Introduction: Inflammatory bowel diseases (IBD), encompassing Crohn's disease and ulcerative colitis, are chronic, inflammatory diseases of the gastrointestinal tract. We have initiated a Danish population-based inception cohort study aiming to investigate the underlying mechanisms for the heterogeneous course of IBD, including need for, and response to, treatment.

Methods and analysis: IBD Prognosis Study is a prospective, population-based inception cohort study of unselected, newly diagnosed adult, adolescent and paediatric patients with IBD within the uptake area of Hvidovre University Hospital and Herlev University Hospital, Denmark, which covers approximately 1 050 000 inhabitants (~20% of the Danish population). The diagnosis of IBD will be according to the Porto diagnostic criteria in paediatric and adolescent patients or the Copenhagen diagnostic criteria in adult patients. All patients will be followed prospectively with regular clinical examinations including ileocolonoscopies, MRI of the small intestine, validated patient-reported measures and objective examinations with intestinal ultrasound. In addition, intestinal biopsies from ileocolonoscopies, stool, rectal swabs, saliva samples, swabs of the oral cavity and blood samples will be collected systematically for the analysis of biomarkers, microbiome and genetic profiles. Environmental factors and quality of life will be assessed using questionnaires and, when available, automatic registration of purchase data. The occurrence and course of extraintestinal manifestations will be evaluated by rheumatologists, dermatologists and dentists, and assessed by MR cholangiopancreatography, MR of the spine and sacroiliac joints, ultrasonography of peripheral joints and entheses, clinical oral examination, as well as panoramic radiograph of the jaws. Fibroscans and dual-energy X-ray absorptiometry scans will be performed to monitor occurrence and course of chronic liver diseases, osteopenia and osteoporosis.

Ethics and dissemination: This study has been approved by Ethics Committee of the Capital Region of Denmark (approval number: H-20065831). Study results will be disseminated through publication in international scientific journals and presentation at (inter)national conferences.

ObjectivesTo assess the reliability of judging the spatial relation between the inferior alveolar nerve (IAN) and mandibular third molar (MTM) based on MRI or CT/CBCT images.

MethodsAltogether, CT/CBCT and MRI images of 87 MTMs were examined twice by 3 examiners with different degrees of experience. The course of the IAN in relation to the MTM, the presence/absence of a direct contact between IAN and MTM, and the presence of accessory IAN were determined.

ResultsThe IAN was in > 40% of the cases judged as inferior, while an interradicular position was diagnosed in < 5% of the cases. The overall agreement was good (κ = 0.72) and any disagreement between the imaging modalities was primarily among the adjacent regions, i.e., buccal/lingual/interradicular vs. inferior. CT/CBCT judgements presented a very good agreement for the inter- and intrarater comparison (κ > 0.80), while MRI judgements showed a slightly lower, but good agreement (κ = 0.74). A direct contact between IAN and MTM was diagnosed in about 65%, but in almost 20% a disagreement between the judgements based on MRI and CT/CBCT was present resulting in a moderate overall agreement (κ = 0.60). The agreement between the judgements based on MRI and CT/CBCT appeared independent of the examiner’s experience and accessory IAN were described in 10 cases in MRI compared to 3 cases in CT/CBCT images.

ConclusionsA good inter- and intrarater agreement has been observed for the assessment of the spatial relation between the IAN and MTM based on MRI images. Further, MRI images might provide advantages in the detection of accessory IAN compared to CT/CBCT.

Clinical relevanceMRI appears as viable alternative to CT/CBCT for preoperative assessment of the IAN in relation to the MTM.

