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1.
  • Bazzani, Davide, et al. (författare)
  • Favorable subgingival plaque microbiome shifts are associated with clinical treatment for peri-implant diseases
  • 2024
  • Ingår i: NPJ BIOFILMS AND MICROBIOMES. - 2055-5008. ; 10:1
  • Tidskriftsartikel (refereegranskat)abstract
    • We performed a longitudinal shotgun metagenomic investigation of the plaque microbiome associated with peri-implant diseases in a cohort of 91 subjects with 320 quality-controlled metagenomes. Through recently improved taxonomic profiling methods, we identified the most discriminative species between healthy and diseased subjects at baseline, evaluated their change over time, and provided evidence that clinical treatment had a positive effect on plaque microbiome composition in patients affected by mucositis and peri-implantitis.
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2.
  • Berglundh, Tord, 1954, et al. (författare)
  • Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions
  • 2018
  • Ingår i: J Clin Periodontol. - : Wiley. - 0303-6979 .- 1600-051X. ; 45
  • Tidskriftsartikel (refereegranskat)abstract
    • A classification for peri-implant diseases and conditions was presented. Focused questions on the characteristics of peri-implant health, peri-implant mucositis, peri-implantitis, and soft- and hard-tissue deficiencies were addressed. Peri-implant health is characterized by the absence of erythema, bleeding on probing, swelling, and suppuration. It is not possible to define a range of probing depths compatible with health; Peri-implant health can exist around implants with reduced bone support. The main clinical characteristic of peri-implant mucositis is bleeding on gentle probing. Erythema, swelling, and/or suppuration may also be present. An increase in probing depth is often observed in the presence of peri-implant mucositis due to swelling or decrease in probing resistance. There is strong evidence from animal and human experimental studies that plaque is the etiological factor for peri-implant mucositis. Peri-implantitis is a plaque-associated pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant mucosa and subsequent progressive loss of supporting bone. Peri-implantitis sites exhibit clinical signs of inflammation, bleeding on probing, and/or suppuration, increased probing depths and/or recession of the mucosal margin in addition to radiographic bone loss. The evidence is equivocal regarding the effect of keratinized mucosa on the long-term health of the peri-implant tissue. It appears, however, that keratinized mucosa may have advantages regarding patient comfort and ease of plaque removal. Case definitions in day-to-day clinical practice and in epidemiological or disease-surveillance studies for peri-implant health, peri-implant mucositis, and peri-implantitis were introduced. The proposed case definitions should be viewed within the context that there is no generic implant and that there are numerous implant designs with different surface characteristics, surgical and loading protocols. It is recommended that the clinician obtain baseline radiographic and probing measurements following the completion of the implant-supported prosthesis.
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3.
  • Berglundh, Tord, 1954, et al. (författare)
  • Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions
  • 2018
  • Ingår i: Journal of Periodontology. - : Wiley. - 0022-3492. ; 89
  • Tidskriftsartikel (refereegranskat)abstract
    • A classification for peri-implant diseases and conditions was presented. Focused questions on the characteristics of peri-implant health, peri-implant mucositis, peri-implantitis, and soft- and hard-tissue deficiencies were addressed. Peri-implant health is characterized by the absence of erythema, bleeding on probing, swelling, and suppuration. It is not possible to define a range of probing depths compatible with health; Peri-implant health can exist around implants with reduced bone support. The main clinical characteristic of peri-implant mucositis is bleeding on gentle probing. Erythema, swelling, and/or suppuration may also be present. An increase in probing depth is often observed in the presence of peri-implant mucositis due to swelling or decrease in probing resistance. There is strong evidence from animal and human experimental studies that plaque is the etiological factor for peri-implant mucositis. Peri-implantitis is a plaque-associated pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant mucosa and subsequent progressive loss of supporting bone. Peri-implantitis sites exhibit clinical signs of inflammation, bleeding on probing, and/or suppuration, increased probing depths and/or recession of the mucosal margin in addition to radiographic bone loss. The evidence is equivocal regarding the effect of keratinized mucosa on the long-term health of the peri-implant tissue. It appears, however, that keratinized mucosa may have advantages regarding patient comfort and ease of plaque removal. Case definitions in day-to-day clinical practice and in epidemiological or disease-surveillance studies for peri-implant health, peri-implant mucositis, and peri-implantitis were introduced. The proposed case definitions should be viewed within the context that there is no generic implant and that there are numerous implant designs with different surface characteristics, surgical and loading protocols. It is recommended that the clinician obtain baseline radiographic and probing measurements following the completion of the implant-supported prosthesis.
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4.
  • Bressan, E., et al. (författare)
  • Experimental and computational investigation of Morse taper conometric system reliability for the definition of fixed connections between dental implants and prostheses
  • 2014
  • Ingår i: Proceedings of the Institution of Mechanical Engineers Part H-Journal of Engineering in Medicine. - : SAGE Publications. - 0954-4119 .- 2041-3033. ; 228:7, s. 674-681
  • Tidskriftsartikel (refereegranskat)abstract
    • Nowadays, dental implantology is a reliable technique for treatment of partially and completely edentulous patients. The achievement of stable dentition is ensured by implant-supported fixed dental prostheses. Morse taper conometric system may provide fixed retention between implants and dental prostheses. The aim of this study was to investigate retentive performance and mechanical strength of a Morse taper conometric system used as implant-supported fixed dental prostheses retention. Experimental and finite element investigations were performed. Experimental tests were achieved on a specific abutment-coping system, accounting for both cemented and non-cemented situations. The results from the experimental activities were processed to identify the mechanical behavior of the coping-abutment interface. Finally, the achieved information was applied to develop reliable finite element models of different abutment-coping systems. The analyses were developed accounting for different geometrical conformations of the abutment-coping system, such as different taper angle. The results showed that activation process, occurred through a suitable insertion force, could provide retentive performances equal to a cemented system without compromising the mechanical functionality of the system. These findings suggest that Morse taper conometrical system can provide a fixed connection between implants and dental prostheses if proper insertion force is applied. Activation process does not compromise the mechanical functionality of the system.
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5.
  • Bressan, Eriberto, et al. (författare)
  • Implant-supported mandibular overdentures: a cross-sectional study
  • 2012
  • Ingår i: Clinical Oral Implants Research. - : Wiley. - 0905-7161. ; 23:7, s. 814-819
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: The aim of this cross-sectional study was to determine the clinical outcome and patient satisfaction in subjects treated with mandibular overdentures supported by two implants. Material and methods: One hundred and fifty-nine patients, who received restorative therapy in the edentulous mandible consisting of a bar-retained overdenture supported by two osseointegrated implants in a private clinic in Italy, were recalled for a clinical and radiographic examination. One hundred and forty-one subjects with 280 implants attended the examination. The average follow-up time was 3.9 years. The radiographic examination included assessments of the distance between the implant margin and the most coronal position of bone-to-implant contact at the mesial and distal aspects of each implant. A questionnaire regarding comfort, satisfaction with the treatment, aesthetics, speaking capacity and efficiency in chewing was obtained from each subject. Biological and technical complications were recorded and the number of visits due to complications between the delivery of the prostheses and the re-examination was determined. Results: The results from the examination revealed that the number of lost implants was small and the average marginal bone level around the implants was 0.67 mm apical of the implant margin. The most frequently observed complication was hyperplasia of the mucosal tissue under the bar construction. Few patients experienced loosening of retention. The vast majority of patients reported to be satisfied in relation to the restorative therapy from both functional and aesthetic points of view. Conclusion: Patients with edentulous mandibles may be successfully rehabilitated by means of two implants supporting a bar-retained overdenture.
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6.
  • Bressan, E., et al. (författare)
  • Influence of soft tissue thickness on marginal bone level around dental implants: A systematic review with meta-analysis and trial-sequential analysis
  • 2023
  • Ingår i: Clinical Oral Implants Research. - : Wiley. - 0905-7161 .- 1600-0501. ; 34:5, s. 405-414
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectivesThe aim of the present review and meta-analysis was to evaluate the influence of soft tissue thickness on initial bone remodeling after implant installation. Materials and MethodsA literature search was conducted by two independent reviewers on electronic databases up to May 2022. Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) performed on human subjects were included. The risk of bias was evaluated using Cochrane Collaboration's tool. Meta-analysis and Trial Sequential Analysis (TSA) were performed on the selected articles. The primary outcome was marginal bone loss. ResultsAfter screening, 6 studies were included in the final analysis, with a total of 354 implants, and a follow-up from 10 to 14 months. 194 implants were placed in a >= 2 mm soft tissue thickness, while 160 had <2 mm soft tissue thickness before implant placement. The included studies had a high level of heterogeneity (I-2 > 50%). The meta-analysis indicated a statistically significant difference between the two groups (0.54; p = .027) and the TSA analysis confirmed the results, despite the limited number of dental implants. Additional analysis showed that age and follow-up parameters were not statistically significant factors influencing the bone loss (p = .22 and p = .16, respectively). ConclusionsBased on the available RCTS and CCTs, initial soft tissue thickness seems to influence marginal bone loss after a short follow-up period. Based on TSA analysis, further studies are needed to assess the influence of the soft tissue thickness on marginal bone loss.PROSPERO registration number: CRD42021235324.
