Periodontics - A Quarterly Newsletter on Dental SpecialtiesJADA Specialty Scan

Predicting peri-implant disease

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Studies from around the world show that peri-implantitis isn’t uncommon. Considering that more than 2 million dental implants are placed annually in the U.S., better understanding of predictive factors for peri-implant disease and implant loss could avert long-term serious oral health and economic consequences.

“Given the possible systemic ramifications of chronic inflammation, it is essential to better understand peri-implant disease prevalence and risk factors so that peri-implant inflammation can be prevented or treated,” said scientists publishing in the March 2015 issue of the Journal of Periodontology. “These peri-implant diseases may lead to discomfort, surgical and nonsurgical treatment and their associated costs, negative effects on systemic health or eventual loss of the implant.”

Aiming to identify predictive factors for peri-implant disease and implant loss, scientists from the University of Washington, in Seattle, and the University of Hong Kong, collected implant placement data records from 96 patients who had received 225 implants between 1998 and 2003. Eight factors from the time of placement were recorded from the patients’ charts, including immediate or delayed placement, bone graft use before or at the time of implant placement, smoking status and health status at the time of placement. Implant status and periodontal status were evaluated at a clinical and radiographic follow-up examination an average of 10.9 years after implant placement.

Researchers hoped to:

Researchers found that one in four patients and one in six implants had peri-implantitis after 11 years. Peri-implantitis was associated with younger ages and diabetes at the time of placement and periodontal status when identified at follow-up. Patients with peri-implantitis were twice as likely to report a problem with an implant as individuals with healthy implants.

Implant failure rates were 8.4% and showed the significant risks were associated with diabetes, immediate placement and larger diameter implants.

“Implant diameter has not been suggested previously as a predictor for implant loss,” authors said. “The possibility was examined that posterior/anterior position could be the factor rather than diameter.” Further investigation showed position was not a significant risk factor. However, the small number of anterior implants prevented a clear separation of the associations with implant outcomes and these two factors, authors added.

Read the original article.


Consulting Editor: Dr. Eros Chaves
Professor and Chair,
Department of Periodontics
University of Oklahoma
Health Sciences Center
College of Dentistry

The Consulting Editor assists in the selection of scientific editorial content but has no connection with any product mentioned or any advertising that appears in this newsletter.

Glycemic control and periodontitis risk

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Scientists examining the association between periodontitis, diabetes mellitus (DM) and glycemic control found that although worse glycemic control means better odds of periodontitis, diabetes status alone was not significantly associated with periodontitis. They published their research in the April 2015 issue of the Journal of Periodontology.

The research suggests that measuring patients’ glycohemoglobin as an objective measure of diabetes severity may more greatly help dentists assess periodontitis risk than awareness of diabetes status alone.

The bidirectional association between periodontal disease and diabetes, including documentation that people with diabetes have an increased risk of developing periodontal disease and that it’s more severe in people with DM is well established. Some studies have indicated that increased severity of periodontal disease negatively affects glycemic control in DM. Periodontal disease treatment has been reported to improve periodontal status, yet the effect of such treatment on improving glycemic control among patients with DM is inconclusive.

Seeking to expand the literature and address knowledge gaps related to periodontitis and glycemic control in DM, the authors conducted their research using a full mouth periodontal examination protocol for periodontitis prevalence estimates, rather than the partial mouth examination protocol often implemented.

Scientists investigated the association between DM and periodontitis using National Health and Nutrition Examination Survey data for 7,042 adults from 2009-2012 and the Centers for Disease Control and Prevention and American Academy of Periodontology definitions to assess total periodontitis. They determined DM status and measured glycohemoglobin to assess glycemic control. Five levels of glycemic control were used to assess severity.

Self-reported DM status was not associated with having periodontitis when glycohemoglobin and other significant demographic covariates were included. However, glycohemoglobin was significantly associated with having periodontitis. Additionally, an 18 percent increase in the odds of having periodontitis was observed at each increasing level of glycohemoglobin.

