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Özişçi Ö. Assessing the quality of YouTube™ videos on fixed dental implant home-care and maintenance protocols. Int J Dent Hyg 2024; 22:444-451. [PMID: 36540951 DOI: 10.1111/idh.12660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 12/13/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The implant's supporting structure differs from that of the teeth when plaque accumulates, making it more prone to inflammation and bone loss. To ensure the implant's longevity, an effective maintenance protocol should be followed. This study aimed to evaluate the information on oral hygiene procedures at home for implant-supported fixed prosthesis. METHODS The keywords 'cleaning dental implant,' 'how to clean dental implant,' and 'dental implant hygiene' used to search for videos on YouTube™. Following the exclusions, two researchers independently analysed the remaining 100 videos for demographic data and content usefulness. RESULTS In terms of usefulness score distribution, 53.52% of the videos were considered slightly useful, 38.4% moderately useful and 8.1% very useful. The video content had the least quantity of knowledge about toothpaste choice (11.1%), but the greatest quantity of knowledge on flossing (68.7%). CONCLUSIONS According to the study's findings, there is presently no evidence-based information on YouTube™ on dental implant oral hygiene protocols for home care procedures hygiene education. Therefore, dental care professionals should analyse the information's quality and reliability before recommending it to patients.
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Affiliation(s)
- Özlem Özişçi
- Department of Prosthodontics, Faculty of Dentistry, Başkent University, Ankara, Turkey
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West N, Chapple I, Culshaw S, Donos N, Needleman I, Suvan J, Nibali L, Patel A, Preshaw PM, Kebschull M. BSP Implementation of Prevention and Treatment of Peri-implant Diseases - The EFP S3 Level Clinical Practice Guideline. J Dent 2024:104980. [PMID: 38697506 DOI: 10.1016/j.jdent.2024.104980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/28/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVES to adapt the supranational European Federation of Periodontology (EFP) Prevention and Treatment of Peri-implant Diseases - The EFP S3 Level Clinical Practice Guideline for UK healthcare environment, taking into account a broad range of views from stakeholders and patients. SOURCES This UK version, based on the supranational EFP guideline [1] published in the Journal of Clinical Periodontology, was developed using S3-level methodology, combining assessment of formal evidence from 13 systematic reviews with a moderated consensus process of a representative group of stakeholders, and accounts for health equality, environmental factors and clinical effectiveness. It encompasses 55 clinical recommendations for the Prevention and Treatment of Peri-implant Diseases, based on the classification for periodontal and peri-implant diseases and conditions [2]. METHODOLOGY The UK version was developed from the source guideline using a formal process called the GRADE ADOLOPMENT framework. This framework allows for adoption (unmodified acceptance), adaptation (acceptance with modifications) and the de novo development of clinical recommendations. Using this framework, following the S3-process, the underlying evidence was updated and a representative guideline group of 111 delegates from 26 stakeholder organisations was assembled into four working groups. Following the formal S3-process, all clinical recommendations were formally assessed for their applicability to the UK and adoloped accordingly. RESULTS AND CONCLUSION Using the ADOLOPMENT protocol, a UK version of the EFP S3-level clinical practice guideline for the Prevention and Treatment of Peri-implant Diseases was developed. This guideline delivers evidence- and consensus-based clinical recommendations of direct relevance to the UK healthcare community including the public. CLINICAL SIGNIFICANCE The S3-level-guidelines combine evaluation of formal evidence, grading of recommendations and synthesis with clinical expertise of a broad range of stakeholders. The international S3-level-guideline was implemented for direct clinical applicability in the UK healthcare system, facilitating a consistent, interdisciplinary, evidence-based approach with public involvement for the prevention and treatment of peri-implant diseases.
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Affiliation(s)
- Nicola West
- Restorative Dentistry, Bristol Dental School, University of Bristol, Bristol BS1 2LY, UK; Restorative Dentistry, Bristol Dental Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Marlborough Street, Bristol, BS1 3NU, Secretary General of the European Federation of Periodontology.
| | - Iain Chapple
- Birmingham NIHR Biomedical Research Centre in Inflammation. The University of Birmingham, Birmingham, United Kingdom; Birmingham Community Healthcare NHS Foundation Trust, Birmingham, United Kingdom
| | - Shauna Culshaw
- University of Glasgow Dental School, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Nikos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London (AMUL), Turner Street, London, E1 2AD
| | - Ian Needleman
- Unit of Periodontology, UCL Eastman Dental Institute, Bloomsbury Campus, Rockefeller Building, 21 University Street, London, WC1E 6DE
| | - Jeanie Suvan
- Unit of Periodontology, UCL Eastman Dental Institute, Bloomsbury Campus, Rockefeller Building, 21 University Street, London, WC1E 6DE
| | - Luigi Nibali
- Periodontology Unit, Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Guys Hospital, Great Maze Pond, London, SE1 9RT
| | - Amit Patel
- Birmingham Dental Specialists, Associate Professor, University of Birmingham, Birmingham, UK, President of the Association of Dental Implantology
| | - Philip M Preshaw
- School of Dentistry, University of Dundee, Dundee UK; School of Dental Sciences, University of Newcastle, Newcastle upon Tyne, UK
| | - Moritz Kebschull
- Birmingham NIHR Biomedical Research Centre in Inflammation. The University of Birmingham, Birmingham, United Kingdom; Birmingham Community Healthcare NHS Foundation Trust, Birmingham, United Kingdom; Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, NY, USA; School of Dentistry, University of Birmingham, Birmingham B5 7EG, UK, President-Elect of the European Federation of Periodontology.
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D'Ambrosio F, Santella B, Di Palo MP, Giordano F, Lo Giudice R. Characterization of the Oral Microbiome in Wearers of Fixed and Removable Implant or Non-Implant-Supported Prostheses in Healthy and Pathological Oral Conditions: A Narrative Review. Microorganisms 2023; 11:microorganisms11041041. [PMID: 37110463 PMCID: PMC10145620 DOI: 10.3390/microorganisms11041041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
Oral commensal microorganisms perform very important functions such as contributing to the health of the host. However, the oral microbiota also plays an important role in the pathogenesis and development of various oral and systemic diseases. The oral microbiome may be characterized by a higher prevalence of some microorganisms than others in subjects with removable or fixed prostheses, depending on oral health conditions, the prosthetic materials used, and any pathological conditions brought about by inadequate prosthetic manufacturing or poor oral hygiene. Both biotic and abiotic surfaces of removable and fixed prostheses can be easily colonized by bacteria, fungi, and viruses, which can become potential pathogens. The oral hygiene of denture wearers is often inadequate, and this can promote oral dysbiosis and the switch of microorganisms from commensal to pathogens. In light of what emerged from this review, fixed and removable dental prostheses on teeth and on implants are subject to bacterial colonization and can contribute to the formation of bacterial plaque. It is of fundamental importance to carry out the daily hygiene procedures of prosthetic products, to design the prosthesis to facilitate the patient's home oral hygiene practices, and to use products against plaque accumulation or capable of reducing oral dysbiosis to improve patients' home oral practices. Therefore, this review primarily aimed to analyze the oral microbiome composition in fixed and removable implant or non-implant-supported prostheses wearers in healthy and pathological oral conditions. Secondly, this review aims to point out related periodontal self-care recommendations for oral dysbiosis prevention and periodontal health maintenance in fixed and removable implant or non-implant-supported prostheses wearers.