Background: Elevation of the schneiderian membrane, during maxillary sinus floor augmentation (MSFA) may theoretically result in devitalization of adjacent teeth, which are in a close spatial relationship to the sinus floor. Purpose: To assess retrospectively the probability of devitalization of teeth adjacent to the osteotomy site after MSFA in a relatively large number of patients. Materials and Methods: All MSFA procedures, performed at a university oral surgery clinic within a time period of 10 years, were assessed on the following eligibility criteria: (1) presence of vital teeth (ie, not root canal treated and no periapical radiolucency on a panoramic radio- graph taken just after MSFA), (2) presence of a 3 to 12 months postoperative radiograph of the teeth adjacent to the osteotomy site displaying the root apices, and (3) complete medical records up to at least 12 months postoperatively. The radiographs of the different time points were compared and any changes in the radiographic status of the adjacent teeth (eg, develop- ment of a periapical lesion, root canal treatment, etc.) were recorded and the spatial relationship of the adjacent teeth to the maxillary sinus classified. Results: Out of 684 MSFAs, 257 fulfilled the inclusion criteria and involved 357 adjacent teeth, of which 221 presented close to and/or intimate relationship to the sinus. In only a single case, tooth vitality might have been lost due to the procedure. Thus, the probability for tooth devitali- zation for teeth with close to and/or intimate spatial relationship to the sinus floor ranged from 0.45% to 0.7%. Conclusions: Even for teeth with apices very close to and/or intimately related to the sinus tooth devitalization after MSFA is an extremely rare complication; that is, the probability of tooth devitalization after MSFA is ≤0.7%.

Gingivainvaginationen treten mit einer hohen Prävalenz von 35 bis 100 % während des kieferorthopädischen Lückenschlusses nach Zahnextraktion auf. Sie sind häufiger im Unterkiefer anzutreffen und können okklusal, vestibulär, oral oder durchgängig von vestibulär nach oral vorliegen. Relevante Folgen von Gingivainvaginationen sind ein verzögerter oder auch inkompletter Lückenschluss. Die Ätiologie ist nach wie vor nicht eindeutig geklärt, aber der Zeitrahmen von Zahnextraktion bis zum Beginn des Lückenschlusses sowie die Dauer des Lückenschlusses werden als wichtige Einflussfaktoren beschrieben. Da Gingivainvaginationen auch mit einer erhöhten Anzahl an Rezidiven durch Lückenöffnung nach Abschluss der kieferorthopädischen Behandlung assoziiert sind und eventuell eine ästhetische Beeinträchtigung für den Patienten darstellen können, sollten sie vor Abschluss des Lückenschlusses exzidiert werden.

Objective: Based on the following 3 questions an overview is given on the topic “orthodontic treatment and gingival tissue recessions”: (1) Should orthodontic treatment be considered as risk factor for developing gingival tissue recessions? (2) Is a “prophylactic” soft tissue augmentation before orthodontic treatment justified to prevent gingival tissue recessions? (3) Should a root coverage procedure of a gingival tissue recession be performed before or after orthodontic treatment?

Background: This cross-sectional study assessed the potential of colored periodontal probes (CPP) to classify gingival phenotype in terms of gingival thickness (GT).

Methods: Buccal GT in 3 anterior teeth in each of 50 patients was measured by transgingival sounding and classified by 3 different methods by 8 examiners. Specifically, the diagnostic potential of visual judgement and transparency of a standard periodontal probe (SPP) to discriminate thin and thick gingiva, and of CPP to discriminate thin, medium, thick, or very thick gingiva was assessed.

Results: GT ranged from 0.57-2.37mm. Using CPP resulted in a medium judgement in 87% of the cases, on average, and only between 1-10 cases/examiner were judged as thick or very thick. Considering 1mm GT as relevant cut-off value, all methods showed a high positive predictive value (≥0.82) to identify thick cases, but also a high false omission rate (≥0.73) indicating that many cases classified as thin were actually thick. Further, 88% of the cases being ≤1mm, were not classified as thin with CPP; this was inferior to SPP, for which, however, still 64% of the cases being ≤1mm thick were wrongly classified. The highest, yet moderate agreement among examiners was achieved by SPP (κ = 0.427), while visual judgement and CPP showed only fair (κ = 0.211) and slight agreement (κ = 0.112), respectively.

PURPOSE: To assess the effect of the shooting angle variation on linear and planimetric measurements of the pink and white tissues on intraoral photographs. METHODS: From intraoral three-dimensional (3D) scans of the anterior region in 10 patients, ninety-nine two-dimensional (2D) "scan pictures" each were generated with different shooting angles, each varying in 5° horizontal and vertical increments. Eleven intraoral photographs of each patient and tooth site were taken free-hand: one shot at baseline and 5 shots after 3 and 6 months at slightly varying shooting angles. Papilla height (PH) and area (PA) and tooth crown area (TCA) were estimated on all photographs; the "best-match-to-baseline" photograph from those taken at 3 and 6 months was chosen by 6 evaluators. RESULTS: Within the first 10° of deviation from the baseline shooting angle, measurements on the 2D "scan pictures" distorted ≤0.5 mm for PH and ≤10% for PA and TCA. Compared to baseline, only 6 out of 100 photographs presented ≥0.5 mm difference in PH, none of the TCA measurements showed distortion ≥10%, and only in 4 instances a ≥10% distortion of the PA was observed. Poor to moderate inter- and intra-rater agreement in choosing the "best-match-to-baseline" photograph was found, but photographs with clinically relevant changes were only seldomly chosen. CONCLUSIONS: Deviations in the shooting angle ≤10° from the baseline shot cause clinically negligible distortions in linear and planimetric measurements. Highly comparable intraoral photographs of the anterior maxillary teeth can be captured "free-hand" in slightly varying perspective, and then selecting the "best-match-to-baseline".

