Publications by authors named "Andreas Stavropoulos"

131 Publications

Distance of insertion points in a mattress suture from the wound margin for ideal primary closure in alveolar mucosa: an experimental study.

J Periodontal Implant Sci 2021 Jun;51(3):189-198

Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea.

Purpose: This study was conducted to determine how the distance of the near insertion points in a vertical mattress suture from the wound margin influences the pattern of primary closure in an experimental model.

Methods: Pairs of 180 porcine gingival and alveolar mucosa samples were harvested from 90 pig jaws and fixed to a specially designed model. A vertical mattress suture was performed with the near insertion point at 3 different distances from the wound margin (1-, 3-, and 5-mm) on both the gingival and mucosal samples (6 groups; n=30 for each group). The margin discrepancy and the presence of epithelium between the wound margins were measured on histologic slides.

Results: The margin discrepancy decreased significantly as the near insertion point became closer to the wound margin both in mucosal tissue (0.241±0.169 mm, 0.945±0.497 mm, and 1.306±0.773 mm for the 1-, 3-, and 5-mm groups, respectively) and in gingival tissue (0.373±0.304 mm, 0.698±0.431 mm, and 0.713±0.691 mm, respectively). The frequency of complications of wound margin adaptation reduced as the distance of the near insertion point from the wound margin decreased both in the mucosal and gingival tissues.

Conclusions: Placing the near insertion point close to the wound margin enhances the precision of wound margin approximation/adaptation using a vertical mattress suture.
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http://dx.doi.org/10.5051/jpis.2100680034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8200382PMC
June 2021

Impact of Orthodontic Forces on Plasma Levels of Markers of Bone Turnover and Inflammation in a Rat Model of Buccal Expansion.

Front Physiol 2021 25;12:637606. Epub 2021 May 25.

Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine (CUMD), University of Geneva, Geneva, Switzerland.

Plasma levels of protein analytes might be markers to predict and monitor the kinetics of bone and tissue remodeling, including maximization of orthodontic treatment stability. They could help predict/prevent and/or diagnose possible adverse effects such as bone dehiscences, gingival recession, or root resorption. The objective of this study was to measure plasma levels of markers of bone turnover and inflammation during orthodontic force application in a rat model of orthodontic expansion. Two different orthodontic forces for bilateral buccal expansion of the maxillary arches around second and third molars were applied in 10 rats equally distributed in low-force (LF) or conventional force (CF) groups. Four rats served as the control group. Blood samples were collected at days 0, 1, 2, 3, 6, 13, 21, and 58. Longitudinal concentrations of osteoprotegerin (OPG), soluble receptor activator of nuclear factor kappaB ligand (sRANKL), interleukin-4 (IL-4), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor α (TNF), and parathyroid hormone (PTH) were determined in blood samples by a multiplex immunoassay. CF and LF resulted in a significantly maxillary skeletal expansion while the CF group demonstrated significantly higher expansion than the LF group in the long term. Bone turnover demonstrated a two-phase response. During the "early phase" (up to 6 days of force application), LF resulted in more sRANKL expression and increased sRANKL/OPG ratio than the CF and control animals. There was a parallel increase in PTH levels in the early phase in response to LF. During the "late phase" (6-58 days), the markers of bone turnover were stable in both groups. IL-4, IL-6, and IL-10 levels did not significantly change the test groups throughout the study. These results suggest that maxillary expansion in response to different orthodontic forces follows different phases of bone turnover that may be force specific.
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http://dx.doi.org/10.3389/fphys.2021.637606DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8186951PMC
May 2021

Patients' opinion on the use of 2 generations of power-driven water flossers and their impact on gingival inflammation.

Clin Exp Dent Res 2021 May 31. Epub 2021 May 31.

Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden.

Objectives: To assess patients' opinion on the use of 2 generations of power-driven water flossers and their impact on gingival inflammation.

Material & Methods: In the present prospective cohort study 24 periodontitis patients under regular supportive periodontal therapy used daily 2 generations of a power-driven water flosser (Sonicare AirFloss [SAF] and Sonicare AirFloss Ultra [SAFU]) for 12 weeks each. Patients were instructed to position the nozzle interproximally from the buccal aspect at each interproximal space. Patients' opinion was assessed by a questionnaire and interproximal bleeding on probing (BoP) was recorded.

Results: Overall satisfaction with SAF/SAFU was rated high, by about 80% of the patients. About 66% of the patients preferred SAF/SAFU compared to their previous interdental cleaning device and indicated that they would continue using SAF/SAFU after the study; none of the patients reported any discomfort or pain. Compared to only tooth brushing, daily use of SAF/SAFU caused a significant reduction of interproximal BoP values, which were well maintained over 6 months; that is, BoP at interproximal buccal and oral sites (pooled), as well as at interproximal buccal and oral sites separately, was proportionately reduced by 29.1%, 41.2%, and 24.8%, respectively (pooled: p = 0.027; buccal sites: p = 0.030; oral sites: p = 0.030).

Conclusion: Patients were very fond of the power-driven water flossers tested herein, and daily use of the devices for 6 months (i.e., each device was used for 3 months) resulted in a significant reduction of gingival inflammation interproximally.
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http://dx.doi.org/10.1002/cre2.456DOI Listing
May 2021

Bacterial colonization of a power-driven water flosser during regular use. A proof-of-principle study.

Clin Exp Dent Res 2021 May 26. Epub 2021 May 26.

Faculty of Odontology, Department of Periodontology, University of Malmö, Malmö, Sweden.

Objectives: The present proof-of-principle study assessed whether daily use of a power-driven water flosser (Sonicare AirFloss; SAF) leads to bacterial colonization in the nozzle and/or the device, resulting in contaminated water-jet.

Material And Methods: In five participants, saliva samples at baseline and water-jet samples of devices used daily with bottled water for 3 weeks (test) were collected. Additionally, water-jet samples from devices used daily with bottled water extra-orally for 3 weeks (positive control) and from brand new devices (negative control), as well as samples from newly opened and 1- and 3-week opened water bottles were collected. Colony forming units (CFU) were recorded after 48 h culturing and 20 oral pathogens were assessed by polymerase chain reaction-based analysis.

Results: Distinct inter-individual differences regarding the number of detected bacteria were observed; water-jet samples of test devices included both aerobic and anaerobic bacterial species, with some similarities to the saliva sample of the user. Water-jet samples from positive control devices showed limited number of aerobic and anaerobic bacterial species, while the samples from negative control devices did not show any bacterial species. Very few aerobic bacteria were detected only in the 3-week-old bottled water samples, while samples of newly and 1-week opened water bottles did not show any bacterial growth.

Conclusions: The present proof-of-principle study showed that daily use of a power-driven water flosser for 3 weeks resulted in bacterial colonization in the nozzle and/or device with both aerobic and anaerobic, not only oral, species, that are transmitted via the water-jet.
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http://dx.doi.org/10.1002/cre2.393DOI Listing
May 2021

Gingival Thickness Assessment at Mandibular Incisors of Orthodontic Patients with Ultrasound and Cone-beam CT. A Cross-sectional Study.

