A Retrospective Analysis

The authors have taken the liberty of presenting this manuscript in two parts. The first is a brief primer on microbial ecology, because, although the importance of microbial ecology in periodontal diseases is widely recognized, most of us do not know precisely what is meant by the term. The second section is a rather extensive overview of current studies of oral microbial ecology based almost entirely on recent in vivo studies.

https://laurieximenez.files.wordpress.com/2011/02/ref-2_socransky-2005_p2000.pdf

Periodontal microbial ecology.

Background Authors were assigned the task to develop case definitions for periodontitis in the context of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. The aim of this manuscript is to review evidence and rationale for a revision of the current classification, to provide a framework for case definition that fully implicates state-of-the-art knowledge and can be adapted as new evidence emerges, and to suggest a case definition system that can be implemented in clinical practice, research and epidemiologic surveillance. Methods Evidence gathered in four commissioned reviews was analyzed and interpreted with special emphasis to changes with regards to the understanding available prior to the 1999 classification. Authors analyzed case definition systems employed for a variety of chronic diseases and identified key criteria for a classification/case definition of periodontitis. Results The manuscript discusses the merits of a periodontitis case definition system based on Staging and Grading and proposes a case definition framework. Stage I to IV of periodontitis is defined based on severity (primarily periodontal breakdown with reference to root length and periodontitis-associated tooth loss), complexity of management (pocket depth, infrabony defects, furcation involvement, tooth hypermobility, masticatory dysfunction) and additionally described as extent (localized or generalized). Grade of periodontitis is estimated with direct or indirect evidence of progression rate in three categories: slow, moderate and rapid progression (Grade A-C). Risk factor analysis is used as grade modifier. Conclusions The paper describes a simple matrix based on stage and grade to appropriately define periodontitis in an individual patient. The proposed case definition extends beyond description based on severity to include characterization of biological features of the disease and represents a first step towards adoption of precision medicine concepts to the management of periodontitis. It also provides the necessary framework for introduction of biomarkers in diagnosis and prognosis.

https://onlinelibrary.wiley.com/doi/epdf/10.1111/jcpe.12945

Staging and grading of periodontitis: Framework and proposal of a new classification and case definition.

Advances in the pathogenesis of periodontitis: summary of developments, clinical implications and future directions

The purpose of this article is to identify the types of complications that have been reported in conjunction with endosseous root form implants and associated implant prostheses. A Medline and an extensive hand search were performed on English-language publications beginning in 1981. The searches focused on publications that contained clinical data regarding success/failure/complications. The complications were divided into the following 6 categories: surgical, implant loss, bone loss, peri-implant soft tissue, mechanical, and esthetic/phonetic. The raw data were combined from multiple studies and means calculated to identify trends noted in the incidences of complications. The most common implant complications (those with a greater than a 15% incidence) were loosening of the overdenture retentive mechanism (33%), implant loss in irradiated maxillae (25%), hemorrhage-related complications (24%), resin veneer fracture with fixed partial dentures (22%), implant loss with maxillary overdentures (21%), overdentures needing to be relined (19%), implant loss in type IV bone (16%), and overdenture clip/attachment fracture (16%). It was not possible to calculate an overall complications incidence for implant prostheses because there were not multiple clinical studies that simultaneously evaluated all or most of the categories of complications. Although the implant data had to be obtained from different studies, they do indicate a trend toward a greater incidence of complications with implant prostheses than single crowns, fixed partial dentures, all-ceramic crowns, resin-bonded prostheses, and posts and cores.

Clinical complications with implants and implant prostheses.

Although specific bacteria, dental plaque, and age are associated with periodontal disease, there are currently no reliable predictors of periodontitis severity. Studies in twins have suggested a genetic contribution to the pathogenesis of periodontitis, but previous attempts to identify genetic markers have been unsuccessful. The pro-inflammatory cytokines interleukin-1 (IL-1) and tumor necrosis factor alpha (TNF alpha) are key regulators of the host responses to microbial infection. IL-1 is also a major modulator of extracellular matrix catabolism and bone resorption. We report a specific genotype of the polymorphic IL-1 gene cluster that was associated with severity of periodontitis in non-smokers, and distinguished individuals with severe periodontitis from those with mild disease (odds ratio 18.9 for ages 40-60 years). Functionally, the specific periodontitis-associated IL-1 genotype comprises a variant in the IL-1B gene that is associated with high levels of IL-1 production. In smokers severe disease was not correlated with genotype. In this study, 86.0% of the severe periodontitis patients were accounted for by either smoking or the IL-1 genotype. This study demonstrates that specific genetic markers, that have been associated with increased IL-1 production, are a strong indicator of susceptibility to severe periodontitis in adults.

