Publications by authors named "Mariano Sanz"

255 Publications

Genome-wide association study of stage III/IV grade C periodontitis (former aggressive periodontitis) in a Spanish population.

J Clin Periodontol 2021 Mar 21. Epub 2021 Mar 21.

Grupo de Investigación en Odontología Médico-Quirúrgica (OMEQUI), Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain.

Aim: To identify loci associated with stages III/IV, grade C periodontitis (PIII/IV-C) through a genome wide association study (GWAS).

Materials And Methods: 441 Caucasian Spanish PIII/IV-C cases from the SEPA Network of Research Clinics and 1141 controls from the Banco Nacional de ADN were genotyped with "Axiom Spain Biobank Array", which contains 757836 markers, including rare and low frequency Spanish variants. The analysis of the individual association and subsequently the gene level analysis with Sequence Kernel Association Test (SKAT), were carried out adjusting for age, sex and PC1 covariates. Pathway Analysis was additionally performed with Ingenuity Pathway Analysis (IPA) software on the top associated genes.

Results: In the individual analyses, no genome-wide significant signals were detected. However, 8 SNPs of 8 loci reached suggestive evidence of association with PIII/IV-C, including FAT3 rs35709256, CSNK1G2 rs4807188, MYH13 rs2074872, CNTN2 rs116611488, ANTXR1 rs4854545, 8p23.2 rs78672540, ANGPT1 rs13439823, and PLEC rs11993287 (p < 5×10 ). SKAT analysis identified other interesting signals at CNTN2, FBXO44, AP1M2, RSPO4, KRI1, BPIFB1 and INMT, although their probability does not exceed the multiple-test correction. IPA indicated significant enrichment of pathways related to cAMP, IL-2, CD28, VDR/RXR and PI3K/Akt.

Conclusions: GWAS found no SNPs significantly associated with PIII/IV-C.
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http://dx.doi.org/10.1111/jcpe.13460DOI Listing
March 2021

In Vitro Anti-Biofilm and Antibacterial Properties of sp. nov.

Microorganisms 2021 Feb 22;9(2). Epub 2021 Feb 22.

ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense of Madrid (UCM), 28040 Madrid, Spain.

The aim of this study was to evaluate the potential anti-biofilm and antibacterial activities of sp. nov. To test anti-biofilm properties, and were grown in a biofilm model in the presence or not of sp. nov. for up to 120 h. For the potential antibacterial activity, 24 h-biofilms were exposed to sp. nov for 24 and 48 h. Biofilms structures and bacterial viability were studied by microscopy, and the effect in bacterial load by quantitative polymerase chain reaction. A generalized linear model was constructed, and results were considered as statistically significant at < 0.05. The presence of sp. nov. during biofilm development did not affect the structure of the community, but an anti-biofilm effect against was observed ( < 0.001, after 96 and 120 h). For antibacterial activity, after 24 h of exposure to sp. nov., counts of ( = 0.019) and ( = 0.020) were significantly reduced in well-structured biofilms. Although moderate, anti-biofilm and antibacterial activities of sp. nov. against oral bacteria, including some periodontal pathogens, were demonstrated in an in vitro biofilm model.
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http://dx.doi.org/10.3390/microorganisms9020450DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7926871PMC
February 2021

Relevance of Biofilm Models in Periodontal Research: From Static to Dynamic Systems.

Microorganisms 2021 Feb 19;9(2). Epub 2021 Feb 19.

ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense of Madrid, 28040 Madrid, Spain.

Microbial biofilm modeling has improved in sophistication and scope, although only a limited number of standardized protocols are available. This review presents an example of a biofilm model, along with its evolution and application in studying periodontal and peri-implant diseases. In 2011, the ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) research group at the University Complutense of Madrid developed an in vitro biofilm static model using representative bacteria from the subgingival microbiota, demonstrating a pattern of bacterial colonization and maturation similar to in vivo subgingival biofilms. When the model and its methodology were standardized, the ETEP research group employed the validated in vitro biofilm model for testing in different applications. The evolution of this model is described in this manuscript, from the mere observation of biofilm growth and maturation on static models on hydroxyapatite or titanium discs, to the evaluation of the impact of dental implant surface composition and micro-structure using the dynamic biofilm model. This evolution was based on reproducing the ideal microenvironmental conditions for bacterial growth within a bioreactor and reaching the target surfaces using the fluid dynamics mimicking the salivary flow. The development of this relevant biofilm model has become a powerful tool to study the essential processes that regulate the formation and maturation of these important microbial communities, as well as their behavior when exposed to different antimicrobial compounds.
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http://dx.doi.org/10.3390/microorganisms9020428DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7922797PMC
February 2021

Immunohistochemical characteristics of lateral bone augmentation using different biomaterials around chronic peri-implant dehiscence defects: An experimental in vivo study.

Clin Oral Implants Res 2021 Feb 25. Epub 2021 Feb 25.

Department of Periodontology, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain.

Aim: To investigate the immunohistochemical characteristics of a highly porous synthetic bone substitute and a cross-linked collagen membrane for guided bone regeneration.

Methods: Three experimental groups were randomly allocated at chronic peri-implant dehiscence defect in 8 beagle dogs: (i) biphasic calcium phosphate covered by a cross-linked collagen membrane (test group), (ii) deproteinized bovine bone mineral covered by a natural collagen membrane (positive control) and (iii) no treatment (negative control). After 8 and 16 weeks of submerged healing, dissected tissue blocks were processed for immunohistochemical analysis. Seven antibodies were used to detect the remaining osteogenic and angiogenic potential, and quantitative immunohistochemical analysis was done by software.

Results: The antigen reactivity of alkaline phosphatase was significantly higher in the test group compared to the positive and negative controls, and it maintained till 16 weeks. The intensity of osteocalcin was significantly higher in the positive control at 8 weeks than the other groups, but significantly decreased at 16 weeks and no difference was found between the groups. A significant large number of TRAP-positive cells were observed in the test group mainly around the remaining particles at 16 weeks. The angiogenic potential was comparable between the groups showing no difference in the expression of transglutaminase II and vascular endothelial growth factor.

Conclusion: Guided bone regeneration combining a highly porous biphasic calcium phosphate synthetic biomaterial with a crosslinked collagen membrane, resulted in extended osteogenic potential when compared to the combination of deproteinized bovine bone mineral and a native collagen membrane.
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http://dx.doi.org/10.1111/clr.13726DOI Listing
February 2021

Delphi Project on the trends in Implant Dentistry in the COVID-19 era: Perspectives from Latin America.

Clin Oral Implants Res 2021 Feb 17. Epub 2021 Feb 17.

ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain.