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7.
  • Bressan, E., et al. (författare)
  • Microbial Leakage at Morse Taper Conometric Prosthetic Connection: An In Vitro Investigation
  • 2017
  • Ingår i: Implant Dentistry. - : Ovid Technologies (Wolters Kluwer Health). - 1056-6163. ; 26:5, s. 756-761
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To evaluate in vitro the sealing capability at the prosthetic connection interface of 2 conometric systems. Materials and Methods: Two conometric systems with the same design and different material were used, for a total of 24 samples. Each sample was assembled by a tapered abutment and respective coping. In group A, the copings were made of gold, whereas in group B they were made of PEEK. Three mu L of mix bacterial suspension (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Fusobacterium nucleatum species) was inoculated into the abutment screw hole, and the coping was inserted on the abutment. Samples were immersed into culture tubes and incubated for 24, 48, and 72 hours into anaerobic conditions. Visual evaluation of turbidity was performed at each time point. Qualitative-quantitative assessment using real-time polymerase chain reaction was performed at 72 hours. Any difference between the groups was checked by means of Fisher exact test. Results: Microbial leakage occurred in both groups, and there was no statistically significant difference between groups. Microbial concentration resulted in a presence inferior to 1 x 10(2) copies/mu L in all positive assemblies. Conclusions: Because of the low bacterial count, it can be concluded that a minimal bacterial infiltration may be allowed by conometric interfaces for prosthetic connection.
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8.
  • Bressan, E. O., et al. (författare)
  • Five-year prospective study on conometric retention for complete fixed prostheses
  • 2019
  • Ingår i: European Journal of Oral Implantology. - 1756-2406. ; 12:1, s. 105-113
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: To evaluate the reliability of a conometric system for fixed retention of complete prostheses (CPs) on four implants after 5 years of function. Materials and methods: Twenty-five patients with a completely edentulous mandible received four implants supporting a CP. A total of 100 implants were immediately loaded with CPs on conometric abutments. A follow-up of 5 years was observed for each patient. Outcome measures were prosthesis and implant success, complications, probing pocket depth changes, marginal bleeding and plaque changes, and patient satisfaction. Results: One patient dropped-out. In total, 96 implants supporting the 24 CPs completed the follow-up examination at 5 years. No implant failed. Two framework fractures occurred after 4 and 5 years of function. No loss of retention was recorded for the CPs. Mucositis was recorded for two implants after 1 year of prostheses function for two patients, for one implant after 3 years and for two implants after 4 years in different patients and successfully treated with interceptive supportive therapy. No significant differences were found between Plaque Index (P1) at baseline and after 2 years (P = 1.0); similar findings were calculated between P1 at baseline and after 5 years (P = 0.6) of function. At baseline, after 2 and after 5 years, respectively, 69%, 64% and 56% of implants showed a P1 of 0; 31%, 36% and 44% of implants showed a P1 between 1 and 3. Modify Bleeding Index (MBI) was not significantly different both between baseline and after 2 years of function (P = 1.0) and between baseline and 5 years of function (P = 0.5). At baseline, after 2 and after 5 years, respectively, 69%, 65% and 61% of implants showed a MBI of 0; 27%, 28% and 29% of implants showed a MBI of 1; and 4%, 7% and 10% of implants showed a MBI of 2. The mean probing pocket depth was 1.2 +/- 0.4 mm at baseline, 1.2 +/- 0.4 mm after 2 years and 1.4 +/- 0.5 mm after 5 years of function. The differences were not statistically significant between baseline and 2 years (P = 1.0) and between baseline and 5 years (P = 0.1). From the patient satisfaction questionnaire, 85% percent of patients were satisfied from both aesthetic and functional points of view after 5 years of conometric prostheses function. Conclusions: The present implant-supported conometric retention system can be used to give fixed retention to a CP supported by four implants. An adequate metal framework should be provided to the definitive restoration in order to avoid fractures in the long term.
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9.
  • Bressan, E., et al. (författare)
  • Ridge Dimensions of the Edentulous Mandible in Posterior Sextants: An Observational Study on Cone Beam Computed Tomography Radiographs
  • 2017
  • Ingår i: Implant Dentistry. - : Ovid Technologies (Wolters Kluwer Health). - 1056-6163. ; 26:1, s. 66-72
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims: To evaluate the ridge dimensions of posterior sextant in totally edentulous mandibles. Material and Methods: Cone beam computed tomography scans of 136 patients were retrospectively included for analysis. At sites corresponding to the second premolar (site a) and the mesial and distal root of first molar (sites b and c, respectively), bone height (BH) and bone width (BW) were measured. Results: BH significantly decreased from site a (11.20 +/- 4.03 mm) to site c (10.28 +/- 3.33 mm). Males showed a significantly higher BH compared with females at all sites (P < 0.001), No signifi- cant impact of age on BH was found. BW increased from coronal to apical at all sites. At all height levels, BW increased from mesial to distal (BWc. BWb. BWa). Conclusions: BH decreased from mesial to distal, whereas BW showed an increase. Sex showed a significant impact on BH, with males having on average a 2.8 mm greater height than females, but not on BW. Age did not significantly influence the dimensions of the residual bone crest.
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10.
  • Brunello, G., et al. (författare)
  • Patients' perceptions of implant therapy and maintenance: A questionnaire-based survey
  • 2020
  • Ingår i: Clinical Oral Implants Research. - : Wiley. - 0905-7161 .- 1600-0501. ; 31:10, s. 917-927
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives To evaluate patients' perceptions regarding implant treatment and maintenance. Material and methods A semi-structured questionnaire was developed focusing on 4 main domains: (a) information regarding possible complications received before implant therapy; (b) information received after treatment regarding maintenance; (c) self-performed daily home care; and (d) implant maintenance received at the dental office. Adult patients, restored with implant-supported prosthesis by at least 6 months, were recruited between June 2016 and December 2017. Results The study population consisted of 522 patients with a mean age of 61 years. The majority of the participants referred to have received information about the need of periodical check-ups (91.6%). However, only 58.9% declared to have been informed about complications and failures before treatment commencement. Even though 91.2% of the participants declared to have received instruction about cleaning measures around implants, less than half of the sample reported to have been asked to try the cleaning tools at the office (40.4%). Even though patients' awareness about implant treatment and maintenance resulted to be low in a consistent part of the sample, patients' satisfaction level about information received regarding implant care was high (Visual Analogue Scale 8.18). Conclusions Most patients appeared to be informed about the importance of specific oral hygiene measurements and recall programs. However, an unsatisfactory level of knowledge about implant-related complications was evidenced. Improvements in time and energy employed by dentists and hygienist in communication with patients are needed, in order to enhance health outcomes and compliance both to the treatment and to the maintenance.
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11.
  • Derks, Jan, 1977, et al. (författare)
  • Effectiveness of implant therapy analyzed in a Swedish population: Early and late implant loss
  • 2015
  • Ingår i: Journal of Dental Research. - : SAGE Publications. - 0022-0345 .- 1544-0591. ; 94
  • Tidskriftsartikel (refereegranskat)abstract
    • Treatment outcomes in implant dentistry have been mainly assessed as implant survival rates in small, selected patient groups of specialist or university clinical settings. This study reports on loss of dental implants assessed in a large and randomly selected patient sample. The results were aimed at representing evaluation of effectiveness of implant dentistry. Using the national data register of the Swedish Social Insurance Agency, 4,716 patients were randomly selected. All had been provided with implant-supported restorative therapy in 2003. Patient files of 2,765 patients (11,311 implants) were collected from more than 800 clinicians. Information on patients, treatment procedures, and outcomes related to the implant-supported restorative therapy was extracted from the files. In total, 596 of the 2,765 subjects, provided with 2,367 implants, attended a clinical examination 9 y after therapy. Implant loss that occurred prior to connection of the supraconstruction was scored as an early implant loss, while later occurring loss was considered late implant loss. Early implant loss occurred in 4.4% of patients (1.4% of implants), while 4.2% of the patients who were examined 9 y after therapy presented with late implant loss (2.0% of implants). Overall, 7.6% of the patients had lost at least 1 implant. Multilevel analysis revealed higher odds ratios for early implant loss among smokers and patients with an initial diagnosis of periodontitis. Implants shorter than 10 mm and representing certain brands also showed higher odds ratios for early implant loss. Implant brand also influenced late implant loss. Implant loss is not an uncommon event, and patient and implant characteristics influence outcomes
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12.