Objectives: To compare the alveolar bone dimensions in patients with lower second premolar (P2) agenesis prior to and after primary molar loss on CT scans, and assess the possibility for straightforward implant placement. Methods: Alveolar bone dimensions were evaluated on 150 mandibular CT scans in three groups: (i) agenesis of P2, with the primary tooth in situ, and regularly erupted first premolar (P1) and molar (M1) (AW); (ii) agenesis of P2, without the primary tooth in situ for ≥3m, but regularly erupted P1 and M1 (AWO); and (iii) P1, P2, and M1 regularly erupted (CTR). The possibility of straightforward placement of an implant 3.5 or 4.3 mm in Ø × 10 mm long was digitally simulated and compared to the actually performed treatment. Results: Buccolingual width (7.3 ± 2.0 mm) at the coronal aspect of the ridge in the AWO group was statistically significantly smaller comparing with both the AW (9.2 ± 1.4 mm) and the CTR (9.5 ± 1.1 mm) group; width reduction appeared to be mainly due to “collapse” of the buccal aspect of the ridge. Simulated straightforward placement of implants with a diameter of 3.5 or 4.3 mm was possible in 62% and 56% of the cases in the AWO vs. 86% and 84% in the AW group (p = .006 and .002, respectively). Straightforward implant placement was actually possible in all patients (22) in the AW group, while 28% (11 of 39) of the patients in the AWO group needed additional hard tissue augmentation. Conclusions: Significant dimensional differences exist in the alveolar ridge, especially in the coronal part, at lower P2 agenesis sites missing the primary tooth for ≥3m, when compared to P2 agenesis sites with the primary tooth in situ. It seems thus reasonable to advise that the primary second molar should be kept as long as possible, in order to facilitate straightforward implant installation and reduce the probability of additional bone augmentation procedures.

Hyaluronan (HY) har på grund av sina egenskaper (bakteriostatiska, antiin ammatoriska et cetera) nyligen introducerats för användning i parodon- tal terapi. Denna litteraturgenomgång bygger del- vis på en nyligen publicerad systematisk översikt, och har kompletterats med gingivitstudier och de senast publicerade vetenskapliga arbetena med HY inom parodontitbehandling. Artikeln ger en sammanfattning av de terapeutiska möjligheterna med HY-applikation som monoterapi eller som ett tillägg till behandling av gingivit och parodontit. Vid sökning i tre litteraturdatabaser fann vi 18 kontrollerade studier. I majoriteten av dessa stu- dier beskrivs för HY-testgruppen jämfört med kontrollgruppen ● en statistiskt signi kant förbättring i gingivalin- dex för gingivitpatienter ● en statistiskt signi kant minskning i blödning vid sondering och fickdjup vid icke-kirurgisk parodontal behandling ( gur I), dock i måttligt kliniskt relevant utsträckning. Att erhålla någon ytterligare vinst i klinisk fästenivå av HY-applikation vid parodontal kirurgi verkar inte troligt. Till dags dato saknas rapporter av oönskade bi- verkningar av HY-applikation. På grund av den avsevärda heterogeniteten i studierna (avseende produkter, metoder för applicering, dos och applikationstid) går det inte att dra någon tydlig slutsats om administration och e ektstorlek av HY vid behandling av gingivit eller parodontit.