Aim: To establish trends in Implant Dentistry in Latin America in the COVID-19 pandemic.

Material And Methods: A steering committee and an advisory group of experts in Implant Dentistry were selected among eighteen countries. An open-ended questionnaire by Delphi methodology was validated including 64 questions, divided in 7 topics, concerning the various trends in dental implantology. The survey was conducted in two rounds, which provided the participants in the second round with the results of the first. The questionnaires were completed on August 2020, and the online meeting conference was held on September 2020. The final prediction was developed through consensus by a selected group of experts.

Results: A total of 197 experts from Latin America answered the first and second questionnaire. In the first round, the established threshold for consensus (65%) was achieved in 30 questions (46.87%). In the second round, performed on average 45 days later, this level was achieved in 47 questions (73.43%). Consensus was completely reached on the item "Diagnostic" (100%), the field with the lowest consensus was "Demand for treatment with dental implants" (37.5%).

Conclusions: The present study in Latin America has provided relevant and useful information on the predictions in the education and practice of Implant Dentistry in the COVID-19 era. The consensus points toward a great confidence of clinicians in the biosecurity protocols used to minimize the risk of SARS-CoV-2 transmission. It is foreseen as an important change in education, with introduction of virtual reality and other simulation technologies in implant training.
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http://dx.doi.org/10.1111/clr.13723DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014337PMC
February 2021

Association between periodontitis and severity of COVID-19 infection: A case-control study.

J Clin Periodontol 2021 Feb 1. Epub 2021 Feb 1.

College of Dental Medicine, QU Health, Qatar University, Doha, Qatar.

Aim: COVID-19 is associated with an exacerbated inflammatory response that can result in fatal outcomes. Systemic inflammation is also a main characteristic of periodontitis. Therefore, we investigated the association of periodontitis with COVID-19 complications.

Materials And Methods: A case-control study was performed using the national electronic health records of the State of Qatar between February and July 2020. Cases were defined as patients who suffered COVID-19 complications (death, ICU admissions or assisted ventilation), and controls were COVID-19 patients discharged without major complications. Periodontal conditions were assessed using dental radiographs from the same database. Associations between periodontitis and COVID 19 complications were analysed using logistic regression models adjusted for demographic, medical and behaviour factors.

Results: In total, 568 patients were included. After adjusting for potential confounders, periodontitis was associated with COVID-19 complication including death (OR = 8.81, 95% CI 1.00-77.7), ICU admission (OR = 3.54, 95% CI 1.39-9.05) and need for assisted ventilation (OR = 4.57, 95% CI 1.19-17.4). Similarly, blood levels of white blood cells, D-dimer and C Reactive Protein were significantly higher in COVID-19 patients with periodontitis.

Conclusion: Periodontitis was associated with higher risk of ICU admission, need for assisted ventilation and death of COVID-19 patients, and with increased blood levels of biomarkers linked to worse disease outcomes.
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http://dx.doi.org/10.1111/jcpe.13435DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014679PMC
February 2021

Do Differences in Cultivable Subgingival Species Exist between Different Periodontitis Stages and Grades?

Oral Health Prev Dent 2021 ;19(1):15-24

Purpose: To investigate the subgingival microbiological profiles of patients with periodontitis, to determine their stage and grade scores and to evaluate the differences in the microbiota among different stages and grades. Materials and Methods: Sixty-seven (n = 67) periodontitis patients were selected. Periodontitis staging and grading, following the 2018 classification system, were defined. Following a clinical examination, subgingival samples were taken from the deepest periodontal pocket of each quadrant for cultivation, identification and quantification. The prevalence, proportion and counts of nine selected periodontal pathogens were determined, and differences between periodontitis stages III and IV and grades B and C were assessed. Results: All nine cultivable periodontal bacteria were detected, of which the most prevalent was P. intermedia (91.0%) and the least prevalent were E. corrodens (9.0%) and C. ochracea (9.0%). The frequency of detection of the two main target pathogens, A. actinomycetemcomitans and P. gingivalis, was 41.8% and 76.1%, respectively. The prevalence (grade B: 80.6%, grade C: 55.6%, p = 0.035) and total counts (grade B: 19.8 colony forming units - CFU/ml-4 (1.9-52.8); grade C: 4.0 CFU/ml-4 (0.0-26.4); p = 0.022) of F. nucleatum were statistically significantly higher in grade B than in grade C periodontitis patients, whereas the counts of P. gingivalis and A. actinomycetemcomitans were similar between grades and stages. Conclusion: Our study suggests that relevant differences between the various grades of periodontitis exist only in the numbers of F. nucleatum. Prevalence and quantities of other cultivable species between different stages and grades of periodontitis seem to be similar.
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http://dx.doi.org/10.3290/j.ohpd.b875525DOI Listing
January 2021

Technology-enhanced learning: a role for video animation.

Br Dent J 2021 Jan 22;230(2):93-96. Epub 2021 Jan 22.

Department of Oral & Maxillofacial Surgery, Red Cross Hospital, Hansteinstraße 29, D-34121 Kassel, Germany; Department of Oral & Maxillofacial Surgery, Lecturer, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, D-24105 Kiel, Germany.

The last 20 years has seen a shift in medical education from printed analogue formats of knowledge transfer to digital knowledge transfer via media platforms and virtual learning environments. Traditional university medical teaching was characterised by lectures and printed textbooks, which to a degree still have an important role to play in knowledge acquisition, but which in isolation do not engage the modern learner, who has become reliant on digital platforms and 'soundbite' learning. Recently, however, traditional methods of teaching and learning have been augmented by, and indeed sometimes replaced by, the alternative learning methods such as: problem-based learning; a greater integration of basic science and clinical considerations; smaller teaching groups; the 'flipped classroom' concept; and various technological tools which promote an interactive learning style. The aim of these new teaching methods is to overcome the well-documented limitations of traditional lectures and printed material in the transfer of knowledge from expert to student, by better engaging the minds of more visual learners and encouraging the use of diverse resources for lifelong learning. In this commentary paper, we share the concept of video animation as an additional educational tool, and one that can help to integrate molecular, cellular and clinical processes that underpin our understanding of biology and pathology in modern education. Importantly, while they can provide focused and attractive formats for 'soundbite' learning, their aim as a tool within the broader educational toolbox is to direct the interested reader towards more traditional formats of learning, which permit a deeper dive into a particular field or concept. In this manner, carefully constructed video animations can serve to provide a broad overview of a particular field or concept and to facilitate deeper learning when desired by the student.
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http://dx.doi.org/10.1038/s41415-020-2588-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7822761PMC
January 2021

Periodontal diseases and depression: A pre-clinical in vivo study.