  • Derks, Jan, 1977, et al. (författare)
  • Effectiveness of Implant Therapy Analyzed in a Swedish Population: Prevalence of Peri-implantitis
  • 2016
  • Ingår i: Journal of Dental Research. - : SAGE Publications. - 0022-0345 .- 1544-0591. ; 95:1, s. 43-49
  • Tidskriftsartikel (refereegranskat)abstract
    • Peri-implantitis is an inflammatory disease affecting soft and hard tissues surrounding dental implants. As the global number of individuals that undergo restorative therapy through dental implants increases, peri-implantitis is considered as a major and growing problem in dentistry. A randomly selected sample of 588 patients who all had received implant-supported therapy 9 y earlier was clinically and radiographically examined. Prevalence of peri-implantitis was assessed and risk indicators were identified by multilevel regression analysis. Forty-five percent of all patients presented with peri-implantitis (bleeding on probing/suppuration and bone loss >0.5 mm). Moderate/severe peri-implantitis (bleeding on probing/suppuration and bone loss >2 mm) was diagnosed in 14.5%. Patients with periodontitis and with >= 4 implants, as well as implants of certain brands and prosthetic therapy delivered by general practitioners, exhibited higher odds ratios for moderate/severe peri-implantitis. Similarly, higher odds ratios were identified for implants installed in the mandible and with crown restoration margins positioned <= 1.5 mm from the crestal bone at baseline. It is suggested that peri-implantitis is a common condition and that several patient-and implant-related factors influence the risk for moderate/severe peri-implantitis (ClinicalTrials.gov NCT01825772).
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13.
  • Derks, Jan, 1977, et al. (författare)
  • Epidemiology of Peri-Implant Diseases
  • 2021
  • Ingår i: Lindhe's Clinical Periodontology and Implant Dentistry, 2 Volume Set, 7th Edition. - Oxford, UK : Wiley-Blackwell. - 9781119438885
  • Bokkapitel (refereegranskat)
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14.
  • Derks, Jan, 1977, et al. (författare)
  • Peri-implant health and disease. A systematic review of current epidemiology.
  • 2015
  • Ingår i: Journal of clinical periodontology. - : Wiley. - 1600-051X .- 0303-6979. ; 42:Suppl 16
  • Forskningsöversikt (refereegranskat)abstract
    • BACKGROUND: To develop preventive strategies addressing peri-implant diseases, a thorough understanding of the epidemiology is required. AIM: The aim was to systematically assess the scientific literature in order to evaluate the prevalence, extent and severity of peri-implant diseases. MATERIAL & METHODS: Data were extracted from identified studies. Meta-analyses for prevalence of peri-implant mucositis and peri-implantitis were performed. The effect of function time and disease definition on the prevalence of peri-implantitis was evaluated by meta-regression analyses. Data on extent and severity of peri-implant diseases were estimated if not directly reported. RESULTS: Fifteen articles describing 11 studies were included. Case definitions for mucositis and peri-implantitis varied. The prevalence of peri-implant mucositis and peri-implantitis ranged from 19 to 65% and from 1 to 47%, respectively. Meta-analyses estimated weighted mean prevalences of peri-implant mucositis and peri-implantitis of 43% (CI: 32-54%) and 22% (CI: 14-30%), respectively. The meta-regression showed a positive relationship between prevalence of peri-implantitis and function time and a negative relationship between prevalence of peri-implantitis and threshold for bone loss. Extent and severity of peri-implant diseases were rarely reported. CONCLUSION: Future studies on the epidemiology of peri-implant diseases should consider (i) applying consistent case definitions and (ii) assessing random patient samples of adequate size and function time.
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15.
  • Derks, Jan, 1977, et al. (författare)
  • Peri-implantitis - onset and pattern of progression.
  • 2016
  • Ingår i: Journal of clinical periodontology. - : Wiley. - 1600-051X .- 0303-6979. ; 43:4, s. 383-388
  • Tidskriftsartikel (refereegranskat)abstract
    • While information on the prevalence of peri-implantitis is available, data describing onset and progression of the disease are limited.
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16.
  • Derks, Jan, 1977, et al. (författare)
  • Prevention and management of peri-implant mucositis and peri-implantitis: A systematic review of outcome measures used in clinical studies in the last 10 years
  • 2023
  • Ingår i: JOURNAL OF CLINICAL PERIODONTOLOGY. - : Wiley. - 0303-6979 .- 1600-051X. ; 50:Suppl 25, s. 55-66
  • Forskningsöversikt (refereegranskat)abstract
    • Objectives To evaluate outcome measures, methods of assessment, and analysis in clinical studies on the prevention and management of peri-implant mucositis and peri-implantitis. Methods Systematic electronic searches (CENTRAL/MEDLINE/SCOPUS) up to April 2021 were conducted to identify longitudinal clinical studies with >= 10 patients on either the prevention or management of peri-implant diseases. Outcome measures of this analysis were the choice of outcome measures, methods of assessment, and analytical methods. Risk of bias was evaluated according to study design. Data were extracted into evidence tables and outcomes were analysed in a descriptive manner. Results The analysis of the 159 selected studies revealed that probing pocket depth (PPD) and bleeding/suppuration on probing (BOP) were reported in 89% and 87% of all studies, respectively. Additional outcome measures included plaque scores (reported in 64% of studies), radiographic outcomes (49%), soft tissue dimensions (34%), and composite outcomes (26%). Adverse events (8%) and patient-reported outcomes (6%) were only rarely mentioned. A primary outcome measure was clearly defined only in 36% of studies. Data on PPD, radiographic outcomes, and soft tissue dimensions were primarily reported as mean values and rarely as frequency distributions. For radiographic outcomes and soft tissue dimensions, it was frequently unclear how clustered data were handled. Conclusions PPD and BOP were routinely reported in studies on the prevention and management of peri-implant mucositis and peri-implantitis, while composite outcomes, adverse events, and patient-reported outcomes were only infrequently described.
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17.
  • Derks, Jan, 1977, et al. (författare)
  • Prevention and management of peri-implant mucositis and peri-implantitis: A systematic review of outcome measures used in clinical studies in the last 10 years
  • 2023
  • Ingår i: Clinical Oral Implants Research. - : Wiley. - 0905-7161 .- 1600-0501. ; 34:Suppl. 25, s. 55-67
  • Forskningsöversikt (refereegranskat)abstract
    • Objectives To evaluate outcome measures, methods of assessment, and analysis in clinical studies on the prevention and management of peri-implant mucositis and peri-implantitis. Methods Systematic electronic searches (CENTRAL/MEDLINE/SCOPUS) up to April 2021 were conducted to identify longitudinal clinical studies with >= 10 patients on either the prevention or management of peri-implant diseases. Outcome measures of this analysis were the choice of outcome measures, methods of assessment, and analytical methods. Risk of bias was evaluated according to study design. Data were extracted into evidence tables and outcomes were analysed in a descriptive manner. Results The analysis of the 159 selected studies revealed that probing pocket depth (PPD) and bleeding/suppuration on probing (BOP) were reported in 89% and 87% of all studies, respectively. Additional outcome measures included plaque scores (reported in 64% of studies), radiographic outcomes (49%), soft tissue dimensions (34%), and composite outcomes (26%). Adverse events (8%) and patient-reported outcomes (6%) were only rarely mentioned. A primary outcome measure was clearly defined only in 36% of studies. Data on PPD, radiographic outcomes, and soft tissue dimensions were primarily reported as mean values and rarely as frequency distributions. For radiographic outcomes and soft tissue dimensions, it was frequently unclear how clustered data were handled. Conclusions PPD and BOP were routinely reported in studies on the prevention and management of peri-implant mucositis and peri-implantitis, while composite outcomes, adverse events, and patient-reported outcomes were only infrequently described.
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18.
  • Derks, Jan, 1977, et al. (författare)
  • Reconstructive surgical therapy of peri-implantitis: A multicenter randomized controlled clinical trial
  • 2022
  • Ingår i: Clinical Oral Implants Research. - : Wiley. - 0905-7161 .- 1600-0501. ; 33:9, s. 921-944
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective To evaluate the potential benefit of the use of a bone substitute material in the reconstructive surgical therapy of peri-implantitis. Methods In this multicenter randomized clinical trial, 138 patients (147 implants) with peri-implantitis were treated surgically, randomized by coin toss to either a control (access flap surgery) or a test group (reconstructive surgery using bone substitute material). Clinical assessments, including probing pocket depth (PPD), bleeding and suppuration on probing (BOP & SOP) as well as soft tissue recession (REC), were recorded at baseline, 6 and 12 months. Marginal bone levels (MBL), measured on intra-oral radiographs, and patient-reported outcomes (PROs) were recorded at baseline and 12 months. No blinding to group allocation was performed. The primary outcome at 12 months was a composite measure including (i) implant not lost, (ii) absence of BOP/SOP at all aspects, (iii) PPD <= 5 mm at all aspects and (iv) <= 1 mm recession of mucosal margin on the buccal aspect of the implant. Secondary outcomes included (i) changes of MBL, (ii) changes of PPD, BOP%, and buccal KM, (iii) buccal REC and (iv) patient-reported outcomes. Results During follow-up, four implants (one in the test group, three in the control group) in four patients were removed due to disease progression. At 12 months, a total of 69 implants in the test and 68 implants in the control group were examined. Thus, 16.4% and 13.5% of implants in the test and control group, respectively, met all predefined criteria of the composite outcome. PPD reduction and MBL gain were 3.7 mm and about 1.0 mm in both groups. Reduction in mean BOP% varied between 45% (test) and 50% (control), without significant differences between groups. Buccal REC was less pronounced in the test group (M = 0.7, SD = 0.9 mm) when compared to controls (M = 1.1, SD = 1.5 mm). PROs were favorable in both groups without significant differences. One case of allergic reaction to the antibiotic therapy was recorded. No other adverse events were noted. Conclusions Surgical therapy of peri-implantitis effectively improved the clinical and radiographic status at 12 months. While the use of a bone substitute material did not improve reductions of PPD and BOP, buccal REC was less pronounced in the test group. Patient satisfaction was high in both groups.