“In this study, there is a linear relationship between the objectively measured glycohemoglobin level and periodontitis, which demonstrates that the odds of having periodontitis increase as glycohemoglobin levels increase,” authors said.

Read the original article.

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Prescription Perio Trays are innovative tools for periodontal care. They have internal peripheral seals to deliver medication into shallow and deep pockets (>6mm), ideal for patients with generalized pocketing or struggling between maintenance visits. Research shows Perio Tray delivery of 1.7% hydrogen peroxide gel combined with SRP achieves better results than SRP alone. They are comfortable, convenient, easy-to-use. To learn more visit


Trial investigates bone loss

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It’s well recognized that management of chewing forces on implant restorations influences long-term prosthetic success. Studies have shown that splinted implants help to distribute occlusal loads and therefore reduce marginal bone loss.

However, there are distinct advantages to nonsplinted implants. Among them is that only one unit needs to be removed if one is compromised, rather than the entire fixed partial denture. Also, nonsplinted single-tooth restorations on adjacent implants are likely to give the impression of being more individual than those that are splinted.

To compare the marginal bone loss around adjacent splinted implants with nonsplinted implants, scientists in Italy conducted a randomized controlled trial. They published their research in the March/April 2015 issue of The International Journal of Oral & Maxillofacial Implants.

Consecutive patients in 2002 and 2003 who received three adjacent implants in a private office setting and in the Implantology Department at the University of Padua, Italy, were enrolled. Maxillary left implants were restored with splinted cemented restorations and maxillary right implants were restored with nonsplinted cemented restorations. Scientists measured marginal bone loss with intraoral radiographs each year over a period of ten years after placement of abutments and restorations. Of an initial 132 implants placed in 44 patients, 114 implants in 38 patients were eligible for study at the 10-year follow-up.

Results showed that the same amount of difference in bone loss at the five-year mark was maintained at the ten-year follow-up and that the bone level changes around the nonsplinted implants was comparable to that around the splinted implants. Although the statistical analysis found a significant difference between the two groups (0.1 millimeter), the authors concluded the difference was not clinically meaningful 10 years after implant insertion.

“Nonsplinted implant restorations can be a better treatment option when superior esthetics is essential,” authors said.

Read the original article.


A practical approach to periodontal regeneration

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A team of scientists from across the U.S. outlined a decision tree approach to therapeutic options for intrabony defects caused by periodontitis. It is published in the February 2015 issue of Clinical Advances in Periodontics.

Clinical attachment loss and formation of bony deformities is characteristic of periodontitis. Randomized controlled studies have documented the potential to achieve periodontal regeneration in intrabony defects using a variety of regenerative therapies. However, the predictability of periodontal regeneration is influenced by multiple factors related to patient behavior, surgical approach and defect site. Therefore, considering these factors is important in treatment planning and selecting a regenerative approach.

Authors created a treatment approach by considering site evaluation, patient-related factors, technical factors and source of regenerative tissues. Illustrative site-related clinical scenarios are included.

“Multiple factors must be considered in the selection of regenerative therapy for the management of intrabony defects,” authors said. “In general, with increasing loss of proximity, height and number of remaining bony walls, the selection of a regenerative approach must help address the need for architectural support, vascular ingrowth, cellular recruitment and clot stabilization. Systemic and behavioral factors, such as compliance and cigarette smoking, which can adversely affect wound healing, should also be considered when treatment planning regenerative therapy.”

Read the original article.

Good for your mom, good for your patients

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What do you do when your mother refuses the periodontal surgery you recommend? Dr. Duane Keller faced this dilemma when his mom insisted he find a noninvasive treatment for her. Answering her plea wasn’t easy. Getting and keeping medication deep in the pockets was challenging. Dr. Keller experimented with tufted floss, special brushes to deliver medications, syringes and irrigation systems. These attempts provided short-term results, but they weren’t easy enough for most patients to use.