Application of hyaluronan (HY) in periodontal treatment has recently increased due to its bacteriostatic and anti-in ammatory pro- perties. This review is based in part on a recent systematic review and also includes newly published studies such as those on gingivitis patients. It summarizes the thera- peutic possibilities of HY application as a monotherapy and as an adjunct in the treatment of gingivitis and periodontitis. Based on literature searches in 3 databases, 18 controlled trials were identi ed. When comparing the HY test group with the control group, the majority of the clinical trials reported (a) a signi cant improvement in gingival indices of gingivitis patients and (b) a signi cant but clinically moderate reduction in bleeding on probing and probing pocket depth after nonsurgical treatment of periodontitis patients. The effect of HY application on clinical attachment level gain after surgical regenerative treatment remains unclear. Because no unexpected side effects were reported after HY-application, its use can thus be considered safe. However, due to the considerable heterogeneity of the available studies, in terms of product diffe- rences and varying application modalities, no recommendation can be provided re- garding the appropriate HY administration or the effective amount for the treatment of gingivitis or periodontitis.

Aim: The aim of this questionnaire-based, case-control study was to assess whether self-reported oral health and periodontitis in ulcerative colitis (UC) and Crohn's disease (CD) patients differ from that in matched controls without inflammatory bowel disease (IBD).

Methods: A survey including questions on general anamnestic information, IBD diagnosis, and oral health was distributed online. Self-perceived overall health of teeth and gums, severe periodontitis, and tooth loss were defined as outcome parameters.

Results: Analyses were based on answers from 1108 IBD patients and 3429 controls. IBD patients reported significantly worse oral health and more periodontal problems compared to controls. Regression analyses corrected for relevant confounders showed for UC and CD patients significantly increased odds for fair or poor self-perceived overall health of teeth and gums (OR 2.147 and 2.736, respectively) and for severe periodontitis (OR 1.739 and 2.574, respectively) compared to controls; CD patients presented additionally 91% higher odds for having <20 remaining teeth.

Conclusions: UC and CD patients have significantly increased odds for worse self-perceived oral health and severe periodontitis compared to controls, with CD patients being more severely affected and losing more teeth. It is strongly recommended that IBD patients are kept under close surveillance to prevent periodontitis development and/or mitigate its progression.

Objectives The aim of this cross-sectional survey was to assess oral health, including prevalence of periodontitis and rate of tooth loss, in a Swedish cohort of patients with inflammatory bowel disease (IBD). Methods A questionnaire on general anamnestic and socio-economic aspects, IBD diagnosis, and various oral health aspects was distributed online. The analyses focused on the comparison between patients diagnosed with ulcerative colitis (UC) or Crohn's disease (CD) as well as on factors associated with self-reported severe periodontitis and tooth loss. Results Analyses were based on answers from 786 patients; 415 with UC, 371 with CD, 74% female. In both disease entities, high prevalence of severe periodontitis (i.e., 38.5%) was reported, and about 19% of the population had less than 20 remaining teeth and 6.5% a poor oral health-related quality of life. CD patients tended to be more severely affected than UC patients (p > 0.05 in the adjusted analysis). Almost 90% of CD patients were aware of being entitled to a bi-annual governmental financial support for dental care due to IBD; however, 1 out of 4 UC patients did not. Furthermore, IBD patients largely believe that the interest of their physicians in any oral lesions due to IBD diagnosis is low. Conclusions Severe periodontitis and high rate of tooth loss are frequent in Swedish IBD patients. Clinical relevanceEven though IBD patients receive bi-annually some special financial support for dental care, it seems this is still not sufficient and more preventive measures appear necessary.

Background: To describe the frequency and impact of oral lesions and professional dental care costs in patients with inflammatory bowel disease (IBD) (i.e., Crohn disease [CD] or ulcerative colitis [UC]) compared to matched controls).

Methods: IBD patients and matched controls were surveyed on general anamnestic information, eating and drinking habits, and oral health- and dental care-related questions; IBD patients were additionally surveyed on oral lesions. Problems related to oral lesions and the amount of money spent for professional dental care in the past 12 months were defined as primary outcome parameters.

Results: Answers from 1108 IBD patients and 3429 controls were analyzed. About 30% of the patients indicated having had problems with oral lesions, with CD patients having 46% higher odds and having them more often in a generalized form compared to UC patients. Further, self-reported severe periodontitis increased the odds of having oral lesions by almost 2.3-times. However, only about 12.5% of IBD patients were informed by their physician about oral lesions and about 10% indicated receiving treatment for them. Compared to controls, IBD patients required more often dental treatment and spent more money; specifically, UC and CD patients had 27 and 89% higher odds, respectively, for having spent ≥3000 DKK (ca. 440 USD) at the dentist compared to controls.