Oral Health Prev Dent 2021 Jan;19(1):263-270

Purpose: To use and evaluate two methods for measuring gingival thickness (GT) at mandibular incisors of orthodontic patients and compare their performance in assessing periodontal anatomy through soft tissue thickness.

Materials And Methods: The sample consisted of 40 consecutive adult orthodontic patients. GT was measured just before bracket placement at both central mandibular incisors, mid-facially on the buccal aspect, 2 mm apically to the free gingival margin with two methods: clinically with an ultrasound device (USD) and radiographically with cone-beam computed tomography (CBCT).

Results: CBCT measurements were consistently higher than USD measurements, with the difference ranging from 0.13 mm to 0.21 mm. No statistically significant difference was noted between the repeated CBCT measurements at the right central incisor (bias = 0.05 mm; 95% CI = -0.01, 0.11; p = 0.104). Although the respective results for the left incisor statistically indicated that the measurements were not exactly replicated, the magnitude of the point estimate was small and not clinically significant (bias = 0.06 mm; 95% CI = 0.01, 0.11; p = 0.014). Small differences between CBCT measurements made by the 2 examiners at the left central incisor (bias = 0.06 mm; 95% CI = 0.01, 0.11; p = 0.014) were detected. However, this difference was minor and also not clinically significant. The respective analysis on the right incisor showed no statistically significant difference (bias = 0.05 mm; 95% CI = -0.01, 0.11; p = 0.246).

Conclusions: Based on reproducibility, CBCT imaging for gingival thickness assessment proved to be as reliable as ultrasound determination. However, CBCT consistently yielded higher values, albeit at a marginal level, than did the ultrasound device.
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http://dx.doi.org/10.3290/j.ohpd.b1248965DOI Listing
January 2021

Greater Osseointegration Potential with Nanostructured Surfaces on TiZr: Accelerated vs. Real-Time Ageing.

Materials (Basel) 2021 Mar 29;14(7). Epub 2021 Mar 29.

Department of Preclinical & Translational Research, Institut Straumann, CH-4002 Basel, Switzerland.

Surface chemistry and nanotopography of dental implants can have a substantial impact on osseointegration. The aim of this investigation was to evaluate the effects of surface chemistry and nanotopography on the osseointegration of titanium-zirconium (TiZr; Roxolid) discs, using a biomechanical pull-out model in rabbits. Two discs each were placed in both the right and left tibiae of 16 rabbits. Five groups of sandblasted acid etched (SLA) discs were tested: (1) hydrophobic without nanostructures (dry/micro) ( = 13); (2) hydrophobic with nanostructures, accelerated aged (dry/nano/AA) ( = 12); (3) hydrophilic without nanostructures (wet/micro) ( = 13); (4) hydrophilic with nanostructures, accelerated aged (wet/nano/AA; SLActive) ( = 13); (5) hydrophilic with nanostructures, real-time aged (wet/nano/RTA). The animals were sacrificed after four weeks and the biomechanical pull-out force required to remove the discs was evaluated. Adjusted mean pull-out force was greatest for group wet/nano/RTA (64.5 ± 17.7 N) and lowest for group dry/micro (33.8 ± 10.7 N). Multivariate mixed model analysis showed that the pull-out force was significantly greater for all other disc types compared to the dry/micro group. Surface chemistry and topography both had a significant effect on pull-out force ( < 0.0001 for both), but the effect of the interaction between chemistry and topography was not significant ( = 0.1056). The introduction of nanostructures on the TiZr surface significantly increases osseointegration. The introduction of hydrophilicity to the TiZr implant surface significantly increases the capacity for osseointegration, irrespective of the presence or absence of nanotopography.
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http://dx.doi.org/10.3390/ma14071678DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8036800PMC
March 2021

Root coverage stability: A systematic overview of controlled clinical trials with at least 5 years of follow-up.

Clin Exp Dent Res 2021 Feb 9. Epub 2021 Feb 9.

Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden.

Objectives: To systematically assess the long-term outcome (≥5 years) of root coverage procedures reported in controlled clinical trials.

Material And Methods: Literature search was performed according to the PRISMA guidelines with the following eligibility criteria: (a) English or German language; (b) controlled (CT) or randomised controlled clinical trials (RCT); (c) root coverage procedure with ≥5 years follow-up; and (d) clinical treatment effect size and/or patient-related outcome measures (PROMs) reported.

Results: Four CT and 14 RCT with a follow-up of 5-20 years fulfilled the eligibility criteria; sample size per study ranged from 8 to 70 patients contributing with 18-149 sites. Coronally advanced flap (CAF) and CAF + connective tissue graft (CTG) were the prevalent treatments (i.e., in 24 and 38% of the groups, respectively), while other flap designs and adjuncts (i.e., enamel matrix derivative, bone graft, collagen membrane) were represented only once. For single Miller class I/II gingival recessions (GR), CAF + CTG appeared advantageous compared to other techniques, and provided low residual recession depths (i.e., ≤0.5 mm), and complete root coverage in ≥2/3 of the patients; similar tendency was observed for multiple GR. No data on Miller class III/IV GR is available. No meta-analysis was feasible due to lack of similarity in the clinical and methodological characteristics across the trials and observed comparisons of interventions.

Conclusions: CAF + CTG appears to be the 'gold standard' technique for the treatment of single and multiple Miller class I/II GR also in regard to long-term (i.e., ≥5 years of follow-up) treatment outcomes. There is little information regarding the performance, on the long-term, of other techniques and adjuncts.
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http://dx.doi.org/10.1002/cre2.395DOI Listing
February 2021

Antimicrobial Potential of Strontium Hydroxide on Bacteria Associated with Peri-Implantitis.

Antibiotics (Basel) 2021 Feb 3;10(2). Epub 2021 Feb 3.

Department of Periodontology, Faculty of Odontology, Malmö University, SE-205 06 Malmö, Sweden.

: Peri-implantitis due to infection of dental implants is a common complication that may cause significant patient morbidity. In this study, we investigated the antimicrobial potential of Sr(OH) against different bacteria associated with peri-implantitis. : The antimicrobial potential of five concentrations of Sr(OH) (100, 10, 1, 0.1, and 0.01 mM) was assessed with agar diffusion test, minimal inhibitory concentration (MIC), and biofilm viability assays against six bacteria commonly associated with biomaterial infections: , , , , , and . : Zones of inhibition were only observed for, 0.01, 0.1, and 1 mM of Sr(OH) tested against , in the agar diffusion test. Growth inhibition in planktonic cultures was achieved at 10 mM for all species tested ( < 0.001). In biofilm viability assay, 10 and 100 mM Sr(OH) showed potent bactericidal affect against , , , , and . : The findings of this study indicate that Sr(OH) has antimicrobial properties against bacteria associated with peri-implantitis.
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http://dx.doi.org/10.3390/antibiotics10020150DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7913193PMC
February 2021

Transgingival probing: a clinical gold standard for assessing gingival thickness.

