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BACKGROUND: Static and dynamic dental implant guidance systems have established themselves as effective choices that result in predictable and relatively accurate dental implant placement. Generally, studies assess this accuracy using a postoperative CBCT, which has disadvantages such as additional radiation exposure for the patient. This pilot study proposed a scanbody-agnostic method of implant position assessment using intraoral scanning technology and applied it as an accuracy test of robotically assisted dental implant placement using the Neocis Yomi. MATERIALS AND METHODS: All of the robotically assisted dental implant surgery was performed in the Postdoctoral Periodontology clinic at Boston University Henry M. Goldman School of Dental Medicine. Completely edentulous patients were excluded. A total of eleven (11) implants were included in the study, eight (8) of which were fully guided. An optical impression of each implant position was obtained using a CEREC Omnicam (SW 5.1) intraoral scanner. Each sample used either a DESS Lab Scan Body or an Elos Accurate Scan Body as a means to indirectly index the position of the implant. A comparison of planned implant position versus executed surgical implant position was performed for each placement using Geomagic Control X software. Global positional and angular deviations were quantified using a proposed scanbody-agnostic method. Intraoral directionality of deviation was visually qualified by the author (D.K). RESULTS: Mean global positional deviations at the midpoints of the top of each scanbody were 1.7417 mm in the partially guided samples and 1.1300 mm in the fully guided samples. Mean global positional deviations at the midpoints of the restorative platforms of each implant were 1.3142 mm in the partially guided sample and 1.27045 mm in the fully guided samples. Mean global positional deviations at the midpoints of the apex of each implant were 1.455 mm in the partially guided samples and 1.574 mm in the fully guided samples. Mean angular deviations were 3.7492 degrees in the partially guided samples and 2.6432 degrees in the fully guided samples. CONCLUSION: Within the sample size limitations, robotically assisted dental implant surgery offers similar implant placement accuracy compared to published static and dynamic implant placement guidance systems. Intraoral optical assessment of dental implant position used in this study allows comparable analysis to other methods without requiring additional exposure to radiation and should be considered the default method of assessing guidance accuracy.

BakgrundDen gingivala biotypen utvärderas regelbundet kring egna tänder före och efter kirurgiska ingrepp (t.ex för behandlingsplanering och riskbedömning). Nyligen presenterade Colorvue® biotypprobe (CBP) en ny metod för bedömning av gingivala biotyper i syfte av att möjliggöra en mer detaljerad klassificering av gingivan. Studien syftade till att bedöma det nya sonderingsystemets reproducerbarhet, repeterbarhet och riktighet vid naturliga tänder.MetoderDenna tvärsnittsstudie omfattade 50 deltagare (3 tänder/deltagare) och gingival biotyp bedömdes med 3 metoder vid en centralincisiv, lateralincisiv och hörntand med: 1) med en standard periodontal sond (SPP), 2) med CBP-proberna (CBP1/2/3), och 3) genom visuell bedömning (VA). Den faktiska tjockleken bedömdes genom transgingival sondering med en endodontisk fil. Utvärderingen gjordes av 8 granskare och reproducerbarhet mellan granskare och repeterbarhet inom granskaren utvärderades.ResultatFördelningen av gingivala tjockleken i studiepopulationen är uppdelad i tunn (18%), mellan (29%), tjock (29%) och mycket tjock (24%). Fördelningen av de fyra CBP-kategorierna är tunn (10%), medium (87%), tjock (2%) och mycket tjock (1%). Intervallet av gingivala biotypen bland de 8 granskarna enligt CBP: tunn (1% till 34%), medium (65% till 86%), tjock (0% till 4%) och mycket tjock (0% till 3%). Statistiskt signifikant skillnad i tjocklek av gingivan hittades i elva av fyrtio utvärderingar bland alla examinator och för alla metoder (VA, CBP och SPP). Fem av de signifikanta skillnaderna hittades bland CBP-sonderna, fyra för SPP och två för VA. Varken SPP eller CBP visade en tydlig tillförlitlighet i bedömning av gingivala tjockleken. SPP visade bäst resultat i både reproducerbarhet och repeterbarhet. Överensstämmelsen mellan