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JADA Specialty Scan - Radiology
Periodontics - A Quarterly Newsletter on Dental SpecialtiesJADA Specialty Scan

Onset and pattern of progression of peri-implantitis

Peri-implantitis tends to progress in a nonlinear, accelerating pattern, and the onset in most cases takes place within 3 years of function. A team of Swedish researchers noted their findings in a study published in the April issue of Journal of Clinical Periodontology.

The authors noted that while some studies estimated an overall prevalence of peri-implantitis between 14% and 30%, reports from cross-sectional studies showed moderate and severe forms of peri-implantitis occurred in subgroups of 15% to 20% of patients with implants.

For the current study, researchers randomly selected 2,765 patient files from the national registry of the Swedish Social Insurance Agency for 2 age groups (45-54 years and 65-74 years). Each group had received implant-supported restorative therapy in Sweden in 2003. From this group, 596 patients underwent a clinical and radiographic examination that consisted of probing pocket depth and bleeding on probing at 9 years.

Radiographs of all relevant implant sites were taken and compared with baseline radiographs. Peri-implant marginal bone loss was assessed from 1 year after prosthesis connection up to 9 years. Radiographs obtained during the 9 years of follow-up were categorized according to the time of examination and grouped by year from prosthesis delivery.

A total of 62 of 427 patients with available baseline radiographs exhibited moderate to severe peri-implantitis and were included in the study. A total of 126 implants from the 62 participants exhibited moderate to severe peri-implantitis. No additional radiographs beyond baseline and the 9-year examination were available for 21 implants. The final sample consisted of 105 implants from 53 patients.

Researchers modeled bone loss patterns for each patient and calculated the overall mean estimated bone loss with a 95% confidence interval. Scientists then measured the time point of onset of peri-implantitis by calculating the cumulative percentage of implants and patients who had estimated bone loss at each year after prosthesis delivery.

The mean number of radiographic examinations for the 105 implants was 4.1, while the mean (standard deviation) bone loss at the 9-year examination was 3.5 (1.5) millimeters. Bone loss of more than 3 mm occurred in 51% of implants, while 29% lost more than 4 mm.

“Results from this study suggest that the onset of peri-implantitis occurred early, as the majority of subjects (81%) presented with signs of detectable bone loss at year 3,” the authors noted. They also noted that in comparison to periodontitis, peri-implantitis appears to have an earlier onset.

Researchers pointed out that clear data on annual bone loss may be misleading, since patterns of bone loss during progression of the disease is not linear. They also warned that their assessment of peri-implantitis was based solely on radiographic signs of bone loss.

Even so, they observed “the data on onset and pattern of progression of peri-implantitis presented in this study provide novel information to the understanding of the disease.”

Read the original article.


Consulting Editor: Tapan Koticha, BDS
Diplomate, American Board of Periodontology
Assistant Professor, Department of Periodontics,
Clinical Director, Graduate Periodontics
University of Oklahoma Health Sciences Center, College of Dentistry

Periodontists surveyed on peri-implant diseases prevalence, etiology and treatments

Peri-implant diseases are encountered often in periodontal practices, and the lack of a standard protocol requires more research and collaboration for evidence-based answers for the prevalence, etiology, and treatment of peri-implant diseases.

That’s the main result of a survey answered by 280 periodontists nationwide and published in the May issue of the Journal of Periodontology. Most of the of respondents placing implants (96%) reported that the prevalence of peri-implant mucositis and peri-implantitis in their practices is up to 25% and that up to 10% of implants must be removed owing to peri-implantitis.

Researchers designed the 20-question survey with 2 goals in mind: investigate the perceived prevalence and etiology of peri-implant mucositis and peri-implantitis and compare the used treatment methods to manage peri-implant pathology.

The e-mailed survey was sent to 1,800 members of the American Academy of Periodontology. Questions focused on 6 key topics: demographics, information regarding implant placement, prevalence of peri-implant diseases, etiologic factors, treatment methods and effectiveness, and maintenance. Researchers collected data from 280 respondents from June 2012 through February 2013.

The 3 most popular factors of mucositis/peri-implantitis noted by participants were bacterial plaque, adverse loading, and smoking. Other factors noted included a history of periodontitis, retention of subgingival excess deposits of cement, inadequate brand of keratinized tissue around the implant, patients’ systemic health, corrosion of titanium, and improper design of implant-supported restorations.