Conclusions: IBD patients have more often oral health problems and higher expenses for professional dental care compared to matched controls. This included problems with IBD-related oral lesions, but these are rarely addressed by the medical or dental team.Keywords: Crohn disease; case-control studies; colitis; dental care; inflammatory bowel diseases; surveys and questionnaires; ulcerative.

Background Agenesis of a permanent tooth has in Europe a prevalence of 2.6 up to 11.3% and the lower second premolar and the upper lateral incisor are most often affected (except for wisdom teeth). Treatment options are maintenance of the deciduous teeth, implant placement, tooth transplantation, orthodontic treatment for space closure or prosthetic tooth replacement. Especially in the case of agenesis of the lower premolars sand-glass like forms of the mandibular bone are described, which might preclude implant placement without previous augmentation procedures. However, to the best of our knowledge, so far no study is available assessing in detail the mandibular bone quantity in case of agenesis of the lower second premolar compared to a matched control group with regular erupted second premolars. Aim The primary aim was to compare mandibular bone quantity in case of agenesis of the lower second premolar with the deciduous tooth in situ to a matched control group with regularly erupted lower second premolars. Secondly, bone quantity in the region of the mesial and distal adjacent teeth was assessed to receive an overview of the neighbouring bone quantity. Thirdly, the test- and control-group in the region of the second premolar was evaluated on the possibility to place a standard implant. Materials and methods The present study included mandibular CT scans of 100 patients. The test group included 50 patients missing one lower second premolar due to agenesis with the deciduous tooth still in situ. Further, the first premolar and first molar were in situ and regularly erupted. The control group was matched according to age, sex, and tooth’s quadrant and presented regularly erupted first and second premolars and first molars. The dental reconstructions slices in the centre of the first molar and first and second premolar of each participant were used to assess the following parameters: width of the mandibular bone (measured each millimetre starting from the buccal alveolar crest), height and area of the mandibular bone. In the dental reconstruction slices the bony contours were manually retraced, the buccal alveolar crest and the inferior alveolar nerve manually assigned, and the tooth/implant axes indicated. Afterwards, a program for automated image analysis was used for standardised measurements. Further, the possibility of implant placement (4.3mm diameter, 10mm length, 1mm space to the buccal and lingual aspects, 2mm distance to the inferior alveolar nerve) was evaluated. Normal distribution of the data was proven graphically and differences between test and control groups were assessed by independent t-test. The false discovery rate was controlled by applying the Benjamini-Hochberg method and p-values <0.05 were considered as statistically significant. Results Mean width and area of the mandibular bone of the test group were significantly reduced in the region of the first and second premolar compared to the control group. No differences were noticed for the region of the first molar as well as for height measurements. The mean width in the upper third (1-10mm) was not reduced in all three regions. Yet, the mean width of the middle (11-20mm) and of the lower third (>20mm) was significantly reduced in the test group in the region of the first and second premolar, but not of the first molar. In the test group in 42 out of 50 cases (84%) the placement of an implant would have been possible compared to 100% in the control group. Manual linings were performed by a single examiner. This examiner and a second examiner repeated 25% of the whole sample and intra- and inter-examiner observations presented high reliability, with an intra-class correlation coefficient > 0.95. Conclusions and clinical implications In patients with agenesis of the lower second premolar, but deciduous tooth in situ, bone quantity is reduced in the region of the agenesis and at the mesial adjacent tooth. However, bone width is reduced only in an area below the first 10mm, which allows the placement of a standard implant in a high percentage of the cases. In an on-going study these data will be compared to agenesis patients with the deciduous tooth missing to test whether primary tooth maintenance preserves bone quantity.