granskarna med avseende på CBP varierade från måttlig till stor överensstämmelse. Reproducerbarhet bland granskaren varierade från dålig till nästan perfekt överenskommelse.SlutsatserBaserat på reproducerbarhet, repeterbarhet och exakthet, är SPP-sondernas förmåga att klassificera gingival biotyp i 4 kategorier av distinkt tjocklek bättre än CBP och VA. / BackgroundThe gingival biotype is regularly assessed around natural teeth before and after surgical procedures (e.g. for treatment planning and risk assessment). Recently, a new set of probes Colorvue® biotype probe (CBP) for gingival biotype assessment has been introduced, with the intention to facilitate a more detailed classification (i.e., 4 categories in total). The study aimed to evaluate the feasibility and reproducibility of this new probe system at natural teeth.MethodsThis cross-sectional study included 50 participants (3 teeth/participant), and gingival biotype was assessed by 3 methods at one maxillary central incisor, lateral incisor and canine with 1) with a standard periodontal probe, 2) with the CBP probes, and 3) by visual judgement. The actual thickness was assessed by transgingival sounding with an endodontic file. The judgements were done by 8 examiners, and inter-examiner reproducibility and intra-examiner repeatability were assessed.ResultsThe distribution of the gingival thickness in the present study population is divided into thin (18%), medium (29%), thick (29%) and very thick (24%). The distribution of the 4 CBP categories are thin (10%), medium (87%), thick (2%) and very thick (1%). The range of gingival biotype among the 8 examinators: thin (1% to 34%), medium (65% to 86%), thick (0% to 4%) and very thick (0% to 3%). A statistically significant difference in gingival thickness was found in eleven out of forty evaluations among all evaluators and for all methods (VA, CBP, and SPP). Five of the significant differences were found among the CBP probes, four for the SPP, and two for the VA. When compared, neither the SPP nor the CBP was clearly more reliability than the other. SPP showed the best results in both inter-examiner reproducibility and intra-examiner repeatability. Inter-examiner reproducibility for the CBP ranged from moderate to substantial agreement. Intra-examiner repeatability varied from poor to almost perfect agreement.ConclusionsBased on the reproducibility, repeatability and accuracy, the SPP method to classify the gingival biotype accurately into 4 categories of distinct thickness performed better than CBP and VA.

SAMMANFATTNINGBakgrundParodontit är en kronisk sjukdom som beror på en endogen infektion i munhålan. Sjukdomen drabbar 8-20% av den vuxna befolkningen globalt och påverkas av såväl genetiska, systemiska och lokala faktorer, som av livsstilsfaktorer. En av de största livsstilsfaktorerna vid parodontal sjukdom är rökning. Rökning är både en stor riskfaktor för utveckling av parodontal sjukdom och en prediktor för en negativ behandlingsutkomst. I tidigare studier har rökare uppvisat en sämre följsamhet till parodontal stödbehandling än icke-rökare.Syfte, material och metodMed hjälp av tobaksanamneser, insamlade på avdelningen för parodontologi på tandvårdshögskolan vid Malmö högskola, var målet att via det elektroniska journalsystemet T4 utvärdera patienternas följsamhet till behandling. Vidare ville vi tydliggöra eventuella skillnader mellan rökare och icke-rökare, mellan olika åldersgrupper och mellan patienter med olika svårighetsgrader av parodontal skada. Tobaksanamneser från 213 patienter, insamlade under år 2013, inkluderades i studien. Samtliga journaler granskades och data relevant för studien extraherades enligt en utformad mall.Resultat och slutsatsEn signifikant skillnad gällande antalet återbud till planerad behandling kan ses mellan grupperna, där de rökande patienter har flest återbud. Antalet återbud påverkas också av bostadsort och parodontal diagnos. Även ålder och operatör kan påverka risken för återbud. Ytterligare skillnader mellan grupperna ses i relation till sysselsättning, där antalet sjukskrivna och arbetslösa patienter är överrepresenterade bland rökarna. Vidare studier bör utformas som prospektiva studier där patienter följs och behandlas enligt en kalibrerad mall. För att få mer pålitliga resultat behöver fler och bättre kontrollerade studier utföras i ämnet. / ABSTRACTIntroductionPeriodontal disease is a chronic disease that