Journal of Clinical Periodontology最新文献

Aim

To assess the efficacy of repeated submarginal mechanical instrumentation, as an adjunct to oral hygiene instruction, in the treatment of peri-implant mucositis.

Material and Methods

Patients with peri-implant mucositis were allocated to a control group receiving oral hygiene instructions only, or a test group with adjunctive repeated ultrasonic instrumentation with a polyetheretherketone tip. Bleeding on probing reduction was the primary outcome. A blinded examiner recorded clinical variables, and intraoral scans were obtained at baseline, 12 weeks and 24 weeks.

Results

In total, 58 patients were recruited, and 50 completed the study. Clinical parameters improved from baseline in both groups. There were no significant differences in the reduction of the extent nor the severity of bleeding on probing between the control and the test group at the 12- and 24-week follow-ups, but a significantly higher reduction in the peri-implant mucosa volume was observed in the test group from 12 to 24 weeks.

Conclusions

Ultrasonic instrumentation with a polyetheretherketone tip adjunctive to oral hygiene instructions did not render a higher reduction in bleeding on probing or lead to improved clinical outcomes. Still, it resulted in a higher reduction of the peri-implant mucosa volume as compared to oral hygiene instructions alone.

Background and Aim

Patients' disease perception plays a fundamental role in adherence to therapy and participation in long-term maintenance programmes. This cross-sectional study aimed to assess the cognitive and emotional representation of peri-implant diseases (PIDs) in a cohort of patients with periodontitis.

Methods

Patients diagnosed with both periodontitis and PIDs were enrolled. Psychometric evaluation was conducted using the Brief Illness Perception Questionnaire (Brief-IPQ) and the Oral Health Impact Profile-14. Differences were analysed based on disease severity, and a multivariate logistic regression model was applied to explore associations between patient and implant-level variables and illness perception.

Results

A total of 148 patients (459 implants) were included. Patients exhibited low perception of PIDs, with no differences between peri-implant mucositis and peri-implantitis. However, participants with both peri-implantitis and stage III/IV periodontitis presented with significantly higher Brief-IPQ scores. Having ≥ 3 implants and a history of periodontitis treatment were associated with a 4.16-fold and 6.58-fold increase, respectively, in the odds of a higher Brief-IPQ score.

Conclusions

The cognitive and emotional representation of PIDs was found to be low among patients with both periodontitis and PIDs, but appeared to increase in more advanced clinical profiles. A higher number of implants and prior periodontal treatment were associated with greater disease representation.

Trial Registration: The study protocol was approved by the University Hospital of Siena Ethics Committee (Siena, Italy) (Sezione Area vasta Toscana Sud Est, no. 25906), and it was registered on Clinicaltrials.gov (registration number: NCT06383351)

Aim

To evaluate bone level changes in implants with 1-mm- or 3-mm-high abutments over a 7-year period and to investigate the role of abutment height upon peri-implant status.

Materials and Methods

Two-piece implants were placed 1.5 mm subcrestally with either 1-mm (control) or 3-mm (test) high definitive abutments. Marginal bone level change from the first to seventh year was the primary outcome. Peri-implant status and other patient and peri-implant clinical variables (smoking, peri-implant maintenance therapy compliance, interproximal hygiene, vertical soft tissue thickness and keratinised mucosa width) were also assessed.

Results

After 7 years, 37 subjects (63 implants) were analysed: 17 subjects with 32 implants in the 1-mm abutment group, and 20 subjects with 31 implants in the 3-mm abutment group. Significant differences in marginal bone level changes were observed at 7 years. The 3-mm abutment group showed smaller changes compared to the 1-mm abutment group at mesial sites (−0.27 ± 1.32 mm vs. −0.42 ± 0.50 mm, respectively) and distal sites (−0.33 ± 1.39 mm vs. −0.35 ± 0.38 mm), with both differences being statistically significant (p < 0.001). In the control group, 18 implants (54.6%) presented peri-implant mucositis and 6 implants (18.2%) showed peri-implantitis. In the test group, 23 implants (74.2%) presented peri-implant mucositis and 1 implant (3.2%) showed peri-implantitis. No statistically significant differences were found (p = 0.158).

Conclusions

Subcrestally inserted implants with 3-mm definitive abutments experienced minimal bone loss over long-term follow-up compared to 1-mm abutments. However, since the differences were not statistically significant, no conclusions could be drawn on the protective effect against peri-implantitis.

