Skip to main content
e-mail Print Share
JADA Specialty Scan - Radiology
Periodontics - A Quarterly Newsletter on Dental SpecialtiesJADA Specialty Scan

Toothbrushing behaviors and periodontal pocketing

A clear dose-response relationship exists between toothbrushing habits and changes in periodontal pocketing, according to a study published online December 13 in Journal of Clinical Periodontology.

Researchers designed the epidemiologic study to assess the association between self-reported toothbrushing behaviors and changes in periodontal pocketing among Finnish adults over 11 years.

Researchers used data from 2 national surveys in Finland (Health 2000 and Health 2011) conducted by that country’s National Institute of Health and Welfare. The study sample included 1,025 dentate adults who completed evaluations at both baseline and follow-up. Researchers created a cumulative measure of regular toothbrushing by counting how often participants reported brushing twice or more daily across the 2 surveys. The measure ranged from 0 to 2; 0 for those who did not report brushing twice or more daily in either survey, 1 for those who reported brushing twice per day either at baseline or follow-up, and 2 for those who reported brushing twice or more per day in both surveys.

The study’s authors determined periodontal status by measuring periodontal pocket depth (PPD) on 4 sites per tooth (distal, mesial, midbuccal, and midlingual), excluding third molars and tooth remnants. Authors considered all teeth with PPD of 4 millimeters or greater at any site as having periodontal pockets. They calculated the change in the number of teeth with pocketing of 4 mm or greater over 11 years by subtracting the number of teeth with pocketing at follow-up from the corresponding figure at baseline.

Brushing twice or more per day was more commonly reported among women, more educated adults, nonsmokers, and those who visited the dentist regularly for check-ups in both the baseline and follow-up surveys. The increment in number of teeth with PPD of 4 mm or greater was significantly larger in men, younger adults, daily smokers, and those who visited the dentist only for emergency treatment.

Researchers found that participants who reported brushing twice or more per day in both surveys had 1.96 (95% confidence interval, 0.98 to 2.93) fewer teeth developing PPD of 4 mm or greater over 11 years than those who did not report this level of brushing in either survey, indicating a cumulative effect of regular toothbrushing on the prevention of disease.

Adults having no teeth with PPD 4mm or greater at baseline were least affected by brushing behavior. Adults with an average of 4-10 teeth affected at baseline exhibited an inverse relationship between tooth-brushing behavior and the change in number of teeth with PPD of 4mm or greater.

The authors concluded that this study “showed a clear dose–response association between toothbrushing behavior and change in periodontal pocketing among Finnish adults. Regular toothbrushing, that is twice or more every day, can help prevent periodontal disease.”

Read the original article here.


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

Restoration contour is a risk indicator for peri-implantitis

A restoration emergence angle of more than 30 degrees on at least 1 proximal surface is a significant risk factor for peri-implantitis in bone-level implants, and a convex profile creates an additional risk, researchers report in a study published online December 5 in Journal of Clinical Periodontology.

Researchers designed the study to compare healthy implants with those with peri-implantitis to determine whether emergence angle and profile were associated with the prevalence of peri-implantitis.

Researchers analyzed a data set consisting of 96 patients (48 men and 48 women aged 34-86 years; mean [standard deviation {SD}] age, 67.6 [10.6] years) with 225 implants. Patients had implants placed in a university setting between 1998 and 2003 and had radiographs obtained after the initial remodeling. New implant radiographs were obtained at the follow-up examination.

Authors defined peri-implantitis as the presence of bleeding on probing, suppuration, or both with 2 millimeters of noticeable bone loss after initial remodeling and a probing depth of 4 mm or greater. Researchers divided all implants into bone-level and tissue-level groups, depending on the location of the implant platforms. The bone-level group included 101 implants placed in 59 patients. The tissue-level group included 67 implants placed in 27 patients. A total of 83 patients with 168 implants met the inclusion criteria.

Authors calculated the emergence angle as the angle between the implant long axis and a line tangent to the restoration. For the implants in the bone-level group, the authors assessed the emergence angle and profile from the platform at the marginal bone level. They assessed the emergence angle and profile for implants in the tissue-level group only above the platform at the tissue level.

Researchers categorized implant depth for the bone-level group as supracrestal, crestal, and subcrestal on each mesial and distal aspect using radiographs at the implant placement. They used generalized estimating equations to measure associations between peri-implantitis and emergence angle and profile.

The implant-level prevalence of peri-implantitis was 22.8% in the bone-level group and 7.5% in the tissue-level group. In the bone-level group, the mean (SD)emergence angle was 27.8 (11.6) degrees on the mesial surface and 25.1 (10.3) degrees on the distal surface. In the tissue-level group, the mean (SD)emergence angle was 28.6 (14.4) degrees on the mesial surface and 28.3 (13.3) degrees on the distal surface.

