Publications by authors named "Gernot Wimmer"

22 Publications

  • Page 1 of 1

In Vitro Study of Surface Changes Induced on Enamel and Cementum by Different Scaling and Polishing Techniques.

Oral Health Prev Dent 2021 ;19(1):85-92

Purpose: To determine how the currently available techniques of scaling and root planing, used either alone or with additional polishing techniques, affect the substance thickness and surface roughness of enamel and cementum.

Materials And Methods: After extraction, impacted third molars were prepared and subjected to air polishing with a nonabrasive powder, ultrasonic scaling, or hand instrumentation. All three techniques were performed alone and in combinations for a total of 9 treatment groups. The control group consisted of untreated surfaces. Optical microcoordination measurements were conducted to separately assess substance loss, mean roughness depth (Rz), and roughness average (Ra) on enamel and cementum. The Rz results were analysed using a t-test for paired samples.

Results: Air polishing alone and with additional rubber-cup polishing using a paste were the only two approaches which caused no enamel loss. Both groups also entailed less cementum loss (≤ 20 μm) than any of the other seven groups, and both yielded the most favorable Rz results on enamel. Air polishing alone was the only group to reveal no significant change in Rz from untreated cementum (p = 0.999). The other 8 approaches statistically significantly reduced the surface roughness of cementum (p ≤ 0.017).

Conclusion: Air polishing with a nonabrasive powder yielded the best hard-tissue preservation. Combining any of the scaling techniques with additional polishing was not beneficial; on the contrary, they caused even more abrasion of hard tissue on both enamel and cementum.
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http://dx.doi.org/10.3290/j.ohpd.b927695DOI Listing
February 2021

Periodontal treatment and vascular inflammation in patients with advanced peripheral arterial disease: A randomized controlled trial.

Atherosclerosis 2020 11 23;313:60-69. Epub 2020 Sep 23.

Division of Operative Dentistry, Periodontology and Prosthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, Austria.

Background And Aims: Observational studies support an association between periodontitis and cardiovascular diseases. The study objective was to assess vascular inflammation after periodontal treatment in patients with peripheral arterial disease.

Methods: Ninety patients with peripheral arterial disease (PAD) and severe periodontitis were enrolled in a randomized, controlled trial. Thirty patients underwent non-surgical periodontal therapy and received additional systemic antibiotics (PT1 group), while 30 patients received the same therapy without antibiotics (PT2 group). The remaining thirty patients did not receive periodontal therapy (CG, control group). The primary outcome of this treatment was a reduction in vascular inflammation three months after periodontal treatment as determined by F-FDG PET/CT values. Secondary outcomes were changes in the inflamed periodontal surface area (PISA) and other periodontal parameters, changes in vascular biomarkers, and adverse cardiovascular events.

Results: After three months of treatment, a significant improvement in periodontal health was observed in the treatment groups. However, no difference in the primary outcome in the aorta was observed in the three study groups (median target to background ratio follow-up/baseline, PT1 1.00; 95% CI 0.97-1.10, PT2 1.00; 95% CI 0.98-1.1, CG 1.1; 95% CI 0.99-1.1, p = 0.75). No significant differences were detected in most diseased segments and active segments. In addition, no differences were observed in F-FDG uptake in the carotid, iliac, femoral, and popliteal arteries. No differences with regard to relative changes in vascular biomarkers were noted, and no serious cardiovascular adverse events occurred.

Conclusions: Periodontal treatment was effective and safe but did not reduce vascular inflammation in patients with PAD.
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http://dx.doi.org/10.1016/j.atherosclerosis.2020.09.019DOI Listing
November 2020

Effectiveness of a 655-nm InGaAsP diode-laser to detect subgingival calculus in patients with periodontal disease.

J Periodontol 2020 Aug 12. Epub 2020 Aug 12.

Austrian Cluster for Tissue Regeneration, Vienna, Austria.

Background: Previous in vitro studies have proven laser fluorescence measurement using a 655-nm Indium Gallium Arsenide Phosphide (InGaAsP) based diode laser radiation to be a useful tool to detect subgingival calculus. The aim of this prospective study was to evaluate the 655-nm InGaAsP diode laser in detecting subgingival calculus in patients with periodontal disease compared with photographic assessment during periodontal surgery.

Methods: Twelve patients (six women, six men) aged between 21 and 75 years with periodontitis scheduled for periodontal surgery were included in this prospective study. All laser fluorescence measurements were made before periodontal surgery. Intraoperatively a mucoperiostal flap was performed, subgingival calculus was visualized, and photographic images were taken. The presence of calculus was recorded for each evaluated site.

Results: A total of 115 tooth surface sites of 32 teeth from the 12 patients were evaluated before (laser) and during surgery (image). Compared with image evaluation the laser assessment showed a sensitivity of 0.70 (CI 0.53 to CI 0.83) and a specificity of 0.97 (CI 0.85 to CI 0.99). The overall probability to correctly detect subgingival calculus with the laser (accuracy) was 0.82 (CI 0.74 to CI 0.88).

