapy and periodontal parameters in rheumatoid arthritis patients Y. MAYER*, A. GURMAN-BALBIR AND E. E. MACHTEI Unit of Periodontology, Rambam HCC, Haifa, Israel Aim: To evaluate the influence of anti TNF-a therapy on the clinical and immunological parameters of the periodontium. Materials and methods: Ten patients with RA who received infusion of 200 mg infliximab routinely (RA+), 10 patients with RA without anti TNF-a therapy (RA-) and 10 healthy patients (C) were included. Clinical parameters PI, GI, PD, CAL and BOP were assessed and total GCF TNF-a level was determined using ELISA. ANOVA with Fisher’s modification and Pearson correlation test were used for statistical analysis. Results: Patients’ age ranged between 22 and 76 years (mean 50.73 ± 9.1). Mean PI was similar between the groups. However, mean inflammatory parameters in the 3 groups varied significantly; GI was greater in the RA- compared with RA+ and C (P = 0.0042). RA+ exhibit less BOP than RA- and C (21.1% ± 3.0%, 45.9% ± 6.2% and 39.1% ± 7.2%; respectively, P = 0.0146) The mean PD in RA+ was shallower than RA- and C (3.22 ± 0.13, 3.85 ± 0.22, 3.77 ± 0.20; P = 0.055). CAL in RA+ was lower than RA- and C (3.68 ± 0.11, 4.52 ± 0.26, 4.35 ± 0.24; P = 0.0273). TNF-a levels in the GCF of RA+ were the lowest (0.663 pg/ml, 1.23 pg/ml and 0.949 pg/ml; P = 0.0401). A significant positive correlation was found between TNF-a levels in the GCF and CAL (r = 0.448, P = 0.0283). Conclusion: Rheumatoid arthritis patients receiving anti TNF-a medications have lower periodontal indices and GCF TNF-a levels. Thus, suppression of pro-inflammatory cytokines might prove beneficial in suppressing periodontal diseases.