With time he developed a simpler solution: a tray with an internal peripheral seal and extensions that could be customized for individual conditions and easily used by patients. Dr. Keller initially prescribed antibiotics for tray delivery. Like most doctors, he had been taught that antibiotics fight bacterial infections, but, curiously, the best results came when a low concentration of peroxide gel was delivered in the tray.

These observations led him back to the science, and he consulted microbiologist Bill Costerton to clarify the results. Hydrogen peroxide works well because it is one of three substances that can debride the matrix covering a biofilm (bromine and chlorine are the other two) and also dissolve the most exposed bacterial cells. In addition, peroxide oxygenates the microenvironment of the pocket, putting biofilm regrowth on the defensive. With tray applications of peroxide in 10- to 15-minute increments, biofilms decrease and inflammation subsides.

Clinical trials have proven the merits of this adjunctive tray approach. Patients in the test groups who used Perio Tray delivery with SRP achieve better bleeding and pocket depth reductions than patients receiving SRP alone. See for the clinical trial and microbiological data.

Your patients can benefit, too. Attend a Perio Protect training and you’ll be ready to write your first script. For more information call 877-434-4867 or visit Patients appreciate Perio Trays. You will, too.


AAP Spring Conference 2015

Join your colleagues at the crossroads of periodontology and technology this spring!

The 2015 AAP Spring Conference, Embracing Technology to Enhance Your Clinical Practice, offers a 360-degree look at how technology is changing traditional collaborative dentistry, including 3D imaging, lasers, regeneration, electronic health records, social media and the Internet.

Taking place May 2-3 at the Hilton Chicago, this interactive and educational 1½ day conference will help you to:

For additional details or to register visit


Get patients on board with SRP

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For patients to accept periodontal therapy—and follow through with it—they may need extra motivation. A recently updated brochure from the ADA reinforces the doctor’s recommendations and explains SRP benefits.

“Scaling and Root Planing: A Treatment for Gum Disease” tells patients that tooth loss is a possible but avoidable result of gum disease. The 8-page brochure explains how disease is diagnosed with probing and x-rays and includes photos and illustrations showing stages of disease. The brochure also describes SRP, post-treatment care, and hygiene considerations.

“Scaling and Root Planing” is sold in packs of 50. Brochure interior can be viewed here. Personalized and Spanish versions are also available. To order, call 1-800- 947-4746 or go to Readers who use the code 15408E before April 30 can save 15 percent on all ADA Catalog products.

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$299 Online Personalized Training
Perio Protect Personalized Training reviews the science behind prescription Perio Tray delivery, case study presentations, and treatment protocols.  This 90 minute training is conducted via and can be scheduled Monday through Friday from 9AM to 5PM Central.  This one-on-one option allows you to ask questions so your team feels comfortable incorporating periodontal medicament carriers into your treatment protocol.


What is Specialty Scan?

This is one in a series of quarterly newsletters updating dentists on selected specialties in dentistry. Information presented is aggregated and summarized from previously published materials, each item attributed to its publication of origin. This issue of JADA Specialty Scan focuses on Periodontics, the second in the series on this topic for 2015. Other Specialty Scan issues are devoted to endodontics, oral and maxillofacial pathology, oral and maxillofacial radiology, orthodontics, pediatric dentistry and prosthodontics. The ADA has engaged the specialty organizations in these areas as well as its own Science Institute and Division of Legal Affairs to assist with these newsletters. We welcome feedback on this and all Specialty Scan issues.

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Any statements of opinion or fact are those of the authors and do not necessarily reflect the views of the American Dental Association. Neither the ADA nor any of its subsidiaries have any financial interest in any products mentioned in this publication. Any reference to a product or service, whether in advertisements or otherwise, is not intended as an endorsement or as approval by the ADA or any of its affiliated organizations unless accompanied by an authorized statement that such approval or endorsement has been granted.

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