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19.
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20.
  • Donati, Mauro, 1966, et al. (författare)
  • Effect of immediate functional loading on osseointegration of implants used for single tooth replacement. A human histological study.
  • 2013
  • Ingår i: Clinical Oral Implants Research. - : Wiley. - 0905-7161. ; 24:7, s. 738-45
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective To analyze hard tissue reactions to immediate functionally loaded single implants that were installed either with a conventional drill preparation procedure or with an osteotome preparation technique. Materials and methods Thirteen subjects with two sites requiring single tooth rehabilitation by means of implants volunteered for the study. Each subject received one test (immediate functionally loaded) and one control (non-loaded) implant. In six subjects (group 1) the implants were placed using a conventional drilling procedure, whereas in the remaining seven subjects (group 2) an osteotome preparation procedure was performed. Block biopsies containing test and control implants and peri-implant bone tissues were collected at 1month in four of the subjects in group 1 and in five subjects of group 2. The remaining implant sites were sampled at 3months after implant placement. The biopsies were prepared for histological examination. Results Two implants of the test-2 group (osteotome preparation) representing 1month of healing and another test-2 implant representing 3months of healing failed to integrate. A multilevel multivariate statistical analysis demonstrated that no differences in bone-to-implant contact (BIC)% were found in between test and control implants, the density of newly formed peri-implant bone was significantly higher around test than control implants at 1 and 3months of healing. Sections representing osteotome technique sites showed fractured trabeculae and large amounts of bone particles. Conclusions It is suggested that immediate loading of implants does not influence the osseointegration process, whereas the density of newly formed peri-implant bone at such sites appears to be increased in relation to unloaded control implants. The use of an osteotome preparation technique during installation results in damage of peri-implant bone and enhances the risk for failure in osseointegration.
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21.
  • Farina, R., et al. (författare)
  • Bleeding on probing around dental implants: a retrospective study of associated factors
  • 2017
  • Ingår i: Journal of Clinical Periodontology. - : Wiley. - 0303-6979. ; 44:1, s. 115-122
  • Tidskriftsartikel (refereegranskat)abstract
    • AimTo (i) identify factors associated with the probability of a peri-implant site to be positive to bleeding on probing (BoP+) and (ii) compare BoP+ probability around dental implants and contra-lateral teeth. MethodsIn 112 patients, data related to 1725 peri-implant sites and 1020 contra-lateral dental sites were retrospectively obtained. To analyse the association between patient-, implant- and site-related factors and BoP+ probability, a logistic, three-level model was built with BoP as the binary outcome variable (+/-). ResultsBoP+ probability for a peri-implant site with probing depth (PD) of 4mm was 27%, and the odds ratio increased by 1.6 for each 1-mm increment in PD (p<0.001). Also, BoP+ probability was higher in females compared to males (OR=1.61; p=0.048), and lower at posterior compared to anterior dental implants (OR=0.55; p<0.01). No significant difference in BoP+ probability was observed between peri-implant and contra-lateral dental sites when controlling for the difference in PD. ConclusionsThe probability of a peri-implant site to bleed upon probing is (i) associated with PD, implant position and gender, and (ii) similar to that observed at contra-lateral dental sites when controlling for the effect of PD.
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22.
  • Farina, R., et al. (författare)
  • Change in the Gingival Margin Profile After the Single Flap Approach in Periodontal Intraosseous Defects
  • 2015
  • Ingår i: Journal of Periodontology. - : Wiley. - 0022-3492 .- 1943-3670. ; 86:9, s. 1038-1046
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The aim of the present study is to evaluate the association of patient-related and site-specific factors, as well as the adopted treatment modality, with the change in buccal (bREC) and interdental (iREC) gingival recession observed at 6 months after treatment of periodontal intraosseous defects with the single flap approach (SFA). Methods: Sixty-six patients contributing 74 intraosseous defects accessed with a buccal SFA and treated with different modalities were selected retrospectively. A two-level (patient and site) model was constructed, with the 6-month changes in bREC and iREC as the dependent variables. Results: 1) Significant 6-month increases in bREC (-0.6 +/- 0.7 mm) and iREC (-0.9 +/- -1.1 mm) were observed. 2) bREC change was significantly predicted by presurgery interproximal probing depth (PD) and depth of osseous dehiscence at the buccal aspect. 3) iREC change was significantly predicted by presurgery interproximal PD and the treatment modality, with defects treated with SFA in combination with a graft material and a bioactive agent being less prone to iREC increase compared to defects treated with SFA alone. Conclusions: After buccal SFA, greater post-surgery increase in bREC must be expected for deep intraosseous defects associated with a buccal dehiscence. The combination of a graft material and a bioactive agent in adjunct to the SFA may limit the postoperative increase in iREC.
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23.
  • Farina, R., et al. (författare)
  • The bleeding site: a multi-level analysis of associated factors
  • 2013
  • Ingår i: Journal of Clinical Periodontology. - : Wiley. - 0303-6979. ; 40:8, s. 735-742
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim To evaluate the association between the probability of a sulcus/pocket to bleed on probing (BoP) and patient related as well as site-specific characteristics. Methods Data from 88960 sites were retrospectively derived from the clinical record charts of 601 adult patients. BoP (positive/negative) had been recorded at the initial periodontal visit after probing pocket depth (PPD) assessment. To analyse the influence of patient-, tooth- and site-related factors on the probability for a site to be BoP+, a logistic, 3-level model was built with BoP as the binary outcome variable. Results (i) The mean probability to be BoP+ for a site with PPD=3mm was 18%, and the log odds increased by 0.69 for each 1mm increment in PPD; (ii) a significantly higher risk for BoP+ was observed for inter-proximal versus approximal surfaces, posterior teeth versus anterior teeth, females versus males, while a significantly lower risk was observed for smokers versus non-smokers; (iii) when controlling for the significant covariates, different BoP+ probabilities could still be observed among sites in patients with a different susceptibility to BoP. Conclusions The probability of a site to be BoP+ was associated with either site-specific (i.e. PPD, tooth aspect, tooth type) or patient-related factors (i.e. gender, smoking status).
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24.
  • Fransson, Christer, 1956, et al. (författare)
  • Extent of peri-implantitis-associated bone loss.
  • 2009
  • Ingår i: Journal of clinical periodontology. - 1600-051X. ; 36:4, s. 357-63
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: The purpose of the present study was to describe the extent of peri-implantitis-associated bone loss with regard to implant position. MATERIAL AND METHODS: Patient files and intra-oral radiographs from 182 subjects were analysed. Among the 1070 examined implants, 419 exhibited peri-implantitis-associated bone loss. The position of each implant within the jaw and fixed reconstructions was determined. In the radiographs the distance between the abutment-fixture junction and the most coronal position of bone to implant contact was assessed at the 419 "affected" implants using a magnifying lens (x 7) with a 0.1 mm graded scale. RESULTS: About 40% of the implants in each subject was affected by peri-implantitis-associated bone loss. The proportion of such implants varied between 30% and 52% in different jaw positions and the most common position was the lower front region. In addition, affected implants were found in larger proportions among "mid" than "end" abutments irrespective of supporting fixed complete or fixed partial dentures. CONCLUSION: It is suggested that peri-implantitis occurs in all jaw positions and that an "end"-abutment position in a fixed reconstruction is not associated with an enhanced risk for peri-implantitis.
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25.
  • Fransson, Christer, 1956, et al. (författare)
  • Severity and pattern of peri-implantitis-associated bone loss.
  • 2010
  • Ingår i: Journal of clinical periodontology. - 1600-051X. ; 37:5, s. 442-8
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: The purpose of the present study was to describe the severity and pattern of peri-implantitis-associated bone loss. Material and Methods: Intra-oral radiographs from 182 subjects were analysed. Bone-level measurements were performed in 419 implants with a history of bone loss. All radiographs obtained in the interval from the 1-year follow-up to the end-point examination (5–23 years) were analysed. The amount of bone loss that occurred from 1 year after prosthesis insertion was assessed and the pattern of bone loss was evaluated. Results: The average bone loss after the first year of function was 1.68 mm and 32% of the implants demonstrated bone loss geqslant R: gt-or-equal, slanted2 mm. The multilevel model revealed that the bone loss showed a non-linear pattern and that the rate of bone loss increased over time. The model also revealed that the pattern of peri-implantitis associated bone loss was similar within the same subject. Conclusion: It is suggested that peri-implantitis-associated bone loss varies between subjects and is, in most cases, characterized by a non-linear progression, with the rate of loss increasing over time. One of the main goals in implant therapy is to preserve tissue integration and thereby maintain bone support. Marginal bone loss is thus considered a critical outcome variable in the evaluation of implant therapy. It has been suggested that data on bone loss during the first year of function should be distinguished from that occurring during the subsequent period of service. According to the suggested success criteria for implants (Albrektsson et al. 1986, Albrektsson & Zarb 1993), marginal bone loss should not exceed 1.5 mm during the first year in function and should be <0.2 mm/year thereafter. A modification to these criteria that indicated a maximum bone loss of 2 mm between prosthesis installation and 5 years of follow-up was presented in a consensus report from the European Workshop on Periodontology in 1999 (Wennström & Palmer 1999). Whether certain amounts of bone loss around implants should be acceptable or not requires an understanding of the mechanisms involved in the process of bone resorption. Although the question on the aetiology of marginal bone loss around implants still has to be completely unravelled, previous studies have demonstrated the association between progressive bone loss during function and clinical signs of inflammation in peri-implant tissues (Roos-Jansåker et al. 2006, Fransson et al. 2008). We have previously reported on the prevalence and extent of peri-implantitis-associated bone loss (Fransson et al. 2005, 2009). From the analysis of radiographs obtained from 662 subjects treated with implant-supported prosthesis, it was documented that 184 (27.8%) of the subjects had geqslant R: gt-or-equal, slanted1 implant with peri-implantitis-associated bone loss (Fransson et al. 2005, 2008). Within this group of subjects, about 40% of the implants were affected (Fransson et al. 2009). Using this subject sample, the purpose of the present study was to describe the severity and pattern of peri-implantitis-associated bone loss.