Conclusions: The 655-nm diode laser was able to detect subgingival calculus. Hence, the 655 nm diode laser may be used as an additional tool for calculus detection in non-surgical periodontal therapy.
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http://dx.doi.org/10.1002/JPER.19-0663DOI Listing
August 2020

Periodontitis and cardiovascular diseases: Consensus report.

J Clin Periodontol 2020 03 3;47(3):268-288. Epub 2020 Feb 3.

Department of Prosthetic Dentistry, School of Dental Medicine, Karl-Franzens University Graz, Graz, Austria.

Background: In Europe cardiovascular disease (CVD) is responsible for 3.9 million deaths (45% of deaths), being ischaemic heart disease, stroke, hypertension (leading to heart failure) the major cause of these CVD related deaths. Periodontitis is also a chronic non-communicable disease (NCD) with a high prevalence, being severe periodontitis, affecting 11.2% of the world's population, the sixth most common human disease.

Material And Methods: There is now a significant body of evidence to support independent associations between severe periodontitis and several NCDs, in particular CVD. In 2012 a joint workshop was held between the European Federation of Periodontology (EFP) and the American Academy of Periodontology to review the literature relating periodontitis and systemic diseases, including CVD. In the last five years important new scientific information has emerged providing important emerging evidence to support these associations RESULTS AND CONCLUSIONS: The present review reports the proceedings of the workshop jointly organised by the EFP and the World Heart Federation (WHF), which has updated the existing epidemiological evidence for significant associations between periodontitis and CVD, the mechanistic links and the impact of periodontal therapy on cardiovascular and surrogate outcomes. This review has also focused on the potential risk and complications of periodontal therapy in patients on anti thrombotic therapy and has made recommendations for dentists, physicians and for patients visiting both the dental and medical practices.
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http://dx.doi.org/10.1111/jcpe.13189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027895PMC
March 2020

Enhancement of Healing of Periodontal Intrabony Defects Using 810 nm Diode Laser and Different Advanced Treatment Modalities: A Blind Experimental Study.

Open Access Maced J Med Sci 2019 Jun 14;7(11):1847-1853. Epub 2019 Jun 14.

Department of Oral Medicine and Periodontology, Meduni Graz, Graz, Austria.

Background: Low-level laser therapy (LLLT) in the early stage of bone healing was demonstrated as a positive local biostimulative effect. It was also shown that platelet-rich fibrin (PRF) and nanohydroxyapatite alloplast (NanoHA) are effective in treating periodontal intrabony defects.

Aim: The study aimed to evaluate the combined effects of LLLT (810 nm), PRF and NanoHA on induced intrabony periodontal defects healing.

Material And Methods: The study was conducted on 16 defects in 8 adult male rabbits (n = 16) divided into 4 groups; Control non-treated group (C), laser irradiated control group (CL), PRF+NanoHA graft (NanoHA-Graft+PRF) treated group and laser irradiated and treated group (NanoHA-Graft+PRF+L). CT radiography was made at baseline, 15 and 30 days later. The defects were induced in the form of one osseous wall defects of 10 mm height, 4 mm depth between the 1 and the 2 molars using a tapered fissure drill coupled to a high-speed motor. Statistical analysis was done using ANOVA.

Results: (NanoHA-Graft+PRF+L) group significantly produced bone density higher than C, CL and NanoHA-G+PRF alone.

Conclusion: The combination of LLLT+PRF+NanoHA as a treatment modality induced the best results in bone formation in the bone defect more than LLLT alone or PRF+NanoHA alone.
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http://dx.doi.org/10.3889/oamjms.2019.484DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6614254PMC
June 2019

Dietary intake in patients with peripheral arterial disease and concomitant periodontal disease.

Br J Nutr 2019 07 2;122(1):78-85. Epub 2019 Jul 2.

Medical University of Graz, Department of Internal Medicine, Division of Angiology, Auenbruggerplatz 15, 8036 Graz, Austria.

Nutrition plays a crucial role in the pathophysiology and management of peripheral arterial disease (PAD) and periodontal disease (PD). As PD can have profound effects on an individual's functional ability to eat and can affect nutrient intake, we aimed to evaluate the role of PD severity on dietary intake (DI) and quality in PAD patients and compare it with current dietary recommendations for CVD. PD stages of 421 consecutive PAD patients were determined according to a standardised basic periodontal examination (Periodontal Screening and Recording Index) ('healthy', 'gingivitis', 'moderate periodontitis' and 'severe periodontitis'). Dietary intake (24-h recall), dietary quality (food frequency index (FFI)) and anthropometrical data were assessed. Nutritional intake was stratified according to the severity of PD. No significant differences in DI of macronutrients, nutrients relevant for CVD and FFI were seen between the PD stages. Only median alcohol intake was significantly different between gingivitis and severe periodontitis (P = 0·001), and positively correlated with PD severity (P = 0·001; r 0·159). PD severity and the patient's number of teeth showed no correlation with investigated nutritional parameters and FFI. Few subjects met the recommended daily intakes for fibre (5 %), SFA (10 %), Na (40 %) and sugar (26 %). Macronutrient intake differed from reference values. In our sample of patients with PAD and concomitant PD, we found no differences in DI of macronutrients, nutrients relevant for CVD and diet quality depending on PD severity. The patients' nutrition was, however, poor, deviating seriously from dietary guidelines and recommendations.
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http://dx.doi.org/10.1017/S0007114519000850DOI Listing
July 2019

Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions.