Aim

The humoral immune system is implicated in the link between periodontitis and atherosclerosis. This study aims to explore how interactions between the oral microbiota and humoral immune responses may contribute to this association.

Materials and Methods

We analysed data from the Northern Finland Birth Cohort 1966, which included 1560 participants who underwent comprehensive health and oral examinations. Serum antibodies against phosphorylcholine (PCho) and malondialdehyde acetaldehyde (MAA) adducts were measured using chemiluminescence immunoassays. In a sub-cohort (n = 868), the oral microbiome from saliva samples was characterised using 16S rRNA gene sequencing.

Results

Higher serum levels of IgA and IgG to PCho, as well as IgA to MAA, were associated with an increased number of teeth with probing pocket depths (PPD) ≥ 4 mm. Several oral bacterial species, including Prevotella dentalis , Filifactor alocis and Treponema denticola , correlated with both PPD ≥ 4 mm and IgA/IgG responses to PCho. Mediation analysis, adjusted for periodontitis risk factors, identified F. alocis as a mediator linking elevated plasma IgG to PCho with the number of teeth with PPD ≥ 4 mm. Additionally, individuals harbouring F. alocis exhibited increased carotid intima-media thickness.

Conclusions

Our findings suggest that F. alocis may serve as a microbial link between periodontitis and atherosclerosis. Future mechanistic studies should investigate how F. alocis induces systemic IgG responses and contributes to atherosclerosis.

Aims

To compare the outcomes of non-surgical periodontal therapy (NSPT) alone and NSPT plus adjacent non-impacted third molar (N-M3) removal on second molars (M2s).

Materials and Methods

In this prospective split-mouth study, 40 patients with periodontitis who had N-M3s on both sides of the same jaw were enrolled. For each patient, a full-mouth NSPT was performed, with one N-M3 extracted (N-M3−) and the other N-M3 retained (N-M3+). Periodontal clinical parameters, gingival crevicular fluid (GCF) and subgingival plaque samples were measured/collected before (T0), 3 months after (T1) and 6 months after (T2) the treatment.

Results

All M2s showed improved probing depth after treatment. At T1 and T2, M2s in the N-M3− group yielded better outcomes in periodontal clinical parameters than the N-M3+ group, along with a significant decrease in the abundance of periodontal pathogens such as Porphyromonas gingivalis , Prevotella nigrescens and Fusobacterium nucleatum in subgingival plaque. At T2, the M2s in the N-M3− group had significantly lower GCF volume and higher interleukin-10 levels than those in the N-M3+ group.

Conclusion

Over the 6-month observation period, removal of adjacent N-M3s enhanced the outcome of NSPT for second molars, as demonstrated clinically, immunologically and microbiologically.

Trial Registration: Chinese Clinical Trail Registry (identification number: ChiCTR2300070343). https://www.chictr.org.cn/showproj.html?proj=194830 Date of Registration: April 10th, 2023

Objective

To evaluate self-reported questionnaires' intrinsic validity and diagnostic accuracy for detecting periodontitis across diverse cultural and geographic contexts.

Materials and Methods

Electronic searches were conducted in PubMed, Embase and the Cochrane Library until 4 March 2025. Studies included those using the Centers for Disease Control and Prevention and the American Academy of Periodontology (CDC/AAP) criteria or the 2017 World Workshop classifications as reference standards and reporting the diagnostic accuracy of self-reported questionnaire items. The validity of the eight-item questionnaire developed by the CDC/AAP was assessed by analysing the proportion of answers, and bias was evaluated using the QUADAS-2 tool. Owing to the limited number of studies using the 2017 World Workshop classifications, the quantitative synthesis was restricted to those using the CDC/AAP criteria. Sensitivity, specificity, diagnostic odds ratio (DOR) and 95% confidence intervals (CIs) were calculated for total periodontitis (including mild, moderate and severe cases), moderate-to-severe periodontitis and severe periodontitis.

Results

Totally, 23 studies (from 22 articles) were included in the systematic review, with 16 studies (from 15 articles) eligible for meta-analysis. The ‘Don't know/Refused’ option across the eight items of the CDC/AAP questionnaire ranged from 0% to 46.1%, indicating variable comprehension of certain items. Pooled sensitivity and specificity across the questionnaire items ranged from 17% to 82% and from 23% to 97%, respectively. DOR varied from 0.75 (95% CI: 0.54–1.03) to 8.01 (95% CI: 2.33–27.45). Significant heterogeneity was observed for most questions.