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26.
  • Ghensi, P., et al. (författare)
  • Effect of Oral Administration of Bromelain on Postoperative Discomfort After Third Molar Surgery
  • 2017
  • Ingår i: Journal of Craniofacial Surgery. - : Ovid Technologies (Wolters Kluwer Health). - 1049-2275. ; 28:2
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction:The purpose of this prospective randomized controlled clinical trial was to evaluate the effect of oral administration of bromelain on discomfort after mandibular third molar surgery. Materials and Methods: Eighty-four consecutive patients requiring surgical removal of a single mandibular impacted third molar under local anesthesia were randomly assigned to receiving no drug (control group, Group A), postoperative 40mg bromelain every 6 hours for 6 days (Group B), preoperative 4mg dexamethasone sodium phosphate as a submucosal injection (Group C), and preoperative 4 mg dexamethasone sodium phosphate as a submucosal injection plus postoperative 40mg bromelain every 6 hours for 6 days (Group D). Standardized surgical and analgesic protocols were adopted. Maximum interincisal distance and facial contours were measured at baseline and on postoperative days 2 and 7. Pain was measured objectively by counting the number of analgesic tablets required. Patient perception of the severity of symptoms was assessed with a follow-up questionnaire (PoSSe scale). Results: On postoperative day 2, there was a statistically significant reduction in facial edema in both Groups C and D compared with the control group, but no statistically significant differences were observed between Group B and the control group. At evaluation on postoperative day 7, Group D showed a statistically significant reduction in postoperative swelling compared with the control group. The combined use of bromelain and dexamethasone (Group D) induced a statistically significant reduction in the total number of analgesic tablets taken after surgery compared with the control group. The treatment groups had a limited, nonsignificant effect on trismus when compared with the control group. Conclusions: Bromelain used singly showed moderate anti-inflammatory efficacy, reducing postoperative swelling, albeit not to any significant extent compared with no drug administration. The combined use of bromelain and dexamethasone sodium phosphate yielded the best results in terms of control of postoperative discomfort.
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27.
  • Ghensi, P., et al. (författare)
  • Strong oral plaque microbiome signatures for dental implant diseases identified by strain-resolution metagenomics
  • 2020
  • Ingår i: Npj Biofilms and Microbiomes. - : Springer Science and Business Media LLC. - 2055-5008. ; 6:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Dental implants are installed in an increasing number of patients. Mucositis and peri-implantitis are common microbial-biofilm-associated diseases affecting the tissues that surround the dental implant and are a major medical and socioeconomic burden. By metagenomic sequencing of the plaque microbiome in different peri-implant health and disease conditions (113 samples from 72 individuals), we found microbial signatures for peri-implantitis and mucositis and defined the peri-implantitis-related complex (PiRC) composed by the 7 most discriminative bacteria. The peri-implantitis microbiome is site specific as contralateral healthy sites resembled more the microbiome of healthy implants, while mucositis was specifically enriched for Fusobacterium nucleatum acting as a keystone colonizer. Microbiome-based machine learning showed high diagnostic and prognostic power for peri-implant diseases and strain-level profiling identified a previously uncharacterized subspecies of F. nucleatum to be particularly associated with disease. Altogether, we associated the plaque microbiome with peri-implant diseases and identified microbial signatures of disease severity.
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28.
  • Gotfredsen, Klaus, et al. (författare)
  • Implants and/or teeth: consensus statements and recommendations.
  • 2008
  • Ingår i: Journal of oral rehabilitation. - : Wiley. - 1365-2842 .- 0305-182X. ; 35:Suppl 1, s. 2-8
  • Forskningsöversikt (refereegranskat)abstract
    • In August 23-25, 2007, the Scandinavian Society for Prosthetic Dentistry in collaboration with the Danish Society of Oral Implantology arranged a consensus conference on the topic 'Implants and/or teeth'. It was preceded by a workshop in which eight focused questions were raised and answered in eight review articles using a systematic approach. Twenty-eight academicians and clinicians discussed the eight review papers with the purpose to reach consensus on questions relevant for the topic. At the conference the consensus statements were presented as well as lectures based on the review articles. In this article the methods used at the consensus workshop are briefly described followed by the statements with comments.
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29.
  • Graziani, F., et al. (författare)
  • Complications and treatment errors in nonsurgical periodontal therapy
  • 2023
  • Ingår i: Periodontology 2000. - : Wiley. - 0906-6713 .- 1600-0757. ; 92:1, s. 21-61
  • Tidskriftsartikel (refereegranskat)abstract
    • Nonsurgical periodontal therapy can be subject to iatrogenesis, which includes all the complications directly or indirectly related to a treatment. These complications include both operator-dependent harms and errors and the consequences and adverse effects of the therapeutic procedures. The complications arising following nonsurgical periodontal treatment can be categorized as intraoperative and postoperative and can affect both soft and hard tissues at an intra-oral and extraoral level. Soft-tissues damage or damage to teeth and restorations can occur while performing the procedure. In the majority of cases, the risk of bleeding associated with nonsurgical therapy is reported to be low and easily controlled by means of local hemostatic measures, even in medicated subjects. Cervicofacial subcutaneous emphysema is not a frequent extraoral intraoperative complication, occurring during the use of air polishing. Moreover, side effects such as pain, fever, and dentine hypersensitivity are frequently reported as a consequence of nonsurgical periodontal therapy and can have a major impact on a patient's perception of the treatment provided. The level of intraoperative pain could be influenced by the types of instruments employed, the characteristics of tips, and the individual level of tolerance of the patient. Unexpected damage to teeth or restorations can also occur as a consequence of procedural errors.
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30.
  • Graziani, F., et al. (författare)
  • Oral Care and Quality Evaluation: A Multicentric Study on Periodontal Treatment
  • 2020
  • Ingår i: Oral Health & Preventive Dentistry. - 1602-1622. ; 18:2, s. 363-371
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: No information is available on the perception of the quality of care in patients treated for periodontitis. The purpose of this article was to assess how periodontitis-affected patients perceive the quality of periodontal treatment (PT) and to measure the factors which may influence it. Materials and Methods: 306 subjects who completed PT were invited to participate. Questionnaires and visual analogic scales (VAS) evaluating perception of quality of care, symptoms, and oral health related quality of life (OHRQoL) were handed out. Oral and periodontal indicators were collected before and after treatment. The impact of different factors on perception of quality was assessed with a regression model. Results: Quality evaluation was high yet unrelated for both patients and clinicians (p = 0.983). Quality was negatively influenced by the number of residual oral infections (p < 0.001), patient's age (p = 0.07) and presence of residual pain at completion of PT (p = 0.02). Professionalism, kindness of the staff and communication skills were the characteristics mostly appreciated. The OHRQoL was influenced by the number of residual teeth (p < 0.001), increasing age of patients (p = 0.08), number of residual infections (p < 0.01) and pain (p = 0.04). Conclusions: Patients' quality perception appeared to be influenced by clinical and emotional aspects. Oral care providers should be aware of the impact of non-clinical factors in patients' appreciation of quality of treatment.
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31.
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32.
  • Ichioka, Yuki, et al. (författare)
  • Factors influencing outcomes of surgical therapy of peri-implantitis: A secondary analysis of 1-year results from a randomized clinical study
  • 2023
  • Ingår i: JOURNAL OF CLINICAL PERIODONTOLOGY. - 0303-6979. ; 50:10, s. 1282-1304
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: To identify predictors of treatment outcomes following surgical therapy of peri-implantitis.Materials and Methods: We performed a secondary analysis of data from a randomized controlled trial (RCT) comparing access flap with or without bone replacement graft. Outcomes at 12 months were probing pocket depth (PPD), bleeding on probing (BOP), soft-tissue recession (REC) and marginal bone level (MBL) change. Multilevel regression analyses were used to identify predictors. We also built an explanatory model for residual signs of inflammation.Results: Baseline PPD was the most relevant predictor, showing positive associations with final PPD, REC and MBL gain, and negative association with probability of pocket closure. Smokers presented higher residual PPD. Absence of keratinized mucosa at baseline increased the probability of BOP but was otherwise not indicative of outcomes. Plaque at 6 weeks was detrimental in terms of residual PPD and BOP. Treatment allocation had an effect on REC. Final BOP was explained by residual PPD & GE;6 mm and plaque at more than two sites.Conclusions: Baseline PPD was the most relevant predictor of the outcomes of surgical therapy of peri-implantitis. Pocket closure should be a primary goal of treatment. Bone replacement grafts may be indicated in aesthetically demanding cases to reduce soft-tissue recession. The importance of smoking cessation and patient-performed plaque control is also underlined.