J Periodontol 2018 06;89 Suppl 1:S74-S84

Division of Periodontology, Niigata University Graduate School of Medical and Dental Sciences, Japan.

Periodontal health is defined by absence of clinically detectable inflammation. There is a biological level of immune surveillance that is consistent with clinical gingival health and homeostasis. Clinical gingival health may be found in a periodontium that is intact, i.e. without clinical attachment loss or bone loss, and on a reduced periodontium in either a non-periodontitis patient (e.g. in patients with some form of gingival recession or following crown lengthening surgery) or in a patient with a history of periodontitis who is currently periodontally stable. Clinical gingival health can be restored following treatment of gingivitis and periodontitis. However, the treated and stable periodontitis patient with current gingival health remains at increased risk of recurrent periodontitis, and accordingly, must be closely monitored. Two broad categories of gingival diseases include non-dental plaque biofilm-induced gingival diseases and dental plaque-induced gingivitis. Non-dental plaque biofilm-induced gingival diseases include a variety of conditions that are not caused by plaque and usually do not resolve following plaque removal. Such lesions may be manifestations of a systemic condition or may be localized to the oral cavity. Dental plaque-induced gingivitis has a variety of clinical signs and symptoms, and both local predisposing factors and systemic modifying factors can affect its extent, severity, and progression. Dental plaque-induced gingivitis may arise on an intact periodontium or on a reduced periodontium in either a non-periodontitis patient or in a currently stable "periodontitis patient" i.e. successfully treated, in whom clinical inflammation has been eliminated (or substantially reduced). A periodontitis patient with gingival inflammation remains a periodontitis patient (Figure 1), and comprehensive risk assessment and management are imperative to ensure early prevention and/or treatment of recurrent/progressive periodontitis. Precision dental medicine defines a patient-centered approach to care, and therefore, creates differences in the way in which a "case" of gingival health or gingivitis is defined for clinical practice as opposed to epidemiologically in population prevalence surveys. Thus, case definitions of gingival health and gingivitis are presented for both purposes. While gingival health and gingivitis have many clinical features, case definitions are primarily predicated on presence or absence of bleeding on probing. Here we classify gingival health and gingival diseases/conditions, along with a summary table of diagnostic features for defining health and gingivitis in various clinical situations.
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http://dx.doi.org/10.1002/JPER.17-0719DOI Listing
June 2018

Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions.

J Clin Periodontol 2018 06;45 Suppl 20:S68-S77

Division of Periodontology, Niigata University Graduate School of Medical and Dental Sciences, Japan.

Periodontal health is defined by absence of clinically detectable inflammation. There is a biological level of immune surveillance that is consistent with clinical gingival health and homeostasis. Clinical gingival health may be found in a periodontium that is intact, i.e. without clinical attachment loss or bone loss, and on a reduced periodontium in either a non-periodontitis patient (e.g. in patients with some form of gingival recession or following crown lengthening surgery) or in a patient with a history of periodontitis who is currently periodontally stable. Clinical gingival health can be restored following treatment of gingivitis and periodontitis. However, the treated and stable periodontitis patient with current gingival health remains at increased risk of recurrent periodontitis, and accordingly, must be closely monitored. Two broad categories of gingival diseases include non-dental plaque biofilm-induced gingival diseases and dental plaque-induced gingivitis. Non-dental plaque biofilm-induced gingival diseases include a variety of conditions that are not caused by plaque and usually do not resolve following plaque removal. Such lesions may be manifestations of a systemic condition or may be localized to the oral cavity. Dental plaque-induced gingivitis has a variety of clinical signs and symptoms, and both local predisposing factors and systemic modifying factors can affect its extent, severity, and progression. Dental plaque-induced gingivitis may arise on an intact periodontium or on a reduced periodontium in either a non-periodontitis patient or in a currently stable "periodontitis patient" i.e. successfully treated, in whom clinical inflammation has been eliminated (or substantially reduced). A periodontitis patient with gingival inflammation remains a periodontitis patient (Figure 1), and comprehensive risk assessment and management are imperative to ensure early prevention and/or treatment of recurrent/progressive periodontitis. Precision dental medicine defines a patient-centered approach to care, and therefore, creates differences in the way in which a "case" of gingival health or gingivitis is defined for clinical practice as opposed to epidemiologically in population prevalence surveys. Thus, case definitions of gingival health and gingivitis are presented for both purposes. While gingival health and gingivitis have many clinical features, case definitions are primarily predicated on presence or absence of bleeding on probing. Here we classify gingival health and gingival diseases/conditions, along with a summary table of diagnostic features for defining health and gingivitis in various clinical situations.
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http://dx.doi.org/10.1111/jcpe.12940DOI Listing
June 2018

Salivary neuropeptides, stress, and periodontitis.