In the bone-level group, researchers found the convex profile on 35.6% of the mesial surfaces and 39.6% of the distal surfaces. In tissue-level group, researchers found the convex profile on 35.8% of the mesial surfaces and 38.8% of the distal surfaces. Researchers found no statistically significant difference in the distribution of the convex profile either within a group or between groups. Emergence angles tended to be larger for convex profiles (mean [SD], 37.5 [11.7]) compared with straight or concave profiles (mean [SD], 26.7 [8.9]), a pattern similar for bone and tissue-level implants.

In the bone-level group, the risk of peri-implantitis was significantly greater when the emergence angle was more than 30 degrees (31.3%) compared with an angle of 30 degrees or less (15.1%) (P = .04). The emergence angle was not associated with peri-implantitis in the tissue-level group.

Researchers also found an association between peri-implantitis and emergence angle as a continuous variable in the bone-level group but not in the tissue-level group.

In the bone-level group, the prevalence of peri-implantitis was 28.8% with a convex profile compared with 16.3% with a straight or concave profile. The difference was not statistically significant, and the emergence profile was not associated with peri-implantitis in the tissue-level group.

An interaction plot for the bone-level group showed that a 37.8% rate of peri-implantitis occurred when a convex profile was combined with a restoration emergence angle of more than 30 degrees. Regression analysis found a statistically significant interaction between the restoration emergence angle and emergence profile. Researchers found no evidence of a combined effect of restoration emergence angle and emergence profile on the rate of peri-implantitis for the tissue-level group.

Read the original article here.


Meet us in Vancouver this year
Early-bird registration is now open for the 104th AAP Annual Meeting in Vancouver, British Columbia.

Over 2,500 attendees are expected to make their way to Vancouver to take in the sights, experience innovative continuing education sessions led by world-class speakers, and mingle with periodontal professionals from around the world. For more information, visit or e-mail


Different probing depths and differences in microbial profiles

Microbial profiles of shallow pockets (3mm or less) exhibited striking differences from those of moderate (4-6mm)/deep (7mm or more) sites in patients with chronic periodontitis (ChP). Profiles of shallow sites also differed in patients with ChP and those exhibiting periodontal health (PH). The findings are from a study published online December 1 in Journal of Clinical Periodontology.

Authors designed the study with a 2-fold purpose. The first was to characterize the subgingival microbiota of shallow, moderate, and deep sites in participants with ChP by comparing plaque samples from sites with different probing depths (PD), and the second was to compare subgingival microbial profiles of participants with ChP and periodontal health (PH) and of the shallow sites in participants with ChP and PH.

The authors collected subgingival biofilm samples from 7 participants with PH and 9 participants with ChP. After removing supragingival biofilm, the authors collected 4 subgingival samples from sites with PD and clinical attachment level of 3 millimeters or less without bleeding on probing from each PH participant. They collected 9 samples (3 per PD category) from each participant with ChP from sites in each of the following categories: shallow (PD ≤ 3 mm), moderate (PD 4- 6 mm), and deep (PD ≥ 7 mm). Samples were subjected to 16S rDNA high-throughput sequencing and the analysis was made using mothur and R packages.

The study found that Spirochaetes, Fusobacterium and Chloroflexi may be implicated in the initial dysbiosis process of periodontal destruction due to their abundance in shallow sites of ChP subjects as compared to PH subjects. This also indicated that clinically healthy (shallow) sites in ChP subjects may exhibit a microbial profile more related to disease than those in PH subjects. Species most associated with disease included previously known pathogens (Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia and Treponemasocranskii) and newly identified putative periodontal pathogens (Filifactor alocis, Fretibacterium fastidiosum, Johnsonella sp HOT166, Peptostreptococcaceae[XIII][G-1] sp HOT113, Porphyromonas endodontalis and Treponema sp. HOT258); all of them anaerobes, with the exception of HOT113.

Authors also found that the abundance of species-level phylotypes Corynebacterium durum, Corynebacterium matruchotii, unclassified Neisseria, and Streptococcus was higher in PH participants than in ChP participants and in shallow rather than moderate or deep sites of the participants with the disease.

Read the original article here.


Study tracks cases of peri-implant mucositis, peri-implantitis after 2 decades

The lack of peri-implant mucositis over time is predictive of future healthy implant conditions, but a peri-implant mucositis diagnosis may not suggest a future diagnosis of peri-implantitis. The findings are from a study published online November 29 in Journal of Clinical Periodontology.

