Surgical treatment of peri‐implantitis: Prognostic indicators of short‐term results

Aim

To evaluate the clinical and radiographic short‐term (6 months) effect of surgical treatment of peri‐implantitis, and to identify prognostic indicators affecting the outcome using a multilevel statistical model.

Materials & Methods

A total of 143 implants (45 patients) with a diagnosis of progressive peri‐implantitis (progressive bone loss (PBL) ≥2.0 mm and bleeding on probing (BoP)/suppuration) received surgical treatment. Clinical and radiographic parameters were assessed 6 months postoperatively. Potential prognostic indicators on subject, implant and site level prior to surgery were analysed to evaluate the effect on individual and composite outcomes using multilevel logistic regression analysis.

Results

At the 6‐month evaluation, none of the implants demonstrated PBL and 14% of the implants were registered with the absence of bleeding and no pocket probing depth ≥6 mm. Multilevel regression analysis identified, among others, suppuration, pocket probing depth >8 mm, bone loss >7 mm and the presence of plaque as criteria associated with the outcome.

Conclusion

Resective peri‐implantitis surgery seemed to reduce the amount of peri‐implant inflammation. However, most of the sites continued to have BoP/suppuration. Thus, long‐term maintenance and evaluation is warranted. The effect of treatment was reduced by some prognostic indicators such as the presence of suppuration prior to interception and peri‐implant bone loss exceeding 7 mm.     

Changes in the fractal dimension on pre- and post-implant panoramic radiographs

Objectives  

The aim of this study was to assess the changes in the fractal dimension before and after implant placement. The study also examined the possibility of using fractal analysis as a prognostic indicator for implant success.     

Prognostic Factors Relating to the Outcome of Endodontic Microsurgery

Introduction

The aim of this retrospective study was to evaluate the outcome of endodontic microsurgery and to examine prognostic factors related to healing.

Methods

The clinical records of all patients who had undergone endodontic microsurgery from 1997–2003 at the National Dental Centre of Singapore were examined. Teeth with a recall period of 1–2 years were selected. All surgical procedures, except for flap raising and suturing, were performed under a surgical operating microscope. Root-end cavities prepared with ultrasonic tips were filled with Intermediate Restorative Material (Caulk, Milford, DE) or mineral trioxide aggregate. Teeth were evaluated for clinical signs and symptoms after surgery. Preoperative and postoperative radiographs were evaluated independently by 2 endodontists.

Results

Of 243 root-end surgeries performed, 93 were eligible for the study. Outcomes were categorized as healed, healing, or persistent disease; 78.5% of teeth were assessed to be healed or healing, and 21.5% had persistent disease. The percentages of healed and healing teeth for anterior and posterior root-end surgeries were 76.5% and 80.4%, respectively, with no significant difference in the procedures (P = .8). Ordinal logistic regression showed a higher likelihood of healing in females compared with males (P = .001) and maxillary anterior teeth compared with mandibular anterior teeth (P = .03). Preoperative probing depths of ≤3 mm were significantly associated with healing (P = .05).

Conclusions

The use of modern endodontic surgical techniques resulted in 78.5% healed and healing teeth with a recall period of 1–2 years. Prognostic factors affecting successful healing include sex, tooth type, and preoperative probing depths.     

Postoperative infections after dental implant placement: Variables associated with increased risk of failure

1 Background

Wound infections after dental implant placement are a rare finding that might lead to early implant failure. However, the available information on this topic is scarce.

2 Methods

This retrospective cohort study was conducted to determine factors that may increase the failure rate of dental implants that presented a postoperative infection during the osseointegration period. Postoperative infections were defined as the presence of pus or fistula in the surgical area, with pain or tenderness, swelling, redness, and heat or fever, before prosthetic loading. A bivariate and multivariate analysis of the data using Cox proportional‐hazards regression was performed to detect prognostic factors for implant failure in patients that suffer infections.

3 Results

The patient‐based prevalence of postoperative infections after implant placement was 2.80% (95% confidence interval (95%CI): 2.04% to 3.83%). Thirty‐three out of 37 (89.19%) patients with infections had to be surgically retreated because of antibiotic failure and 65% of the infected implants were removed. The bivariate analysis showed a significant association between implant failure and the collar surface (HR: 3.12; 95% CI: 1.16 to 8.41; P = 0.014). Cox proportional‐hazards regression indicated that rough‐surfaced collars increased 2.35 times the likelihood of failure (95% CI: 0.87 to 6.37; P = 0.071).