Conclusions

Self-reported questionnaires show potential for monitoring periodontitis but face issues with sensitivity and cross-cultural validity. Future research should focus on culturally adaptive designs and standardised validation protocols to enhance diagnostic accuracy and improve their effectiveness in global periodontal health screening.

Aim

To investigate whether early re-entry surgery following simultaneous guided bone regeneration (GBR) and implant placement has a negative impact on the outcome of bone regeneration and osseointegration.

Materials and Methods

In the edentulous mandible of six mongrel dogs, buccal peri-implant dehiscence defects were surgically created. Bone-level implants were placed with GBR, followed by submerged healing. Two experimental groups were randomly assigned according to the timing of re-entry and healing abutment connection at 2 months (early group) and 4 months (late group) following GBR. All animals were euthanised 5 months after GBR for histological analysis.

Results

One implant in the late group failed as a result of fibrin incarceration. There was no statistically significant difference between the two groups regarding new bone area (1.98 mm² [interquartile range, 1.53–2.98] and 0.88 mm² [0.09–1.79]; early vs. late group, respectively; p = 0.063); bone-to-implant contact (53.80% [40.88–63.10] and 54.15% [45.21–66.02], early vs. late groups, respectively; p > 0.999); width and height of the augmented tissue (p > 0.05); and peri-implant mucosal dimensions including thickness, height and volume (p > 0.05).

Conclusion

Early second-stage surgery results in similar bone regeneration, osseointegration and mucosal dimensions as late abutment connection.

Aim

Alveolar ridge preservation (ARP) after tooth extraction aims to maintain ridge dimensions for future implant placement. However, limited evidence is available for posterior sites. We evaluated the dimensional changes in posterior extraction sockets using four approaches: modified free gingival graft (MFGG); MFGG with xenograft (MFGG + XG); guided bone regeneration with titanium membrane and xenograft (TM + XG); and unassisted socket healing (USH).

Materials and Methods

Patients requiring posterior tooth extraction were randomly assigned to one of four groups (n = 22/group). Cone-beam computed tomography (CBCT) was performed immediately after operation and at 6 months to assess vertical and horizontal alveolar ridge changes and implant-related outcomes.

Results

Significant dimensional changes occurred in all groups (p < 0.05). The TM + XG and MFGG + XG groups showed better preservation of vertical ridge dimensions than the USH and MFGG groups (p < 0.05). Horizontal reductions were significant in all groups (p < 0.05). USH presented the highest sinus floor elevation rate (67% of maxillary cases) and the most frequent use of short implants (< 8.5 mm; 71%). Postoperative pain was significantly greater in the MFGG groups compared to the USH group (p < 0.05).

Conclusion

Bone grafting with MFGG or a titanium membrane enhanced ridge preservation and reduced the need for additional surgery compared to USH.

Trial Registration: ClinicalTrials.gov identifier: NCT06081296

Aim

To investigate the interplay between oxidative stress and gut microbiota in the pathogenesis of increased periodontitis in diabetic mice and explore potential therapeutic strategies.

Materials and Methods

Diabetic periodontitis (DP) mouse models were established and subjected to interventions including antioxidant treatment, co-housing experiments and faecal microbiota transplantation (FMT). Alveolar bone loss, periodontal inflammation, oxidative stress markers, gut microbiota composition and intestinal barrier function were evaluated.

Results

Diabetes exacerbated alveolar bone loss and inflammation markers in mice with periodontitis. DP mice exhibited significantly elevated systemic oxidative stress and gut dysbiosis compared to controls. Curcumin treatment effectively improved these parameters. Co-housing experiments between curcumin-treated and untreated DP mice showed that beneficial gut microbiota could be transferred between cage mates, leading to improved periodontal outcomes in untreated mice. Additionally, FMT from healthy donors reduced alveolar bone loss and periodontal inflammatory markers while improving oxidative stress parameters and restoring gut microbiota balance and barrier function.

Conclusions

This study demonstrates that the interaction between oxidative stress and gut dysbiosis may form a pathogenic loop associated with the exacerbation of periodontitis in diabetic conditions. The successful outcomes of antioxidant treatment and FMT suggest multiple adjunctive therapeutic approaches for managing DP.