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33.
  • Jepsen, Sören, et al. (författare)
  • Primary prevention of peri-implantitis: Managing peri-implant mucositis.
  • 2015
  • Ingår i: Journal of clinical periodontology. - : Wiley. - 1600-051X .- 0303-6979. ; 42 Suppl 16
  • Forskningsöversikt (refereegranskat)abstract
    • Over the past decades, the placement of dental implants has become a routine procedure in the oral rehabilitation of fully and partially edentulous patients. However, the number of patients/implants affected by peri-implant diseases is increasing. As there are - in contrast to periodontitis - at present no established and predictable concepts for the treatment of peri-implantitis, primary prevention is of key importance. The management of peri-implant mucositis is considered as a preventive measure for the onset of peri-implantitis. Therefore, the remit of this working group was to assess the prevalence of peri-implant diseases, as well as risks for peri-implant mucositis and to evaluate measures for the management of peri-implant mucositis.
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34.
  • Karlsson, Karolina, 1975, et al. (författare)
  • Efficacy of access flap and pocket elimination procedures in the management of peri-implantitis: A systematic review and meta-analysis
  • 2023
  • Ingår i: Journal of Clinical Periodontology. - : Wiley. - 0303-6979 .- 1600-051X. ; 50:Suppl 28, s. 244-284
  • Forskningsöversikt (refereegranskat)abstract
    • Aim To evaluate the efficacy of access flap and pocket elimination procedures in the surgical treatment of peri-implantitis. Materials and Methods Systematic electronic searches (Central/MEDLINE/EMBASE) up to March 2022 were conducted to identify prospective clinical studies evaluating surgical therapy (access flap or pocket elimination procedures) of peri-implantitis. Primary outcome measures were reduction of probing depth (PD) and bleeding on probing (BOP). Risk of bias was evaluated according to study design. Meta-analysis and meta-regression were performed. Results were expressed as standardized mean effect with 95% confidence interval (CI). Results Evidence from studies directly comparing surgical with non-surgical therapy is lacking. Based on pre-post data originating from 13 prospective patient cohorts, pronounced reductions of PD (standardized mean effect: 2.2 mm; 95% CI 1.8-2.7) and BOP% (27.0; 95% CI 19.8-34.2) as well as marginal bone level gain (0.2 mm; 95% CI -0.0 to 0.5) were observed at evaluation time points ranging from 1 to 5 years. Wide prediction intervals suggested a high degree of heterogeneity. Reduction of mean PD increased by 0.7 mm (95% CI 0.5-0.9) for every millimetre in increase of mean PD at baseline. During the follow-up period ranging from 1 to 5 years, disease recurrence occurred frequently and implant loss was not uncommon. Conclusions Access flap and pocket elimination surgery are effective procedures in the management of peri-implantitis, although rates of disease recurrence during 5 years were high. Treatment outcomes were affected by baseline conditions.
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35.
  •  
36.
  • Lindhe, Jan, 1935, et al. (författare)
  • Ridge preservation with the use of deproteinized bovine bone mineral
  • 2014
  • Ingår i: Clinical Oral Implants Research. - : Wiley. - 0905-7161. ; 25:7, s. 786-790
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: The aim was to examine the tissue composition of extraction sockets that had been grafted with deproteinized bovine bone mineral and allowed to heal for 6 months. Material and methods: Twenty-five subjects with one tooth each scheduled for extraction and replacement with dental implants were recruited. The assigned teeth were carefully removed. The site/patient was thereafter allocated to a test or a control group. In the test group patients, Bio-Oss (R) Collagen was placed to fill the fresh extraction socket while in the controls no grafting was performed. After about 6 months of healing, a biopsy was sampled from the center of the extraction site. The specimens were decalcified, embedded in paraffin, sectioned, and stained in HTX. The proportions occupied by mineralized bone, osteoid, bone marrow, fibrous tissue, and Bio-Oss (R) particles were determined by morphometric point counting. Results: Mineralized bone made up 57.4 +/- 12.4% of the control sites (C) and 48.9 +/- 8.5% of the T1 sites (graft material not included). The amount of bone marrow (C: 7.1 +/- 6.1%, T1: 2.1 +/- 3.1%) and osteoid (C: 7.3 +/- 4.9%, T1: 1.9 +/- 2.1%) was about five times greater in the control than in the test sites. Fibrous tissue comprised 23.1 +/- 16.3% (C) and 40.0 +/- 11.9% (T1). I n the T2 sites (graft material included), the percentage mineralized bone was 39.9 +/- 8.6 while the proportions of bone marrow and osteoid were 1.8 +/- 2.5% and 1.6 +/- 1.8%. Fibrous tissue occupied 32.4 +/- 9.2% and Bio-Oss (R) particles 19.0 +/- 6.5% of the T2 sites. Conclusion: Placement of the biomaterial in the fresh extraction socket retarded healing. The Bio-Oss (R) particles were not resorbed but became surrounded by new bone. This may explain why grafted extraction sites may fail to undergo dimensional change.
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37.
  • Lindskog Stokland, Birgitta, 1959, et al. (författare)
  • Changes in molar position with missing opposed and/or adjacent tooth: a 12-year study in women
  • 2012
  • Ingår i: Journal of Oral Rehabilitation. - 0305-182X. ; 39:2, s. 136-43
  • Tidskriftsartikel (refereegranskat)abstract
    • Summary The aim of this study was to radiographically analyse long-term changes in (i) overeruption of unopposed molars and (ii) tipping of molars with a mesial edentulous space, and whether there is an interaction between the two events. A further aim was to analyse if loss of alveolar bone height might influence overeruption and tipping. The sample consisted of panoramic radiographs taken at an interval of 12years of 292 subjects from a prospective population study of women. The panoramic radiographs were scanned and analysed. Changes in tipping, overeruption and alveolar bone height of molars and control teeth were measured. The results showed that unopposed molars were more commonly found in the upper jaw and that unopposed molars showed 4·9 times higher risk of overeruption of ≥2mm (95% CI 1·5-15·3) than opposed molars during the 12-year observation period. The average overeruption for the unopposed molars was 4·5% (s.d. 7·6), which corresponds to approximately 0·9mm. The degree of overeruption increased with decreased bone support. Molars with a mesial edentulous space were most prevalent in the lower jaw, but neither an edentulous space nor alveolar bone level/bone level change were found to have a significant effect on tipping of the molars. The average mesial tipping was 0·8° (s.d. 5·6). In conclusion, unopposed molars showed a significantly increased risk for overeruption. Molars facing a mesial edentulous space showed a low risk for mesial tipping, but a significant interaction between overeruption and tipping was identified.
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38.
  • Liss, Anna, 1979, et al. (författare)
  • Patient-reported experiences and outcomes following two different approaches for non-surgical periodontal treatment: a randomized field study
  • 2021
  • Ingår i: BMC Oral Health. - : Springer Science and Business Media LLC. - 1472-6831. ; 21
  • Tidskriftsartikel (refereegranskat)abstract
    • Context: The current report is part of a prospective, multi-center, two-arm, quasi-randomized field study focusing on the effectiveness in general praxis of evidence-based procedures in the non-surgical treatment of patients with periodontitis. Objective: The specific aims were to (i) evaluate patient-reported experience and outcome measures of treatment following a guided approach to periodontal infection control (GPIC) compared to conventional non-surgical therapy (CNST) and to (ii) identify potential predictors of subjective treatment outcomes and patient’s adherence to self-performed infection control, i.e. adequate oral hygiene. Methods: The study sample consisted of 494 patients treated per protocol with questionnaire- and clinical data at baseline and 6-months. The GPIC approach (test) comprised patient education for adequate oral hygiene prior to a single session of full-mouth ultra-sonic instrumentation, while the CNST approach (control) comprised education and instrumentation (scaling and root planing) integrated at required number of consecutive appointments. Clinical examinations and treatment were performed by Dental Hygienists, i.e. not blinded. Data were processed with bivariate statistics for comparison between treatment groups and with multiple regression models to identify potential predictors of subjective and clinical outcomes. The primary clinical outcome was gingival bleeding scores. Results: No substantial differences were found between the two treatment approaches regarding patient-reported experiences or outcomes of therapy. Patients’ experiences of definitely being involved in therapy decisions was a significant predictor for a desirable subjective and clinical outcome in terms of; (i) that oral health was considered as much improved after therapy compared to how it was before, (ii) that the treatment definitively had been worth the cost and efforts, and (iii) adherence to self-performed periodontal infection control. In addition, to be a current smoker counteracted patients’ satisfaction with oral health outcome, while gingival bleeding scores at baseline predicted clinical outcome in terms of bleeding scores at 6-months. Conclusions: The results suggest that there are no differences with regard to patient-reported experiences and outcomes of therapy following a GPIC approach to periodontal infection control versus CNST. Patients’ experiences of being involved in therapy decisions seem to be an important factor for satisfaction with care and for adherence to self-performed periodontal infection control. Registered at: ClinicalTrials.gov (NCT02168621).