4 Conclusions

The survival of implants placed in the maxilla, with smooth collar, and late‐onset of infection was higher than those placed in the mandible, with a rough collar and early onset of infection. In general, signs of infection after dental implant placement compromises the survival rate of the affected fixtures.     

Evaluation of Microsurgery with SuperEBA as Root-end Filling Material for Treating Post-treatment Endodontic Disease: A 2-year Retrospective Study

Introduction

This retrospective study assessed the effects of microsurgical treatment of post-treatment endodontic disease using SuperEBA (Bosworth, Skokie, IL) as the root-end filling material and evaluated the potential prognostic factors in relation to outcome.

Methods

Data were collected from patients diagnosed with post-treatment endodontic disease who then underwent endodontic microsurgery between April 2007 and October 2010. The effect was evaluated 2 years after the operation. Surgical procedures were performed by a single endodontic specialist. After surgery, operation records were recorded including preoperative, intraoperative, and postoperative factors from the clinical and radiographic measures. For statistical analysis of the predisposing factors, the dependent variable was the dichotomous outcome (ie, success vs failure).

Results

Eighty-two patients with 101 treated teeth met the inclusion criteria. The recall rate was 87.2%. Of these microsurgically treated cases, the overall healing rate was 93.1%. At the 0.05 significance level, age, sex, tooth position, size of periapical radiolucency, biopsy result of periapical lesion, and presence of a sinus tract appeared to have no significant effects on the outcome (P > .05).

Conclusions

Microsurgical endodontic treatment using SuperEBA as the root-end filling material is a favorable option for post-treatment endodontic disease.     

P53 immunohistochemical expression does not correlate with clinical features in 207 carcinomas of the oral cavity and in the head and neck region

Objectives

The present study aims to investigate the relevance of immunohistochemical p53 expression in carcinomas of the oral cavity and of the head and neck region. Long-term clinical and histopathological follow-up findings as well as HPV status are correlated with the results of this examination.

Materials and methods

Sections made from two tissue arrays composed of 222 oral squamous cell carcinomas and 427 squamous cell carcinomas of the head and neck region, respectively, were examined for p53 expression and Ki-67 index by means of immunohistochemistry. Correlation of long-term clinical findings of the patients and pathological features of tumours with laboratory results were examined statistically.

Results

No significant correlation was found between the p53 immunohistochemical expression in the 207 oral carcinomas and features of the tumours and patient outcomes. There was no significant association between the Ki-67 labelling index and the p53 expression.

Discussion

Our failure in detecting any association of the p53 immunohistochemical expression regardless of HPV status with clinical features of these tumours suggests it lacks a prognostic value for squamous cell carcinomas of the oral cavity.

Clinical relevance

The prognostic value of p53 immunostaining in oral squamous carcinoma is not clarified yet. In the present study, there is no impact on any prognostical item nor even a correlation with cell proliferation (Ki-67) regardless of HPV status.     

Mucoepidermoid Carcinoma of the Salivary Glands: Survival and Prognostic Factors

Objective

The aim of this study was to establish global survival rates and potential prognostic factors for mucoepidermoid carcinoma (MC) of the salivary glands in patients diagnosed at the Dr. Eduardo Cáceres Graziani National Institute for Neoplastic Diseases (INEN), Lima, Peru, between 2002 and 2012.

Materials and Methods

This was an observational, analytical and longitudinal (information reconstructed in time) retrospective cohort study. Data were obtained from clinical records and used to determine the overall survival (OS) rate at 2 and 5 years, and the individual percentage survival for each prognostic factor using the actuarial technique. We also performed univariate analysis for each possible prognostic factor using log-rank analysis, and multivariate analysis using Cox’s regression model. The study was approved by the institutional review board at Dr. Eduardo Caceres Graziani INEN and conducted in accordance with the 1964 Declaration of Helsinki. For this type of study formal consent was not required.