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Affiliation(s)
- Francesco D'Ambrosio
- Department of Medicine, Surgery and Dentistry "Schola Medica Salernitana", University of Salerno, Via S. Allende, 84081 Baronissi, Italy
| | - Biagio Santella
- Department of Medicine, Surgery and Dentistry "Schola Medica Salernitana", University of Salerno, Via S. Allende, 84081 Baronissi, Italy
| | - Maria Pia Di Palo
- Department of Medicine, Surgery and Dentistry "Schola Medica Salernitana", University of Salerno, Via S. Allende, 84081 Baronissi, Italy
| | - Francesco Giordano
- Department of Medicine, Surgery and Dentistry "Schola Medica Salernitana", University of Salerno, Via S. Allende, 84081 Baronissi, Italy
| | - Roberto Lo Giudice
- Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital "G. Martino" of Messina, Via Consolare Valeria 1, 98123 Messina, Italy
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Carra MC, Blanc-Sylvestre N, Courtet A, Bouchard P. Primordial and primary prevention of peri-implant diseases: A systematic review and meta-analysis. J Clin Periodontol 2023. [PMID: 36807599 DOI: 10.1111/jcpe.13790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/21/2023]
Abstract
AIM This systematic review and meta-analysis aims to assess the efficacy of risk factor control to prevent the occurrence of peri-implant diseases (PIDs) in adult patients awaiting dental implant rehabilitation (primordial prevention) or in patients with dental implants surrounded by healthy peri-implant tissues (primary prevention). MATERIALS AND METHODS A literature search was performed without any time limit on different databases up to August 2022. Interventional and observational studies with at least 6 months of follow-up were considered. The occurrence of peri-implant mucositis and/or peri-implantitis was the primary outcome. Pooled data analyses were performed using random effect models according to the type of risk factor and outcome. RESULTS Overall, 48 studies were selected. None assessed the efficacy of primordial preventive interventions for PIDs. Indirect evidence on the primary prevention of PID indicated that diabetic patients with dental implants and good glycaemic control have a significantly lower risk of peri-implantitis (odds ratio [OR] = 0.16; 95% confidence interval [CI]: 0.03-0.96; I2 : 0%), and lower marginal bone level (MBL) changes (OR = -0.36 mm; 95% CI: -0.65 to -0.07; I2 : 95%) compared to diabetic patients with poor glycaemic control. Patients attending supportive periodontal/peri-implant care (SPC) regularly have a lower risk of overall PIDs (OR = 0.42; 95% CI: 0.24-0.75; I2 : 57%) and peri-implantitis compared to irregular attendees. The risk of dental implant failure (OR = 3.76; 95% CI: 1.50-9.45; I2 : 0%) appears to be greater under irregular or no SPC than regular SPC. Implants sites with augmented peri-implant keratinized mucosa (PIKM) show lower peri-implant inflammation (SMD = -1.18; 95% CI: -1.85 to -0.51; I2 : 69%) and lower MBL changes (MD = -0.25; 95% CI: -0.45 to -0.05; I2 : 62%) compared to dental implants with PIKM deficiency. Studies on smoking cessation and oral hygiene behaviors were inconclusive. CONCLUSIONS Within the limitations of available evidence, the present findings indicate that in patients with diabetes, glycaemic control should be promoted to avoid peri-implantitis development. The primary prevention of peri-implantitis should involve regular SPC. PIKM augmentation procedures, where a PIKM deficiency exists, may favour the control of peri-implant inflammation and the stability of MBL. Further studies are needed to assess the impact of smoking cessation and oral hygiene behaviours, as well as the implementation of standardized primordial and primary prevention protocols for PIDs.
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Affiliation(s)
- Maria Clotilde Carra
- U.F.R. d'Odontologie, Université Paris Cité, Paris, France.,Service of Odontology, Periodontal and Oral Surgery Unit, Rothschild Hospital (AP-HP), Paris, France.,Population-Based Epidemiologic Cohorts Unit, Inserm, UMS 11, Villejuif, France
| | - Nicolas Blanc-Sylvestre
- U.F.R. d'Odontologie, Université Paris Cité, Paris, France.,Service of Odontology, Periodontal and Oral Surgery Unit, Rothschild Hospital (AP-HP), Paris, France.,URP 2496, Université Paris Cité, Paris, France
| | - Alexandre Courtet
- U.F.R. d'Odontologie, Université Paris Cité, Paris, France.,Service of Odontology, Periodontal and Oral Surgery Unit, Rothschild Hospital (AP-HP), Paris, France
| | - Philippe Bouchard
- U.F.R. d'Odontologie, Université Paris Cité, Paris, France.,URP 2496, Université Paris Cité, Paris, France
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Abstract
BACKGROUND This study investigated the preferences of dentists in Australia in providing professional implant maintenance and implant-specific oral hygiene instructions (OHI). METHODS General dentists were surveyed online about their preferences in peri-implant diagnostics, maintenance provision, armamentarium used, and implant OHI techniques and frequency. RESULTS Most of the 303 respondents (96%) provided maintenance services; 87.6% reviewed implants regularly while 10.7% only performed diagnostics after detecting clinical signs/symptoms. Supragingival prosthesis cleaning was performed by 77.9% of respondents, 35.0% performed subgingival debridement, 41.9% treated peri-implant mucositis and 18.2% treated peri-implantitis. About 15% did not treat nor refer peri-implant disease, including significantly more non-implant providers and dentists without implant training. Maintenance armamentarium commonly included floss (76.3%), prophylaxis (73.9%), plastic curettes (43.3%) and stainless-steel ultrasonics (38.0%). Brushing (86.5%), flossing (73.9%) and interdental brush use (68.3%) were most commonly recommended. Implant OHI was repeated routinely by 57.4% of dentists who provided it. Dentists with greater implant training and experience were more likely to perform reviews and complex maintenance procedures. CONCLUSIONS Peri-implant diagnostics performed, treatments provided and armamentarium varied among dentists. Implant providers and those with higher levels of training had more preventative approaches to implant OHI. Possible shortcomings in disease management and OHI reinforcement were identified.