J Periodontol 2018 01;89(1):9-18

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

Background: Scientific evidence for psychologic stress as a risk factor for periodontitis is fragmentary and relies mostly on either questionnaire-based or biomarker studies. The aim of this study is to investigate brain-derived neurotrophic factor, substance P, vasoactive intestinal peptide (VIP), neuropeptide Y (NPY), calcitonin gene-related peptide, and adrenomedullin as well as cortisol in saliva and serum in periodontal health and disease combined with different aspects of stress and possible associations with clinical parameters.

Methods: In total, 56 patients with aggressive and chronic periodontitis and 44 healthy controls were screened by enzyme-linked immunosorbent assay and mass spectrometry for presence of neuropeptides and cortisol in saliva and serum. Psychologic stress was evaluated by validated questionnaires. All substances were explored for a possible relationship to periodontitis, clinical parameters, and stress.

Results: VIP and NPY showed significantly higher levels in saliva but not in serum of patients with periodontitis. These neuropeptides correlated with the extent, severity, and bleeding on probing scores in patients with periodontitis. Females had significantly lower salivary VIP levels. There were no differences among participants regarding psychologic stress.

Conclusion: VIP and NPY in saliva could be potential sex-specific salivary biomarkers for periodontitis regardless of psychologic stress.
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http://dx.doi.org/10.1902/jop.2017.170249DOI Listing
January 2018

From Mouth to Model: Combining and Oral Biofilm Growth.

Front Microbiol 2016 21;7:1448. Epub 2016 Sep 21.

Institute of Plant Sciences, University of Graz Graz, Austria.

Oral biofilm studies based on simplified experimental setups are difficult to interpret. Models are limited mostly by the number of bacterial species observed and the insufficiency of artificial media. Few studies have attempted to overcome these limitations and to cultivate native oral biofilm. This study aimed to grow oral biofilm before transfer to a biofilm reactor for incubation. The survival of this oral biofilm and the changes in bacterial composition over time were observed. Six human enamel-dentin slabs embedded buccally in dental splints were used as biofilm carriers. Fitted individually to the upper jaw of 25 non-smoking male volunteers, the splints were worn continuously for 48 h. During this time, tooth-brushing and alcohol-consumption were not permitted. The biofilm was then transferred on slabs into a biofilm reactor and incubated there for 48 h while being nourished in BHI medium. Live/dead staining and confocal laser scanning microscopy were used to observe bacterial survival over four points in time: directly after removal (T0) and after 1 (T1), 24 (T2), and 48 h (T3) of incubation. Bacterial diversity at T0 and T3 was compared with 454-pyrosequencing. Fluorescence hybridization (FISH) was performed to show specific taxa. Survival curves were calculated with a specially designed MATLAB script. Acacia and QIIME 1.9.1 were used to process pyrosequencing data. SPSS 21.0 and R 3.3.1 were used for statistical analysis. After initial fluctuations at T1, survival curves mostly showed approximation of the bacterial numbers to the initial level at T3. Pyrosequencing analysis resulted in 117 OTUs common to all samples. The genera and (both ) dominated at T0 and T3. They make up two thirds of the biofilm. Genera with lower relative abundance had grown significantly at T3. FISH analysis confirmed the pyrosequencing results, i.e., the predominant staining of . We demonstrate the survival of native primary oral biofilm in its natural complexity over 48 h. Our results offer a baseline for cultivation studies of native oral biofilms in (phyto-) pharmacological and dental materials research. Further investigations and validation of culturing conditions could also facilitate the study of biofilm-induced diseases.
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http://dx.doi.org/10.3389/fmicb.2016.01448DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5030783PMC
September 2016

Accuracy of commercial kits and published primer pairs for the detection of periodontopathogens.

Clin Oral Investig 2016 Dec 29;20(9):2515-2528. Epub 2016 Mar 29.

Division of Orthodontics and Maxillofacial Orthopedics, Department of Dentistry and Maxillofacial Surgery, Medical University of Graz, Billrothgasse 4, A-8010, Graz, Austria.

Objectives: Despite the input of microbiome research, a group of 20 bacteria continues to be the focus of periodontal diagnostics and therapy. The aim of this study was to compare three commercial kits and laboratory-developed primer pairs for effectiveness in detecting such periodontopathogens.

Materials And Methods: Fourteen bacterial mock communities, consisting of 16 randomly assembled bacterial strains, were used as reference standard for testing kits and primers. Extracted DNA from mock communities was analyzed by PCR in-house with specific primers and forwarded for analysis to the manufacturer's laboratory of each of the following kits: ParoCheck®Kit 20, micro-IDent®plus11, and Carpegen® Perio Diagnostik.

Results: The kits accurately detected Fusobacterium nucleatum, Prevotella intermedia/Prevotella nigrescens, Parvimonas micra, Aggregatibacter actinomycetemcomitans, Campylobacter rectus/showae, Streptococcus mitis, Streptococcus mutans, and Veillonella parvula. The in-house primers for F.nucleatum were highly specific to subtypes of the respective periopathogen. Other primers repeatedly detected oral pathogens not present in the mock communities, indicating reduced specificity.