J Clin Periodontol 2021 Jan 12. Epub 2021 Jan 12.

ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group (UCM), Madrid, Spain.

Aim: To analyse, through a pre-clinical in vivo model, the possible mechanisms linking depression and periodontitis at behavioural, microbiological and molecular levels.

Materials And Methods: Periodontitis (P) was induced in Wistar:Han rats (oral gavages with Porphyromonas gingivalis and Fusobacterium nucleatum) during 12 weeks, followed by a 3-week period of Chronic Mild Stress (CMS) induction. Four groups (n = 12 rats/group) were obtained: periodontitis and CMS (P+CMS+); periodontitis without CMS; CMS without periodontitis; and control. Periodontal clinical variables, alveolar bone levels (ABL), depressive-like behaviour, microbial counts and expression of inflammatory mediators in plasma and brain frontal cortex (FC), were measured. ANOVA tests were applied.

Results: The highest values for ABL occurred in the P+CMS+ group, which also presented the highest expression of pro-inflammatory mediators (TNF-α, IL-1β and NF-kB) in frontal cortex, related to the lipoprotein APOA1-mediated transport of bacterial lipopolysaccharide to the brain and the detection of F. nucleatum in the brain parenchyma. A dysregulation of the hypothalamic-pituitary-adrenal stress axis, reflected by the increase in plasma corticosterone and glucocorticoid receptor levels in FC, was also found in this group.

Conclusions: Neuroinflammation induced by F. nucleatum (through a leaky mouth) might act as the linking mechanism between periodontal diseases and depression.
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http://dx.doi.org/10.1111/jcpe.13420DOI Listing
January 2021

Guided bone regeneration of chronic non-contained bone defects using a volume stable porous block TiO2 scaffold: An experimental in vivo study.

Clin Oral Implants Res 2021 Mar 28;32(3):369-381. Epub 2021 Jan 28.

Department of Periodontology, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway.

Objectives: To evaluate new lateral bone formation and lateral volume augmentation by guided bone regeneration (GBR) in chronic non-contained bone defects with the use of a non-resorbable TiO -block.

Materials And Methods: Three buccal bone defects were created in each hemimandible of eight beagle dogs and allowed to heal for 8 weeks before treatment by GBR. Each hemimandible was randomly allocated to 4- or 12-week healing time after GBR, and three intervention groups were assigned by block randomization: TiO block: TiO -scaffold and a collagen membrane, DBBM particles: Deproteinized bovine bone mineral (DBBM) and a collagen membrane, Empty control: Collagen membrane only. Microcomputed tomography (microCT) was used to measure the lateral bone formation and width augmentation. Histological outcomes included descriptive analysis and histomorphometric measurements.

Results: MicroCT analysis demonstrated increasing new bone formation from 4 to 12 weeks of healing. The greatest width of mineralized bone was seen in the empty controls, and the largest lateral volume augmentation was observed in the TiO block sites. The DBBM particles demonstrated more mineralized bone in the grafted area than the TiO blocks, but small amounts and less than the empty control sites.

Conclusion: The TiO blocks rendered the largest lateral volume augmentation but also less new bone formation compared with the DBBM particles. The most new lateral bone formation outward from the bone defect margins was observed in the empty controls, indicating that the presence of either graft material leads to slow appositional bone growth.
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http://dx.doi.org/10.1111/clr.13708DOI Listing
March 2021

Association between caries and periodontal diseases in a sample of employed adults in Spain: a cross-sectional study.

Clin Oral Investig 2021 Jan 6. Epub 2021 Jan 6.

ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, Complutense University, Madrid, Spain.

Objectives: To study whether there is an association between caries and periodontitis in a representative sample from employed Spanish adults.

Materials And Methods: This cross-sectional study is part of a wide epidemiological survey (WORALTH, Workers' ORAL healTH). Oral examination was carried out in 5130 dentate subjects. Periodontal status was assessed by clinical attachment level (CAL) and Community Periodontal Index (CPI) in index teeth. For caries, all teeth were classified as healthy, decayed (D), filled (F), or missed (M), and DMFT index and prevalence of cavitated caries were calculated. ANOVA, Chi-square tests, and regression models were performed.

Results: DMFT increased with CAL values, being 7.8, 9.6, and 10.5 for CAL 0-3 mm, 4-5 mm, and ≥ 6 mm, respectively. After adjustment for confounders, subjects with CPI ≥ 3 showed an odds ratio of 1.6 (95% confidence interval (CI) [1.3; 1.8]; p < 0.001) for presenting cavitated caries, and patients with CAL ≥ 6 mm had 0.8 higher mean DMFT (95% CI [0.2; 1.5]; p = 0.015), and 0.3 higher mean DFR (95% CI [0.2; 0.5]; p < 0.001) than those with CAL < 6 mm.

Conclusions: The presence of CAL ≥ 6 m mm was associated with an increased DMFT and DFR, and the presence of CPI ≥ 3 was associated with a higher prevalence of cavitated caries in this representative sample.

Clinical Relevance: There is a tendency to present higher prevalence of dental caries among patients with periodontitis. Therefore, common preventive measures in dentistry, such as oral hygiene practices, should ideally include actions aimed to prevent at the same time dental caries and periodontitis.
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http://dx.doi.org/10.1007/s00784-020-03726-2DOI Listing
January 2021

Prevalence and risk/protective indicators of buccal soft tissue dehiscence around dental implants.

J Clin Periodontol 2021 Mar 21;48(3):455-463. Epub 2021 Jan 21.

Section of Graduate Periodontology, Faculty of Odontology, University Complutense, Madrid, Spain.

Aim: To evaluate the prevalence of buccal peri-implant soft tissue dehiscence (PISTD) in anterior implants and to identify the risk/protective indicators of PISTD in implants not suffering peri-implantitis.

Materials And Methods: 240 randomly selected patients from a university clinic database were invited to participate in the present cross-sectional study. Those who accepted, after the evaluation of their medical and dental records, were clinically examined to assess the prevalence of buccal PISTD in non-molar implants. Multilevel multivariate logistic regression analyses were then carried out to identify those factors associated either positively (risk) or negatively (protective) with buccal PISTD in implants without peri-implantitis.

Results: 92 patients with a total of 272 dental implants were analysed. At implant-level, the prevalence of buccal PISTD was 16.9%, while when selecting only implants without peri-implantitis it was 12.0%. Buccal PISTD was present in 26.7% of the implants diagnosed with peri-implantitis. The following factors were identified as risk/protective indicators of buccal PISTD in implants without peri-implantitis: malposition (too buccal vs. correct: OR=14.67), thin peri-implant phenotype (OR=8.31), presence of at least one adjacent tooth (OR=0.08) and presence of abutment (OR=0.12).