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Affiliation(s)
- M C Cheung
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC, Australia
| | - M S Hopcraft
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC, Australia
| | - I B Darby
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC, Australia
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Abstract
BACKGROUND This study investigated the possible correlations between patient-performed implant hygiene and peri-implant success and disease, as well as patient-reported outcomes, in a community-based cohort. METHODS Fifty-one patients (78 implants) from two private general practices were surveyed on their dental implant treatment history, oral hygiene instructions (OHI) received, home hygiene habits and current implant concerns. Their dentition, plaque/calculus scores and clinical implant parameters were examined. Correlations between hygiene habits, risk factors, implant success and peri-implant disease rates were assessed. RESULTS Implants had a patient-reported mean time in function of 6.7 years. Floss (74.4%), interdental brushes (IDB) (44.9%) and mouthwash (39.7%) were commonly used, while 7.7% of implants were only cleaned by brushing. Over half (56.4%) of implants fulfilled the success criteria, 61.5% had peri-implant health, 24.4% had mucositis and 7.7% had peri-implantitis. Only brushing (P < 0.001) and detectable plaque/calculus (P < 0.001) were significantly associated with more peri-implant disease. Local prosthetic factors affecting cleaning accessibility significantly reduced implant success (P < 0.001). Patients reported mixed recall of implant OHI, 7.7% of implants were aesthetically unsatisfactory and 9.0% had peri-implant symptoms. CONCLUSIONS Lack of interproximal cleaning and the presence of plaque/calculus were significantly associated with peri-implant disease in a community-based general practice setting, and patients reported mixed recall of OHI.
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Affiliation(s)
- Monique Charlene Cheung
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC, Australia.,Private practice, Sydney, NSW, Australia
| | - Matthew S Hopcraft
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC, Australia
| | - Ivan B Darby
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC, Australia
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Cheung MC, Hopcraft MS, Darby IB. Dental implant maintenance teaching in Australia-A survey of education providers. Eur J Dent Educ 2020; 24:310-319. [PMID: 31977128 DOI: 10.1111/eje.12499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/13/2019] [Accepted: 01/18/2020] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Implant treatments and peri-implant maintenance continue apace, while the evidence for implant maintenance and home hygiene continues to be developed. Information sources for dental practitioners and patients in peri-implant health maintenance and disease management are generally not known. This study investigated the implant maintenance topics taught, the discipline backgrounds of convenors and presenters and information delivery methods within implant dentistry teaching in Australia. MATERIALS AND METHODS An online survey was distributed to 56 convenors of implant dentistry and maintenance education programmes in Australia, garnering responses from 24 individuals which outlined 43 different education programmes. RESULTS Lectures were the main delivery method for implant maintenance information across the different course types. Peri-implant diagnostics were generally taught according to current literature recommendations, but coverage varied in topics where the evidence is yet to be established (eg home hygiene, professional maintenance and implant review). Some educators reported awareness of limitations in their programmes. CONCLUSION Implant dentistry education programmes in Australia vary widely in teaching implant maintenance, coverage of which should be current and evidence-based at all education levels. The structure of implant dentistry teaching at the continuing professional development level requires further development.
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Affiliation(s)
- Monique C Cheung
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC, Australia
| | - Matthew S Hopcraft
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC, Australia
| | - Ivan B Darby
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC, Australia
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Ng C, Tsoi JKH, Lo ECM, Matinlinna JP. Safety and Design Aspects of Powered Toothbrush-A Narrative Review. Dent J (Basel) 2020; 8:dj8010015. [PMID: 32033270 PMCID: PMC7148448 DOI: 10.3390/dj8010015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/10/2019] [Accepted: 12/27/2019] [Indexed: 11/19/2022] Open
Abstract
The powered toothbrush has become a modern dental tool that is available in the supermarket. Indeed, the design of the powered toothbrush, e.g., mechanical and electrical, would affect not only the efficacy but also the safety of the products. This narrative review attempted to view the powered toothbrush from design, safety, and application points with respect to tufts, filaments, handles, mechanics, motions, and materials interactions from various available sources. Different brands and models of powered toothbrushes have their own designs that might affect the clinical outcome. The rotational design was advocated to be clinically more effective than the manual one, some modern models might be designed with vibrational or oscillation (or mixed) tufts head that might be useful in patients with specific needs, such as having xerostomia or for the elderly. To conclude, tuft retention design is important in the powered toothbrush as it contributes significantly to safety as the fallen off tufts, filaments and metal parts might cause injury. Tests revealing the retention force of brush head plates and brush head bristles will be significant references for consumers to determine which design of powered toothbrushes is relatively safer.
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Checchi V, Racca F, Bencivenni D, Lo Bianco L. Role of Dental Implant Homecare in Mucositis and Peri-implantitis Prevention: A Literature Overview. Open Dent J 2019. [DOI: 10.2174/1874210601913010470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Correlation between high plaque index and inflammatory lesions around dental implants has been shown and this highlights the importance of patient plaque control. Until now, knowledge of peri-implant home care practices has been based on periodontal devices.
Objective:
The aim of this overview is to identify the presence of scientific evidence that peri-implant homecare plays a role in mucositis and peri-implantitis prevention.
Methods:
Different databases were used in order to detect publications reflecting the inclusion criteria. The search looked into peri-implant homecare studies published from 1991 to 2019 and the terms used for the identification of keywords were: Dental implants, Brush, Interproximal brushing, Interdental brushing, Power toothbrush, Cleaning, Interdental cleaning, Interspace cleaning, Flossing, Super floss, Mouth rinses, Chlorhexidine. The type of studies included in the selection for this structured review were Randomized Clinical Trials, Controlled Clinical Trials, Systematic Reviews, Reviews, Cohort Studies and Clinical cases.
Results:
Seven studies fulfilled all the inclusion criteria: 3 RCTs, one Consensus report, one cohort study, one systematic review and one review. Other 14 studies that partially met the inclusion criteria were analyzed and classified into 3 different levels of evidence: good evidence for RCTs, fair evidence for case control and cohort studies and poor evidence for expert opinion and case report.
Conclusion:
Not much research has been done regarding homecare implant maintenance. Scientific literature seems to show little evidence regarding these practices therefore most of the current knowledge comes from the periodontal literature. Manual and powered toothbrushes, dental floss and interdental brushes seem to be useful in maintaining peri-implant health. The use of antiseptic rinses or gels does not seem to have any beneficial effects.
It can be concluded that to better understand which are the most effective home care practices to prevent mucositis and peri-implantitis in implant-rehabilitated patients, new specific high evidence studies are needed.
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Cortellini S, Favril C, De Nutte M, Teughels W, Quirynen M. Patient compliance as a risk factor for the outcome of implant treatment. Periodontol 2000 2019; 81:209-225. [PMID: 31407429 DOI: 10.1111/prd.12293] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Peri-implantitis can be explained using a multicausality model. Many factors are involved in the etiology of peri-implantitis, but patient compliance also plays a key role. Oral hygiene, attending recall visits, smoking behavior, and therapy comprehension are relevant factors that contribute to peri-implant health. The clinician should create the most optimal conditions for patients to facilitate adequate oral self-care and to help patients improve their oral hygiene skills. Implementation of a supportive periodontal therapy program is mandatory to control inflammation and plaque accumulation, as well as to keep the incidence of peri-implant diseases low. Patient compliance, including plaque control and dental follow-up, must be optimal. Consequently, precautions must be taken with patients treated with dental implants.