Quintessence Int 2021 ;0(0):394-401

Objective: Transgingival probing is often used in the clinic to assess gingival thickness. However, what is not completely known is how well this method represents the true value of soft tissue thickness. The aim of this study was to assess differences and variation in gingival thickness when measured with transgingival probing or scanned with an intraoral device.

Method And Materials: This ex vivo study evaluated gingival thickness on 20 porcine cadavers. Gingival thickness was assessed at both central and lateral mandibular incisors through transgingival probing with a standard metal periodontal probe and also using intraoral scanning, which was considered as the method providing the 'true value' of soft tissue thickness. Intra-examiner repeatability and method error were evaluated.

Results: No evidence of systematic difference for any of the mandibular central or lateral incisors (mandibular right incisors: mean difference -0.17 to -0.01 mm, and mandibular left incisors: mean difference -0.11 to 0.04 mm) was observed between the periodontal probe and intraoral scanning methods. The absolute differences between the repeated measurements with intraoral scanning for each tooth type (n = 30) were calculated: the overall median was 0.089 mm and the interquartile range was 0.080 mm.

Conclusions: Transgingival probing with a standard metal periodontal probe for assessing gingival thickness is a reliable method, with values very close to the true gingival thickness, and it can thus be considered as the clinical gold standard.
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http://dx.doi.org/10.3290/j.qi.b937015DOI Listing
February 2021

The lived experience of performing a periodontal treatment in the context of general dentistry.

BDJ Open 2021 Jan 28;7(1). Epub 2021 Jan 28.

Department of Oral Diagnostics, Faculty of Odontology, Malmö University, SE-205 06, Malmö, Sweden.

Aim: To describe what characterises the lived experience of performing a periodontal treatment in the context of general dentistry.

Materials And Methods: Three dental hygienists from general dentistry in Sweden, were purposively selected as participants and interviewed. The participants described a situation in which they had performed a periodontal treatment. The descriptions were analysed using the descriptive phenomenological psychological method.

Results: The general meaning structure of the lived experience of performing a periodontal treatment comprised five constituents, (a) an established treatment routine, (b) importance of oral hygiene, (c) self-awareness and motivation of the patient, (d) support and doubt, and (e) mechanical infection control. The periodontal treatment is perceived as being set prior to its commencement and as following established routines, in which the patients' oral hygiene is experienced as a crucial part. The patients' self-awareness and a supportive clinician are seen as important factors in motivating the patient towards positive behavioural change, although there is a presence of doubt in patients' ability to maintain this positive change. Mechanical infection control is perceived as successful but sometimes difficult to perform.

Conclusions: Important, patient-related, factors are constituting the phenomenon of performing a periodontal treatment but an experience that the pre-existing standardised workflow influences patient management was also present.
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http://dx.doi.org/10.1038/s41405-021-00059-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7843605PMC
January 2021

GTR Treatment in Furcation Grade II Periodontal Defects with the Recently Reintroduced Guidor PLA Matrix Barrier: A Case Series with Chronological Step-by-Step Illustrations.

Case Rep Dent 2020 16;2020:8856049. Epub 2020 Dec 16.

Department of Periodontology, School of Dentistry, Faculty of Health, University of Witten, Alfred-Herrhausen Str. 45 58455 Witten, Germany.

Molars with a furcation involvement (FI) exceeding grade 1 according to Hamp's classification are at approximately doubled risk of tooth loss. Guided tissue regeneration (GTR) is a regenerative approach in the treatment of periodontal defects and is aimed at achieving new clinical attachment formation. The aim of this case series was to assess the efficacy of a newly reintroduced polylactic acid (PLA) matrix barrier and to evaluate the feasibility of the surgical approach. 11 patients with an average age of 58.7 years were treated with GTR using a PLA matrix barrier. Patients were instructed not to brush and chew on the treated side for 4 weeks. A gentle clinical probing was performed after 6 months for the first time after surgery. The patients were included into individual maintenance program at three months' interval. The clinical improvement was expressed by reduced horizontal penetration of the probe accompanied by vast resolution of the vertical defect component. The change from grade II to grade I or complete resolution of the FI could be seen in 8 from 11 sites included. The newly reintroduced PLA matrix barrier showed promising results after a 12-month observation period with clinical attachment gain.
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http://dx.doi.org/10.1155/2020/8856049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7758137PMC
December 2020

How old is old for implant therapy in terms of implant survival and marginal bone levels after 5-11 years?

Clin Oral Implants Res 2021 Mar 20;32(3):337-348. Epub 2021 Jan 20.

Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden.

Aim: To evaluate implant survival and marginal bone levels (MBL ) at least 5 years after implant installation in patients ≥65 years old.

Methods: Patient records were screened retrospectively for the following inclusion criteria: (1) ≥65 years of age at the time of implant installation, and (2) ≥5-year radiographic follow-up or registered implant loss. Association between patient- and implant-related data with radiographically assessed data [i.e. implant survival, mean MBL (i.e. average of mesial and distal level) and maximum marginal bone loss (i.e. either mesial or distal loss; maximum MBL )] were statistically evaluated by mixed effects multi-level regression models.

Results: Two-hundred-eighteen implants in 74 patients were included with a mean follow-up of 6.2 years (range: 5 to 10.7 years); four early and six late implant losses have been registered (implant survival rate: 95.4%). Mean MBL and maximum MBL was 1.24 ± 0.9 mm and 1.48 ± 1.0 mm, respectively. Maximum MBL  < 2 mm, 2 to 5 mm and ≥5 mm was found in 70.7, 28.8 and 0.5% of the implants, respectively. For both, mean MBL and maximum MBL , age presented a slightly protective effect (mean MBL : Coef. -0.041, p = .016; maximum MBL : Coef. -0.045, p = .014).

Conclusion: The high implant survival rate (95.4%), low mean MBL (1.24 mm) and low frequency of maximum MBL  ≥ 5 mm (0.5%) observed herein after 5 to 11 years follow-up suggest that older age should not be considered as a limiting factor for implant treatment.
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http://dx.doi.org/10.1111/clr.13704DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7986728PMC
March 2021

The role of strontium ranelate and guided bone regeneration in osteoporotic and healthy conditions.

J Periodontal Res 2021 Apr 26;56(2):330-338. Epub 2020 Dec 26.

Centre for Oral Immunobiology & Regenerative Medicine, Institute of Dentistry, Bart's & The London School of Dentistry & Medicine, Queen Mary University of London, London, UK.

Background/ Objectives: SR is a chemical agent developed for the treatment of osteoporosis. In vitro, SR enhanced replication of osteoprogenitor cells and bone formation. In vivo, in ovariectomized rats SR prevented the biomechanical deterioration of bone while in non-ovariectomized rats, enhanced bone architecture and increased trabecular and cortical bone mass. The aim of this study was to evaluate the effect of SR on bone healing of calvarial critical size defects treated with a deproteinized bovine bone mineral (DBBM) and a collagen barrier (CM), in healthy and osteoporotic rats.