Results

The OS rate of the 51 patients enrolled in the study was 81 % at 2 years and 78 % at 5 years. In the multivariate analysis, the equation that best explained the survival result contained the variable, clinical stage (p = 0.063).

Conclusions

The results revealed the importance of clinical stage regarding the survival of patients with a primary diagnosis of MC of the salivary glands.

     

Adapting the German version of the dental environment stress questionnaire

Aims

To develop a German version of the Dental Environment Stress (DES) questionnaire, and to evaluate its reliability and validity.

Methods

The original English DES questionnaire was translated into German using a forward–backward translation process. To evaluate construct stability, a subgroup of dental students (n = 43) completed the DES twice (interval: 1 week). To evaluate how the DES responds to anticipated changes in stress, all dental students' (n = 64) DES scores and saliva cortisol levels administered from a clinical study were compared between holiday and term time. Furthermore, the Depression, Anxiety and Stress Scale (DASS) and a stress self-assessment were used to determine the validity of the DES. Reliability analyses were calculated using Kendall's tau correlations. To estimate reliability strength, correlation coefficients and intraclass correlations (ICCs) were used.

Results

Regarding construct stability, 24 of 25 DES items had at least moderate correlations, and most items showed strong correlations. Correlations for the seven subdomains were good (range: 0.778–1.000). The same was true for the total DES score (ICC: 0.944). Correlations for response to term-time stress were weaker and more varied. Validity analyses revealed fair correlations between the DES and students' self-assessment (Pearson's r = .592) and DASS score (Pearson's r = .392), suggesting satisfactory validity. Stress levels were quite similar between baseline and follow-up.

Conclusion

The German DES is a reliable tool for evaluating stress in dental students. Because it can be used to identify individual stressors in various categories, it might enable the detection of specific stress situations in educational situations and facilitate solutions (adjustment of curricula, tailored consulting services).     

Prognostic indicators for conventional complete denture therapy: A review of the literature

Objectives

To review the current literature on prognostic indicators for conventional complete denture therapy.

Data

Original articles studying outcome measures and patient satisfaction with conventional complete dentures.

Sources

Ovid databases from 1988 to present and subsequent review of related articles from the 1960s onwards. Searches were limited to English language only and used a variety of keywords.

Conclusions

There remains a paucity of research in this area. From the best available data, construction of technically correct dentures, a well-formed mandibular ridge and accuracy of jaw relations are positive indicators for success. Patient neuroticism and a poorly formed mandibular ridge are negative indicators for success. Other prognostic indicators have not been shown to be of significant value. There exists a minority of patients who will never adapt to any conventional complete denture. This problem is more acute in the mandible than the maxilla. There is need for further research in this area.     

A clinical,randomized study on the influence of dental whitening on Streptococcus mutans population

Background

Dental whitening with peroxides has been popularized through the at‐home technique, which employs low concentrations of peroxide applied in individual trays. However, there are few clinical trials reporting the effects of its continuous use on oral microbiota. Thus, the purpose of the present clinical, randomized study was to evaluate the influence of at‐home whitening treatment on Streptococcus mutans in saliva, buccal mucosa, and subgingival and supragingival plaque.

Methods

Thirty volunteers were randomly divided into two study groups (N = 15) according to the whitening therapy: G CP, whitening using 10% carbamide peroxide 4 h daily for 21 days; and G HP, whitening using 6% hydrogen peroxide 1.5 h daily for 21 days. Samples from the predetermined locations were collected at three evaluation periods: T1, before; T2, immediately after; and T3, 30 days after the beginning of the treatment. The microbiological evaluation was made using conventional and molecular methods.

Results

Student's t‐test demonstrated a statistically significant decrease in S. mutans population in the subgingival and supragingival plaque for HP samples between T1 and T2 no difference was found between T1 and T3 regardless of the location and the whitening product used (α = 0.05).

Conclusions

Although HP reduced S. mutans during treatment, the levels returned to baseline when assessed 30 days after the treatment.     

Investigation of factors that influence pain experienced and the use of pain medication following periodontal surgery

Aims

To determine the relationship between anticipated pain and actual pain experienced following soft tissue grafting or implant surgery; to identify the factors that predict actual pain experienced and the use of pain medication following soft tissue grafting or implant surgery.

