Journal of Clinical Periodontology最新文献

Aim

To investigate the impact of different vertical interimplant distances (VIDs) on the long-term success of two adjacent single-unit implants.

Materials and Methods

This retrospective study categorized implants into two groups based on VID: Group 1 (VID < 2 mm) and Group 2 (VID ≥ 2 mm). Further classification was done according to horizontal inter-implant distance (HID). Statistical models were used to evaluate the primary outcome of implant survival, secondary outcomes of complication-free survival rates and radiological findings.

Results

We included 290 patients with 376 two adjacent single-unit implants. Group 1 included 223 patients with 280 implants, whereas Group 2 comprised 89 patients with 96 implants. The implant survival rates were 93.2% in Group 1 and 96.8% in Group 2 over the 8 years, with no significant association between the groups. Similarly, the overall complication-free survival rates were 60.6% in Group 1 and 65.6% in Group 2, showing no significant association between the groups. Radiological assessments also showed no notable association between the groups. This trend was consistent in the subgroup analyses based on HID, with no significant differences in implant survival, complication-free survival rates or radiological outcomes.

Conclusions

Considering the study limitations of an 8-year post-prosthetic review period and despite varying VIDs, our findings showed no significant difference in implant survival, complication-free survival rates or radiological assessments. This underscores the positive prognosis of two adjacent single-unit implants and contributes to a deeper understanding of the success factors in implantology.

Trial Registration: The study was registered in the Chinese Clinical Trial Registry (ChiCTR2300073215)

Aim

The aim of this study was to investigate the non-inferiority of alveolar ridge preservation (ARP) with membrane stabilization compared with non-stabilization, focusing on changes of soft-tissue contour in periodontally compromised extraction sockets. Secondary outcomes included changes in hard-tissue contour, patient-reported outcomes and new bone formation.

Materials and Methods

Twenty-four patients with periodontally compromised teeth were randomly assigned to ARP with (test group) or without (control group) membrane stabilization. To assess profilometric and hard-tissue dimensional changes, dental impressions and cone beam computed tomography scans were performed at baseline (T0), immediately after ARP (T1) and 4 months post surgery (T2). Soft-tissue healing in open healing sites was evaluated at T2, and wound closure was assessed 10 days post surgery. Patient-reported outcomes were documented, and core biopsies were obtained for histomorphometric analysis.

Results

The absolute profilometric horizontal width change at 3 mm below the crest in the test group was not inferior to that in the control group. For the relative values, horizontal width reduction (3 and 5 mm below the crest) and volumetric shrinkage (3–5 mm below the crest) were lower in the test group. No significant differences were observed in bone dimensional changes, wound healing, pain and swelling or histomorphometric outcomes.

Conclusion

ARP with membrane stabilization in periodontally compromised extraction sockets is non-inferior in terms of soft-tissue contour changes to those without membrane fixation.

Trial Registration: Clinical Research Information Service (CRIS), KCT0005280. Registered 4 August 2020, https://cris.nih.go.kr/cris/search/detailSearch.do?seq=19165&search_page=L

Aim

This study aimed to evaluate the efficiency of and discrepancies between planned and final implant positions using dynamic computer-assisted implant surgery (d-CAIS) and autonomous robotic computer-assisted implant surgery (r-CAIS) in clinical practice.

Materials and Methods

The study included 83 patients, who received 135 implants between December 2022 and March 2024 (r-CAIS group: 43 patients with 71 implants; d-CAIS group: 40 patients with 64 implants). Cone-beam computed tomography scans taken before and after surgery assessed linear and angular deviations between the groups in both 2D and 3D spaces. The duration of surgery was also analysed.

Results

The angular deviation between d-CAIS and r-CAIS was 3.61° ± 1.65° versus 1.62° ± 0.93° (p < 0.001), the platform deviation was 1.12 ± 0.51 mm versus 0.50 ± 0.19 mm (p < 0.001) and the apex deviation was 1.36 ± 0.57 mm versus 0.58 ± 0.21 mm (p < 0.001). The d-CAIS group experienced significantly longer drilling and implant placement times compared to the r-CAIS group (10.6 ± 3.8 vs. 8.3 ± 3.4 min, p < 0.01), while preparation time showed no statistical difference between the groups (7.2 ± 3.3 vs. 6.2 ± 2.7 min, p > 0.05).