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39.
  • Marini, L., et al. (författare)
  • Reliability assessment of the 2018 classification case definitions of peri-implant health, peri-implant mucositis, and peri-implantitis
  • 2023
  • Ingår i: Journal of Periodontology. - 0022-3492. ; 94:12, s. 1461-1474
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundThe purpose of this study was to evaluate the reliability and accuracy in the assignment of the case definitions of peri-implant health and diseases according to the 2018 Classification of Periodontal and Peri-implant Diseases and Conditions. MethodsTen undergraduate students, 10 general dentists, and 10 experts in implant dentistry participated in this study. All examiners were provided with clinical and radiographic documentation of 25 dental implants. Eleven out the 25 cases were also accompanied by baseline readings. Examiners were asked to define all cases using the 2018 classification case definitions. Reliability among examiners was evaluated using the Fleiss kappa statistic. Accuracy was estimated using percentage of complete agreement and quadratic weighted kappa for pairwise comparisons between each rater and a gold standard diagnosis. ResultsThe Fleiss kappa was 0.50 (95% CI: 0.48 to 0.51) and the mean quadratic weighted kappa value was 0.544. Complete agreement with the gold standard diagnosis was achieved in 59.8% of the cases. Expertise in implantology affected accuracy positively (p < 0.001) while the absence of baseline readings affected it negatively (p < 0.001). ConclusionBoth reliability and accuracy in assigning case definitions to dental implants according to the 2018 classification were mostly moderate. Some difficulties arose in the presence of specific challenging scenarios.
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40.
  • Marini, L., et al. (författare)
  • The staging and grading system in defining periodontitis cases: consistency and accuracy amongst periodontal experts, general dentists and undergraduate students
  • 2021
  • Ingår i: Journal of Clinical Periodontology. - : Wiley. - 0303-6979 .- 1600-051X. ; 48:2, s. 205-215
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim The objective of this study was to evaluate consistency and accuracy of the periodontitis staging and grading classification system. Methods Thirty participants (10 periodontal experts, 10 general dentists and 10 undergraduate students) and a gold-standard examiner were asked to classify 25 fully documented periodontitis cases twice. Fleiss kappa was used to estimate consistency across examiners. Intraclass correlation coefficient (ICC) was used to calculate consistency across time. Quadratic weighted kappa and percentage of complete agreement versus gold standard were computed to assess accuracy. Results Fleiss kappa for stage, extent and grade were 0.48, 0.37 and 0.45 respectively. The highest ICC was provided by students for stage (0.91), whereas the lowest ICC by general dentists for extent (0.79). Pairwise comparisons against gold standard showed mean value of kappa >0.81 for stage and >0.41 for grade and extent. Agreement with the gold standard for all three components of the case definition was achieved in 47.2% of cases. The study identified specific factors associated with lower consistency and accuracy. Conclusions Diagnosis was highly consistent across time and moderately between examiners. Accuracy was almost perfect for stage and moderate for grade and extent. Additional efforts are required to improve training of general dentists.
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41.
  • Paniz, G., et al. (författare)
  • Dual-Center Cross-Sectional Analysis of Periodontal Stability Around Anterior All-Ceramic Crowns with a Feather-Edge or Chamfer Subgingival Preparation
  • 2020
  • Ingår i: International Journal of Periodontics & Restorative Dentistry. - : Quintessence Publishing. - 0198-7569. ; 40:4, s. 499-507
  • Tidskriftsartikel (refereegranskat)abstract
    • Subgingival margins are often associated with adverse periodontal reactions, such as recession and gingival inflammation. The purpose of this cross-sectional dual-center study was to evaluate the periodontal health and stability of intrasulcular margins, comparing two prosthetic margin preparations: subgingival chamfer (SC) and subgingival feather-edge (SF) with gingival curettage. Ninety-six patients with 205 crowns (buccal margin 0.5 mm into the gingival sulcus) were included in the study. SF, gingival curettage, and intrasulcular restorative margin were prepared on 109 crowns; SC was prepared on 96. Restorations were in place for a mean of 55.9 months (range: 12 months to 10 years). No significant differences were found regarding probing depth between the two groups (mean buccal: 1.6 mm; mean interproximal: 2.3 mm). Significant increased recession was present around SCs, showing a higher margin-exposure frequency (buccal: 19.8% vs 3.7%; interproximal: 5.2% vs 1.4%). SC showed 8.5 times the risk of margin exposure compared to SF, men 5.5 times compared to women, and smokers 3.7 times compared to nonsmokers. Follow-up time was not a significant factor. SC sites showed a tendency for reduced buccal bleeding on probing compared to SF sites (3.0% vs 12.1%), but no significant difference was seen in a regression model. Plaque presence increased the risk of bleeding (4.1x), and women presented a higher risk of bleeding than men (3x). Subgingival margins can provide adequate periodontal health and stability if restorative procedures are well controlled and if patients are enrolled in an adequate maintenance program. SF with intrasulcular margin favors facial soft tissue stability, as reduced gingival recession was observed. The technique should be carefully applied to promote an adequate periodontal response.
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42.
  • Romeo, Eugenio, et al. (författare)
  • Implant-supported fixed cantilever prosthesis in partially edentulous jaws: a cohort prospective study.
  • 2009
  • Ingår i: Clinical oral implants research. - : Wiley. - 1600-0501 .- 0905-7161. ; 20:11, s. 1278-85
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Reconstructive procedures present a higher rate of biological costs due to the necessity of bone harvest and grafts, use of semipermeable barriers etc. On the hand, implant supported cantilever prostheses could allow a simpler rehabilitation procedure. AIMS: The aim of the present study was to assess the clinical outcome of patients treated with implant-supported fixed partial dentures (FPD) with cantilever after a mean follow-up time of 8 years. MATERIAL AND METHODS: The study included 45 consecutive partially edentulous patients treated between January 1994 and August 2006 with 59 partial cantilever fixed prostheses supported by 116 ITI implants. The primary outcome variable considered was the presence of complications at the subject and bridge level; the secondary outcome variable was marginal bone loss (MBL). The frequency of complications was analyzed according to cantilever location and opposite dentition and tested by Fisher's exact test. A multilevel regression model was constructed to analyze the factors influencing MBL with three levels: subject as the highest, and then implant and site. During the follow-up period, 11 implants showed a bone loss exceeding the limit for success, out of which two implants showed an infection of the peri-implant tissue. RESULTS: After an average observation of 8.2 years of cantilever prostheses loading, the implant success and survival rates were 90.5% and 100%, respectively. Besides, the prosthetic success and survival rate were 57.7% and 100%, respectively. DISCUSSION: None of the predictors included in the multilevel model presented a significant impact on the bone loss between baseline and the follow-up examination. CONCLUSIONS: The authors concluded that the prognosis of implant-supported FPDs and marginal bone loss at implants were not influenced by the position or the length of the cantilever, the location of the bridge and type of opposite dentition. Implant-supported fixed cantilever prosthesis can be considered a suitable treatment choice.
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43.
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44.
  • Simonelli, A., et al. (författare)
  • Prognostic value of a composite outcome measure for periodontal stability following periodontal regenerative treatment: A retrospective analysis at 4 years
  • 2023
  • Ingår i: Journal of Periodontology. - 0022-3492. ; 94:9, s. 1090-1099
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundRecently, a composite outcome measure (COM) was proposed to describe the short-term results of periodontal regenerative treatment. The present retrospective study aimed at evaluating the prognostic value of COM on clinical attachment level (CAL) change over a 4-year period of supportive periodontal care (SPC). MethodsSeventy-four intraosseous defects in 59 patients were evaluated at 6 months and 4 years following regenerative treatment. Based on 6-month CAL change and probing depth (PD), defects were classified as: COM1 (CAL gain & GE;3 mm, PD & LE;4 mm); COM2 (CAL gain <3 mm, PD & LE;4 mm); COM3 (CAL gain & GE;3 mm, PD >4 mm); or COM4 (CAL gain <3 mm, PD >4 mm). COM groups were compared for "stability" (i.e., CAL gain, no change in CAL or CAL loss <1 mm) at 4 years. Also, groups were compared for mean change in PD and CAL, need for surgical retreatment, and tooth survival. ResultsAt 4 years, the proportion of stable defects in COM1, COM2, COM3, and COM4 group was 69.2%, 75%, 50%, and 28.6%, respectively, with a substantially higher probability for a defect to show stability for COM1, COM2, and COM3 compared with COM4 (odds ratio 4.6, 9.1, and 2.4, respectively). Although higher prevalence of surgical reinterventions and lower tooth survival were observed in COM4, no significant differences were detected among COM groups. ConclusionsCOM may be of value in predicting CAL change at sites undergoing SPC following periodontal regenerative surgery. Studies on larger cohorts, however, are needed to substantiate the present findings.