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Affiliation(s)
- Simone Cortellini
- Section of Periodontology, Department of Oral Health Sciences, KU Leuven & Dentistry, University Hospitals, KU Leuven, Leuven, Belgium
| | - Charlotte Favril
- Section of Periodontology, Department of Oral Health Sciences, KU Leuven & Dentistry, University Hospitals, KU Leuven, Leuven, Belgium
| | - Mathieu De Nutte
- Section of Periodontology, Department of Oral Health Sciences, KU Leuven & Dentistry, University Hospitals, KU Leuven, Leuven, Belgium
| | - Wim Teughels
- Section of Periodontology, Department of Oral Health Sciences, KU Leuven & Dentistry, University Hospitals, KU Leuven, Leuven, Belgium
| | - Marc Quirynen
- Section of Periodontology, Department of Oral Health Sciences, KU Leuven & Dentistry, University Hospitals, KU Leuven, Leuven, Belgium
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Abstract
PURPOSE Patient-administered and professionally administered periimplant maintenance have been recommended to ensure long-term periimplant tissue health. In this narrative review, the effectiveness of patient and professionally administered interventions and the current level of evidence that periimplant maintenance therapy is effective in preventing the occurrence of periimplant disease were examined. MATERIALS AND METHODS A systematic literature search was performed in Ovid MEDLINE, EMBASE, Cochrane Library, and Web of Science, for evidence-based articles in support of the above topics. RESULTS Twenty-six clinical trials were included and stratified into categories based on topics. CONCLUSIONS The following conclusions were reached: (a) mechanical plaque removal is the foundation of successful periimplant therapy; (b) patient- and professionally administered plaque control has been shown to reduce periimplant inflammation, although complete resolution of inflammation is not always evident; (c) the use of adjunctive chemical agents in maintaining periimplant health still remains to be determined; and (d) regular periimplant maintenance plays a significant role in maintaining periimplant soft and hard tissue health.
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Maeda T, Mukaibo T, Masaki C, Thongpoung S, Tsuka S, Tamura A, Aonuma F, Kondo Y, Hosokawa R. Efficacy of electric-powered cleaning instruments in edentulous patients with implant-supported full-arch fixed prostheses: a crossover design. Int J Implant Dent 2019; 5:7. [PMID: 30911853 PMCID: PMC6434005 DOI: 10.1186/s40729-019-0164-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 01/23/2019] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this study was to evaluate the plaque removal efficacies of electric toothbrushes and electric dental floss compared with conventional manual toothbrushing in cleaning the fitting surface of an All-on-4™ concept (Nobel Biocare, Zürich-Flughafen, Switzerland) implant-supported fixed dental prosthesis (FDP). Methods Nine patients with maxillary edentulous arches participated in the study. We investigated two electric-powered brushes (Sonicare Diamond Clean®, Koninklijke Philips N.V., Amsterdam, the Netherlands [SD group], and the Oral-B Professional Care Smart Series 5000®, Braun GmbH, Kronberg, Germany [OralB group]) and one electric dental floss unit (Air Floss®, Koninklijke Philips N.V. [AF group]). A manual toothbrush (Tuft24® MS, OralCare Inc., Tokyo, Japan) was used by the control group. The fitting surface of the FDP was stained to allow visualization of the entire accumulated plaque area. Both the buccal and palatal portions of the plaque area were assessed before and after brushing to evaluate each instrument’s plaque removal rate using a crossover study design. Two-week washout periods were employed between each evaluation. Results The plaque removal rates were 53.5 ± 8.5%, 70.9 ± 6.5%, 75.4 ± 6.3%, and 74.4 ± 4.2% for the control, AF, OralB, and SD groups, respectively. When participants were divided into two groups based on their plaque removal rates with a manual toothbrush (poor brushing and good brushing), the poor brushing group showed significant improvement in the plaque removal rate when using electric-powered toothbrushes. The plaque removal rates for the buccal area were significantly higher for the OralB and SD groups than for the manual brushing group (control group), with rates of 52.8 ± 7.9%, 70.1 ± 7.3%, 77.7 ± 6.5%, and 79.5 ± 3.7% for the control, AF, OralB, and SD groups, respectively. The plaque removal rates in the palatal area were consistently lower than those in the buccal area for each of the three electric instruments. Conclusions The results suggest that patients who are not adept at manual toothbrushing may potentially improve their removal of plaque from the fitting surfaces of FDPs by using electric toothbrushes.
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Affiliation(s)
- Toru Maeda
- Division of Oral Reconstruction and Rehabilitation, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-Ku, Kitakyushu City, Fukuoka, 803-8580, Japan
| | - Taro Mukaibo
- Division of Oral Reconstruction and Rehabilitation, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-Ku, Kitakyushu City, Fukuoka, 803-8580, Japan.
| | - Chihiro Masaki
- Division of Oral Reconstruction and Rehabilitation, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-Ku, Kitakyushu City, Fukuoka, 803-8580, Japan
| | - Sirapat Thongpoung
- Division of Oral Reconstruction and Rehabilitation, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-Ku, Kitakyushu City, Fukuoka, 803-8580, Japan
| | - Shintaro Tsuka
- Division of Oral Reconstruction and Rehabilitation, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-Ku, Kitakyushu City, Fukuoka, 803-8580, Japan
| | - Akiko Tamura
- Division of Oral Reconstruction and Rehabilitation, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-Ku, Kitakyushu City, Fukuoka, 803-8580, Japan
| | - Fumiko Aonuma
- Division of Oral Reconstruction and Rehabilitation, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-Ku, Kitakyushu City, Fukuoka, 803-8580, Japan
| | - Yusuke Kondo
- Division of Oral Reconstruction and Rehabilitation, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-Ku, Kitakyushu City, Fukuoka, 803-8580, Japan
| | - Ryuji Hosokawa
- Division of Oral Reconstruction and Rehabilitation, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-Ku, Kitakyushu City, Fukuoka, 803-8580, Japan
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Allocca G, Pudylyk D, Signorino F, Grossi GB, Maiorana C. Effectiveness and compliance of an oscillating-rotating toothbrush in patients with dental implants: a randomized clinical trial. Int J Implant Dent 2018; 4:38. [PMID: 30536124 PMCID: PMC6286907 DOI: 10.1186/s40729-018-0150-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 10/24/2018] [Indexed: 11/25/2022] Open
Abstract
Background The aim of this randomized clinical trial was to assess the efficacy of an oscillating-rotating toothbrush in reducing plaque and inflammation around dental implants. Methods Eighty patients presenting dental implants were enrolled in this study and assigned randomly to two different groups: 40 patients in the test group and 40 in the control one. Each patient in the test group received an oscillating-rotating toothbrush while in the control group patients kept using the manual toothbrush. Furthermore, the test group received a special toothbrush head designed for dental implants and another one for natural teeth. Domiciliary oral hygiene instructions were given to both groups. Periodontal parameters like plaque index (PI), bleeding on probing (BoP), and probing pocket depth (PPD) were recorded at the baseline and after 1 and 3 months. Results At the end of the study, the difference of plaque and bleeding indices with the baseline was statistically significant for both test and control groups (P < 0.0001). Implant sites showed higher values of both BoP and PI when compared to the natural teeth. In the second part of the study, comparing the 1–3-month period, the oscillating-rotating toothbrush was effective in reducing new plaque formation (P < 0.0001) and bleeding (P < 0.0001) both at the implant sites and the dental sites comparing to manual ones (P > 0.05). No significant differences were appreciated concerning the PPD. Conclusions The oscillating-rotating toothbrush can be successfully used for the plaque and bleeding control of the peri-implant tissues.