Material And Methods: Sixty-four, 4-month-old Wistar female rats were used. Osteoporosis was induced by ovariectomy and calcium-deficient diet in half of them. Sixteen ovariectomized (OSR) and 16 healthy (HSR) rats were treated with SR while no medication was administered in the remaining 16 healthy (H) and 16 ovariectomized (O) rats. At 6 weeks after ovariectomy, a 5mm defect was created in each parietal bone of every animal. One defect was treated with DBBM and CM, while the contralateral was left untreated. Qualitative and quantitative histological analysis was performed at 30 and 60 days of healing. A generalized estimating equations test was performed to evaluate the effect of SR and osteoporosis, on new bone formation (NB).

Results: After 30 days of healing, NB in the untreated defects was 3.4%±1.7%, 4.3%±6.2%, 3.2±4.5%, 15.9±23.5% in O, OSR, H and HSR groups, respectively; after 60 days, NB was 4.7%±4.3%, 11.3%±7%, 7.1%±13.2, 12.1%±13.5%, respectively. In the GBR-treated defects, after 30 days, NB was 2.6%±1.4%, 2.4%±1.6%, 4.5%±4.1%, 10.3%±14.4% in O, OSR, H and HSR groups, respectively; after 60 days, NB was 2.2%±1.6%, 4.3%±4.2%, 7%±5.1%, 10.8%±17.4%, respectively. Osteoporosis (p=0.008) and the absence of strontium ranelate treatment (p=0.01) had a negative impact on NB.

Conclusion: SR may promote bone formation in calvarial defects in healthy and osteoporotic rats, albeit in a moderate extent.
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http://dx.doi.org/10.1111/jre.12825DOI Listing
April 2021

Medium- and long-term clinical benefits of periodontal regenerative/reconstructive procedures in intrabony defects: Systematic review and network meta-analysis of randomized controlled clinical studies.

J Clin Periodontol 2021 03 21;48(3):410-430. Epub 2021 Jan 21.

European Research Group on Periodontology (ERGOPERIO), Genova, Italy.

Background: Systematic reviews have established the short-term improvements of periodontal regenerative/reconstructive procedures compared to conventional surgical treatment in intrabony defects. However, a hierarchy of periodontal regenerative/reconstructive procedures regarding the medium- to long-term results of treatment does not exist.

Aim: To systematically assess the literature to answer the focused question "In periodontitis patients with intrabony defects, what are the medium- and long-term benefits of periodontal regenerative/reconstructive procedures compared with open flap debridement (OFD), in terms of clinical and/or radiographic outcome parameters and tooth retention?".

Material & Methods: Randomized controlled clinical trials (RCTs), reporting on clinical and/or radiographic outcome parameters of periodontal regenerative/reconstructive procedures ≥3 years post-operatively, were systematically assessed. Clinical [residual probing pocket depth (PD) and clinical attachment level (CAL) gain, tooth loss] and radiographic [residual defect depth (RDD), bone gain (RBL)] outcome parameters were assessed. Descriptive statistics were calculated, and Bayesian random-effects network meta-analyses (NMA) were performed where possible.

Results: Thirty RCTs, presenting data 3 to 20 years after treatment with grafting, GTR, EMD, as monotherapies, combinations thereof, and/or adjunctive use of blood-derived growth factor constructs or with OFD only, were included. NMA based on 21 RCTs showed that OFD was clearly the least efficacious treatment; regenerative/reconstructive treatments resulted in significantly shallower residual PD in 4 out 8 comparisons [range of mean differences (MD): -2.37 to -0.60 mm] and larger CAL gain in 6 out 8 comparisons (range of MD: 1.26 to 2.66 mm), and combination approaches appeared as the most efficacious. Tooth loss after regenerative/reconstructive treatment was less frequent (0.4%) compared to OFD (2.8%), but the evidence was sparse. There were only sparse radiographic data not allowing any relevant comparisons.

Conclusion: Periodontal regenerative/reconstructive therapy in intrabony defects results, in general, in shallower residual PD and larger CAL gain compared with OFD, translating in high rates of tooth survival, on a medium (3-5 years) to long-term basis (5-20 years). Combination approaches appear, in general, more efficacious compared to monotherapy in terms of shallower residual PD and larger CAL gain. A clear hierarchy could, however, not be established due to limited evidence.
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http://dx.doi.org/10.1111/jcpe.13409DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7986220PMC
March 2021

Characteristics and frequency distribution of bone defect configurations in peri-implantitis lesions-A series of 193 cases.

Clin Implant Dent Relat Res 2021 Apr 10;23(2):178-188. Epub 2020 Nov 10.

Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria.

Background: Knowledge on peri-implantitis bone defect characteristics and predictors is still limited.

Purpose: To describe peri-implantitis bone defect characteristics and identify possible predictors.

Methods: Various parameters at patient- (age, gender, smoking, and supra-structure), implant- (surface, type, connection, platform, and misfit), and site level (region, alveolar ridge position, defect characteristics, neighboring structure) were recorded retrospectively.

Results: Among 193 implants, the most prevalent defects were class Ic (25.4%), and Id (23.8%); a previously non-described category "class Id with only one bone wall" was frequently observed (11.9%). Mean intrabony defect depth and width ranged from 4.5 to 6.2 mm and from 2.7 to 2.9 mm, respectively; mean dehiscence extent ranged from 2.8 to 7.0 mm. A total of 37.8% of the defects presented horizontal bone loss and an intrabony component; in 52.7% of the implants, total defect extent was >6 mm. Jaw region, implant position within the alveolar ridge, and implant/abutment misfit showed significant associations either to defect configuration and/or defect extent.

Conclusion: (a) Most common peri-implantitis defects exhibited a combination of intrabony component and a buccal/oral dehiscence, while purely circumferential defects were relatively seldom; (b) implants with defects with bone dehiscence were placed more frequently closer to the lateral aspect of the ridge harboring the dehiscence; (c) implants placed in the lower anterior region had the highest risk for more severe peri-implant bone loss; and (d) peri-implant bone defects with only a single bone wall appropriate for regenerative procedure were relatively frequent.
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http://dx.doi.org/10.1111/cid.12961DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8246974PMC
April 2021

Xeno-Free Spheroids of Human Gingiva-Derived Progenitor Cells for Bone Tissue Engineering.

Front Bioeng Biotechnol 2020 19;8:968. Epub 2020 Aug 19.

Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway.