Conclusions: PISTD are highly prevalent among patients with dental implants in this university-based population, and several factors were identified as risk and protective indicators of PISTD in implants not suffering peri-implantitis.
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http://dx.doi.org/10.1111/jcpe.13417DOI Listing
March 2021

Diagnosis of peri-implantitis in the absence of baseline data: A diagnostic accuracy study.

Clin Oral Implants Res 2021 Mar 17;32(3):297-313. Epub 2021 Feb 17.

Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.

Objectives: The aim of the present study was to evaluate the diagnostic accuracy of clinical and radiographic evaluations made at a single time point during follow-up in identifying (a) a history of peri-implant bone loss and (b) the presence of peri-implantitis.

Material & Methods: 427 patients provided with implant-supported reconstructions 9 years earlier were evaluated clinically by Probing Pocket Depth, Bleeding or Suppuration on Probing (PPD, BoP & SoP) and radiographically. Bone levels were assessed relative to the most coronal point of the intra-osseous part of the implant. A history of bone loss and diagnosis of peri-implantitis was confirmed through baseline documentation (direct evidence). Diagnostic accuracy of radiographic bone levels at 9 years and clinical findings (indirect evidence/secondary case definition) in identifying a history of bone loss and peri-implantitis were evaluated through correlation and multilevel regression analyses as well as receiver operating characteristic curves. Results were expressed as sensitivity/specificity and area under the curve (AUC).

Results: Bone levels observed at 9 years were highly accurate in identifying pronounced bone loss (>2 mm; AUC = 0.96; 95% CI 0.95-0.98). In the absence of baseline documentation, a secondary case definition based on the presence of BoP/SoP & bone level ≥ 1 mm (indirect evidence) provided the overall best diagnostic accuracy (AUC = 0.80; 95% CI 0.77-0.82) in identifying peri-implantitis cases (direct evidence: BoP/SoP & bone loss > 0.5 mm). Moderate/severe peri-implantitis (BoP/SoP & bone loss > 2 mm) was most accurately identified by the combination of BoP/SoP & bone level ≥ 2 mm (AUC = 0.93; 95% CI 0.91-0.96). Sensitivity of the secondary case definition suggested by the 2017 World Workshop of Periodontology (WWP) (BoP/SoP ≥ 1 site & bone level ≥ 3 mm & PPD ≥ 6 mm) was low.

Conclusions: The present results underline the importance of baseline documentation for the correct diagnosis of peri-implantitis, especially in its early/incipient forms. The secondary case definition of peri-implantitis suggested at the 2017 WWP demonstrated a high level of specificity but low sensitivity. Moderate/severe peri-implantitis was most accurately identified by the combination of BoP/SoP & bone level ≥ 2 mm.
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http://dx.doi.org/10.1111/clr.13700DOI Listing
March 2021

Clinical findings and history of bone loss at implant sites.

Clin Oral Implants Res 2021 Mar 18;32(3):314-323. Epub 2021 Jan 18.

Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.

Objectives: The aim of the present study was to evaluate whether clinical findings at implant sites are relevant as screening tests for a history of marginal bone loss.

Material And Methods: 427 patients provided with implant-supported reconstructions 9 years earlier were evaluated clinically (probing pocket depth (PPD), bleeding on probing (BoP)) and radiographically. A history of bone loss was confirmed through baseline documentation. Diagnostic accuracy was evaluated through receiver operating characteristic curves and multi-level regression analyses. Results were expressed as sensitivity/specificity, area under the curve, and odds ratios.

Results: While the sensitivity of PPD in regard to bone loss was low, specificity was generally high. Multi-level modeling revealed that each additional millimeter of PPD corresponded to an additional bone loss of 0.30 mm (95% CI 0.27; 0.33). The sensitivity of BOP in regard to bone loss >2 mm was 80.9% (95% CI 73.9; 86.7), while the specificity was 42.2% (95% CI 39.6; 44.8).

Conclusions: Clinical parameters at implant sites obtained at a single time point were associated with a history of marginal bone loss. While BoP demonstrated a high level of sensitivity, the sensitivity of PPD was generally low. The present data suggest that BoP is a relevant screening test for history of bone loss.
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http://dx.doi.org/10.1111/clr.13701DOI Listing
March 2021

Screening of undiagnosed hyperglycaemia in the dental setting: The DiabetRisk study. A field trial.

J Clin Periodontol 2021 Mar 21;48(3):378-388. Epub 2020 Dec 21.

ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain.

Aim: To evaluate the efficacy of different screening protocols for undiagnosed hyperglycaemia in a Research Network of Dental Clinics coordinated by the Spanish Society of Periodontology (SEPA).

Material And Methods: A total of 1143 patients were included in the study. Participants filled a questionnaire considering diabetes risk factors (FINDRISC) and received a periodontal screening examination. Patients with a slightly elevated score according to the Findrisc (≥7), received a point-of-care HbA1c and were eventually referred to their physician for confirmatory diagnosis. Receiver Operating Characteristic (ROC) curves were used to assess the performance of various predictive models with confirmed hyperglycaemia as outcome.

Results: From this population, 97 (8.5%) were finally diagnosed of diabetes (n = 28; 2.5%) or prediabetes (n = 69; 6.0%). When only including the results from the FINDRISC questionnaire, the model reported an area under the curve (AUC) of 0.866 (95% confidence interval - CI [0.833; 0.900]). This model significantly improved when a basic periodontal examination (EPB Code; AUC = 0.876; 95% CI [0.845: 0.906]; p = .042) or a point-of-care HbA1c were added (AUC = 0.961; 95% CI [0.941; 0.980]; p < .001).

Conclusions: The tested protocol, combining the FINDRISC questionnaire and a point-of-care HbA1c, showed to be feasible when carried out in a dental clinic setting and was efficient to identify subjects with undiagnosed diabetes or prediabetes.
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http://dx.doi.org/10.1111/jcpe.13408DOI Listing
March 2021

Clinical signs, symptoms, perceptions, and impact on quality of life in patients suffering from peri-implant diseases: a university-representative cross-sectional study.

Clin Oral Implants Res 2021 Jan 20;32(1):100-111. Epub 2020 Dec 20.

Section of Graduate Periodontology, Faculty of Odontology, University Complutense, Madrid, Spain.

Objectives: To study the symptoms and perception reported by patients with peri-implant diseases, as well as their signs and their potential impact on the oral health quality of life.