Conclusions: The commercial kits used in this study are reliable tools to support periodontal diagnostics. Whereas the detection profile of the kits is fixed at a general specificity level, the design of primers can be adjusted to differentiate between highly specific strains. In-house primers are more error-prone. Bacterial mock communities can be established as a reference standard for any similar testing.

Clinical Relevance: The tested kits render good results with selected bacterial species. Primers appear to be less useful for routine clinical diagnostics and of limited applicability in research. Basic information about the periodontopathogens identified in this study supports clinical decision-making.
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http://dx.doi.org/10.1007/s00784-016-1748-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5119851PMC
December 2016

Oral biofilm analysis of palatal expanders by fluorescence in-situ hybridization and confocal laser scanning microscopy.

J Vis Exp 2011 Oct 20(56). Epub 2011 Oct 20.

Department of Orthodontics and Maxillofacial Orthopedics, Medical University of Graz.

Confocal laser scanning microscopy (CLSM) of natural heterogeneous biofilm is today facilitated by a comprehensive range of staining techniques, one of them being fluorescence in situ hybridization (FISH). We performed a pilot study in which oral biofilm samples collected from fixed orthodontic appliances (palatal expanders) were stained by FISH, the objective being to assess the three-dimensional organization of natural biofilm and plaque accumulation. FISH creates an opportunity to stain cells in their native biofilm environment by the use of fluorescently labeled 16S rRNA-targeting probes. Compared to alternative techniques like immunofluorescent labeling, this is an inexpensive, precise and straightforward labeling technique to investigate different bacterial groups in mixed biofilm consortia. General probes were used that bind to Eubacteria (EUB338 + EUB338II + EUB338III; hereafter EUBmix), Firmicutes (LGC354 A-C; hereafter LGCmix), and Bacteroidetes (Bac303). In addition, specific probes binding to Streptococcus mutans (MUT590) and Porphyromonas gingivalis (POGI) were used. The extreme hardness of the surface materials involved (stainless steel and acrylic resin) compelled us to find new ways of preparing the biofilm. As these surface materials could not be readily cut with a cryotome, various sampling methods were explored to obtain intact oral biofilm. The most workable of these approaches is presented in this communication. Small flakes of the biofilm-carrying acrylic resin were scraped off with a sterile scalpel, taking care not to damage the biofilm structure. Forceps were used to collect biofilm from the steel surfaces. Once collected, the samples were fixed and placed directly on polysine coated glass slides. FISH was performed directly on these slides with the probes mentioned above. Various FISH protocols were combined and modified to create a new protocol that was easy to handle. Subsequently the samples were analyzed by confocal laser scanning microscopy. Well-known configurations could be visualized, including mushroom-style formations and clusters of coccoid bacteria pervaded by channels. In addition, the bacterial composition of these typical biofilm structures were analyzed and 2D and 3D images created.
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http://dx.doi.org/10.3791/2967DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3227208PMC
October 2011

Immediate provisional restoration of screw-type implants in the posterior mandible: results after 5 years of clinical function.

Clin Oral Implants Res 2010 Aug 3;21(8):815-21. Epub 2010 May 3.

Department of Prosthodontics, School of Dentistry, Medical University Graz, Graz, Austria.

Objective: The aim of this prospective study was to evaluate the outcome of immediately provisionally restored implants in the posterior mandible after a minimum of 60 months in function.

Material And Methods: Twenty-four patients were treated with 40 screw-type implants replacing mandibular molars and premolars. Implants were provisionalized immediately after placement. Radiographic coronal bone levels, implant survival and success were evaluated 12, 24, 36, 48 and 60 months after the final restoration.

Results: Measurements of the mean marginal bone levels around immediately loaded implants after 12 months showed a significant bone loss (P<0.001) within the first year after the final restoration. Measurements of coronal bone levels after 24, 36, 48 and 60 months, respectively, showed no further significant increase of bone resorption. Two implants were lost within the first year after the final restoration, resulting in an overall survival rate of 95%; a total of three implants were recorded as failures (two implant losses and one excessive bone resorption above 50%), resulting in an overall success rate of 92.5 after an implant observation period of up to 8 years.

Conclusion: The present data revealed results comparable to conventionally loaded implants. Careful patient selection in combination with high primary stability seem to be key factors for immediately loaded implants. Larger long-term randomized clinical trials are needed to confirm the final evidence of this protocol as the standard treatment concept for the partially edentulous mandible.
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http://dx.doi.org/10.1111/j.1600-0501.2010.01919.xDOI Listing
August 2010

Clinical effectiveness of photodynamic therapy in the treatment of periodontitis.

J Clin Periodontol 2009 Jul;36(7):575-80

Department of Periodontology and Restorative Dentistry, Dental School, University of Graz, Graz, Austria.

Aim: A randomized-controlled clinical pilot trial was designed to evaluate photodynamic therapy (PDT) for its bactericidal potential and clinical effect in the treatment of periodontitis.