Gingiva has been identified as a minimally invasive source of multipotent progenitor cells (GPCs) for use in bone tissue engineering (BTE). To facilitate clinical translation, it is important to characterize GPCs in xeno-free cultures. Recent evidence indicates several advantages of three-dimensional (3D) spheroid cultures of mesenchymal stromal cells (MSCs) over conventional 2D monolayers. The present study aimed to characterize human GPCs in xeno-free 2D cultures, and to test their osteogenic potential in 3D cultures, in comparison to bone marrow MSCs (BMSCs). Primary GPCs and BMSCs were expanded in human platelet lysate (HPL) or fetal bovine serum (FBS) and characterized based on proliferation, immunophenotype and multi-lineage differentiation. Next, 3D spheroids of GPCs and BMSCs were formed via self-assembly and cultured in HPL. Expression of stemness- (SOX2, OCT4, NANOG) and osteogenesis-related markers (BMP2, RUNX2, OPN, OCN) was assessed at gene and protein levels in 3D and 2D cultures. The cytokine profile of 3D and 2D GPCs and BMSCs was assessed via a multiplex immunoassay. Monolayer GPCs in both HPL and FBS demonstrated a characteristic MSC-like immunophenotype and multi-lineage differentiation; osteogenic differentiation of GPCs was enhanced in HPL vs. FBS. CD271 GPCs in HPL spontaneously acquired a neuronal phenotype and strongly expressed neuronal/glial markers. 3D spheroids of GPCs and BMSCs with high cell viability were formed in HPL media. Expression of stemness- and osteogenesis-related genes was significantly upregulated in 3D vs. 2D GPCs/BMSCs; the latter was independent of osteogenic induction. Synthesis of SOX2, BMP2 and OCN was confirmed via immunostaining, and mineralization via Alizarin red staining. Finally, secretion of several growth factors and chemokines was enhanced in GPC/BMSC spheroids, while that of pro-inflammatory cytokines was reduced, compared to monolayers. In summary, monolayer GPCs expanded in HPL demonstrate enhanced osteogenic differentiation potential, comparable to that of BMSCs. Xeno-free spheroid culture further enhances stemness- and osteogenesis-related gene expression, and cytokine secretion in GPCs, comparable to that of BMSCs.
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http://dx.doi.org/10.3389/fbioe.2020.00968DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7466771PMC
August 2020

Does implantoplasty affect the failure strength of narrow and regular diameter implants? A laboratory study.

Clin Oral Investig 2021 Apr 7;25(4):2203-2211. Epub 2020 Sep 7.

Department of Periocdontology, Faculty of Odontology, University of Malmö, Malmö, Sweden.

Objective: To assess whether the impact of implantoplasty (IP) on the maximum implant failure strength depends on implant type/design, diameter, or material.

Methods: Fourteen implants each of different type/design [bone (BL) and tissue level (TL)], diameter [narrow (3.3 mm) and regular (4.1 mm)], and material [titanium grade IV (Ti) and titanium-zirconium alloy (TiZr)] of one company were used. Half of the implants were subjected to IP in a computerized torn. All implants were subjected to dynamic loading prior to loading until failure to simulate regular mastication. Multiple linear regression analyses were performed with maximum implant failure strength as dependent variable and IP, implant type/design, diameter, and material as predictors.

Results: Implants subjected to IP and TL implants showed statistically significant reduced implant failure strength irrespective of the diameter compared with implants without IP and BL implants, respectively. Implant material had a significant impact for TL implants and for regular diameter implants, with TiZr being stronger than Ti. During dynamic loading, 1 narrow Ti TL implant without IP, 4 narrow Ti TL implants subjected to IP, and 1 narrow TiZr TL implant subjected to IP were fractured.

Conclusion: IP significantly reduced the maximum implant failure strength, irrespective implant type/design, diameter, or material, but the maximum implant failure strength of regular diameter implants and of narrow BL implants remained high.

Clinical Relevance: IP seems to have no clinically relevant impact on the majority of cases, except from those of single narrow Ti TL implants, which may have an increased risk for mechanical complications. This should be considered for peri-implantitis treatment planning (e.g., communication of potential complications to the patient), but also in the planning of implant installation (e.g., choosing TiZr instead of Ti for narrow implants).
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http://dx.doi.org/10.1007/s00784-020-03534-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7966130PMC
April 2021

Accuracy of cone-beam computed tomography is limited at implant sites with a thin buccal bone: A laboratory study.

J Periodontol 2021 04 16;92(4):592-601. Epub 2020 Sep 16.

Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden.

Background: To evaluate whether buccal bone thickness (BBT), implant diameter, and abutment/crown material influence the accuracy of cone-beam computed tomography (CBCT) to determine the buccal bone level at titanium implants.

Methods: Two implant beds (i.e., narrow and standard diameter) were prepared in each of 36 porcine bone blocks. The implant beds were positioned at a variable distance from the buccal bone surface; thus, resulting in three BBT groups (i.e., >0.5 to 1.0; >1.0 to 1.5; >1.5 to 2.0 mm). In half of the blocks, a buccal bone dehiscence of random extent ("depth") was created and implants were mounted with different abutment/crown material (i.e., titanium abutments with a metal-ceramic crown and zirconia abutments with an all-ceramic zirconia crown). The distance from the implant shoulder to the buccal bone crest was measured on cross-sectional CBCT images and compared with the direct measurements at the bone blocks.

Results: While abutment/crown material and implant diameter had no effect on the detection accuracy of the buccal bone level at dental implants in CBCT scans, BBT had a significant effect. Specifically, when BBT was ≤1.0 mm, a dehiscence was often diagnosed although not present, that is, the sensitivity was high (95.8%), but the specificity (12.5%) and the detection accuracy (54.2%) were low. Further, the average measurement error of the distance from the implant shoulder to the buccal bone crest was 1.6 mm.

Conclusions: Based on the present laboratory study, BBT has a major impact on the correct diagnosis of the buccal bone level at dental titanium implants in CBCT images; in cases where the buccal bone is ≤1 mm thick, detection of the buccal bone level is largely inaccurate.
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http://dx.doi.org/10.1002/JPER.20-0222DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8247288PMC
April 2021

Surface roughness of titanium disks influences the adhesion, proliferation and differentiation of osteogenic properties derived from human.

Int J Implant Dent 2020 Aug 25;6(1):46. Epub 2020 Aug 25.

Department of Prosthodontics and Periodontics, Discipline of Periodontics, School of Dentistry at Bauru, University of São Paulo, Bauru, SP, 17012-901, Brazil.

Purpose: The aim of this study was to investigate the response of osteogenic cell lineage and gingival fibroblastic cells to different surface treatments of grade IV commercially pure Titanium (cpTi) disks.

Material And Methods: Grade IV cpTi disks with different surfaces were produced: machined (M), sandblasting (B), sandblasting and acid subtraction (NP), and hydrophilic treatment (ACQ). Surface microtopography characteristics and chemical composition were investigated by scanning electron microscopy (SEM) and energy dispersive x-ray spectrometry (EDS). Adhesion and proliferation of SC-EHAD (human surgically-created early healing alveolar defects) and HGF-1 (human gingival fibroblasts) on Ti disks were investigated at 24 and 48 h, and osteogenic differentiation and mineralization were evaluated by assessing alkaline phosphatase (ALP) activity and alizarin red staining, respectively.

Results: No significant differences were found among the various surface treatments for all surface roughness parameters, except for skewness of the assessed profile (Rsk) favoring M (p = 0.035 ANOVA). M disks showed a slightly higher (p > 0.05; Kruskal-Wallis/Dunn) adhesion of HGF-1 (89.43 ± 9.13%) than SC-EHAD cells (57.11 ± 17.72%). ACQ showed a significantly higher percentage of SC-EHAD (100%) than HGF-1 (69.67 ± 13.97%) cells adhered at 24 h. SC-EHAD cells expressed increased ALP activity in osteogenic medium at M (213%) and NP (235.04%) surfaces, but higher mineralization activity on ACQ (54.94 ± 4.80%) at 14 days.