Material And Methods: Two hundred and forty randomly selected patients were invited to participate. As part of the history assessment, the patient OHIP-14Sp was evaluated together with, for each implant, the patient perception regarding the peri-implant health status and the history of pain, spontaneous discomfort, bleeding, suppuration, swelling, and discomfort during brushing. As part of the clinical examination, the following potential signs of peri-implant diseases were collected: probing pocket depth (PPD), mucosal dehiscence (MD), extent of BoP, presence of SoP, and visual signs of redness and swelling. Those parameters were analyzed in relation to the actual peri-implant health diagnosis.

Results: Ninety-nine patients with a total of 458 dental implants were studied. Even in case of peri-implantitis, 88.9% of the implants were perceived by the patients as healthy. The total OHIP-14Sp sum score did not differ in relation to the peri-implant health diagnosis. Increased reports of spontaneous discomfort, bleeding, swelling, and discomfort during brushing were observed in presence of disease. However, only a minor proportion of implants with peri-implant diseases presented symptoms. PPD ≥ 6 mm was more frequent in diseased than in healthy implants (p < .01), while PPD ≥ 8 in pre-peri-implantitis/peri-implantitis than in healthy/mucositis implants (p < .01). Implants with peri-implantitis showed higher MD than implants without peri-implantitis (p < .01).

Conclusion: Peri-implant diseases are in most cases asymptomatic and not perceived by the patients. Despite being unable to accurately discriminate between peri-implant mucositis and peri-implantitis, PPD and MD resulted as the only two clinical signs associated with pre-peri-implantitis/peri-implantitis.
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http://dx.doi.org/10.1111/clr.13683DOI Listing
January 2021

Crestal bone loss associated with different implant surfaces in the posterior mandible in patients with a history of periodontitis. A retrospective study.

Clin Oral Implants Res 2021 Jan;32(1):88-99

Faculty of Odontology, ETEP Research Group, University Complutense of Madrid, Madrid, Spain.

Objective: To retrospectively assess the interproximal bone loss (CBL) in external hexagon implants (EHI), with different surface micro-topography, placed in the posterior mandible in patients with a history of periodontitis undergoing supportive periodontal care.

Material And Methods: 268 consecutive patients received 755 EHI implants in the mandibular molar region between 2007 and 2015 with the following surface characteristics: 72 turned, 145 hybrids (double acid-etched/turned), and 538 anodized. CBL was yearly evaluated by analysing calibrated digital periapical radiographs, with a follow-up of 1-6 years. Data on implant survival were also calculated.

Results: At 6 years (53 patients), the mean CBL was 1.34/1.42 mm at patient/implant level, respectively (range: 0-5.2 mm). Significantly higher CBL was detected in anodized implants than in turned and hybrid implants (1.92/1.46/1.02 mm) (p < .01). The maximum CBL values were found in 2 anodized implants at 4 years (6.3 and 8.1 mm). CBL ≥2 mm was detected in 18% of implants at 3 years and 35% at 6 (p < 2.2 × 10 ), this prevalence being 2.6 times higher in the anodized than in the hybrid and turned group (40%/15.6%, p < .0094). At 6 years, 25 anodized implants presented CBL ≥3 mm (18%). 6 anodized implants (5 patients) were removed between 4 and 5 years.

Conclusion: A significant higher CBL was observed in anodized, compared to hybrid and turned implants, when placed in the mandibular molar region of periodontal patients, with a follow-up of 1 to 6 years.
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http://dx.doi.org/10.1111/clr.13682DOI Listing
January 2021

Prevalence and risk/protective indicators of peri-implant diseases: A university-representative cross-sectional study.

Clin Oral Implants Res 2021 Jan 29;32(1):112-122. Epub 2020 Dec 29.

Section of Graduate Periodontology, Faculty of Odontology, University Complutense, Madrid, Spain.

Aim: To evaluate the prevalence of peri-implant diseases and to identify risk/protective indicators of peri-implantitis.

Materials And Methods: Two hundred and forty randomly selected patients from a university clinic database were invited to participate. Those who accepted, once data from their medical and dental history were collected, were examined clinically and radiographically to assess the prevalence of peri-implant health and diseases. Peri-implantitis was defined as the presence of BoP/SoP together with radiographic bone levels (BL) ≧2 mm. An intermediate peri-implant health category between peri-implant mucositis and peri-implantitis was also identified, defined by the presence of BoP/SoP together with 1 mm ≦BL < 2 mm. A multilevel multivariate logistic regression analysis was carried out to identify those factors associated either positively (risk) or negatively (protective) with peri-implantitis.

Results: Ninety-nine patients with a total of 458 dental implants were analyzed. The prevalences of pre-periimplantitis and of peri-implantitis were, respectively, 31.3% and 56.6% at patient-level, while 31.7% and 27.9% at implant level. The following factors were identified as risk indicators for peri-implantitis: smoking (OR = 3.59; 95% CI: 1.52-8.45), moderate/severe periodontitis (OR = 2.77; 95% CI: 1.20-6.36), <16 remaining teeth (OR = 2.23; 95% CI: 1.05-4.73), plaque (OR = 3.49; 95% CI: 1.13-10.75), implant malposition (too vestibular: OR = 2.85; 95% CI: 1.17-6.93), implant brand (Nobel vs. Straumann: OR = 4.41;95% CI: 1.76-11.09), restoration type (bridge vs. single crown: OR = 2.47; 95% CI: 1.19-5.12), and trauma as reason of tooth loss (vs. caries: OR = 6.51; 95% CI: 1.45-29.26). Conversely, the following factors were identified as protective indicators: interproximal flossing/brushing (OR = 0.27; 95% CI: 0.11-0.68), proton pump inhibitors (OR = 0.08; 95% CI: 0.01-0.90), and anticoagulants (OR = 0.08; 95% CI: 0.01-0.56).

Conclusions: Peri-implant diseases are highly prevalent among patients with dental implants in this university-based population. Several factors were identified as risk- and protective- indicators of peri-implantitis.
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http://dx.doi.org/10.1111/clr.13684DOI Listing
January 2021

Differences in the progression of experimental peri-implantitis depending on the implant to abutment connection.

Clin Oral Investig 2020 Nov 12. Epub 2020 Nov 12.

ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, Faculty of Odontology, Universidad Complutense de Madrid, 28040, Madrid, Spain.

Objectives: The aim was to evaluate the rate of bone loss progression during experimentally induced peri-implantitis using two different implant-abutment connections in implants with identical surface topography.

Material And Methods: Forty-eight Regular Neck tissue-level SLA implants with a matching implant to abutment connection (TL) and 36 bone-level SLA implants with a switching platform implant to abutment connection (BL) were subjected to experimental peri-implantitis in two independent in vivo pre-clinical investigations. Experimental peri-implantitis was induced by means of silk ligatures during 3 months (induction phase), and followed for one extra month without ligatures (progression phase). Radiographic and clinical outcomes were evaluated longitudinally along both studies and subsequently compared between experiments.