Material And Methods: Fifty-eight subjects with chronic periodontitis were included. Each subject exhibited at least three active periodontal pockets 5mm or deeper, bleeding on probing and the presence of Porphyromonas gingivalis. Subjects were randomly assigned to a control group treated by subgingival ultrasound only or to a study group additionally treated by PDT. Baseline clinical values of gingival index, bleeding on probing, probing pocket depths and clinical attachment levels were recorded and re-evaluated 90 days later. Pathogen screening for P. gingivalis, Tannerella forsythia and Treponema denticola was conducted at baseline as well as 10, 42 and 90 days after treatment.

Results: P. gingivalis was significantly reduced in both groups (laser group: p=0.020; control group: p=0.042). No significant reductions of T. forsythia and T. denticola were observed in either group. For the microbial parameters, no significant difference was found between the laser and the control group. All clinical parameters were significantly reduced in both groups after treatment. The mean probing pocket depths decreased from 5.79 to 4.55mm in the laser group and from 5.54 to 4.51 in the control group. The intergroup difference was not significant (p=0.82). Bleeding on probing was reduced from 100% evaluated at baseline to 47% in the laser group and 59% in the control group. The intergroup difference was not significant (p=0.28). No significant differences were observed in any other parameters.

Conclusion: Application of a single cycle of PDT was not effective as an adjunct to ultrasonic periodontal treatment. There were no extra reductions in pocket depths and bleeding on probing. With regard to eradicating bacteria, however, there are no additional effects as compared with conventional treatment alone.
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http://dx.doi.org/10.1111/j.1600-051x.2009.01412.xDOI Listing
July 2009

A critical assessment of adverse pregnancy outcome and periodontal disease.

J Clin Periodontol 2008 Sep;35(8 Suppl):380-97

Department of Dentistry and Maxillofacial Surgery, Division of Prosthodontics, Restorative Dentistry, Periodontology and Implantology, Medical University of Graz, Graz, Austria.

Background: Pre-term birth is a major cause of infant mortality and morbidity that has considerable societal, medical, and economic costs. The rate of pre-term birth appears to be increasing world-wide and efforts to prevent or reduce its prevalence have been largely unsuccessful.

Aim: To review the literature for studies investigating periodontal disease as a possible risk factor for pre-term birth and adverse pregnancy outcomes.

Main Findings And Conclusion: Variability among studies in definitions of periodontal disease and adverse pregnancy outcomes as well as widespread inadequate control for confounding factors and possible effect modification make it difficult to base meaningful conclusions on published data. However, while there are indications of an association between periodontal disease and increased risk of adverse pregnancy outcome in some populations, there is no conclusive evidence that treating periodontal disease improves birth outcome. Based on a critical qualitative review, available evidence from clinical trials indicates that, although non-surgical mechanical periodontal treatment in the second trimester of pregnancy is safe and effective in reducing signs of maternal periodontal disease, it does not reduce the rate of pre-term birth. Clinical trials currently underway will further clarify the potential role of periodontal therapy in preventing adverse birth outcomes. Regardless of the outcomes of these trials, it is recommended that large, prospective cohort studies be conducted to assess risk for adverse pregnancy outcome in populations with periodontal disease. It is critical that periodontal exposure and adverse birth outcomes be clearly defined and the many potential confounding factors and possible effect modifiers for adverse pregnancy outcome be controlled in these studies. If periodontal disease is associated with higher risk of adverse pregnancy outcome in these specific populations, large multicenter randomized-controlled trials will be needed to determine if prevention or treatment of periodontal disease, perhaps combined with other interventions, has an effect on adverse pregnancy outcome in these women.
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http://dx.doi.org/10.1111/j.1600-051X.2008.01284.xDOI Listing
September 2008

Immediate provisional restoration of XiVE screw-type implants in the posterior mandible.

Clin Oral Implants Res 2008 Feb 23;19(2):160-5. Epub 2007 Oct 23.

Department of Oral Surgery and Radiology, School of Dentistry, Medical University Graz, Graz, Austria.

Objectives: This prospective study evaluated the clinical outcome of immediately restored screw-type implants for the replacement of mandibular (pre)molars. The results were based on survival, clinical stability and on changes of bone levels from implant placement to delivery of the definitive superstructure 6 months after insertion.

Material And Methods: In this study, 24 patients were treated according to an immediate loading protocol. Forty XiVE implants were placed in the mandibular (pre)molar regions for single-tooth restoration and the treatment of free-end situations. Radiographic bone levels in relation to implant margins were measured at the time of insertion and recorded. All implants were provided with a transfer coping and restored with provisional crowns within 7 days. After 6 months, the final restorations were fabricated. At this time, survival, Periotest value and radiographic bone levels were assessed.

Results: A total of 40 XiVE implants were placed with an insertion torque value of at least 45 N cm. The median Periotest value 6 months post-insertion was -5 (maximum -2, minimum -7). The mean radiographic coronal bone level at prosthetic delivery was 1.4 mm (SD+/-0.57) compared with 0.47 mm (SD+/-0.37) at the time of insertion. No implant failures were observed up to prosthetic restoration 6 months post-insertion.

Conclusion: The present data of immediately loaded implants in the posterior mandible are comparable to results with conventional loaded implants. Additional long-term data will be necessary to include this protocol as a standard procedure in our treatment concepts for the edentulous posterior mandible.
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http://dx.doi.org/10.1111/j.1600-0501.2007.01268.xDOI Listing
February 2008

Galvanoforming for large-span fixed restorations in the treatment of periodontally compromised patients.