Conclusions

The robotic system demonstrated higher accuracy and efficiency of implant placement than the dynamic navigation system in partially edentulous patients.

Aim

To establish a reproducible experimental animal model for systemic lupus erythematosus (SLE)-associated periodontitis (PD), investigate the effects of SLE on PD and assess the therapeutic potential of alpha-ketoglutarate (αKG) for SLE-PD treatment.

Materials and Methods

An SLE-PD murine model was established via ligature-induced PD in MRL-lpr strain, with MRL/MpJ strain as a non-SLE control. The periodontal state was assessed using micro-CT, real-time PCR, histology, immunofluorescence and flow cytometry assays. αKG levels were analysed, and a thermoresponsive gel was designed as a periodontal dimethyl (DM)-αKG delivery system. αKG levels were analysed in gingival crevicular fluid (GCF) of PD patients with or without SLE.

Results

SLE significantly increased the periodontal inflammation and bone resorption in the SLE-PD model. αKG levels in GCF were lower in PD patients with SLE than in PD patients without SLE. Decreased αKG levels in the gingiva and macrophage M1/M2 imbalance were observed in SLE-PD mice. However, DM-αKG thermoresponsive gel effectively alleviated the periodontal inflammation, bone resorption and macrophage M1/M2 imbalance in SLE-PD mice.

Conclusions

Our study established, for the first time, a novel SLE-PD murine model and revealed that SLE increases the severity of PD in vivo. Our findings highlight the therapeutic potential of αKG for SLE-associated PD.

Aim

To characterize the gingival crevicular fluid (GCF) and plasma extracellular vesicles (EVs) and explore their proteomic cargo in healthy pregnant women compared to those with gestational diabetes mellitus (GDM) and periodontitis.

Methods

One-hundred and four pregnant women were recruited at 24–30 gestation weeks. GDM was diagnosed by an oral glucose tolerance test. GCF and plasma samples were obtained to isolate EVs and characterized by nanoparticle tracking, immunoassays, electron microscopy and mass spectrometry.

Results

Of the recruits,17.3% women were healthy, 50% had periodontitis and 32.7% had both GDM and periodontitis. Probing depth, clinical attachment loss and bleeding on probing were more severe in GDM and periodontitis pregnancies (p < 0.0001). Additionally, this group showed an increase concentration of total, small and large GCF-EVs (p = 0.0015, p = 0.0011 and p = 0.0008, respectively), with decreased expression of CD9, CD81 and CD81/CD63 ratio (p = 0.0461, p = 0.0164 and p = 0.0005, respectively). No differences were observed in plasmatic EVs concentration or markers expression. Proteomic analysis of GCF-EVs showed peptides of both host and bacterial origin. Gene ontology analysis revealed that proteins of GCF-EVs participate in immune inflammatory responses, glucose metabolism and insulin response mechanisms.

Conclusion

GCF-EVs were increased in both GDM and periodontitis, and their proteomic cargo suggest their involvement in immune inflammatory response, glucose metabolism and insulin pathways during pregnancy.

Aim

To assess the glycaemic status of Asian patients in a tertiary care dental setting and develop a risk model for undiagnosed diabetes mellitus (DM).

Material and Methods

A total of 1074 participants completed a diabetes risk test questionnaire, full-mouth periodontal examination and a point-of-care HbA1c finger-prick blood test. Univariable logistic regression was performed to assess the effect of potential factors to predict DM, with confirmed diabetes as the outcome. Subsequently, multivariable logistic regression analysis with stepwise variable selection was employed to develop the final models for predicting DM.

Results

Sixty-five (6.1%) and 83 (7.7%) of the 1074 participants were medically confirmed with T2DM and prediabetes, respectively. The ‘best’ predictive risk model for DM included body mass index (BMI), family history of diabetes, smoking and a diagnosis of Stage III/IV or severe periodontitis with an area under the curve (AUC) of 0.717 (95% confidence interval, CI [0.689–0.744]) and 0.721 (95% CI [0.693–0.748]), respectively. Including the oral health measure marginally increased the AUC.

Conclusions

Dental patients clinically diagnosed with advanced periodontitis in combination with high BMI, positive family history of DM and smoking are potentially at high risk for DM and should be screened for DM and referred for medical confirmation and management.

Aim

To analyse whether some selected inflammatory biomarkers collected from venous blood and gingival crevicular fluid (GCF) were associated with the outcome of non-surgical periodontal therapy.