For the treatment of mucositis, most survey participants reported always or often applying oral hygiene instructions, antimicrobial gel/mouthrinse and nonsurgical debridement. In addition, most participants also reported more frequent use of systemic antibiotics and surgical debridement to treat peri-implantitis. A higher number of respondents preferred to use systemic antibiotics postoperatively to manage mucositis and peri-implantitis compared with preoperatively.

Researchers noted a significant association between years of placing implants and the use of local and systemic antibiotics to manage mucositis. The more years that participants placed implants, the more they tended to use local and systemic antibiotics. The same association held true for the treatment of peri-implantitis.

Overall, just 5% of respondents rated current treatment of peri-implantitis as “very effective,” and over 35% rated peri-implantitis treatment as “little” to “not effective.” A majority (59.6%) considered current management as “moderately effective,” indicating the need for further research into the treatment of peri-implant diseases.

Researchers also noted that the more implants participants placed, the more surgical debridement and systemic antibiotics they tended to use and the less nonsurgical debridement they tended used for the management of mucositis.

Most participants believed that the best maintenance frequency after treatment for peri-implantitis was every 3 months. More than 60% reported that radiographic evaluation must be conducted 6 months after treatment.

The authors also noted that the opinion of periodontists might have changed since data were collected in 2013 and recommended further research.

Read the original article.


AAP Annual Meeting heads to San Diego this September
Register by Aug. 9th and save at least $100
The 102nd Annual Meeting of the American Academy of Periodontology will be held Sept. 10-13, 2016, at the San Diego Convention Center. This meeting will be held in collaboration with the Japanese Society of Periodontology and the Japanese Academy of Clinical Periodontology. Take advantage of early-bird discounts when you register by Aug. 9. For more information, visit perio.org/meetings or e-mail meetings@perio.org.


Detecting undiagnosed diabetes and prediabetes in the dental office

Dentists’ routine measurement of glycated hemoglobin (HbA1c) levels in patients can identify people with undiagnosed diabetes and prediabetes while the disease is in the early stages. People with periodontitis and a body mass index in the overweight or obese categories are relevant targets for diabetes and prediabetes screening.

A group of Danish researchers published their findings in the April issue of Journal of Periodontology.

Researchers noted that more than 200,000 people in the Danish population had undiagnosed type 2 diabetes mellitus (T2DM) and that more than 750,000 had undiagnosed prediabetes. They also observed that since most adults with apparent health problems attend a dental clinic more often than a general physician clinic, dentists were in a good position to screen populations for these conditions.

Participants in the study included 291 people attending the School of Dentistry, University of Copenhagen, Copenhagen, Denmark. A total of 245 people were in the periodontitis group, and 46 were in the nonperiodontitis control group. Participants were 74.9% white, 16.5% Middle Eastern, and 8.6% African, Asian, or Hispanic.

Dental students conducted full-mouth periodontal examinations, excluding third molars, which focused on probing depth, gingival margin position, and bleeding on probing at 6 sites per tooth. Students obtained blood samples using a finger-stick blood sample test. They calculated body mass index using height, weight, and waist circumference.

Researchers identified 9 participants (3.1%) with diabetes, and 79 participants (27.1%) with prediabetes. A total of 157 people (54.0%) were identified as overweight or severely overweight. From this group, 142 were also diagnosed with periodontitis.

Of the 88 patients identified with blood-glucose levels above 39 millimoles per mole, 59 were identified with periodontitis and fat percentages above national guidelines. And 60 of the 88 patients with blood-glucose levels above 39 mmol/mol were identified with periodontitis and body mass index levels above 25 kilograms per square meter.

Researchers observed that the 3.1% of study patients identified with diabetes was in accordance with estimates of 3.6% from the Danish Diabetes Association (DDA). But they noted that the 27.1% of study patients identified with prediabetes was roughly double the 13.6% DDA levels.

The study’s authors also noted that identifying 80 of the 88 patients with undiagnosed diabetes or prediabetes with periodontitis was in line with other studies suggesting patients could be diagnosed for all 3 conditions through a periodontal examination and blood-glucose test.

“These findings suggest that HbA1c screening of individuals seeking dental treatment may be a valuable tool for identification of both DM [diabetes] and prediabetes,” the authors concluded.

Study limitations included the fact that 84% of participants were identified with periodontitis, which was considerably higher than the reported 40% for the general population. Another limitation was that clinical registration was performed by uncalibrated examiners (that is, dental students), which the authors noted, “could possibly result in the overestimation or underestimation of periodontitis.” A significantly higher mean age also was observed in the periodontitis group than the control group. Since the prevalence of periodontitis and diabetes increases with age, some of the differences observed in the study could be a result of age differences between groups.

Read the original article.