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Affiliation(s)
- Giuseppe Allocca
- Center for Edentulism and Jaw Atrophies, Maxillofacial Surgery and Dentistry Unit, Fondazione IRCCS Cà Granda - Ospedale Maggiore Policlinico, University of Milan, Via Commenda 10, 20122, Milan, Italy
| | - Diana Pudylyk
- Center for Edentulism and Jaw Atrophies, Maxillofacial Surgery and Dentistry Unit, Fondazione IRCCS Cà Granda - Ospedale Maggiore Policlinico, University of Milan, Via Commenda 10, 20122, Milan, Italy
| | - Fabrizio Signorino
- Center for Edentulism and Jaw Atrophies, Maxillofacial Surgery and Dentistry Unit, Fondazione IRCCS Cà Granda - Ospedale Maggiore Policlinico, University of Milan, Via Commenda 10, 20122, Milan, Italy.
| | - Giovanni Battista Grossi
- Oral Surgery, Maxillofacial Surgery and Dentistry Unit, Fondazione IRCCS Cà Granda - Ospedale Maggiore Policlinico, University of Milan, Via Commenda 10, 20122, Milan, Italy
| | - Carlo Maiorana
- Center for Edentulism and Jaw Atrophies, Maxillofacial Surgery and Dentistry Unit, Fondazione IRCCS Cà Granda - Ospedale Maggiore Policlinico, University of Milan, Via Commenda 10, 20122, Milan, Italy
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Sánchez M, Fernández E, Llama-palacios A, Figuero E, Herrera D, Sanz M. Response to antiseptic agents of periodontal pathogens in in vitro biofilms on titanium and zirconium surfaces. Dent Mater 2017; 33:446-53. [DOI: 10.1016/j.dental.2017.01.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/19/2017] [Accepted: 01/31/2017] [Indexed: 11/21/2022]
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Abstract
BACKGROUND The health of peri-implant soft tissues is one of the most important aspects of osseointegration necessary for the long-term survival of dental implants. PURPOSE To review the process of soft tissue healing around osseointegrated implants and discuss the maintenance requirements as well as the possible short-comings of peri-implant soft tissue integration. MATERIALS AND METHODS Literature search on the process involved in osseointegration, soft tissue healing and currently available treatment modalities was performed and a brief description of each process was provided. RESULTS The peri-implant interface has been shown to be less effective than natural teeth in resisting bacterial invasion because gingival fiber alignment and reduced vascular supply make it more vulnerable to subsequent peri-implant disease and future bone loss around implants. And we summarized common procedures which have been shown to be effective in preventing peri-implantitis disease progression as well as clinical techniques utilized to regenerate soft tissues with bone loss in advanced cases of peri-implantitis. CONCLUSION Due to the difference between peri-implant interface and natural teeth, clinicians and patients should pay more attention in the maintenance and recovery of soft tissues around implants.
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Affiliation(s)
- Yulan Wang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST), Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Yufeng Zhang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST), Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Richard J Miron
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST), Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
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Salvi GE, Ramseier CA. Efficacy of patient-administered mechanical and/or chemical plaque control protocols in the management of peri-implant mucositis. A systematic review. J Clin Periodontol 2015; 42 Suppl 16:S187-201. [PMID: 25495416 DOI: 10.1111/jcpe.12321] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 11/30/2022]
Abstract
AIM To systematically assess the efficacy of patient-administered mechanical and/or chemical plaque control protocols in the management of peri-implant mucositis (PM). MATERIAL AND METHODS Randomized (RCTs) and Controlled Clinical Trials (CCTs) were identified through an electronic search of three databases complemented by manual search. Identification, screening, eligibility and inclusion of studies was performed independently by two reviewers. Studies without professional intervention or with only mechanical debridement professionally administered were included. Quality assessment was performed by means of the Cochrane Collaboration's tool for assessing risk of bias. RESULTS Eleven RCTs with a follow-up from 3 to 24 months were included. Definition of PM was lacking or heterogeneously reported. Complete resolution of PM was not achieved in any study. One study reported 38% of patients with complete resolution of PM. Surrogate end-point outcomes of PM therapy were often reported. The choice of control interventions showed great variability. The efficacy of powered toothbrushes, a triclosan-containing toothpaste and adjunctive antiseptics remains to be established. High quality of methods and reporting was found in four studies. CONCLUSIONS Professionally- and patient-administered mechanical plaque control alone should be considered the standard of care in the management of PM. Therapy of PM is a prerequisite for the prevention of peri-implantitis.
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Affiliation(s)
- Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Figuero E, Graziani F, Sanz I, Herrera D, Sanz M. Management of peri-implant mucositis and peri-implantitis. Periodontol 2000 2014; 66:255-73. [DOI: 10.1111/prd.12049] [Citation(s) in RCA: 194] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2013] [Indexed: 11/28/2022]
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Louropoulou A, Slot DE, Weijden FVD. Mechanical Self-performed Oral Hygiene of Implant Supported Restorations: A Systematic Review. J Evid Based Dent Pract 2014; 14:60-69.e1. [DOI: 10.1016/j.jebdp.2014.03.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
AIM This systematic literature review was performed to establish a definition of peri-implantitis, what makes a patient more susceptible to peri-implantitis, the signs and symptoms of peri-implantitis (including radiographic findings), treatment options for peri-implantitis, and to investigate what constitutes a suitable oral hygiene regime. METHOD A systematic literature review and analysis of publications included in PubMed (articles published between 1998 and 2003; English language; search terms "peri-implantitis"; "mucositis"; "partially edentulous"; "preventative maintenance"; "peri-implantitis and plaque control"; "tissue augmentation"; "diet maintenance of peri-implantitis"; "oral hygiene instruction for implants") was performed to identify papers providing information about peri-implantitis. Separately sourced publications with peri-implantitis related titles and abstracts were reviewed and analysed. The set criteria for inclusion were peer-reviewed articles. Of 53 papers identified, 23 were included for systematic review. RESULTS Analysis of the papers revealed that patients with implants are more susceptible to developing peri-implantitis than are patients with natural teeth to developing periodontal disease. This is due to the varied peri-implant tissue that surrounds the implant in comparison with the tissue that surrounds a natural tooth. If active periodontal disease is present, peri-implantitis may also develop; however, other secondary factors may also need to be present for this to occur. CONCLUSION A comprehensive periodontal examination should be carried out prior to implant surgery. The patient should be informed of the necessity of regular maintenance following implant surgery and the prerequisite of maintaining a comprehensive oral hygiene regime to avoid peri-implantitis.