Results: During the induction phase, radiographic bone loss was significantly higher in implants with matched abutments compared with those with platform switching connections (2.65 ± 0.66 mm vs 0.84 ± 0.16 mm, respectively, p = 0.001). During the progression phase, both types of implant-abutment connection exhibited similar rates of radiographic bone loss. Similar outcomes were observed clinically.

Conclusions: A platform switching connection resulted in a more benign development of peri-implantitis during the experimental induction phase of the disease. These differences, however, disappeared once the ligatures were removed (progression phase).

Clinical Relevance: Influence of the implant-abutment connection in peri-implantitis progression may be relevant when considering implant selection in the moment of placement. In this sense, platform switching abutment demonstrated less peri-implantitis development when compared to implant matching connection.
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http://dx.doi.org/10.1007/s00784-020-03680-zDOI Listing
November 2020

Significance of implant design on the efficacy of different peri-implantitis decontamination protocols.

Clin Oral Investig 2020 Nov 10. Epub 2020 Nov 10.

Section of graduate Periodontology, Faculty of Odontology, Complutense University of Madrid, Madrid, Spain.

Objective: To assess the efficacy of three mechanical decontamination methods in four types of commercially available implants.

Material And Methods: Ninety-six implants of four commercial brands with different designs (regarding thread depth and thread pitch) were soaked in a surrogate biofilm (ink) and air-dried. Circumferential standardized peri-implant defects with 6 mm in depth and 1.55 mm in width were custom-made with a 3D printer. Stained implants were inserted in the defects and instrumented with three different methods: a titanium brush (TNB), a metallic ultrasonic tip (IST) and an air abrasive (PF). Standardized photographs were taken vertically to the implant axis (flat view), and with angulations of 60° (upper view) and 120° (lower view) to the implant long axis. The percentage of residual stain (PRS) was calculated with the image analysis software. Scanning electron microscope evaluations were performed on the buccal aspect of the implants at the central level of the defect.

Results: The efficacy of PF was significantly inferior to the TNB and IST in all implant designs, while there were no significant differences between TNB and IST. IST showed significantly higher PRS in the implant with the highest thread pitch, while the TNB had the highest PRS in the implant with a marked reverse buttress-thread design. The micro-thread design had the lowest values of PRS for all decontamination methods. The apically facing threads represented the areas with highest PRS for all implant designs and decontamination methods.

Conclusion: Thread geometry influenced the access of the decontamination devices and in turn its efficacy. Implants with lower thread pitch and thread depth values appeared to have less residual staining.

Clinical Relevance: Clinicians must be aware of the importance of thread geometry in the decontamination efficacy.
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http://dx.doi.org/10.1007/s00784-020-03681-yDOI Listing
November 2020

The association between metabolic syndrome and periodontitis in Spain: Results from the WORALTH (Workers' ORAL healTH) Study.

J Clin Periodontol 2021 Jan 17;48(1):37-49. Epub 2020 Nov 17.

ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Spain.

Introduction: Evidence of an association between periodontitis and MetS (metabolic syndrome) remains controversial. The objective of this study is to evaluate the association between periodontitis and MetS in a cross-sectional population survey.

Material And Methods: WORALTH (Workers' ORAL healTH) Study is a cross-sectional survey, conducted on a representative sample of the Spanish employed population, including 5154 participants. An oral examination following the World Health Organization (WHO) criteria evaluated the periodontal status using the Community Periodontal Index (CPI) and Clinical Attachment Levels (CAL). Logistic regression analysis with adjustment for potential confounders was used to evaluate the association between periodontitis and MetS, and its individual components.

Results: Participants presenting a CPI = 4 were more likely to have MetS than subjects with CPI < 4 [odds ratio, OR = 1.41; 95% confidence interval (CI) 1.10-1.81; p < 0.001]. High blood pressure was the component with stronger association with periodontal status (OR = 1.94 for CAL ≥6 mm; 95% CI 1.49-2.53; p < 0.001). After stratifying for sex, the association was higher in women (OR = 2.20 for CPI = 4; 95% CI 1.31-3.62; p < 0.001). Non-metabolically healthy subjects, obese or not, presented a worse periodontal condition.

Conclusion: Severe periodontitis (CPI = 4) was associated with MetS in a representative sample of the Spanish employed population. This association seems to be independent of body mass index and other potential confounders.
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http://dx.doi.org/10.1111/jcpe.13391DOI Listing
January 2021

One- versus two-stage crown lengthening surgical procedure for aesthetic restorative purposes: A randomized controlled trial.

J Clin Periodontol 2020 12 20;47(12):1511-1521. Epub 2020 Oct 20.

Faculty of Odontology, University Complutense of Madrid, Madrid, Spain.

Aim: This randomized controlled trial aimed to assess the efficacy of a two-stage crown lengthening intervention (SCL) in the aesthetic zone compared with a one-stage crown lengthening procedure (CCL).

Materials And Methods: Thirty subjects were randomly assigned to either SCL (n = 15) or CCL (n = 15) groups. SCL consisted of full-thickness flaps followed by bone recontouring and gingivectomy 4 months postoperatively, if required. In CCL, osseous recontouring after submarginal incisions was performed, followed by flap repositioning. Records were obtained at baseline, 4 months (only in SCL), 6 months and 12 months. Primary outcome was the precision in achieving a pre-determined gingival margin position. Other outcomes considered were changes in the gingival margin position and keratinized tissue width (KTW) at 12 months, and patient-reported outcomes (PROMs).

Results: Surgical precision was comparable between groups (0.2 ± 0.4 mm in the CCL group and -0.2 ± 0.5 mm in the SCL group). Four patients in the SCL group (27.7%) did not require a second-stage surgery. KTW was significantly higher in the SCL group (6.3 ± 1.4 mm versus 5.0 ± 1.4 mm, p = 0.017). SCL resulted in a lower impact on quality of life when compared to the CCL group.

Conclusions: Both approaches were highly accurate obtaining the desired crown length. SCL was associated with a lower reduction in KTW and more favourable oral health-related quality of life (OHIP-14).
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http://dx.doi.org/10.1111/jcpe.13375DOI Listing
December 2020

Periodontal regeneration using a xenogeneic bone substitute seeded with autologous periodontal ligament-derived mesenchymal stem cells: A 12-month quasi-randomized controlled pilot clinical trial.

J Clin Periodontol 2020 11;47(11):1391-1402

ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain.