Shallow vestibular depth associated with greater peri-implant bone loss

Shallow vestibular depth (VD) could jeopardize the maintenance of soft- and hard-tissue health around dental implants. Inadequate VD may serve as a risk factor for peri-implant disease.

The study, published in the March issue of Journal of Clinical Periodontolgy, was designed to evaluate the association between shallow VD and peri-implant parameters. The team of Israeli researchers hypothesized that shallow VD would be associated with greater pocket depth and higher incidences of peri-implant disease.

For their study, researchers chose 61 patients attending the Department of Periodontology, Rambam Health Care Campus, Haifa, Israel, for supportive periodontal therapy. All were 18 years or older and had at least 1 implant placed at the department with functional restoration that had been in place for a least a year.

Of the 234 dental implants examined, 191 were bone level and 43 were tissue level. Implants were restored by a single crown or by fixed partial denture. The average implant diameter was 3.75 millimeters, and the average length was 11.5 mm.

A single, calibrated examiner recorded all data. VD was measured from the mucosal margin to the point of greatest concavity of the mucosal fold. Radiographic bone level (RBL) was measured on periapical radiographs obtained at implant insertion and at follow-up using the paralleling technique.

Researchers found higher amounts of radiographic peri-implant bone loss in sites with shallow VD.

“Shallow VD may aggravate peri-implant bone loss since it facilitates plaque accumulation, due to inappropriate accessibility for home care and even professional cleaning, which may result in greater inflammation and consequently more bone loss,” the authors noted.

Researchers also noted that patients who were nonstable periodontally exhibited higher peri-implant inflammatory parameters, including PI, GI, PPD, and RAL.

“These results can be attributed to the possible similarity in the pathophysiological characteristics of both periodontal and peri-implant diseases, and their risk profiles,” they wrote.

The authors also observed a positive association between the implants’ years in service with increased PPD, MR, and RAL, which was in agreement with previous studies.

Researchers pointed out 3 potential limitations of their study: the direct effect of vestibular health on peri-implant health could not be assessed owing to the study’s retrospective nature, RBL and shallow VD were measured in 2 different locations (interproximal versus midbuccal), and using 3-dimensional cone-beam computed tomography would more accurately measure the association between the 2 parameters.

Read the original article.

Study: gum disease may increase lung cancer risk

New findings published in the Journal of Periodontology have found that individuals with periodontal disease might be at an increased risk of developing lung cancer.

The report, titled “Periodontal Disease and Incident Lung Cancer Risk: A Meta-Analysis of Cohort Studies,” also notes that study participants who were drinkers, smokers, and had been diagnosed with diabetes—which is an independent risk factor for both lung cancer and periodontal disease—demonstrated a 1.36-fold increase in lung cancer risk.

The data also indicate that women with periodontal disease are more likely than men to develop lung cancer. 

The findings serve as a call to action for all dental professionals to educate their patients about the risk of periodontal disease and thoroughly assess every patient for disease with annual comprehensive periodontal evaluations.

Have your patients seen Gumblr?

As the online destination for Love The Gums You’re With, the AAP’s consumer awareness campaign, Gumblr.org offers various creative and informative assets designed to educate the public on the value of gum health. With interactive quizzes, videos, articles, and an array of periodontal care tips, Gumblr is a fun way for patients to learn why it’s important to love their gums for life. Share it with your patients—Gumblr.org.


ADA brochure motivates perio patients

To encourage periodontal patients to stick with treatment, the ADA offers the patient education brochure, “Periodontal Maintenance: Stay Ahead of Gum Disease.” The brochure explains how regular periodontal cleanings reduce bacteria and help pockets shrink. It features vivid illustrations, reader-friendly text, and before-and-after photos of periodontal treatment.
“Periodontal Maintenance” also touches on the oral-systemic connection and cautions against tobacco use. The 8-panel brochure is available in packs of 50 from the ADA Catalog. To order, call 1-800-947-4746 or go to adacatalog.org. The title is available personalized or in Spanish as well. Readers who use the code 16404E before Aug. 5 can save 15% on all ADA Catalog products.


Available for download: clinical and scientific papers from the AAP
The American Academy of Periodontology has developed a suite of resources to be used as guidelines for dentists dealing with periodontal health issues. These resources include: disease classifications, AAP-commissioned reviews, parameters of care, position papers, consensus papers/clinical recommendations, and Academy statements. View and download these materials by clicking here.


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 third in the series on this topic for 2016. Other Specialty Scan issues are devoted to endodontics, oral pathology, oral and maxillofacial radiology, orthodontics 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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