Background Agenesis of a permanent tooth has in Europe a prevalence of 2.6 up to 11.3% and the lower second premolar and the upper lateral incisor are most often affected (except for wisdom teeth). Treatment options are maintenance of the deciduous teeth, implant placement, tooth transplantation, orthodontic treatment for space closure or prosthetic tooth replacement. Especially in the case of agenesis of the lower premolars sand-glass like forms of the mandibular bone are described, which might preclude implant placement without previous augmentation procedures. However, to the best of our knowledge, so far no study is available assessing in detail the mandibular bone quantity in case of agenesis of the lower second premolar compared to a matched control group with regular erupted second premolars. Aim The primary aim was to compare mandibular bone quantity in case of agenesis of the lower second premolar with the deciduous tooth in situ to a matched control group with regularly erupted lower second premolars. Secondly, bone quantity in the region of the mesial and distal adjacent teeth was assessed to receive an overview of the neighbouring bone quantity. Thirdly, the test- and control-group in the region of the second premolar was evaluated on the possibility to place a standard implant. Materials and methods The present study included mandibular CT scans of 100 patients. The test group included 50 patients missing one lower second premolar due to agenesis with the deciduous tooth still in situ. Further, the first premolar and first molar were in situ and regularly erupted. The control group was matched according to age, sex, and tooth’s quadrant and presented regularly erupted first and second premolars and first molars. The dental reconstructions slices in the centre of the first molar and first and second premolar of each participant were used to assess the following parameters: width of the mandibular bone (measured each millimetre starting from the buccal alveolar crest), height and area of the mandibular bone. In the dental reconstruction slices the bony contours were manually retraced, the buccal alveolar crest and the inferior alveolar nerve manually assigned, and the tooth/implant axes indicated. Afterwards, a program for automated image analysis was used for standardised measurements. Further, the possibility of implant placement (4.3mm diameter, 10mm length, 1mm space to the buccal and lingual aspects, 2mm distance to the inferior alveolar nerve) was evaluated. Normal distribution of the data was proven graphically and differences between test and control groups were assessed by independent t-test. The false discovery rate was controlled by applying the Benjamini-Hochberg method and p-values <0.05 were considered as statistically significant. Results Mean width and area of the mandibular bone of the test group were significantly reduced in the region of the first and second premolar compared to the control group. No differences were noticed for the region of the first molar as well as for height measurements. The mean width in the upper third (1-10mm) was not reduced in all three regions. Yet, the mean width of the middle (11-20mm) and of the lower third (>20mm) was significantly reduced in the test group in the region of the first and second premolar, but not of the first molar. In the test group in 42 out of 50 cases (84%) the placement of an implant would have been possible compared to 100% in the control group. Manual linings were performed by a single examiner. This examiner and a second examiner repeated 25% of the whole sample and intra- and inter-examiner observations presented high reliability, with an intra-class correlation coefficient > 0.95. Conclusions and clinical implications In patients with agenesis of the lower second premolar, but deciduous tooth in situ, bone quantity is reduced in the region of the agenesis and at the mesial adjacent tooth. However, bone width is reduced only in an area below the first 10mm, which allows the placement of a standard implant in a high percentage of the cases. In an on-going study these data will be compared to agenesis patients with the deciduous tooth missing to test whether primary tooth maintenance preserves bone quantity.

Objectives: To perform a within-subject comparison of the cortical bone micro-architecture of the maxillary sinus floor (MSF) to that of the buccal aspect of the anterior and posterior maxilla. Methods: Micro-CT scans of the buccal aspect of the anterior and posterior maxilla and of the MSF in 14 human anatomical specimens were recorded. Within-subject comparisons were performed for cortical thickness (Ct.Th) and porosity (Ct.Po), average pore volume (AvgPo.V), and pore density (Po.Dn). Results: The MSF presented the lowest and the anterior maxilla the highest Ct.Th, while Ct.Po was significantly higher at the MSF compared to the posterior maxilla (p = 0.021). No relevant differences were recorded for AvgPo.V and Po.Dn among regions (p > 0.067). Further, an increased Ct.Th at the MSF was significantly associated with a lower Po.Dn, while a higher Ct.Th and an increased AvgPo.V in the anterior maxilla were associated with a higher Ct.Th and an increased AvgPo.V, respectively, in the posterior maxilla and MSF. Finally, within each region, the AvgPo.V was associated positively with Ct.Po and negatively with Po.Dn. Conclusions: The cortical bone of the MSF is slightly less thick and slightly more porous compared to the cortical bone at the buccal aspect of the anterior and posterior maxilla. Clinical relevance: During lateral and vertical bone augmentation procedures, the cortical recipient bone is perforated several times to open the bone marrow compartment to facilitate provision of osteoinductive cells and molecules in the augmented space. Whether it is meaningful to approach the MSF in a similar way during MSF augmentation procedures or whether the slightly more porous structure of the MSF observed herein reduces the cortical barrier function already sufficiently has to be assessed in future clinical trials.