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Graziani F, Figuero E, Herrera D. Systematic review of quality of reporting, outcome measurements and methods to study efficacy of preventive and therapeutic approaches to peri-implant diseases. J Clin Periodontol 2012; 39 Suppl 12:224-44. [PMID: 22533959 DOI: 10.1111/j.1600-051x.2011.01832.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM To systematically review the literature and to assess the quality of reporting, outcome measurements and methods in both preventive and therapeutic approaches to peri-implant mucositis (PM) and peri-implantitis (PI). MATERIALS AND METHODS Randomized (RCT) and Controlled Clinical Trials (CCT), evaluating preventive or therapeutic interventions in patients with PM or PI, were identified through searching in electronic databases and in relevant journals. Reporting and methods were evaluated through an analysis of the risk of biases and quality score. Sub-analysis was performed in four subgroups: prevention of PM and PI, treatment of PM, and non-surgical and surgical treatment of PI. RESULTS Thirty-two trials (29 RCT) were identified as accomplishing inclusion criteria after full-text reading. Seven focused on prevention, and among those dealing with therapy, six were related to PM and 19 related to PI therapy (10 non-surgical and 9 surgical). Analysis found that quality of reporting and methods was generally low and surrogate outcomes were often chosen. CONCLUSIONS Current literature on PM and PI prevention and treatment does not allow extracting applicable clinical information. Quality of methods and reporting guidelines should be encouraged. In particular, ad hoc guidelines should be designed for peri-implant diseases.
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Affiliation(s)
- Filippo Graziani
- Department of Surgery, Unit of Dentistry and Oral Surgery, University of Pisa, Pisa, Italy.
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Grusovin MG, Coulthard P, Worthington HV, George P, Esposito M. Interventions for replacing missing teeth: maintaining and recovering soft tissue health around dental implants. Cochrane Database Syst Rev 2010; 2010:CD003069. [PMID: 20687072 PMCID: PMC6866073 DOI: 10.1002/14651858.cd003069.pub4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND It is important to institute an effective supportive therapy to maintain or recover soft tissue health around dental implants. Different maintenance regimens have been suggested, however it is unclear which are the most effective. OBJECTIVES To assess the effects of different interventions for 1) maintaining and 2) recovering soft tissue health around osseointegrated dental implants. SEARCH STRATEGY We searched the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Handsearching included several dental journals. We checked the bibliographies of the identified randomised controlled trials (RCTs) and relevant review articles for studies outside the handsearched journals. We wrote to authors of all identified RCTs, to more than 55 oral implant manufacturers and to an Internet discussion group to find unpublished or ongoing RCTs. No language restrictions were applied. The last electronic search was conducted on 2 June 2010. SELECTION CRITERIA All randomised controlled trials comparing agents or interventions for maintaining or recovering healthy tissues around dental implants. DATA COLLECTION AND ANALYSIS Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. Results were expressed as random-effects models using standardised mean differences for continuous data and risk ratios for dichotomous data with 95% confidence intervals. MAIN RESULTS Five trials compared interventions for maintaining soft tissue health around implants and a further six trials compared interventions to recover soft tissue health where there was evidence of peri-implant mucositis. No statistically significant differences were found between the effectiveness of powered versus manual toothbrushes for either maintaining or recovering soft tissue health. There was no statistically significant difference found between different types of self administered antimicrobials for maintaining soft tissue health (hyaluronic acid gel compared to chlorhexidine gel, amine fluoride/stannous fluoride mouthwash compared to chlorhexidine mouthwash) and triclosan dentifrice compared to sodium fluoride dentifrice showed no statistically significant difference in recovering soft tissue health. However chlorhexidine irrigation was more effective in reducing plaque and marginal bleeding scores compared to chlorhexidine mouthwash and Listerine mouthwash was found to be statistically significantly better than placebo with regard to reducing mean plaque scores and marginal bleeding scores. When interventions administered by dental professional were compared there was no statistically significant difference found between chlorhexidine and physiologic solutions as irrigants at second stage surgery to maintain health of soft tissues. In patients with peri-implant mucositis two trials evaluated interventions performed by dental professionals. There was no statistically significant difference between mechanical debridement followed by either minocycline or chlorhexidine gel, or between debridement with a titanium curette compared to an ultrasonic debridement tool. AUTHORS' CONCLUSIONS There was only low quality evidence for which are the most effective interventions for maintaining or recovering health of peri-implant soft tissues. The included RCTs had short follow-up periods and few subjects and although overall the risk of bias of the studies was either low or unclear, only single trials were available for each outcome. There was no reliable evidence as to which regimens are most effective for long term maintenance. This should not be interpreted as meaning that current maintenance regimens are ineffective. There was weak evidence that antibacterial mouthrinses are effective in reducing plaque and marginal bleeding around implants. More RCTs should be conducted in this area. In particular, there is a definite need for trials powered to find possible differences, using primary outcome measures and with much longer follow up. Such trials should be reported according to the CONSORT guidelines (www.consort-statement.org/).