depends on an endogenous infection in the oral cavity. The disease affects 8-20% of the adult population worldwide and is influenced by both genetic, systemic, local and lifestyle factors. One of the major lifestyle factors in periodontal disease is smoking. Smoking is both a major risk factor for development of periodontal disease and a predictor of adverse treatment outcome. In previous studies, smokers showed a lower adherence to periodontal support therapy.Study design, methods and materialUsing tobacco anamnesis, collected in the Department of Periodontology at the School of Dentistry at Malmö University, the purpose was to to evaluate patient compliance to treatment taking into account various variables. Tobacco anamnesis from 213 subjects collected in 2013, were included in the study. All records were reviewed and data relevant to the study extracted according to a designed template.Results and conclusionSmokers, and non-smokers were compared and significant differences between the groups regarding number of cancellations of planned treatment could be seen. Smokers tended to have more cancellations. The number of cancellations were affected by place of residence and periodontal diagnosis. Also age and therapist could affect the risk. Differences between the groups was seen in relation to employment, where unemployed patients, as well as patients in early retirement/long term sickness were overrepresented among smokers. To get more reliable results more and better -controlled studies are needed.

Objectives: One potential impact of oral probiotic products involves use of known bacterial antagonisms to alter the ecologic environment in periodontal pockets from one inhabited by pathogenic dental plaque microorganisms to one more favorable to colonization by non-pathogenic species (bacterial replacement). Until recently, the ability to introduce such beneficial effector bacteria into the oral cavity of periodontitis patients has been limited by the lack of specifically-formulated available commercial probiotic products. PerioBalance (Sunstar GUM), with two strains of the gram-positive, aerobic species Lactobacillus reuteri, and EvoraPlus (Oragenics), with freeze-dried strains of the gram-positive, aerobic species Streptococcus oralis, Streptococcus uberis, and Streptococcus rattus, are two recently-introduced commercial oral probiotic products proposed to have beneficial effects against periodontal disease. However, it is not known if the microbial species contained in these two oral probiotics are viable after the manufacturing process, and have the capability to exert inhibitory effects against putative periodontal bacterial pathogens when reconstituted in the oral cavity. Thus, the objective of the present study was to determine whether PerioBalance lactobacilli and EvoraPlus streptococci are viable upon product use, and possess in vitro inhibitory effects against fresh clinical strains of the putative periodontal bacterial pathogens, Tannerella forsythia and Prevotella intermedia/nigrescens, in the presence of anaerobic growth conditions. Methods: Commercial lots of PerioBalanceÒ and EvoraPlusÒ tablets were aseptically removed from the product packaging with sterile forceps, dissolved into Möller’s VMG I anaerobic dispersion solution, plated onto pre-reduced, enriched Brucella blood agar, and subjected to overnight anaerobic incubation at 35ºC in a culture cabinet containing 85% N2-10% H2-5% CO2, and to overnight aerobic incubation in a 5% CO2-95% air atmosphere. All culture plates were then visually examined under magnification for microbial colony growth. In vitro solid media competition assays were used to assess the in vitro inhibition capability of the two oral probiotics against T. forsythia and P. intermedia/nigrescens. Pioneer PerioBalance lactobacilli and EvoraPlus streptococci colonies were first grown on enriched Brucella blood agar media, followed by secondary spotting of T. forsythia and P. intermedia/nigrescens isolates immediately next to the established pioneer EvoraPlus and PerioBalanceÒ bacterial colonies such that they almost touched each other. After an additional overnight anaerobic incubation period, growth inhibition of the putative periodontal bacterial pathogens by the pioneer PerioBalance and EvoraPlus colonies was noted as the visual presence without magnification of a proximal zone of inhibition at the intersection of the