Int J Periodontics Restorative Dent 2006 Aug;26(4):329-35

Department of Prosthodontics and Periodontology, School of Dental Medicine, Medical University of Graz, Graz, Austria.

Large-span fixed restorations in the treatment of periodontally compromised patients are technically difficult to realize. Despite existing techniques of regenerative periodontal surgery and implant therapy aimed at preventing large spans by increasing the number of abutments, prosthetic complications do occur. The present article describes a method that introduces galvanic caps to conventional prosthetic technology, which facilitates clinical procedures and reduces complications by improving precision of fit.
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August 2006

Periodontal treatment improves endothelial dysfunction in patients with severe periodontitis.

Am Heart J 2005 Jun;149(6):1050-4

Division of Angiology, Department of Medicine, University Hospital, Graz, Austria.

Background: Because epidemiological studies provide evidence that periodontal infections are associated with an increased risk of progression of cardiovascular and cerebrovascular disease, we postulated that endothelial dysfunction, a critical element in the pathogenesis of atherosclerosis, would be present in patients with periodontal disease.

Methods: We tested endothelial function in 30 patients with severe periodontitis and 31 control subjects using flow-mediated dilation (FMD) of the brachial artery. The groups were matched for age, sex, and cardiovascular risk factors. Three months after periodontal treatment, including both mechanical and pharmacological therapy, endothelial function was reassessed by brachial artery FMD. Markers of systemic inflammation were measured at baseline and at follow up.

Results: Flow-mediated dilation was significantly lower in patients with periodontitis than in control subjects (6.1% +/- 4.4% vs 8.5% +/- 3.4%, P = .002). Successful periodontal treatment resulted in a significant improvement in FMD (9.8% +/- 5.7%; P = .003 compared to baseline) accompanied by a significant decrease in C-reactive protein concentrations (1.1 +/- 1.9 vs 0.8 +/- 0.8 at baseline, P = .026). Endothelium-independent nitro-induced vasodilation did not differ between the study groups at baseline or after periodontal therapy.

Conclusion: These results indicate that treatment of severe periodontitis reverses endothelial dysfunction. Whether improved endothelial function will translate into a beneficial effect on atherogenesis and cardiovascular events needs further investigation.
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http://dx.doi.org/10.1016/j.ahj.2004.09.059DOI Listing
June 2005

Coping with stress: its influence on periodontal therapy.

J Periodontol 2005 Jan;76(1):90-8

School of Dental Medicine, Department of Prosthetics and Periodontology, Medical University Graz, Graz, Austria.

Background: Individual stress coping strategies appear to influence periodontal disease: individuals with inadequate stress behavior may be at greater risk of developing disease. The purpose of this 24-month prospective study was to examine the influence of different coping behaviors on a non-surgical periodontal therapy and on the course of periodontal disease.

Methods: In 80 patients with chronic periodontitis, a non-surgical periodontal treatment was conducted after their individual stress coping strategies had been recorded. After 2 years of regular maintenance, their periodontal condition was evaluated. The stress coping questionnaire was used to obtain psychodiagnostic data. Clinical attachment loss (CAL) served as the clinical parameter.

Results: Patients with a defensive coping style had statistically significant poorer attachment values (P= 0.000) after 2 years compared to patients with other coping behaviors. The percentage of sites with slight to moderate CAL (<5 mm) was significantly less in patients with a defensive coping style than in patients with other coping strategies (P = 0.000). The number of sites with severe advanced CAL (>5 mm) was significantly correlated with a suppressive coping style (P= 0.0001). None of the individual stress coping styles revealed significant overall changes over time. The subtest of drug use (alcohol, nicotine, tranquilizers) as well as changes in this subtest over time were significantly correlated with the CAL (P = 0.003); an increase in the t value of the subtest of drug use was accompanied by a significant increase in CAL.

Conclusions: The results of this study show that passive coping strategies were more pronounced in advanced disease as well as in cases of poor response to a non-surgical periodontal treatment, whereas patients with active coping modes had milder disease and a more favorable course of treatment. Thus, maladaptive behavior, especially in association with behavior-related risk factors such as smoking, are of great importance in the medical history, treatment, and maintenance of patients with periodontal disease.
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http://dx.doi.org/10.1902/jop.2005.76.1.90DOI Listing
January 2005

Immediate loading of single-tooth implants in the anterior maxilla. Preliminary results after one year.

Clin Oral Implants Res 2003 Apr;14(2):180-7

Department of Prosthetic Dentistry, School of Dental Medicine, Karl-Franzens-University Graz, Austria.