Aim: To evaluate the safety and efficacy of autologous periodontal ligament-derived mesenchymal stem cells (PDL-MSCs) embedded in a xenogeneic bone substitute (XBS) for the regenerative treatment of intra-bony periodontal defects.

Material And Methods: This quasi-randomized controlled pilot phase II clinical trial included patients requiring a tooth extraction and presence of one intra-bony lesion (1-2 walls). Patients were allocated to either the experimental (XBS + 10 × 10 PDL-MSCs/100 mg) or the control group (XBS). Clinical and radiographical parameters were recorded at baseline, 6, 9 and 12 months. The presence of adverse events was also evaluated. Chi-square, Student's t test, Mann-Whitney U, repeated-measures ANOVA and regression models were used.

Results: Twenty patients were included. No serious adverse events were reported. Patients in the experimental group (n = 9) showed greater clinical attachment level (CAL) gain (1.44, standard deviation [SD] = 1.87) and probing pocket depth (PPD) reduction (2.33, SD = 1.32) than the control group (n = 10; CAL gain = 0.88, SD = 1.68, and PPD reduction = 2.10, SD = 2.46), without statistically significant differences.

Conclusion: The application of PDL-MSCs to XBS for the treatment of one- to two-wall intra-bony lesions was safe and resulted in low postoperative morbidity and appropriate healing, although its additional benefit, when compared with the XBS alone, was not demonstrated.
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http://dx.doi.org/10.1111/jcpe.13368DOI Listing
November 2020

Antimicrobial Activity of EPA and DHA against Oral Pathogenic Bacteria Using an In Vitro Multi-Species Subgingival Biofilm Model.

Nutrients 2020 Sep 14;12(9). Epub 2020 Sep 14.

ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, 28040 Madrid, Spain.

In search for natural products with antimicrobial properties for use in the prevention and treatment of periodontitis, the purpose of this investigation was to evaluate the antimicrobial activity of two omega-3 fatty acids, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), using an in vitro multi-species subgingival biofilm model including , , , , , and . The antimicrobial activities of EPA and DHA extracts (100 µM) and the respective controls were assessed on 72 h biofilms by their submersion onto discs for 60 s. Antimicrobial activity was evaluated by quantitative polymerase chain reaction (qPCR), confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). ANOVA with Bonferroni correction was used to evaluate the antimicrobial activity of each of the fatty acids. Both DHA and EPA significantly reduced ( < 0.001 in all cases) the bacterial strains used in this biofilm model. The results with CLSM were consistent with those reported with qPCR. Structural damage was evidenced by SEM in some of the observed bacteria. It was concluded that both DHA and EPA have significant antimicrobial activity against the six bacterial species included in this biofilm model.
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http://dx.doi.org/10.3390/nu12092812DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551721PMC
September 2020

Hard and soft tissue changes after guided bone regeneration using two different barrier membranes: an experimental in vivo investigation.

Clin Oral Investig 2021 Apr 26;25(4):2213-2227. Epub 2020 Aug 26.

Postgraduate Periodontology Clinic, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain.

Objective: To assess the contour and volumetric changes of hard and soft tissues after guided bone regeneration (GBR) using two types of barrier membranes together with a xenogeneic bone substitute in dehiscence-type defects around dental implants.

Material And Methods: In 8 Beagle dogs, after tooth extraction, two-wall chronified bone defects were developed. Then, implants were placed with a buccal dehiscence defect that was treated with GBR using randomly: (i) deproteinized bovine bone mineral (DBBM) covered by a synthetic polylactic membrane (test group), (ii) DBBM plus a porcine natural collagen membrane (positive control) and (iii) defect only covered by the synthetic membrane (negative control group). Outcomes were evaluated at 4 and 12 weeks. Micro-CT was used to evaluate the hard tissue volumetric changes and STL files from digitized cast models were used to measure the soft tissues contour linear changes.

Results: Test and positive control groups were superior in terms of volume gain and contour changes when compared with the negative control. Soft tissue changes showed at 4 weeks statistically significant superiority for test and positive control groups compared with negative control. After 12 weeks, the results were superior for test and positive control groups but not statistically significant, although, with a lesser magnitude, the negative control group exhibited gains in both, soft and hard tissues.

Conclusions: Both types of membranes (collagen and synthetic) attained similar outcomes, in terms of hard tissue volume gain and soft tissue contours when used in combination with DBBM CLINICAL RELEVANCE: Synthetic membranes were a valid alternative to the "gold standard" natural collagen membrane for treating dehiscence-type defects around dental implants when used with a xenogeneic bone substitute scaffold.
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http://dx.doi.org/10.1007/s00784-020-03537-5DOI Listing
April 2021

The Subgingival Microbiome in Patients with Down Syndrome and Periodontitis.

J Clin Med 2020 Aug 2;9(8). Epub 2020 Aug 2.

Medical-Surgical Dentistry Research Group, Health Research Institute of Santiago de Compostela, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain.

Objective: To describe the subgingival microbiome of individuals with Down syndrome (DS).

Methods: We conducted a cross-sectional observational study that obtained bacterial DNA samples from 50 patients with DS, 25 with periodontitis (PDS) and 25 with a healthy periodontal condition (HDS). The samples were analyzed by sequencing the 16S rRNA gene V3-V4 hypervariable region using the MiSeq System. Taxonomic affiliations were assigned using the naïve Bayesian classifier integrated in QIIME2 plugins. We evaluated the difference in bacteria abundance between the sample groups using Wilcoxon and Kruskal-Wallis tests. We evaluated the alpha diversity of the identified species using the Observed, Chao1metric, ACE and Shannon indices and evaluated beta diversity with principal coordinate analysis (registration code: 2018/510).

Results: Twenty-one genera and 39 bacterial species showed a significantly different abundance between the study groups. Among the genera, , , and were more abundant in the PDS group than in the HDS group, as were the less commonly studied , and genera. Among the species, spp. and spp. were the most abundant in the PDS group; the most abundant species in the HDS group were spp., spp. and spp.

Conclusion: Well-recognized periodontal pathogens and newly proposed pathogenic taxa were associated with periodontitis in patients with DS.
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http://dx.doi.org/10.3390/jcm9082482DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7463899PMC
August 2020

Epidemiology of mid-buccal gingival recessions in NHANES according to the 2018 World Workshop Classification System.

J Clin Periodontol 2020 10 2;47(10):1180-1190. Epub 2020 Sep 2.

Section of Graduate Periodontology, Faculty of Odontology, University Complutense, Madrid, Spain.