Conclusion: These findings suggest that surface treatment influences the chemical composition and the adhesion and differentiation of osteogenic cells in vitro.

Clinical Relevance: Hydrophilic surface treatment of grade IV cpTi disks influences osteogenic cell adhesion and differentiation, which might enhance osseointegration.
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http://dx.doi.org/10.1186/s40729-020-00243-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445212PMC
August 2020

Use of platelet-rich fibrin for the treatment of gingival recessions: a systematic review and meta-analysis.

Clin Oral Investig 2020 Aug 26;24(8):2543-2557. Epub 2020 Jun 26.

Department of Periodontology, University of Bern, Bern, Switzerland.

Objectives: The aim of this systematic review and meta-analysis was to compare the use of platelet-rich fibrin (PRF) with other commonly utilized treatment modalities for root coverage procedures.

Materials And Methods: The eligibility criteria comprised randomized controlled trials (RCTs) comparing the performance of PRF with that of other modalities in the treatment of Miller class I or II (Cairo RT I) gingival recessions. Studies were classified into 5 categories as follows: (1) coronally advanced flap (CAF) alone vs CAF/PRF, (2) CAF/connective tissue graft (CAF/CTG) vs CAF/PRF, (3) CAF/enamel matrix derivative (CAF/EMD) vs CAF/PRF, (4) CAF/amnion membrane (CAF/AM) vs CAF/PRF, and (5) CAF/CTG vs CAF/CTG/PRF. Studies were evaluated for percentage of relative root coverage (rRC; primary outcome), clinical attachment level (CAL), keratinized mucosa width (KMW), and probing depth (PD) (secondary outcomes).

Results: From 976 articles identified, 17 RCTs were included. The use of PRF statistically significantly increased rRC and CAL compared with CAF alone. No change in KMW or reduction in PD was reported. Compared with PRF, CTG resulted in statistically significantly better KMW and RC. No statistically significant differences were reported between the CAF/PRF and CAF/EMD groups or between the CAF/PRF and CAF/AM groups for any of the investigated parameters.

Conclusions: The use of CAF/PRF improved rRC and CAL compared with the use of CAF alone. While similar outcomes were observed between CAF/PRF and CAF/CTG for CAL and PD change, the latter group led to statistically significantly better outcomes in terms of rRC and KTW. In summary, the use of PRF in conjunction with CAF may represent a valid treatment modality for gingival recessions exhibiting adequate baseline KMW.

Clinical Relevance: The data indicate that the use of PRF in conjunction with CAF statistically significantly improves rRC when compared with CAF alone but did not improve KMW. Therefore, in cases with limited baseline KMW, the use of CTG may be preferred over PRF.
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http://dx.doi.org/10.1007/s00784-020-03400-7DOI Listing
August 2020

Guided Lateral Sinus Lift Procedure Using 3-Dimensionally Printed Templates for a Safe Surgical Approach: A Proof-of-Concept Case Report.

J Oral Maxillofac Surg 2020 Sep 6;78(9):1529-1537. Epub 2020 May 6.

Head of Division, Clinical Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria.

The purpose of this article was to present a guided lateral window sinus lift procedure with the aid of a fully digital workflow using surgical templates for window osteotomy preparation and implant placement. A 22-year-old patient with insufficient residual bone height in the posterior maxilla was treated with a maxillary sinus augmentation procedure with a lateral window technique and simultaneous implant installation using 3-dimensionally printed surgical guides. The surgical guides, used for the preparation of both the lateral window and the implant site according to the optimal prosthodontic and anatomic position, were based on a fully digital workflow and virtual pre-planning with modified implant-planning software. Successful functional and esthetic rehabilitation of the patient was accomplished using standard surgical techniques and instruments but an innovative method for the production and application of surgical templates ensured a precise and safe approach for the lateral window osteotomy preparation. This guided lateral window sinus lift technique may reduce the incidence of surgical complications and failures and enhance patient-related outcomes.
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http://dx.doi.org/10.1016/j.joms.2020.04.042DOI Listing
September 2020

Cyclosporine A impairs bone repair in critical defects filled with different osteoconductive bone substitutes.

Braz Oral Res 2020 7;34:e007. Epub 2020 Feb 7.

Universidade Estadual de São Paulo - Unesp, School of Dentistry Araraquara, Department of Diagnosis and Surgery, Araraquara, SP, Brazil.

The aim of this study was to assess the influence of cyclosporine administration on the repair of critical-sized calvaria defects (CSDs) in rat calvaria filled with diverse biomaterials. Sixty animals were divided into two groups: the control (CTR) group (saline solution) and the cyclosporine (CCP) group (cyclosporine, 10 mg/kg/day). These medications were administered daily by gavage, beginning 15 days before the surgical procedure and lasting until the day the animals were euthanized. A CSD (5 mm Ø) was made in the calvaria of each animal, which was allocated to one of 3 subgroups, according to the biomaterial used to fill the defect: coagulum (COA), deproteinized bovine bone (DBB), or biphasic calcium phosphate ceramics of hydroxyapatite and β-phosphate tricalcium (HA/TCP). Euthanasia of the animals was performed 15 and 60 days after the surgical procedure (n = 5 animals/period/subgroup). Bone repair (formation) assessment was performed through microtomography and histometry, while the analyses of the expression of the BMP2, Osteocalcin, and TGFβ1 proteins were performed using immunohistochemistry. The CSDs not filled with biomaterials demonstrated lower bone formation in the CCP group. At 15 days, less bone formation was observed in the CSDs filled with DBB, a smaller volume of mineralized tissue was observed in the CSDs filled with HA/TCP, and the expression levels of BMP2 and osteocalcin were lower in the CCP group compared to the CTR group. The use of cyclosporine impaired bone repair in CSD, and this effect can be partially explained by the suppression of BMP2 and osteocalcin expression.
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http://dx.doi.org/10.1590/1807-3107bor-2020.vol34.0007DOI Listing
February 2020

Ridge reconstruction in damaged extraction sockets using tunnel β-tricalcium phosphate blocks: A 6-month histological study in beagle dogs.

J Periodontal Res 2020 Aug 27;55(4):496-502. Epub 2020 Jan 27.

Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.

Objective: The present study aimed to evaluate the histological outcome of tunnel β-TCP blocks grafting in extraction sockets missing the buccal bone wall, after 6 months of healing.

Background: Tunnel β-tricalcium phosphate (β-TCP) blocks made of randomly organized tunnel-shaped β-TCP ceramics appeared promising for alveolar ridge preservation in tooth extraction sockets missing the buccal bone, in a previous study in dogs, with a 2-month healing time.

Methods: In six beagle dogs, the maxillary first premolars were extracted and the buccal bone was surgically removed to create bone defects of 4 mm (mesio-distal) × 5 mm (apico-coronal) × 4 mm (bucco-palatal). Thus, extraction sockets missing the buccal bone plate were grated with tunnel β-TCP blocks (test) or left empty for spontaneous healing (control). Histology/histomorphometry was performed after 6 months of healing.