Objectives: To assess, retrospectively, whether older age has an impact on implant osseointegration when compared with younger age. Methods: All patients ≥65 years old at implant installation, in an university setting over a time-period of 11.5 years, with complete anamnestic data and follow-up until prosthetic restoration were included and any early implant loss (EIL; i.e., lack of osseointegration prior to or at time-point of prosthetic restoration) was recorded. Further, one implant, from each of the elderly patients was attempted matched to one implant in a younger patient (35 to <55 years old at implant installation) from the same clinic based on: (1) gender, (2) implant region, (3) smoking status, and (4) bone grafting prior to/simultaneously with implant installation. The potential impact of various local and systemic factors on EIL in the entire elderly population, and in the matched elderly and younger patient group were statistically assessed. Results: Four-hundred-forty-four patients ≥65 years old (range 65.1-91.3; 56.8% female) receiving 1517 implants were identified; 10 patients had one EIL each (implant/patient level: 0.66/2.25%). Splitting this patient cohort additionally into 4 age groups [65-69.9 (n=213), 70-74.9 (n=111), 75-79.9 (n=80), ≥80 (n=40)] EIL was on the implant level 0.41, 0.83, 0.34, and 2.26%, respectively, (p=0.102) and on the patient level 1.41, 2.70, 1.25, and 7.50%, respectively, (p=0.104); multilevel analysis showed weak evidence of association of increasing age with higher EIL rate (p = 0.090). Matching was possible in 347 cases, and 5 (1.44%) and 9 (2.59%) EIL in the elderly and younger patients, respectively, were observed (p=0.280). EIL could not be associated with any systemic condition or medication intake. Conclusions: Elderly patients ≥65 years old presented a similarly low EIL rate as younger patients 35 to <55 years old, while patients ≥80 years old may have a slight tendency for a higher EIL rate. Hence, aging does not seem to compromise osseointegration, and if at all, then only slightly and at a later stage of life.

OBJECTIVES: The present proof-of-principle study assessed whether daily use of a power-driven water flosser (Sonicare AirFloss; SAF) leads to bacterial colonization in the nozzle and/or the device, resulting in contaminated water-jet.

MATERIAL AND METHODS: In five participants, saliva samples at baseline and water-jet samples of devices used daily with bottled water for 3 weeks (test) were collected. Additionally, water-jet samples from devices used daily with bottled water extra-orally for 3 weeks (positive control) and from brand new devices (negative control), as well as samples from newly opened and 1- and 3-week opened water bottles were collected. Colony forming units (CFU) were recorded after 48 h culturing and 20 oral pathogens were assessed by polymerase chain reaction-based analysis.

RESULTS: Distinct inter-individual differences regarding the number of detected bacteria were observed; water-jet samples of test devices included both aerobic and anaerobic bacterial species, with some similarities to the saliva sample of the user. Water-jet samples from positive control devices showed limited number of aerobic and anaerobic bacterial species, while the samples from negative control devices did not show any bacterial species. Very few aerobic bacteria were detected only in the 3-week-old bottled water samples, while samples of newly and 1-week opened water bottles did not show any bacterial growth.

CONCLUSIONS: The present proof-of-principle study showed that daily use of a power-driven water flosser for 3 weeks resulted in bacterial colonization in the nozzle and/or device with both aerobic and anaerobic, not only oral, species, that are transmitted via the water-jet.

Objectives: To assess patients' opinion on the use of 2 generations of power-driven water flossers and their impact on gingival inflammation.

Material & Methods: In the present prospective cohort study 24 periodontitis patients under regular supportive periodontal therapy used daily 2 generations of a power- driven water flosser (Sonicare AirFloss [SAF] and Sonicare AirFloss Ultra [SAFU]) for 12 weeks each. Patients were instructed to position the nozzle interproximally from the buccal aspect at each interproximal space. Patients' opinion was assessed by a questionnaire and interproximal bleeding on probing (BoP) was recorded.

Results: Overall satisfaction with SAF/SAFU was rated high, by about 80% of the patients. About 66% of the patients preferred SAF/SAFU compared to their previous interdental cleaning device and indicated that they would continue using SAF/SAFU after the study; none of the patients reported any discomfort or pain. Compared to only tooth brushing, daily use of SAF/SAFU caused a significant reduction of inter- proximal BoP values, which were well maintained over 6 months; that is, BoP at interproximal buccal and oral sites (pooled), as well as at interproximal buccal and oral sites separately, was proportionately reduced by 29.1%, 41.2%, and 24.8%, respec- tively (pooled: p = 0.027; buccal sites: p = 0.030; oral sites: p = 0.030).