The authors designed the study to assess peri-implant diseases after 20 through 26 years of implants regarding function at the patient level and to assess risk factors for the development of peri-implantitis.

The longitudinal study examined 294 patients treated with titanium dental implants from 1988 through 1992. The authors divided examination dates into 3 categories: examination I (1 and 5 years after implant placement), examination II (9-14 years after implant placement, 218 patients), and examination III (21-26 years after implant placement, 86 patients).

The authors diagnosed periodontitis based on radiographic evidence of bone loss of 4 millimeters or greater in 30% or more of remaining teeth. Patients who received a diagnosis of peri-implantitis either before or at examination II received surgical intervention. At examination II, the authors obtained dental radiographs using the long-cone technique. Threads not supported by bone were counted at the mesial and distal aspect of each implant.

Among the 12 patients who received surgical treatment for peri-implantitis, 22 of 67 (32.8%) implants experienced more bone loss (≥ 2 threads), while 10.8% of implants developed bone loss between examinations II and III. Bone level gain of 2 or more threads occurred in 9.9% of the implants.

The authors also evaluated bone loss that occurred from 9 through 14 years and after 20 through 26 years. They diagnosed peri-implant mucositis based on the presence of bleeding on probing, suppuration, or both without any evidence of bone loss.

At examination III, 50 of the 86 patients (58.1%) who showed no evidence of bone loss at examination II received a diagnosis of peri-implant mucositis.

Also at examination III, 5 of the 23 patients (21.7%) with no diagnosis of peri-mucositis or peri-implantitis at examination II received a diagnosis of peri-implantitis. The prevalence of peri-implantitis in relation to examination I was 19 patients (22.1%) at examination III.

Among the 13 of 86 patients treated for peri-implantitis between examinations II and III, 6 still had 3 or more threads exposed as assessed from radiographs and bleeding on probing or pus. In 3 of 13 patients treated for peri-implantitis after examination II, the authors defined recurrence of peri-implantitis as an additional bone loss of 3 or more threads combined with bleeding on probing or pus.

“These data highlight the importance to communicate to the clinicians that there is a potential for further improvement of the results following implant therapy,” the authors concluded. “The supportive care must, therefore, concentrate on the treatment of peri-implant mucositis and to improve the patient’s daily oral hygiene measures.”

Read the original article here.

AAP publishes proceedings from best evidence consensus meeting on CBCT

The American Academy of Periodontology (AAP) recently published its first-ever “best evidence consensus” (BEC) proceedings on the topic of cone-beam computed tomography (CBCT). The proceedings are the result of the AAP’s inaugural BEC meeting, a model of scientific inquiry rooted in the best available published research and expert opinion.
The panel of more than 10 periodontists who participated in the BEC meeting determined that CBCT has diverse applications for both dental implant therapy and periodontal-orthodontic therapy and should be used when the benefit to the patient outweighs the risk. The use of CBCT in dental implant and periodontal-orthodontic cases can not only assist in planning a safer approach to treatment, but also facilitate interdisciplinary communication. For patients with periodontitis, 2D full-mouth radiographs combined with clinical probing remain the gold standard; however, CBCT may be beneficial in certain advanced cases. Click here to read the report in the Journal of Periodontology.

AAP, European Federation of Periodontology host World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions

On Nov. 9-11, 2017, more than 100 international researchers, educators, and clinicians gathered in Chicago to review the latest literature and come to consensus on up-to-date guidelines for periodontal and peri-implant disease diagnosis and definition. Participants at the event deliberated diagnostic considerations for a number of topic areas, including peri-implant disease and conditions—a first, accommodating for what scientists and practitioners have come to understand about implant dentistry.

Click here to read more


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.


JADA+ Specialty Scans and JADA+ Scans

JADA+ Specialty Scans and JADA+ Scans are quarterly newsletters updating dentists on the latest research in selected specialties and disciplines in dentistry. ADA Publishing and the consulting editors from the represented specialties and disciplines aggregate and summarize research from previously published materials, each item attributed to its publication of origin. JADA+ Scan specialties and disciplines include endodontics, oral pathology, orthodontics, pediatric dentistry, periodontics, prosthodontics, radiology, cosmetic/esthetic and osseointegration. 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. View past issues here.

Editorial and Advertising Policies

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.

All matters pertaining to advertising should be addressed to the advertising sales manager, Sales and Marketing Department, American Dental Association, Publishing Division, 211 E. Chicago Ave., Chicago, Ill 60611, 1-312-440-2740, fax 1-312-440-2550. All advertising appearing in ADA publications must comply with official published standards of the American Dental Association, a copy of which is available on request.