Materials and Methods

Two-hundred and nine patients affected by periodontitis were enrolled in the study, who had undergone steps I and II therapy as well as a non-surgical re-instrumentation (NSRI) of periodontal pockets after 6 months. Serum (SE), plasma (PL) and GCF samples were quantitatively analysed for the following inflammatory biomarkers: active matrix metalloproteinase-8 (aMMP-8), prostaglandin E2 (PGE2) and surfactant protein D (SP-D). Therapy outcomes were evaluated using a ‘treat-to-target’ endpoint (T2T) at the patient level, defined as ≤ 4 sites with pocket depth ≥ 5 mm.

Results

Patients presented with 23 ± 6 teeth (mean ± SD) at baseline. After steps I and II therapy, 41.6% of the patients reached T2T and after NSRI 47.4%. Univariate analysis identified a potential association between high levels of PL-SP-D and more favourable treatment outcomes. Multivariate binary logistic regression adjusted for sex, mean baseline probing depth, diabetes and current smoking status confirmed an independent relationship between baseline PL-SP-D and the T2T after steps I and II therapy (aOR 0.432, p = 0.011), implying that a higher level PL-SP-D at baseline is associated with a > 50% reduced risk of failing T2T. However, no such association was found for PL-SP-D and NSRI.

Conclusion

Higher baseline PL-SP-D levels might be associated with more favourable treatment outcomes after steps I and II therapy. This may be due to its role in the regulation of neutrophil function. However, further investigation is required to confirm this hypothesis. If proven, PL-SP-D could play a role as a biomarker for identifying individuals who respond differentially to primary therapy.

Aim

Periodontal disease (PD) screening models based on a self-reported questionnaire were previously established and externally validated. The aim of the present study is to explore whether the screening models could be modified to improve prediction performance; this methodology is called ‘updating’.

Methods

Updating the models for ‘total’ and ‘severe’ PD was performed using two datasets. One dataset from a previous study (n = 155) was used to explore the updating, and a second (n = 187, built for the current study) was used to validate whether updating improved performance. Updating was based on different statistical approaches, including model recalibration and revision. Discrimination and calibration were assessed after updating.

Results

For ‘total’ PD, the update based on model revision improved its performance. However, still low AUCs were found: 0.64 (0.56–0.73) and 0.61 (0.53–0.69) with corresponding O:E ratios 1.00 (0.80–1.23) and 0.92 (0.75–1.13) in the update and validation cohorts, respectively. For ‘severe’ PD, performance of the original model without update performed still the best; AUCs were 0.72 (0.61–0.83) and 0.75 (0.66–0.84) in the update and validation cohorts, respectively, with corresponding O:E ratios 0.60 (0.38–0.84) and 0.62 (0.42–0.87).

Conclusions

The updating methodology did not further improve the performance of the original ‘severe’ PD screening model; it performed satisfactorily in the medical care setting. Despite updating attempts, the screening model for ‘total’ PD remained sub-optimal. Screening for ‘severe’ PD can now be implemented in the medical care setting.

Aim

To investigate the effect of periodontitis on the long-term changes of the cardio-ankle vascular index (CAVI).

Materials and Methods

A 10-year retrospective cohort study of 3842 Thai participants (range 25–76 years) with normal CAVI at the study initiation was undertaken. Full-mouth periodontal examination was performed by calibrated periodontists, and the extent and severity of periodontitis were determined at 5-year intervals. Serial CAVI measurements were used to examine the incidence of high CAVI (≥ 9.0) and changes in CAVI over time (ΔCAVI).

Results

Participants with a higher extent or severity of periodontitis were found to have a significantly higher mean ΔCAVI. The incidence of high CAVI was also observed to be higher in those with periodontitis compared to those without it. The adjusted risk ratios for developing high CAVI were 1.309 and 1.513 for localized and generalized periodontitis, respectively. Participants with severe periodontitis had a 37% higher likelihood of developing CAVI ≥ 9.0 compared to individuals with no/mild periodontitis. This risk was consistent with a significant change in ΔCAVI of 0.054–0.140.

Conclusions

Periodontitis, both in terms of extent and severity, was found to have a significant dose-dependent effect on the risk of developing high CAVI over a 10-year period, suggesting a causal relationship between these two parameters.