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Affiliation(s)
| | - Paul Coulthard
- Institute of Dentistry, Queen Mary University of LondonDean's Office, Floor 5, Turner StreetLondonUKE1 2AD
| | - Helen V Worthington
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthCoupland Building 3Oxford RoadManchesterUKM13 9PL
| | | | - Marco Esposito
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthCoupland Building 3Oxford RoadManchesterUKM13 9PL
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Grusovin MG, Coulthard P, Jourabchian E, Worthington HV, Esposito MAB. Interventions for replacing missing teeth: maintaining and recovering soft tissue health around dental implants. Cochrane Database Syst Rev 2008:CD003069. [PMID: 18254015 DOI: 10.1002/14651858.cd003069.pub3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND It is important to institute an effective supportive therapy to maintain or recover soft tissue health around dental implants. Different maintenance regimens have been suggested, however it is unclear which are the most effective. OBJECTIVES To test the null hypotheses of no difference between different interventions (1) for maintaining healthy peri-implant soft tissues, and (2) for recovering soft tissue health, against the alternative hypothesis of a difference. SEARCH STRATEGY We searched the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Handsearching included several dental journals. We checked the bibliographies of the identified randomised controlled trials (RCTs) and relevant review articles for studies outside the handsearched journals. We wrote to authors of all identified RCTs, to more than 55 oral implant manufacturers and to an internet discussion group to find unpublished or ongoing RCTs. No language restrictions were applied. The last electronic search was conducted on 13 June 2007. SELECTION CRITERIA All randomised controlled trials comparing agents or interventions for maintaining or recovering healthy tissues around dental implants. DATA COLLECTION AND ANALYSIS Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. Results were expressed as random-effects models using standardised mean differences for continuous data and risk ratios for dichotomous data with 95% confidence intervals. MAIN RESULTS Eighteen RCTs were identified. Nine of these trials, which reported results from a total of 238 patients, were included. Follow ups ranged between 6 weeks and 1 year. No meta-analysis could be made since every RCT tested different interventions. Listerine mouthwash showed a reduction of 54% in plaque and 34% in marginal bleeding compared with a placebo. Two trials evaluated the efficacy of powered and sonic toothbrushes compared to manual toothbrushing and showed no statistically significant differences, though more patients liked the sonic brush. No statistical differences were found between brushing with a hyaluronic or a chlorhexidine gel, between cleaning with an etching gel or manually, between injecting a chlorhexidine or a physiologic solution inside the implant's inner part and between submucosal minocycline and a chlorhexidine gel. When an amine fluoride/stannous fluoride (AmF/SnF(2)) mouthrinse was compared with a chlorhexidine one, no statistically significant differences were found for implant failures and staining index while patients preferred and had less taste change with the AmF/SnF(2) mouthrinse. Self administered subgingival chlorhexidine irrigation resulted in statistically significantly lower plaque and marginal bleeding than a chlorhexidine mouthwash, however the mouthwash was given at a suboptimal dosage. AUTHORS' CONCLUSIONS There was only little reliable evidence for which are the most effective interventions for maintaining or recovering health of peri-implant soft tissues. The included RCTs had short follow-up periods and few subjects. There was not any reliable evidence for the most effective regimens for long term maintenance. This should not be interpreted as current maintenance regimens are ineffective. There was weak evidence that Listerine mouthwash, used twice a day for 30 seconds, as an adjunct to routine oral hygiene, is effective in reducing plaque and marginal bleeding around implants. More RCTs should be conducted in this area. In particular, there is a definite need for trials powered to find possible differences, using primary outcome measures and with much longer follow up. Such trials should be reported according to the CONSORT guidelines (http://www.consort-statement.org/).
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Affiliation(s)
- M G Grusovin
- School of Dentistry, Department of Oral and Maxillofacial Surgery, University of Manchester, Higher Cambridge Street, Manchester, UK M15 6FH.
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Vandekerckhove B, Quirynen M, Warren PR, Strate J, van Steenberghe D. The safety and efficacy of a powered toothbrush on soft tissues in patients with implant-supported fixed prostheses. Clin Oral Investig 2004; 8:206-10. [PMID: 15583919 DOI: 10.1007/s00784-004-0278-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2004] [Accepted: 06/22/2004] [Indexed: 11/24/2022]
Abstract
The safety, efficacy and acceptability of an oscillating/rotating powered toothbrush was assessed in patients rehabilitated with fixed prostheses on implants. One hundred consecutive patients (aged 18-80; mean 56.3; 51 females), who met the inclusion/exclusion criteria and who participated in a regular annual recall scheme, were enrolled. They were instructed on how to use the powered toothbrush, as well as on classical interdental plaque control. The electric toothbrush had to be used twice daily for 2 min. The following periodontal parameters were measured at baseline and at 3 months, 6 months and 12 months: presence/absence of gingival and/or mucosal ulceration/desquamation; sulcus bleeding index; probing pocket depth; periodontal pocket-bleeding index and gingival recession. At 3 months and at the end of the study, patients completed a questionnaire concerning the overall acceptability and convenience of the powered toothbrush, as compared with their habitual manual toothbrush. A total of 80 patients completed the study. No dropouts were related to the use of the powered toothbrush. All parameters improved over the course of the study. The mean overall pocket depth decreased from 3.3 mm at baseline to 3.0 mm at 12 months, while the mean decrease in recession was 0.1 mm at 12 months. During the 1-year observation, there was a slight gain in periodontal attachment level. Gingival ulcerations were not observed at any point in the study. High scores for convenience and comfort of the powered toothbrush were reported, and the majority (95%) said that they would continue to use it for habitual oral hygiene. It is concluded that the powered toothbrush investigated is effective, safe and comfortable for patients rehabilitated by means of oral implant-supported prostheses.
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Affiliation(s)
- B Vandekerckhove
- Department of Periodontology, School of Dentistry, Oral Pathology and Maxillo-Facial Surgery, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
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Abstract
BACKGROUND To maintain healthy tissues around dental implants it is important to institute an effective preventive regimen (supportive therapy). Different maintenance regimens have been suggested, however it is unclear which are the most effective. OBJECTIVES To test the null hypothesis of no difference between different interventions for maintaining healthy tissues around dental implants. SEARCH STRATEGY We searched the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Handsearching included several dental journals. We checked the bibliographies of the identified randomised controlled trials (RCTs) and relevant review articles for studies outside the handsearched journals. We wrote to authors of all identified RCTs, to more than 55 oral implant manufacturers and an internet discussion group to find unpublished or ongoing RCTs. No language restrictions were applied. The last electronic search was conducted on 2 February 2004. SELECTION CRITERIA All randomised controlled trials of oral implants comparing agents or interventions for maintaining or recovering healthy tissues around dental implants. DATA COLLECTION AND ANALYSIS We carried out a quality assessment of the included RCTs in duplicate and contacted the authors for missing information. We independently extracted the data in duplicate. We followed the Cochrane Oral Health Group's statistical guidelines. MAIN RESULTS Fourteen RCTs were identified. Five of these trials, which reported results from a total of 127 patients, were suitable for inclusion in the review. Two trials evaluated the efficacy of powered and sonic toothbrushes, respectively, when compared to manual toothbrushing and showed no statistically significant differences. One RCT compared Listerine versus placebo mouthwashes showing a reduction of 54% in plaque and 34% in marginal bleeding compared with the placebo. One trial compared self administered subgingival chlorhexidine irrigation versus chlorhexidine mouthwash. The group using chlorhexidine irrigation resulted in statistically significantly lower mean plaque scores and a marginal bleeding index than the group using chlorhexidine mouthwash, however the mouthwash was given at a suboptimal dosage. One study compared etching gel with mechanical debridement showing no statistical differences. Follow ups ranged between 6 weeks and 5 months. It was not possible to make any meta-analysis as each trial assessed different interventions. REVIEWERS' CONCLUSIONS There is only little reliable evidence for which are the most effective interventions for maintaining health around peri-implant tissues. There was no evidence that the use of powered or sonic toothbrushes was superior to manual toothbrushing. There is weak evidence that Listerine mouthwash, used twice a day for 30 seconds, as adjunct to routine oral hygiene is effective in reducing plaque formation and marginal bleeding around implants. There was no evidence that phosphoric etching gel offered any clinical advantage over mechanical debridement. These findings are based on RCTs having short follow-up periods and few subjects. There is not any reliable evidence for the most effective regimens for long term maintenance. More RCTs should be conducted in this area. In particular, there is a definite need for trials powered to find possible differences, using primary outcome measures and with much longer follow up. Such trials should be reported according the CONSORT guidelines (http://www.consort-statement.org/).