Aim: There are no nationally representative epidemiological studies available reporting on the different recession types according to the 2018 classification system or focusing on the aesthetic zone. The aims of this cross-sectional study were (a) to provide estimates on the prevalence, severity and extent of mid-buccal GRs according to the 2018 classification and (b) to identify their risk indicators in the adult U.S. population from the NHANES database.

Materials And Methods: Data from 10,676 subjects, representative of 143.8 millions of adults, were retrieved from the NHANES 2009-2014 database. GR prevalence was defined as the presence of at least one mid-buccal GR ≥1 mm. GRs were categorized following the 2018 World Workshop classification system (RT1, RT2, RT3) and according to different severity cut-offs. An analysis for GR risk indicators was also performed, selecting subjects without periodontitis.

Results: The patient-level prevalence of mid-buccal GRs (all types) was 91.6%, while it decreased to 70.7% when considering only the aesthetic zone. When focusing on RT1 GRs, the patient-level prevalence (whole mouth) was 12.4%, while it was 5.8% considering only the aesthetic zone. The majority of RT1 GRs were considered as mild (1-2 mm). The whole-mouth patient-level prevalence of RT2 and RT3 GRs was 88.8% and 55.0%, respectively. Age (35-49 years), gender (female), ethnicity (non-Hispanic Whites), last dental visit (>6 months before), tooth type (incisors) and the arch (mandible) resulted as risk indicators associated with the presence of RT1 GR.

Conclusions: Mid-buccal GRs affect almost the entire US population. Age, gender, ethnicity, dental care exposure, tooth type and arch were identified as risk indicators for RT1 GRs.
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http://dx.doi.org/10.1111/jcpe.13353DOI Listing
October 2020

Efficacy of a 0.03% chlorhexidine and 0.05% cetylpyridinium chloride mouth rinse in reducing inflammation around the teeth and implants: a randomized clinical trial.

Clin Oral Investig 2021 Apr 31;25(4):1729-1741. Epub 2020 Jul 31.

ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, Faculty of Dentistry, University Complutense of Madrid, Madrid, Spain.

Objectives: To evaluate the efficacy of a 0.03% chlorhexidine (CHX) and 0.05% cetylpyridinium chloride (CPC) mouth rinse, as an adjunct to professional plaque removal (PPR) and mechanical hygiene, in the treatment of peri-implant mucositis (PiM) and gingivitis.

Material And Methods: Patients displaying PiM in, at least, one implant were included in this randomized, double-blinded, clinical trial. Subjects received PPR (at baseline and 6-month visits) and were instructed to rinse, twice daily, during 1 year with the tested mouth rinse or a placebo. Clinical and patient-reported outcomes were recorded at baseline and 6 and 12 months.

Results: Fifty-four patients were included in the study and 46 attended the final visit. In the teeth and implants with inflammation, a higher reduction in BOP was observed in the test group. Statistically significant differences between groups were only observed in the lingual sites of the teeth with gingivitis (mean difference = 11.96%; 95% confidence interval [1.09; 22.83]; p = 0.03). Overall, compliance and satisfaction were good, even though staining were higher for the test group (p < 0.05).

Conclusions: The combined use of mechanical debridement with a 0.03% CHX and 0.05% CPC mouth rinse may have adjunctive benefits in the management of gingivitis, and it is associated with a higher degree of staining.

Clinical Relevance: The control of gingivitis can be improved, after professional mechanical debridement, with toothbrushing and the supplementary use of a 0.03% CHX and 0.05% CPC mouth rinse at home.

Clinical Trial Registration Number: NCT03533166.
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http://dx.doi.org/10.1007/s00784-020-03474-3DOI Listing
April 2021

Locally Applied Slow-Release of Minocycline Microspheres in the Treatment of Peri-Implant Mucositis: An Experimental In Vivo Study.

Pharmaceutics 2020 Jul 16;12(7). Epub 2020 Jul 16.

Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul 03772, Korea.

Background: The objective of this is preclinical investigation was to evaluate the differential drug sustainability and pharmacodynamic properties of two local minocycline microsphere carriers: chitosan-coated alginate (CA) and poly(meth)acrylate-glycerin (PG).

Methods: Four dental implants were placed unilaterally in the edentulous mandible of six beagle dogs. Each implant was randomly assigned to receive one of the following four treatments: (i) CA (CA-based minocycline), (ii) placebo (CA substrate without minocycline), (iii) PG (PG-based minocycline) and (iv) control (mechanical debridement only). After inducing peri-implant mucositis, the randomly assigned treatments were administered into the gingival sulcus twice at a 4-week interval using a plastic-tipped syringe. Drug sustainability and pharmacodynamic (clinical, radiographical and cell marker intensity) evaluations were performed after each administration.

Results: The CA microspheres remained longer around the healing abutment compared to the PG microspheres at both administrations and a longer bacteriostatic effect was observed from CA (7.0 ± 5.7 days) compared to PG (1.2 ± 2.6 days). The efficacy of the applied therapies based on clinical, radiographical and histological analyses were comparable across all treatment groups.

Conclusions: CA microspheres showed longer carrier and bacteriostatic effect sustainability when compared to PG microspheres, however, longer drug sustainability did not lead to improved treatment outcomes.
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http://dx.doi.org/10.3390/pharmaceutics12070668DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7407908PMC
July 2020

Oral Care and Quality Evaluation: A Multicentric Study on Periodontal Treatment.

Oral Health Prev Dent 2020 Apr 1;18(1):363-371. Epub 2020 Apr 1.

Purpose: No information is available on the perception of the quality of care in patients treated for periodontitis. The purpose of this article was to assess how periodontitis-affected patients perceive the quality of periodontal treatment (PT) and to measure the factors which may influence it.

Materials And Methods: 306 subjects who completed PT were invited to participate. Questionnaires and visual analogic scales (VAS) evaluating perception of quality of care, symptoms, and oral health related quality of life (OHRQoL) were handed out. Oral and periodontal indicators were collected before and after treatment. The impact of different factors on perception of quality was assessed with a regression model.

Results: Quality evaluation was high yet unrelated for both patients and clinicians (p = 0.983). Quality was negatively influenced by the number of residual oral infections (p < 0.001), patient's age (p = 0.07) and presence of residual pain at completion of PT (p = 0.02). Professionalism, kindness of the staff and communication skills were the characteristics mostly appreciated. The OHRQoL was influenced by the number of residual teeth (p < 0.001), increasing age of patients (p = 0.08), number of residual infections (p < 0.01) and pain (p = 0.04).

Conclusions: Patients' quality perception appeared to be influenced by clinical and emotional aspects. Oral care providers should be aware of the impact of non-clinical factors in patients' appreciation of quality of treatment.
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http://dx.doi.org/10.3290/j.ohpd.a44444DOI Listing
April 2020