According to the standard protocol, a load-free healing period is one of the most emphasized requirements for implant integration. Recent studies have encouraged a progressive shortening of the healing period for single-tooth implants and immediate loading has been proposed for the aesthetic zone in the maxilla. The present study evaluated clinical outcomes of immediately loaded FRIALIT-2 Synchro implants 12 months after placement in the maxillary incisal region. In the course of our investigation, nine patients have been treated following an immediate loading protocol. The stepped-screw type implants were inserted with an increasing torque up to 45 Ncm, thus measuring the primary stability of the implants. All implants were immediately restored with unsplinted acrylic resin provisional crowns and the patients provided with occlusal splints. Regular controls were performed at monthly intervals, intraoral radiographs were taken directly after implant placement, 6 and 12 months post insertion. The survival rate, clinical stability (Periotest) and radiographic coronal bone defects (CBD) were evaluated at delivery of the definitive superstructures (CBD 6) and 6 months later (CBD 12). Twelve FRIALIT-2 Synchro stepped screws of 3.8, 4.5 and 5.5 mm diameter and 13 and 15 mm length were placed in the incisal maxillary region. The median Periotest value 6 months post insertion was -2 with a minimum of -5 and a maximum of +2. The mean coronal bone level changes (CBD) at 6 and 12 months were 0.45 and 0.75 mm. No implant failed up to 12 months after insertion, resulting in a 100% survival rate. The presented results showed promising data for immediately loaded single-tooth implants in the anterior maxilla. Periotest values were within the range published for submerged implants. The radiographic coronal bone resorption after 6 and 12 months was even less than evaluated for implants placed in a standard two-stage procedure. It is evident that successful immediate loading protocols require a careful and strict patient selection aimed at achieving the best primary stability and avoiding any excessive functional or non-functional loading. Additional research needs to be done to provide data in situations where problems of poor bone quality, multiple implants or augmentation procedures must be overcome.
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http://dx.doi.org/10.1034/j.1600-0501.2003.140207.xDOI Listing
April 2003

Coping with stress: its influence on periodontal disease.

J Periodontol 2002 Nov;73(11):1343-51

Department of Prosthetics and Periodontology, Karl Franzens University of Graz, School of Dental Medicine, Graz, Austria.

Background: Various forms of stress behavior were documented and in patients with periodontitis their relationship with periodontal disease was investigated.

Methods: Eighty-nine patients with different forms of chronic periodontitis were included in this retrospective case-control study. They were all undergoing periodontal treatment at the Department of Dental Prosthetics, University of Graz, or a private dental practice. The control group consisted of 63 persons employed in health care at the Clinic of Graz. All participants completed a stress coping questionnaire of 114 items and 19 actional and intrapsychic stress coping modes. The questionnaire served as a psychodiagnostic survey aimed at collecting data on stress coping strategies. Clinical attachment loss (CAL) served as the clinical parameter.

Results: With the help of a factor analysis with a factorization and Varimax rotation, 5 factors were extracted from the 19 subtests. The reliability of the questionnaire was less than 0.70 only for subtests "escape" and "pharmaceutical drugs." Otherwise the internal consistency ranged between 0.74 and 0.92, and the retest reliability between 0.72 and 0.84. Subsequent assessment with the t test for independent random samples at the 5% level showed that patients differ significantly from controls in regard of factor 2 (active coping, P = 0.40) and 3 (distractive coping, P = 0.033), and that they differ very significantly from controls in regard of factor 4 (defensive coping, P = 0.000) and 5 (coping through aggression and pharmaceutical drugs, P = 0.007). In the statistical analysis of factors with regard to the severity of periodontal disease, the patients were divided into 2 groups (mild to moderate and severe). The t test for independent random samples showed significance for factor 4 (defensive coping) in that patients with a defensive coping style had greater attachment loss (pF4 = 0.04).

Conclusions: The data corroborate the thesis that periodontitis patients with inadequate stress behavior strategies (defensive coping) are at greater risk for severe periodontal disease. However, further investigations are required to confirm the significance of inappropriate coping styles with respect to the advancement of periodontal disease.
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http://dx.doi.org/10.1902/jop.2002.73.11.1343DOI Listing
November 2002

Primary wound healing after lower third molar surgery: evaluation of 2 different flap designs.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002 Jan;93(1):7-12

The Department for Oral Surgery and Radiology, Dental School, Karl-Franzens University Graz, Austria.

Objectives: Wound dehiscences after lower third molar surgery potentially extend the time of postsurgical treatment and may cause long-lasting pain. It was the aim of this prospective study to evaluate the primary wound healing of 2 different flap designs.

Methods: Sixty completely covered lower third molars were removed. In 30 cases, the classic envelope flap with a sulcular incision from the first to the second molar and a distal relieving incision to the mandibular ramus was used, whereas the other 30 third molars were extracted after preparation of a modified triangular flap first similarly described by Szmyd. Wound healing was controlled on the first postoperative day, as well as 1 and 2 weeks after surgery.

Results: The overall result was a total of 33% wound dehiscence. In the envelope-flap group, wound dehiscences developed in 57% of the cases. This represents a relative risk ratio of 5.67, with a 95% CI from 1.852 to 12.336. With the modified triangular-flap technique, only 10% of the wounds gaped during wound healing.

Conclusion: This study confirms evidence that the flap design in lower third molar surgery considerably influences primary wound healing. The modified triangular flap is significantly less conducive to the development of wound dehiscence.
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http://dx.doi.org/10.1067/moe.2002.119519DOI Listing
January 2002