Materials and Methods

Prior to dental implant placement (n = 98) or soft tissue grafting (n = 115) and for seven days following the procedure, patients completed a visual analog scale indicating anticipated or experienced pain, respectively. The use of pain medication and alcohol, and smoking were measured.

Results

Actual pain experienced on day 1 was lower (p < .01) than anticipated pain and continued to decrease (p ≤ .01) for each of the 7 consecutive days. Anticipated and actual pain were positively correlated. Increasing age (p < .05), having sedation during the surgery (p < .05), and lower use of pain pills (p < .01) predicted lower pain experienced. Actual pain experienced was a predictor of pain pill use (p < .01). Greater nervousness (p < .01) prior to surgery was a predictor of greater anticipated pain.

Conclusions

Patients anticipated more pain than they actually experienced. Sedation, age and number of pain pills used predicted pain experienced. This trial was registered with clinicaltrials.gov as NCT03064178.     

Repression of G protein–coupled receptor family C group 5 member A is associated with pathologic differentiation grade of oral squamous cell carcinoma

Background

G protein–coupled receptor family C group 5 member A (GPRC5A), a member of G protein–coupled receptor family, has been shown to function as a tumor suppressor in lung tissue. The biological functions of GPRC5A have therefore been linked to lung tissue. However, the biological significance of this gene product remains obscure. In this study, we investigated the expression of GPRC5A proteins in normal oral tissue and oral squamous cell carcinoma (OSCC), and we characterized its biological activity in OSCC cell lines.

Methods

Western blot analysis and immunohistochemical staining were used to investigate the expression of GPRC5A in both OSCC cell lines and clinical samples. GPRC5A stable transfectants and their parental OSCC cells were characterized for their biological activities in anchorage‐independent growth.

Results

High levels of immunohistochemical GPRC5A expression were detected in normal oral tissue, especially differentiated area. In contrast, GPRC5A expression was dramatically repressed in OSCCs (P < 0.01). The immunohistochemical GPRC5A expression was moderately well differentiated, but greatly repressed in moderately differentiated OSCCs and completely repressed in poorly differentiated OSCCs. Overexpression of GPRC5A in OSCC CAL27 cells resulted in a suppressed anchorage‐independent growth activity, a transforming phenotype.

Conclusions

GPRC5A is expressed in normal oral epithelium. Repression of GPRC5A is associated with poorly differential grade of OSCCs. Overexpression of GPRC5A in OSCC cell line reversed the malignant phenotype. Thus, GPRC5A is important for homeostasis in oral tissue, and deletion or repression of this gene may involve in tumorigenesis of OSCCs and may serve as a prognostic marker for malignant type of OSCCs.     

Spinal disorders and mastication: The potential relationship between adolescent idiopathic scoliosis and alterations of the chewing patterns

Objective

To evaluate mastication in a group of patients with adolescent idiopathic scoliosis (AIS) with a control group, by means of the prevalence of reverse chewing cycles (RCCs).

Material and Methods

This study included a group of patients (N = 32; F = 24; M = 8; mean age ± SD = 14 ± 3 years) with a confirmed diagnosis of AIS and a group of control subjects (N = 32; F = 24; M = 8; mean age ± SD = 13 ± 6 years) without spinal disorders. Mastication was recorded with both a hard and a soft bolus, following a standardized protocol, and the prevalence of RCCs was compared between the groups.

Results

The prevalence of RCCs was significantly higher in the AIS group, with both a soft and a hard bolus, compared to the control group (P < .001).

Conclusion

The results of this study indicate that the presence of AIS influences mastication, one of the main functions of the stomatognathic system. A multidisciplinary approach to these patients may be relevant in providing the best possible treatment outcomes.     

Effect of head rotation on the pathway of a food bolus through the pharynx as evaluated by a videofluoroscopic swallow study

Purposes  

Head rotation is widely used as a postural technique for dysphagic patients. In this study, we evaluated the effects of head rotation on pharyngeal swallowing in healthy subjects.     

Three-dimensional observations of the incisive canal and the surrounding bone using cone-beam computed tomography

Objectives  

The shape of the anterior region of the maxilla is critical when planning implant treatment. The purpose of the present study was to assess the typical morphology of the incisive canal and surrounding bone.     