Results: The horizontal bucco-palatal width of the alveolar ridge was significantly greater at test sites than at control sites. The amount of mineralized tissue was greater at test sites (57.8% ± 11.1%) than at control sites (28.9% ± 8.5%), while the amount of connective tissue was significantly greater at control sites (41.7% ± 6.4%) than at test sites (19.6% ± 9.2%). No significant difference was found between sites in terms of basic multicellular units and bone marrow. Residual β-TCP at test sites was 5.8% ± 3.2%.

Conclusion: Grafting with tunnel β-TCP block significantly limited the resorption of the alveolar ridge at extraction sockets missing the buccal bone compared with sites left to heal spontaneously, even after 6-month follow-up.
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http://dx.doi.org/10.1111/jre.12735DOI Listing
August 2020

Does the time-point of orthodontic space closure initiation after tooth extraction affect the incidence of gingival cleft development? A randomized controlled clinical trial.

J Periodontol 2020 05 17;91(5):572-581. Epub 2019 Oct 17.

Division of Orthodontics, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria.

Background: Gingival clefts (GCs) develop frequently during orthodontic space closure and may compromise the treatment outcome. This study assessed whether the time-point of orthodontic space closure initiation, after permanent tooth extraction, affects the incidence of GC.

Methods: In 25 patients requiring bilateral premolar extraction because of orthodontic reasons, one premolar, chosen at random, was extracted 8 weeks before space closure initiation ("delayed movement," DM), whereas the contralateral premolar was extracted 1 week before ("early movement," EM) ("treatment group"). Presence or absence of GC after 3 and 6 months ("time-point") was recorded and any association with various parameters (i.e., treatment group, time-point, gender, jaw, craniofacial growth, gingival biotype, buccal bone dehiscence after extraction, space closure) was statistically assessed.

Results: Twenty-one patients contributing with 26 jaws were finally included in the analysis. Overall, GCs were frequent after 3 (DM: 53.9%; EM: 69.2%) and 6 months (DM: 76.9%; EM: 88.5%). EM (P = 0.014) and larger space closure within the study period (P = 0.001) resulted in a significantly higher incidence of GC. Further, there was a tendency for GC development in the presence of buccal bone dehiscence (P = 0.052) and thin gingival biotype (P = 0.054). "Fast movers" (herein cases with a tooth movement ≥1 mm per month) developed a GC in >90% of the cases already after 3 months. "Slow movers" developed a GC in 25% and 70% after 3 months and final evaluation, respectively.

Conclusions: GC development is a frequent finding during orthodontic space closure and seems to occur more frequently with early tooth movement initiation and in "fast movers."
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http://dx.doi.org/10.1002/JPER.19-0376DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7317775PMC
May 2020

How old is old for implant therapy in terms of early implant losses?

J Clin Periodontol 2019 12 8;46(12):1282-1293. Epub 2019 Nov 8.

Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden.

Objectives: To assess, retrospectively, whether older age has an impact on implant osseointegration when compared with younger age.

Methods: All patients ≥65 years old at implant installation, in an university setting over a time-period of 11.5 years, with complete anamnestic data and follow-up until prosthetic restoration were included, and any early implant loss (EIL; i.e. lack of osseointegration prior to or at the time-point of prosthetic restoration) was recorded. Further, one implant, from each of the elderly patients, was attempted matched to one implant in a younger patient (35 to <55 years old at implant installation) from the same clinic based on (a) gender, (b) implant region, (c) smoking status and (d) bone grafting prior to/simultaneously with implant installation. The potential impact of various local and systemic factors on EIL in the entire elderly population, and in the matched elderly and younger patient group was statistically assessed.

Results: Four hundred forty-four patients ≥65 years old (range 65.1-91.3; 56.8% female) receiving 1,517 implants were identified; 10 patients had one EIL each (implant/patient level: 0.66/2.25%). Splitting this patient cohort additionally into four age groups [65-69.9 (n = 213), 70-74.9 (n = 111), 75-79.9 (n = 80) and ≥80 (n = 40)], EIL was on the implant level 0.41, 0.83, 0.34 and 2.26%, respectively, (p = .102) and on the patient level 1.41, 2.70, 1.25 and 7.50%, respectively, (p = .104); multilevel analysis showed weak evidence of association of increasing age with higher EIL rate (p = .090). Matching was possible in 347 cases, and 5 (1.44%) and 9 (2.59%) EIL in the elderly and younger patients, respectively, were observed (p = .280). EIL could not be associated with any systemic condition or medication intake.

Conclusions: Elderly patients ≥65 years old presented a similarly low EIL rate as younger patients 35 to <55 years old, while patients ≥80 years old may have a slight tendency for a higher EIL rate. Hence, ageing does not seem to compromise osseointegration, and if at all, then only slightly and at a later stage of life.
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http://dx.doi.org/10.1111/jcpe.13199DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6899847PMC
December 2019

Enamel matrix derivative in liquid form as adjunct to natural bovine bone grafting at buccal bone dehiscence defects at implant sites: An experimental study in beagle dogs.

Clin Oral Implants Res 2019 Oct 13;30(10):989-996. Epub 2019 Aug 13.

Department of Periodontology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan.

Objectives: To evaluate the effect of enamel matrix derivative in liquid form (EMD-liquid) as adjunct to grafting with natural bovine bone (NBB), on new bone formation and osseointegration in buccal dehiscence defects at dental implants.

Material And Methods: In six beagles, 3 months after extraction of the mandibular premolars and first molars. Three titanium implants (3.3 Ø × 8.0 mm) were inserted, and dehiscence-type defects (mesiodistal width 3 mm × 5 mm depth) were created on their buccal aspect. The defects were randomly assigned to one of the following three treatment groups: Group 1: NBB, Group 2: NBB/EMD-L, Group 3: Control. All sites were covered with a collagen membrane. Histomorphometric measurements were performed after 3 months of healing.

Results: New bone area, bone-to-implant contact (BIC), and first BIC (fBIC) in the NBB and NBB/EMD-L groups were significantly greater than in the control group (p < .05). Further, f-BIC was at a significantly more coronal position in the NBB + EMD-liquid group (0.4 ± 0.1 mm) compared with the NBB group (1.2 ± 0.2 mm).

Conclusions: Natural bovine bone grafting enhances bone regeneration and osseointegration at implants with buccal bone dehiscences compared with no grafting, and adjunct use of EMD-liquid appears to further enhance bone formation and osseointegration.
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http://dx.doi.org/10.1111/clr.13512DOI Listing
October 2019

Mechanical and biological complications after implantoplasty-A systematic review.

Clin Oral Implants Res 2019 Sep 17;30(9):833-848. Epub 2019 Jul 17.

Department of Oral Rehabilitation, Faculty of Health and Medical Sciences, School of Dentistry, University of Copenhagen, Copenhagen, Denmark.