pioneer colonies and the T. forsythia and P. intermedia/nigrescens colonies. Results: PerioBalance lactobacilli grew readily and in abundance in vitro on anerobically and anaerobically-incubated EBBA, with no other colony types or contaminating organisms. In contrast, EvoraPlus product samples purchased over-the-counter from drug stores in Maryland and Pennsylvania failed to exhibit any in vitro microbial growth under anaerobic and aerobic incubation conditions, with only EvoraPlus tablets obtained directly from the manufacturer yielding in vitro streptococcal growth. No in vitro inhibition was noted under anaerobic conditions of established PerioBalance lactobacilli and EvoraPlus streptococci pioneer colonies against subsequent growth of clinical isolates of T. forsythia and P. intermedia/nigrescens, with no zone of inhibition developing between their colonies and the immediately-adjacent established oral probiotic pioneer colonies. Conclusions: The two commercial oral probiotics evaluated varied considerably in the viability of their microbial constituents, with abundant growth of PerioBalance lactobacilli found in over-the-counter product material, and the lack of any EvoraPlus streptococci growth in product tablets obtained from sources other than directly from the manufacturer. Both oral probiotic products failed in vitro, in solid media competition assays, to inhibit growth of fresh clinical isolates the putative periodontal bacterial pathogens T. forsythia and P. intermedia/nigrescens under anaerobic growth conditions. These findings question the potential effectiveness of the two oral probiotic products to alter the subgingival ecology in periodontal pockets when anaerobic environmental conditions are present. Additional research is needed to assess the inhibitory potential of PerioBalance lactobacilli and EvoraPlus streptococci against additional isolates of subgingival bacterial species, and in circumstances where microaerophilic or aerobic environmental conditions are found. / Oral Biology

Periodontitis is a chronic inflammatory disease caused by pathogenic bacteria residing in a complex biofilm within a susceptible host. Amixicile is a non-toxic, readily bioavailable novel antimicrobial that targets strict anaerobes through inhibition of the activity of Pyruvate Ferredoxin Oxidoreductase (PFOR), a major enzyme mediating oxidative decarboxylation of pyruvate. Our study aimed to evaluate the efficacy of amixicile, when compared to metronidazole, in inhibiting the growth of bacteria present in a microbiome harvested from patients with chronic periodontitis. Plaque samples were harvested from patients with severe chronic periodontitis and cultured under anaerobic conditions. The microbiomes were grown in the presence of amixicile and metronidazole and the growth was compared to that of bacteria grown in the absence of the antimicrobials. Following 24 hour growth the bacterial DNA was analyzed using quantitative PCR (qPCR) using primers specific for 12 bacterial species: P. gingivalis (Pg), P. intermedia (Pi), F.nucleatum (Fn), S.gordonii (Sg), S. anginosus (Sa), V. atypical (Va), L. acidophilus (La), A.actinomycetemcomitans (Aa), T.denticola (Td), S.mutans (Sm), and S.sanguis (Ss). Both drug treatment groups yielded a statistical significant reduction for several anaerobic bacteria: Pi (P

Background: Current research has demonstrated that aspirin and fish oil (EFA) increase plasma levels of specialized pro-resolution molecules (SPMs). This study investigates their effects on SPM precursor pools in platelet rich fibrin (PRF). Methods: Twenty healthy volunteers were randomly assigned to take aspirin; EFA or aspirin and EFA. Four hours later, SPM precursor levels were quantified using combined Liquid Chromatography tandem mass spectrometry. The differences between the groups: Aspirin (yes or no), EFA (yes or no), were analyzed by ANCOVA, testing for group differences after covarying out the baseline value. Results: There were 4 significant interactions, 1 with an aspirin effect, 2 with an EFA effect, and 64 with no difference between the groups. The significant interaction effect was found for the following lipidome: LPE(20:4), LPI(16:1), LPI(18:1), and LPI(20:3). Aspirin decreased the LPG(16:4) levels, and EFA decreased the LPE(22:5) and PG(16:0/18:0) lipidomes. Conclusions: Some SPM precursor pools in PRF were increased following supplementation.