Endosseous alveolar distractor (LEAD™) in the management of residual alveolar ridge resorption

Background  

Lack of sufficient alveolar bone height or width is one of the most frequent problems in the dental rehabilitation of the edentulous patient.     

Arthrocentesis for the Treatment of Internal Derangement of the Temporomandibular Joint

Objective  

The study aims to evaluate the efficacy of arthrocentesis in the treatment of internal derangement of the temporomandibular joint (TMJ).     

Treatment Outcome of Mineral Trioxide Aggregate or Calcium Hydroxide Direct Pulp Capping: Long-term Results

Introduction

This controlled, historic cohort study project continues a previously reported trial aiming to assess treatment outcome of direct pulp capping with mineral trioxide aggregate (MTA) versus calcium hydroxide (CH). Potential prognostic factors were re-evaluated on the basis of a larger sample size and longer follow-up periods.

Methods

Clinical and radiographic outcomes of 229 teeth treated with direct pulp capping between 2001 and 2011 were investigated 24 up to 123 months post-treatment (median = 42 months). Pre-, intra-, and postoperative information was evaluated and statistically analyzed using a logistic regression model as well as generalized estimating equation logit models.

Results

Two hundred five patients (229 teeth) were available for follow-up (74% recall rate). The overall success rates were 80.5% (95% confidence interval [CI], 74.5–86.5) of teeth in the MTA group (137/170) and 59% (95% CI, 46.5–71.5) of teeth in the CH group (35/59). Multivariate analyses (generalized estimating equation logit model) indicated a significantly increased risk of failure for teeth that were directly pulp capped with CH compared with MTA (odds ratio = 2.67; 95% CI, 1.36–5.25; P = .001). Teeth that were permanently restored ≥2 days after direct pulp capping had a significantly worse prognosis irrespective of the pulp capping material chosen (odds ratio = 3.18; 95% CI, 1.61–6.3; P = .004).

Conclusions

The results of this study indicate that MTA provides better long-term results after direct pulp capping compared with CH. Placing a permanent restoration immediately after direct pulp capping is recommended.     

An unusual case of hemifacial microsomia with overgrowth of the facial muscles

Aim  

To present a case of severe hemifacial microsomia with unusual muscle overgrowth at presentation.     

Prevalence of comorbidities in periodontitis patients compared with the general Austrian population

1 Background

The majority of patients with periodontitis present with comorbidities, however only little is known on prevalence of these comorbidities in comparison with the general population. This study aims to analyze the prevalence and impact of comorbidities in patients with periodontitis in Austria.

2 Methods

Prevalence of comorbidities was evaluated in 1,199 patients with periodontitis (median age: 49, range: 14 to 83 years). These data were compared with a randomly selected age‐ and sex‐matched cohort of the Austrian population by an unconditional logistic regression model.

3 Results

Comorbidities were found in 821 of 1,199 (68.5%) patients. Allergies had the highest prevalence (29.2%), followed by hypertension (19.4%), musculoskeletal (11.2%), and endocrine disorders (9.7%). Chronic pulmonary disorders (no influenza/pneumonia) were associated with a higher approximal plaque index (72% versus 63%, P = 0.02). No association between characteristics of periodontitis and comorbidities was observed. Prevalence of allergies (29.2% versus 22.9%) and pulmonary disorders (8.5% versus 4.3%) was significantly higher in periodontitis patients compared with the Austrian population (P < 0.001), whereas asthma (1.5% versus 5.6%), cardiovascular disorders (1.8% versus 10.5%), depression (7.1% versus 10.4%), headache (1.3% versus 20%), hyperlipidemia (6.4% versus 14.8%), hypertension (14.2% versus 24.5%), musculoskeletal disorders (11.2% versus 41.7%), and osteoporosis (2.8% versus 5.1%) were found less frequently (P < 0.001). No differences were observed for cancer, diabetes mellitus, gastrointestinal disorders, or psychiatric disorders (P = 0.95, P = 0.76, P = 0.68, P = 0.23, respectively).

4 Conclusion

In Austria, the majority of patients with periodontitis present with comorbidities, and the adjusted prevalence differs significantly from the general population.