Objectives: Implantoplasty, that is, the mechanical modification of the implant, including thread removal and surface smoothening, has been proposed during surgical peri-implantitis treatment. Currently, there is no information about any potential mechanical and/or biological complications after this approach. The aim of the current review was to systematically assess the literature to answer the focused question "Are there any mechanical and/or biological complications due to implantoplasty?".

Materials And Methods: A systematic literature search was performed in three databases until 23/09/2018 to assess potential mechanical and/or biological complications after implantoplasty. All laboratory, preclinical in vivo, and clinical studies involving implantoplasty were included, and any complication potentially related to implantoplasty was recorded and summarized.

Results: Out of 386 titles, 26 publications were included in the present review (six laboratory, two preclinical in vivo, and 18 clinical studies). Laboratory studies have shown that implantoplasty does not result in temperature increase, provided proper cooling is used, but leads in reduced implant strength in "standard" dimension implants; further, preclinical studies have shown titanium particle deposition in the surrounding tissues. Nevertheless, no clinical study has reported any remarkable complication due to implantoplasty; among 217-291 implants subjected to implantoplasty, no implant fracture was reported during a follow-up of 3-126 months, while only a single case of mucosal discoloration, likely due to titanium particle deposition, has been reported.

Conclusions: Based on all currently available, yet limited, preclinical in vivo and clinical evidence, implantoplasty seems not associated with any remarkable mechanical or biological complications on the short- to medium-term.
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http://dx.doi.org/10.1111/clr.13499DOI Listing
September 2019

Biological factors involved in alveolar bone regeneration: Consensus report of Working Group 1 of the 15 European Workshop on Periodontology on Bone Regeneration.

J Clin Periodontol 2019 06;46 Suppl 21:6-11

Faculty of Dentistry, University of Oslo, Oslo, Norway.

Background And Aims: To describe the biology of alveolar bone regeneration.

Material And Methods: Four comprehensive reviews were performed on (a) mesenchymal cells and differentiation factors leading to bone formation; (b) the critical interplay between bone resorbing and formative cells; (c) the role of osteoimmunology in the formation and maintenance of alveolar bone; and (d) the self-regenerative capacity following bone injury or tooth extraction were prepared prior to the workshop.

Results And Conclusions: This summary information adds to the fuller understanding of the alveolar bone regenerative response with implications to reconstructive procedures for patient oral rehabilitation. The group collectively formulated and addressed critical questions based on each of the reviews in this consensus report to advance the field. The report concludes with identified areas of future research.
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http://dx.doi.org/10.1111/jcpe.13130DOI Listing
June 2019

Histologic evidence of periodontal regeneration in furcation defects: a systematic review.

Clin Oral Investig 2019 Jul 4;23(7):2861-2906. Epub 2019 Jun 4.

Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.

Objective: To systematically review the available histologic evidence on periodontal regeneration in class II and III furcations in animals and humans.

Materials And Methods: A protocol including all aspects of a systematic review methodology was developed including definition of the focused question, defined search strategy, study inclusion criteria, determination of outcome measures, screening methods, data extraction and analysis, and data synthesis. The focused question was defined as follows: "What is the regenerative effect obtained by using or not several biomaterials as adjuncts to open flap surgery in the treatment of periodontal furcation defects as evaluated in animal and human histological studies?"

Search Strategy: Using the MEDLINE database, the literature was searched for articles published up to and including September 2018: combinations of several search terms were applied to identify appropriate studies. Reference lists of review articles and of the included articles in the present review were screened. A hand search of the most important dental journals was also performed.

Criteria For Study Selection And Inclusion: Only articles published in English describing animal and human histological studies evaluating the effect of surgical treatment, with or without the adjunctive use of potentially regenerative materials (i.e., barrier membranes, grafting materials, growth factors/proteins, and combinations thereof) for the treatment of periodontal furcation defects were considered. Only studies reporting a minimum of 8 weeks healing following reconstructive surgery were included. The primary outcome variable was formation of periodontal supporting tissues [e.g., periodontal ligament, root cementum, and alveolar bone, given as linear measurements (in mm) or as a percentage of the instrumented root length (%)] following surgical treatment with or without regenerative materials, as determined histologically/histomorphometrically. Healing type and defect resolution (i.e., complete regeneration, long junctional epithelium, connective tissue attachment, connective tissue adhesion, or osseous repair) were also recorded.

Results: In animals, periodontal regeneration was reported in class II and III defects with open flap debridement alone or combined with various types of bone grafts/bone substitues, biological factors, guided tissue regeneration, and different combinations thereof. The use of biological factors and combination approaches provided the best outcomes for class II defects whereas in class III defects, the combination approaches seem to offer the highest regenerative outcomes. In human class II furcations, the best outcomes were obtained with DFDBA combined with rhPDGF-BB and with GTR. In class III furcations, evidence from two case reports indicated very limited to no periodontal regeneration.

Conclusions: Within their limits, the present results suggest that (a) in animals, complete periodontal regeneration has been demonstrated in class II and class III furcation defects, and (b) in humans, the evidence for substantial periodontal regeneration is limited to class II furcations.

Clinical Relevance: At present, regenerative periodontal surgery represents a valuable treatment option only for human class II furcation defects but not for class III furcations.
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http://dx.doi.org/10.1007/s00784-019-02964-3DOI Listing
July 2019

Diagnostic Judgement and Treatment Decisions in Periodontology by Periodontists and General Dental Practitioners in Sweden - A Questionnaire-based Study.

Oral Health Prev Dent 2019 ;17(4):329-337

Purpose: To evaluate if periodontists are coherent in their judgement and treatment decisions of patients with different periodontal conditions, and to compare them with general dental practitioners' (GDPs) findings.

Materials And Methods: Eighty-six periodontists participated in a questionnaire study based on four patient cases: (a) generalised bone loss but minimal signs of inflammation (well-maintained); (b) generalised bone loss and signs of inflammation (periodontitis); (c) negligible bone loss and minimal signs of inflammation (healthy); and (d) negligible bone loss but with signs of inflammation (gingivitis). Periodontists had the option to judge each patient as healthy or diseased, propose a diagnosis, evaluate treatment needs, propose a treatment plan and assess the prognosis. Comparison between periodontists considered: (a) level of experience and (b) judgement of each patient case as healthy or diseased. Periodontists were additionally compared to a previous sample of GDPs (n = 74).

Results: Periodontists' response rate was 77%. The diagnostic judgement of the four patient cases showed rather large variation both among periodontists and GDPs. Periodontists' intention to treat and prognostic assessment depended on their judgement of each patient, as healthy or diseased (p < 0.05). GDPs intended to treat three out of four patient cases (except periodontitis case) more often and were more pessimistic in their prognostic assessment of patients with negligible bone loss (p < 0.05), comparing to periodontists.

Conclusions: Both periodontists and GDPs are defining periodontal health and disease differently, which affects treatment decisions and prognostic assessment. There is a need to define periodontal health and disease more precisely, in order to improve coherence in judgement.
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http://dx.doi.org/10.3290/j.ohpd.a42505DOI Listing
November 2019