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45.
  • Suvan, J, et al. (författare)
  • Subgingival Instrumentation for Treatment of Periodontitis. A Systematic Review.
  • 2020
  • Ingår i: Journal of Clinical Periodontology. - : Wiley. - 0303-6979 .- 1600-051X. ; 47:Suppl 22, s. 155-75
  • Forskningsöversikt (refereegranskat)abstract
    • To evaluate the efficacy of subgingival instrumentation (PICOS-1), sonic/ultrasonic/hand instruments (PICOS-2) and different subgingival instrumentation delivery protocols (PICOS-3) to treat periodontitis.Systematic electronic search (CENTRAL/MEDLINE/EMBASE/SCOPUS/LILACS) to March 2019 was conducted to identify randomized controlled trials (RCT) reporting on subgingival instrumentation. Duplicate screening and data extraction were performed to formulate evidence tables and meta-analysis as appropriate.As only one RCT addressed the efficacy of subgingival instrumentation compared to supragingival cleaning alone (PICOS-1), baseline and final measures from 11 studies were considered. The weighted pocket depth (PD) reduction was 1.7 mm (95%CI: 1.3-2.1) at 6/8 months and the proportion of pocket closure was estimated at 74% (95%CI: 64-85). Six RCTs compared hand and sonic/ultrasonic instruments for subgingival instrumentation (PICOS-2). No significant differences were observed between groups by follow-up time point or category of initial PD. Thirteen RCTs evaluated quadrant-wise vs full-mouth approaches (PICOS-3). No significant differences were observed between groups irrespective of time-points or initial PD. Five studies reported patient-reported outcomes, reporting no differences between groups.Nonsurgical periodontal therapy by mechanical subgingival instrumentation is an efficacious means to achieve infection control in periodontitis patients irrespective of the type of instrument or mode of delivery. Prospero ID:CRD42019124887.
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46.
  • Tomasi, Cristiano, 1964, et al. (författare)
  • A randomized multi-centre study on the effectiveness of non-surgical periodontal therapy in general practice
  • 2022
  • Ingår i: Journal of Clinical Periodontology. - : Wiley. - 0303-6979 .- 1600-051X. ; 49:11, s. 1092-1105
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim To evaluate the effectiveness of two non-surgical treatment protocols for periodontitis patients in general dental practice. Materials and Methods Ninety-five dental hygienists (59 dental clinics) were randomly assigned to one of two treatment protocols: (i) establishment of adequate self-performed oral hygiene prior to a single session of ultrasonic instrumentation (guided periodontal infection control [GPIC]) or (ii) conventional non-surgical therapy (CNST) including patient education and scaling and root planing integrated in multiple sessions. Residual pockets at 3 months were retreated in both groups. The primary outcome was pocket closure (probing pocket depth <= 4 mm) at 6 months. Multilevel models were utilized. Results Based on data from 615 patients, no significant differences with regard to clinical outcomes were observed between treatment protocols. Treatment-related costs (i.e., chair time, number of sessions) were significantly lower for GPIC than CNST. Smoking and age significantly affected treatment outcomes. Conclusions No significant differences between the two approaches were observed in regard to clinical outcomes. GPIC was more time-effective. Patient education should include information on the detrimental effects of smoking. ClinicalTrials.gov (NCT02168621).
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47.
  • Tomasi, Cristiano, 1964, et al. (författare)
  • Bone dimensional variations at implants placed in fresh extraction sockets: a multilevel multivariate analysis.
  • 2010
  • Ingår i: Clinical oral implants research. - : Wiley. - 1600-0501 .- 0905-7161. ; 21:1, s. 30-36
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM: To use multilevel, multivariate models to analyze factors that may affect bone alterations during healing after an implant immediately placed into an extraction socket. MATERIAL AND METHODS: Data included in the current analysis were obtained from a clinical trial in which a series of measurements were performed to characterize the extraction site immediately after implant installation and at re-entry 4 months later. A regression multilevel, multivariate model was built to analyze factors affecting the following variables: (i) the distance between the implant surface and the outer bony crest (S-OC), (ii) the horizontal residual gap (S-IC), (iii) the vertical residual gap (R-D) and (iv) the vertical position of the bone crest opposite the implant (R-C). RESULTS: It was demonstrated that (i) the S-OC change was significantly affected by the thickness of the bone crest; (ii) the size of the residual gap was dependent of the size of the initial gap and the thickness of the bone crest; and (iii) the reduction of the buccal vertical gap was dependent on the age of the subject. Moreover, the position of the implant opposite the alveolar crest of the buccal ridge and its bucco-lingual implant position influenced the amount of buccal crest resorption. CONCLUSIONS: Clinicians must consider the thickness of the buccal bony wall in the extraction site and the vertical as well as the horizontal positioning of the implant in the socket, because these factors will influence hard tissue changes during healing.
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48.
  • Tomasi, Cristiano, 1964, et al. (författare)
  • Clinical research of peri-implant diseases--quality of reporting, case definitions and methods to study incidence, prevalence and risk factors of peri-implant diseases.
  • 2012
  • Ingår i: Journal of clinical periodontology. - 1600-051X. ; 39:Suppl 12, s. 207-23
  • Forskningsöversikt (refereegranskat)abstract
    • Aim: To review the quality of reporting and the methodology of clinical research on the incidence, prevalence and risk factors of peri-implant diseases. Methods: A MEDLINE search was conducted for cross-sectional, case-control and prospective longitudinal studies reporting on peri-implant diseases. To evalu- ate the quality of reporting of the selected studies the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist was utilized. Results: The search provided 306 titles and abstracts, out of which 40 were selected for full-text analysis. Finally, 16 studies were included out of which five assessed prevalence and only two the incidence of peri-implant diseases. 13 articles studied risk indicators for peri-implant diseases. None of the scrutinized articles adhered fully to the STROBE criteria. The large majority of articles did not (i) clearly state the applied study design, (ii) describe any effort to address potential sources of bias, (iii) explain how missing data were addressed, (iv) per- form any kind of sensitivity analysis, (v) indicate the number of participants with missing data for each variable of interest. Conclusion: Collectively, the findings of this review indicate a need for improved reporting of epidemiological studies on peri-implant diseases.
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49.
  • Tomasi, Cristiano, 1964, et al. (författare)
  • Early healing of peri-implant mucosa in man
  • 2016
  • Ingår i: Journal of Clinical Periodontology. - : Wiley. - 0303-6979 .- 1600-051X. ; 43:10, s. 816-824
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: To analyse (i) cellular and vascular densities in the connective tissue interface portion of the peri-implant mucosa and (ii) tissue interactions with the titanium surface during early stages of healing. Materials and Methods: Circumferential biopsies of peri-implant soft tissues were retrieved together with custom-made abutments at 27 implants in 21 patients after 2, 4, 6, 8 and 12weeks of healing. Following fixation, the peri-implant soft tissue was separated from the abutments, divided into four units and embedded in paraffin. Sections were produced and prepared for immunohistochemical analysis. The abutments were examined by SEM. Results: T and B cells occurred in clusters with a decreasing cell density from 4 to 8weeks of healing in the connective tissue lateral of the abutment. Macrophages were evenly distributed in the connective tissue along the abutment/tissue interface, while polymorphonuclear (PMN) cells were confined to the tissue portion lateral to the junctional epithelium. Vascular structures showed a decrease in density from 2 to 8weeks of healing. SEM analyses of the abutments revealed an increased presence of tissue remnants attached to the surface with increasing healing time. A biofilm was consistently observed in a supra-mucosal position, apical of which a “clear zone” occurred that separated the tissue remnants and the biofilm. Conclusion: Onset and resolution of inflammation together with increasing tissue attachment to the implant characterize healing of peri-implant mucosa. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
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50.
  • Tomasi, Cristiano, 1964, et al. (författare)
  • Effect of socket grafting with deproteinized bone mineral: An RCT on dimensional alterations after 6 months
  • 2018
  • Ingår i: Clinical Oral Implants Research. - : Wiley. - 0905-7161. ; 29:5, s. 435-442
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectiveTo examine if (i) characteristics of the fresh extraction socket site influenced subsequent dimensional alterations and (ii) placement of deproteinized bovine mineral in the socket affected volumetric change during healing. Materials and methodsTwenty seven subjects and 28 extraction sites were included. Immediately after the removal of the tooth and after 6months of healing, stone and virtual models of the jaw were produced. A cone beam computerized tomography scan was obtained immediately after extraction and the thickness of the buccal bone wall at the extraction site was measured. Extraction sites were randomly assigned to test or control group. In the test group, extraction sockets were filled with deproteinized bone mineral and covered with a collagen membrane. In the control group, only a collagen membrane was placed. ResultsThe thickness of the buccal bone wall at the extraction site influenced the amount of volume reduction that occurred. Socket grafting influenced the degree of ridge diminution only at sites where the buccal bone wall was thin ( 1mm). ConclusionA graft comprised of collagen-enriched deproteinized bovine bone mineral, placed to fill extraction sockets failed to influence the overall diminution of the ridge that occurred during healing. The thickness of the buccal bone wall apparently had a significant influence on volumetric alterations of the edentulous ridge following tooth extraction.
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