Evidence linking periodontitis and cardiovascular disease points to systemic inflammation as the primary etiology. The investigation into this association has focused on periodontitis as a low grade chronic infection, and subsequently, systemic inflammation and the cascade of numerous markers and mediators integrally involved in the human inflammatory response. The aim of this study was to measure the differences in circulating levels of C-reactive protein and human soluble CD40 ligand as markers and mediators of systemic inflammation in the serum of patients with moderate to severe periodontitis before, during, and after non-surgical periodontal therapy.Twenty-one patients were treated with full mouth scaling and root planing performed on two separate appointments spaced approximately 2 weeks apart. The third visit, an evaluation of non-surgical therapy, occurred 8 weeks after completion of scaling and root planing. Blood samples were procured from each patient at the first and second appointment prior to scaling and root planing and again at a third visit. CRP and sCD40 ligand levels were measured using ELISA. CRP levels remained relatively constant throughout the study maintaining a mean level of 2.44 mg/L at visit 1, 2.53 mg/L at visit 2, and 2.63 mg/L at visit 3. These differences were not statistically significant. sCD40 ligand mean levels were reported to be 847.7 pg/mL, 637.3 pg/mL, and 859.5 pg/mL, respectively for visits 1, 2, and 3. These values were not statistically significant. Within the limitations of this study, no evidence was found to directly relate non-surgical periodontal therapy with the lowering of systemic markers CRP and human soluble CD40 ligand.

Cellular adhesion molecules (CAMs) and selectins are cell-surface proteins involved in the binding of cells to the vascular endothelium. Elevated levels of sCAMs and soluble E-selectin (sE-selectin) have been reported in patients with periodontitis. The aim of this study was to determine if periodontal scaling and root planing would influence the serum concentration of sICAM-1, sVCAM-1, and sE-selectin. Twenty-one subjects with chronic periodontitis received scaling and root planing in conjunction with blood serum sample analysis using enzyme-linked immunosorbent assay (ELISA), to determine if periodontal instrumentation results in changes in serum concentrations of sICAM-1, sVCAM-1, and sE-selectin. No change was observed in serum concentration of sICAM-1 or sVCAM-1. However, in a subset of 17 patients a statistically significant change in serum sE-selectin was observed (P < 0.05). This suggests that there is a decrease in endothelial activation following periodontal treatment.

Background: There is mounting evidence to indicate that periodontitis may be a risk factor for cardiovascular disease (CVD). Periodontitis may be linked to CVD as either an etiologic mechanism or a predisposing factor that can hasten disease progression. Proinflammatory cytokines, elevated fibrinogen, and platelet aggregation are all potential mechanisms. The purpose of this study is to compare and review the serological differences in subjects with severe periodontitis, some of which involve established risk factors for atherosclerosis, particularly heightened C-reactive protein levels. Methods: A total of 184 subjects, comprising of two periodontal subgroups, non-periodontal (NP = 91) and generalized aggressive periodontitis (SP = 93), had serum evaluated for C-reactive protein (CRP) levels using a high sensitive ELISA test. The CRP levels were compared against clinical and demographical data to include race, age, gender, number of teeth, probing depth, attachment level, bleeding index, plaque index, and gingival index. Results: After adjusting for potential confounding variables, probing depth (p Conclusion: Pocket depth is significantly related to elevated levels of CRP, which is why it is imperative to treat periodontal pockets. This study may provide a possible link between CRP and periodontal disease, but a causal relationship cannot be inferred.