The interleukin-1 genotype as a severity factor in adult periodontal disease

Purpose The aim of this article was to review the current literature with regard to survival and success rates, along with the clinical procedures and outcomes associated with immediate and delayed implant placement Materials and methods A MEDLINE search was conducted of studies published between 1990 and June 2003 Randomized and nonrandomized clinical trials, cohort studies, case-control studies, and case reports with a minimum of 10 cases were included Studies reporting on success and survival rates were required to have follow-up periods of at least 12 months Results Thirty-one articles were identified Most were short-term reports and were not randomized with respect to timing of placement and augmentation methods used All studies reported implant survival data; there were no reports on clinical success Peri-implant defects had a high potential for healing by regeneration of bone, irrespective of healing protocol and bone augmentation method Sites with horizontal defects (HD) of 2 mm or less healed by spontaneous bone fill when implants with rough surfaces were used In the presence of HDs larger than 2 mm, or when socket walls were damaged, concomitant augmentation procedures with barrier membranes and bone grafts were required Delayed implant placement allowed for resolution of local infection and an increase in the area and volume of soft tissue for flap adaptation However, these advantages were diminished by simultaneous buccolingual ridge resorption and increased requirements for tissue augmentation Discussion Immediate and delayed immediate implants appear to be predictable treatment modalities, with survival rates comparable to implants in healed ridges Relatively few long-term studies were found Successful clinical outcomes in terms of bone fill of the peri-implant defect were well established However, there was a paucity of data on long-term success as measured by peri-implant tissue health, prosthesis stability, and esthetic outcomes Conclusions Short-term survival rates and clinical outcomes of immediate and delayed implants were similar and were comparable to those of implants placed in healed alveolar ridges

Immediate or early placement of implants following tooth extraction: review of biologic basis, clinical procedures, and outcomes.

Background: Cement-retained restorations are commonly used on dental implants. Residual excess cement after placement of fixed partial dentures has been associated with clinical and radiographic signs of peri-implant disease. The purpose of this study was to explore the relationship between excess dental cement and peri-implant disease using the dental endoscope.Methods: Thirty-nine consecutive patients with implants exhibiting clinical and/or radiographic signs of peri-implant disease were studied. Patients were enrolled in the study during a 5-year period in a private periodontal practice. Twelve of these patients had similar implants without signs of inflammation; these implants served as controls. There were 20 controls and 42 test implants. All were evaluated using a dental endoscope initially, and all but one implant was evaluated at a 30-day follow-up. Results from both groups were assessed by two trained operators and recorded.Results: None of the controls and all 42 of the test implants had clini...

The Positive Relationship Between Excess Cement and Peri-Implant Disease: A Prospective Clinical Endoscopic Study

Consensus statements and recommended clinical procedures regarding the placement of implants in extraction sockets.

Biofilms form on all hard non-shedding surfaces in a fluid system, i.e. both on teeth and oral implants. As a result of the bacterial challenge, the host responds by mounting a defence mechanism leading to inflammation of the soft tissues. In the dento-gingival unit, this results in the well-described lesion of gingivitis. In the implanto-mucosal unit, this inflammation is termed “mucositis”. If plaque is allowed to accumulate for prolonged periods of time, experimental research has demonstrated that “mucositis” may develop into “periimplantitis” affecting the periimplant supporting bone circumferentially. Although the bony support may be lost coronally, the implant still remains osseointegrated and hence, clinically stable. This is the reason why mobility represents an insensitive, but specific diagnostic feature of “periimplantitis”. More sensitive and more reliable parameters of developing and existing periimplant infections are “bleeding on probing”, “probing depths” and radiographic interpretation of conventional or subtraction radiographs. Depending on the diagnosis made continuously during recall visits, a maintenance system termed Cummulative Interceptive Supportive Therapy (CIST) has been proposed.

Thomas G. Wilson

Papers

The interleukin-1 genotype as a severity factor in adult periodontal disease

Immediate or early placement of implants following tooth extraction: review of biologic basis, clinical procedures, and outcomes.

The Positive Relationship Between Excess Cement and Peri-Implant Disease: A Prospective Clinical Endoscopic Study

Consensus statements and recommended clinical procedures regarding the placement of implants in extraction sockets.

Biological complications with dental implants: their prevention, diagnosis and treatment.