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Affiliation(s)
- M Esposito
- Department of Biomaterials and Department of Prosthetic Dentistry/Dental Material Sciences, Sahlgrenska Academy at Goteborg University, PO Box 412, Medicinaregatan 8B, Goteborg, Sweden, SE-405 30.
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Esposito M, Worthington HV, Coulthard P, Thomsen P. Maintaining and re-establishing health around osseointegrated oral implants: a Cochrane systematic review comparing the efficacy of various treatments. Periodontol 2000 2003; 33:204-12. [PMID: 12950853 DOI: 10.1046/j.0906-6713.2003.03317.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Marco Esposito
- Institute for Surgical Sciences, Department of Biomaterials, The Salgrenska Academy at Göteborg University, Sweden
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McCracken GI, Chapple IL, Milward M, Steen N, DeJager M, Heasman PA. Efficacy of a prototype brush head for a powered toothbrush. A multicentre study. J Clin Periodontol 2002; 29:889-95. [PMID: 12445220 DOI: 10.1034/j.1600-051x.2002.291003.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PRIMARY OBJECTIVE To evaluate a multicentre clinical trial design for testing powered toothbrushes. SECONDARY OBJECTIVE To compare the efficacy of a prototype brush head (N2.3) for the Philips Jordan Sensiflex 2000 powered toothbrush (PTB) to that of Braun Oral-B D15 PTB in removing dental plaque MATERIAL AND METHODS 137 volunteers (ages 18-25 years) were recruited to this 3-centre, 2-week, 2-group, 2-treatment, single-blind trial. Plaque was recorded at screening and again 14 days later at baseline. Stratification of subjects, for gender and screening PI, occurred at baseline. Subjects were then asked to abstain from all oral hygiene measures for 48 h followed by a supervised episode of brushing for 3 min with the allocated PTB. The allocated PTB was used at home for the next 12 days before a second abstinence from all oral hygiene measures for the 48 h prior to a second supervised brushing episode. Plaque levels were scored using a modification of the Quigley & Hein plaque index (PI) at full mouth (FM), interproximal (IP) and smooth surfaces (SS). To enable the means of the within subject differences (pre to postbrushing) to be compared between groups PIs were recorded before and after the supervised brushing episodes, differences between centres, groups and visits were examined. RESULTS No significant differences in PI between groups at screening, baseline or prior to the supervised brushings were detected (P > 0.05 anova). The results of the analysis of variance showed there to be a highly significant difference (P < 0.001) between brushing groups, but, significant differences between centres (P < 0.001) and a significant interaction effect between centre and brushing group (P < 0.001) was also detected. Therefore the difference between groups was not present at all three centres. Further examination of the single centre data showed there to be greater levels of plaque removed by the N2.3 compared to the D15 (FM reduction in PI 1.95 vs. 1.13, respectively) at centre 3 in contrast to the other two centres where no difference was detected. The precise reason for these differences could not be established. CONCLUSIONS A multicentre study design is applicable for evaluating PTBs but a minimum of 3 centres should be included so that differences between centres can be identified. The prototype brush head N2.3 for the Philips Jordan Sensiflex 2000 PTB has comparable plaque removal efficacy to the Braun Oral-B D15 PTB at FM, IP and SS sites.
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Affiliation(s)
- G I McCracken
- Restorative Dentistry, Dental School, University of Newcastle upon Tyne, UK
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Tawse-Smith A, Duncan WJ, Payne AGT, Thomson WM, Wennström JL. Relative effectiveness of powered and manual toothbrushes in elderly patients with implant-supported mandibular overdentures. J Clin Periodontol 2002; 29:275-80. [PMID: 11966923 DOI: 10.1034/j.1600-051x.2002.290401.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIM The aim of this study was to compare the clinical effectiveness of a powered toothbrush (Braun Oral-B Plaque Remover 3-D) and a manual soft toothbrush (Oral-B Squish-grip brush) for the control of supragingival plaque and soft tissue inflammation around implants supporting mandibular overdentures. MATERIAL AND METHODS The study sample involved 40 edentulous subjects, aged 55-80 years, having 2 unsplinted mandibular implants supporting a complete removable overdenture opposed by a maxillary complete denture. In this single-blinded, randomised, cross-over clinical trial, two 6-week experimental phases were separated by a 2-week wash-out period. 2 weeks prior to each experimental phase (pre-entry visits), implant abutments were polished to remove all plaque and a standardised instruction in the use of the toothbrush was given. Modified plaque and bleeding indices were recorded at the start and end of each experimental period. Mean index scores at each phase were analysed using paired t-test, and the mean number of sites showing a change in plaque or mucositis were compared using the Mann-Whitney U-test. Combined data from 2 different implant systems were considered after controlling for implant type. RESULTS Only minor changes in plaque and bleeding scores were observed following the two test periods. There were no statistically significant differences between the manual and powered toothbrushes. CONCLUSION Manual and powered brushes were found to be of comparable efficacy with regard to improvement in peri-implant bleeding and plaque indices.
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Affiliation(s)
- A Tawse-Smith
- Department of Oral Rehabilitation, School of Dentistry, Dunedin, New Zealand.
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Toijanic JA, Ward CB, Gewerth ME, Banakis ML. A longitudinal clinical comparison of plaque-induced inflammation between gingival and peri-implant soft tissues in the maxilla. J Periodontol 2001; 72:1139-45. [PMID: 11577943 DOI: 10.1902/jop.2000.72.9.1139] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Little information exists concerning the periimplant soft tissue response to plaque compared to the gingiva of the dentition. The purpose of this study was to compare this relative tissue response to plaque in humans over time. METHODS Two hundred seventy-five (275) hydroxyapatite-coated implants were placed in the maxillae of 50 subjects followed by prosthetic rehabilitation. Baseline gingival (GI) and plaque (PI) index scores were obtained for all implants. Two to 4 teeth per subject were similarly measured, serving as controls. Measurements were repeated at 6-month intervals over 30-months. GI scores were evaluated relative to PI scores at 4 separate sites for each implant, to implant location within the oral cavity, and to length of time that each implant was in function. RESULTS The peri-implant mucosa demonstrated a significantly greater likelihood of having elevated GI scores relative to PI scores when compared to the gingiva (chi-square for combined PI scores of 0 and 1 = 85.0, df = 1, P <0.001; for combined P1 scores of 2 and 3 = 114.6, df = 1, P <0.001). A logistic generalized linear model confirmed the significance of these results (Student t for implant effect = 21.602). It further demonstrated significantly elevated GI scores for implant sites over time and for implants located in the posterior oral cavity. CONCLUSIONS The results indicate that maxillary peri-implant soft tissues are at increased risk for plaque-induced inflammation relative to the gingiva of the dentition. Hygiene recall standards and treatment regimens may require revisions to minimize peri-implantitis and prevent bone loss.
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Affiliation(s)
- J A Toijanic
- The University of Chicago, Section of Dentistry, IL 60637, USA.
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Affiliation(s)
- B Tüzün
- Department of Dermatology, Trakya University, Medical Faculty, Edirne, Turkey.
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