Stefan Renvert

Cluster of Bacteria Associated with Peri-Implantitis.

BACKGROUND Information on the microbiota in peri-implantitis is limited. We hypothesized that neither gender nor a history of periodontitis/smoking or the microbiota at implants differ by implant status. MATERIALS AND METHODS Baseline microbiological samples collected at one implant in each of 166 participants with peri-implantitis and from 47 individuals with a healthy implant were collected and analyzed by DNA-DNA checkerboard hybridization (78 species). Clinical and radiographic data defined implant status. RESULTS Nineteen bacterial species were found at higher counts from implants with peri-implantitis including Aggregatibacter actinomycetemcomitans, Campylobacter gracilis, Campylobacter rectus, Campylobacter showae, Helicobacter pylori, Haemophilus influenzae, Porphyromonas gingivalis, Staphylococcus aureus, Staphylococcus anaerobius, Streptococcus intermedius, Streptococcus mitis, Tannerella forsythia, Treponema denticola, and Treponema socranskii (p < .001). Receiver operating characteristic curve analysis identified T. forsythia, P. gingivalis, T. socranskii, Staph. aureus, Staph. anaerobius, Strep. intermedius, and Strep. mitis in peri-implantitis comprising 30% of the total microbiota. When adjusted for gender (not significant [NS]), smoking status (NS), older age (p = .003), periodontitis history (p < .01), and T. forsythia (likelihood ratio 3.6, 95% confidence interval 1.4, 9.1, p = .007) were associated with peri-implantitis. CONCLUSION A cluster of bacteria including T. forsythia and Staph. aureus are associated with peri-implantitis.

Long‐term stability of surgical bone regenerative procedures of peri‐implantitis lesions in a prospective case–control study over 3 years

OBJECTIVES To evaluate the extent of bone fill over 3 years following the surgical treatment of peri-implantitis with bone grafting with or without a membrane. MATERIAL AND METHODS In a non-submerged wound-healing mode, 15 subjects with 27 implants were treated with a bone substitute (Algipore(®)) alone and 17 subjects with 29 implants were treated with the bone substitute and a resorbable membrane (Osseoquest(®)). Implants with radiographic bone loss ≥1.8 mm following the first year in function and with bleeding and/or pus on probing were included. Following surgery, subjects were given systemic antibiotics (10 days) and rinsed with chlorhexidine. After initial healing, the subjects were enrolled in a strict maintenance programme. RESULTS Statistical analysis failed to demonstrate changes in bone fill between 1 and 3 years both between and within procedure groups. The mean defect fill at 3 years was 1.3 ± (SD) 1.3 mm if treated with the bone substitute alone and 1.6 ± (SD) 1.2 mm if treated with an adjunct resorbable membrane, (p=0.40). The plaque index decreased from approximately 40-10%, remaining stable during the following 2 years. CONCLUSION Defect fill using a bone substitute with or without a membrane technique in the treatment of peri-implantitis can be maintained over 3 years.

Surgical therapy for the control of peri‐implantitis

MATERIAL AND METHODS Articles on surgical treatment of peri-implantitis in humans published up to December 2011 were included. RESULTS Twenty-six studies were selected, thus limiting the available evidence. There is marked heterogeneity between study designs and case definitions for peri-implantitis in the studies cited, limiting the generalization of the reported results. Adjunctive systemic antibiotics were used in most studies, but no study evaluated the adjunctive benefit of systemic antibiotics. Access flap surgery, removal of granulation tissue and implant surface decontamination has been demonstrated to decrease plaque index, BOP, suppuration, probing depths and to arrest bone loss for 58% of implant sites over 5 years. Laser treatment of the exposed implant surface during surgery was not shown to be beneficial. Available data indicate that it is possible to obtain defect fill of peri-implantitis defects following surgical-treatment modalities with concomitant placement of bone or bone substitutes in such defects. However, there is lack of evidence that placement of membranes in addition to grafting procedures provides any additional defect fill. CONCLUSIONS Surgical therapy for treating peri-implantitis is a predictable method for treating peri-implant disease and patients receiving this therapy have benefited from it in the short term.

Comparison of different treatment modalities for oral halitosis

Abstract Objectives. To assess the effects on intra-oral halitosis by a mouth rinse containing zinc acetate (0.3%) and chlorhexidine diacetate (0.025%) with and without adjunct tongue scraping. Materials and methods. Twenty-one subjects without a diagnosis of periodontitis were randomized in a cross-over clinical trial. Organoleptic scores (OLS) were assessed to define intra-oral halitosis by total volatile sulfur compound (T-VSC) measurements and by gas chromatography. Results. Twenty-one subjects with a mean age of 45.7 years (SD: ±13.3, range: 21–66). The OLS were significantly lower following active rinse combined with tongue scraping (p < 0.001) at all time points. Immediately after, at 30 min, and at day 14, the T-VSC values were lower in the active rinse sequence than in the negative rinse sequence (p < 0.001, p < 0.001 and p < 0.05, respectively). At 30 min and at day 14, the hydrogen sulfide (H2S) and methyl mercaptan (MM) values were lower in the active rinse sequence compared to the inactive rinse sequence (p < 0.001). The inactive rinse sequence with tongue scraping reduced T-VSC at 30 min (p < 0.001) but not at 14 days. Similar reductions in T-VSC, H2S and MM were found in the active rinse sequence with or without tongue scraping. Conclusion. The use of a tongue scraper did not provide additional benefits to the active mouth rinse, but reduced OLS and tongue coating index.

Probiotic supplements and debridement of peri-implant mucositis: A randomized controlled trial

Abstract Objective. The aim of this double-blind randomized placebo-controlled trial was to evaluate the effects of probiotic supplements in adjunct to conventional management of peri-implant mucositis. Materials and methods. Forty-nine adult patients with peri-implant mucositis were consecutively recruited after informed consent. After initial mechanical debridement and oral hygiene instructions, the patients received a topical oil application (active or placebo) followed by twice-daily intake of lozenges (active or placebo) for 3 months. The active products contained a mix of two strains of Lactobacillus reuteri. Patients were clinically monitored and sampled at baseline and after 1, 2, 4, 12 and 26 weeks. The clinical end-points were pocket-probing depth (PPD), plaque index (PI) and bleeding on probing (BOP). In addition, the subgingival microbiota was processed with checkerboard DNA-DNA hybridization and samples of gingival crevicular fluid (GCF) were analyzed for selected cytokines with the aid of multiplex immunoassays. Results. After 4 and 12 weeks, all clinical parameters were improved in both the test and the placebo group. PPD and BOP were significantly reduced compared with baseline (p < 0.05), but no significant differences were displayed between the groups. The clinical improvements persisted 3 months after the intervention. No major alterations of the subgingival microflora were disclosed and the levels of inflammatory mediators in GCF did not differ between the groups. Conclusions. Mechanical debridement and oral hygiene reinforcement resulted in clinical improvement of peri-implant mucositis and a reduction in cytokine levels. Probiotic supplements did not provide added benefit to placebo.

Tooth loss and cognitive functions among older adults

Abstract Objective. To evaluate the association between the number of teeth and cognitive functions adjusted for age and education level in a cohort of older adults living in Sweden. Materials and methods. The study employed a cross-sectional design in which 1147 individuals between 60–96 years underwent a clinical oral examination. The cognitive functions were assessed using Mini-Mental State Examination (MMSE) and Clock-test. The level of education was obtained from a questionnaire. Data were subjected to Chi-square tests and multivariate logistic regression analyses were employed, grouping the different variables into pre-determined categories. Results. The co-variables age and education were significantly associated with the number of teeth (p < 0.05). The multivariate logistic regression analysis revealed that the association between the number of teeth and the cognitive functions persisted even after adjusting for age and level of education. Conclusions. The findings suggest that the presence of teeth may be of importance for cognitive abilities in older adults.

Assessment of carotid calcifications on panoramic radiographs in relation to other used methods and relationship to periodontitis and stroke: a literature review

Abstract Objectives. To assess the literature on carotid calcifications defined from panoramic radiographs (PMX) and concurrent diagnosis of stroke and periodontitis. Materials and methods. A literature search screening for publications using search terms such as PMX and carotid calcification, stroke and periodontitis was performed in November 2012. Results. A total of 189 articles were retrieved, among which 30 were included in the review. The sensitivity for PMX findings of carotid calcifications (CC) compared to a diagnosis by Doppler sonography varied between 31.1–100%. The specificity for PMX findings of carotid calcifications compared to a diagnosis by Doppler sonography varied between 21.4–87.5%. Individuals with CC findings from PMX have more periodontitis and risk for stroke. Conclusions. There is a shortage of well-designed studies in older dentate individuals assessing the associations between periodontitis and radiographic evidence of CC and in relation to stroke or other cardiovascular diseases. Statement of Clinical Relevance. Carotid calcifications are prevalent in patients with periodontitis and such individuals may have an increased risk for stroke. The absence of signs of carotid calcification on panoramic radiographs is indicative of no calcification of carotid arteries.

Antibacterial activity of berry juices, an in vitro study

Abstract Objective. The aim of the present study was to evaluate in vitro antibacterial activities of blackcurrant and sea buckthorn juices on bacteria associated with gingival inflammation. Materials and methods. The growth of selected bacteria (Streptococcus mitis, Streptococcus mutans, Streptococcus sanguinis, Streptococcus gordonii, Staphylococcus aureus, Staphylococcus epidermidis and Pseudomonas aeruginosa) was studied in vitro on agar plates. The content of phenols in the different extracts was measured with HPLC-ESI-MS. Results. The spectrometric analysis identified that the highest level of the single phenols studied was found for ferulic acid (113 μg/ml) in blackcurrant juice. Sea buckthorn contained low levels of selected phenols. Total bacterial inhibition for all bacterial species studied was found at 20% berry juice concentration with pH varying between 4.1–5.4. Conclusions. The present study identified that in vitro bacterial growth on agar plates was inhibited by blackcurrant and sea buckthorn juices and that low juice pH explains bacterial in vitro growth. This may have clinical implications in biofilm development, reducing the risks for both tooth decay and gingivitis.

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.

Heel DXA T-scores and panoramic radiographs in the prediction 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.