Conclusion: Patients were very fond of the power-driven water flossers tested herein, and daily use of the devices for 6 months (i.e., each device was used for 3 months) resulted in a significant reduction of gingival inflammation interproximally.

Objective To assess whether bacterial colonisation in a power-driven water flosser can be prevented. Materials and methods Twenty-four patients undergoing supportive periodontal treatment used 2 power-driven water flossers [Sonicare AirFloss (SAF), AirFloss Ultra (SAFU)] for 12 weeks each as follows: (a) with bottled water (BW); (b) with BW and cleaning the device extra-orally twice per week with chlorhexidine gluconate or (c) essential-oil-based (EO) mouth-rinse; (d) with EO only. Water-jet samples were taken after 6 and 12 weeks with the used nozzle and after exchanging to a brand-new nozzle. After 12 weeks, all devices underwent an intensive cleaning procedure. Samples were analysed by PCR-based method for cariogenic and periodontal pathogens and culture for staphylococci, aerobe gram-negative bacteria, and Candida sp. Results Contamination of SAF/SAFU with Streptococcus mutans was found in > 95% of the samples; periodontal pathogens and aerobe gram-negative bacteria were detected in 19-56% of the samples, while Staphylococcus aureus and Candida sp. were identified only in few samples. Contamination rate was basically unaffected by time-point, device, or way of use. Further, exchanging the nozzle did not prevent transmission of a contaminated water-jet, but the intensive cleaning reduced most of the pathogens significantly, except of S. mutans. Conclusion Neither a specific way of use nor exchanging the nozzle prevented bacterial colonisation and transmission of biofilm components via the water-jet of SAF/SAFU.

Objectives: To report two cases of adverse reaction after mucosal hyaluronan (HY) injection around implant-supported crowns, with the aim to augment the missing interdental papilla. Material and Methods: Two patients with single, non-neighbouring, implants in the anterior maxilla, who were treated within the frames of a randomized controlled clinical trial testing the effectiveness of HY gel injection to reconstruct missing papilla volume at single implants, presented an adverse reaction. Injection of HY was performed bilaterally using a 3-step technique: (i) creation of a reservoir in the mucosa directly above the mucogingival junction, (ii) injection into the attached gingiva/mucosa below the missing papilla, and (iii) injection 2–3 mm apically to the papilla tip. The whole-injection session was repeated once after approximately 4 weeks. Results: Both patients presented with swelling and extreme tenderness with a burning sensation on the lip next to the injection area, after the second injection session. In one of the cases, a net- like skin discoloration (livedo reticularis) was also noted. The symptoms lasted for up to 7 days, and in both cases, symptoms resolved without any signs of skin or mucosal necrosis or any permanent damage. Conclusion: Most likely, water attraction over time by the highly hygroscopic HY, exerted progressively an external vascular compression and at least partial occlusion of neighbouring blood vessels. An infection or an allergic reaction seems unlikely, since all symptoms gradually disappeared within a week irrespective use of antimicrobials, while an allergic reaction most likely would not have been restricted to one side.

OBJECTIVES: The present randomized controlled trial aimed to assess the effect of hyaluronan (HY) injections to augment deficient interproximal papillae at implant-supported crowns in the anterior maxilla. METHODS: Twenty-two patients with a deficient papilla in the anterior maxilla next to an implant-supported crown were randomly assigned to receive twice either HY (test) or saline solution (control) injection. The following parameters were recorded prior to injection (baseline) and 3 and 6 months after injection: distance between the papilla tip and contact point (PT-CP), modified papilla index score (MPIS), and standard clinical periodontal parameters. Pain level after injection was recorded on a visual analogue scale (VAS). The deficient area was evaluated on clinical photographs, and the esthetic appearance was recorded on a VAS. Differences in mucosal volume were assessed after 3 months by intraoral scans. The bone level was assessed on periapical radiographs. RESULTS: No differences were observed between groups, neither at baseline nor at 3 and 6 months post-treatment. Mean PT-CP ranged between 1.8 mm and 2.3 mm without significant differences between groups or over time within groups; MPIS was 2 for all patients at all time points. Similarly, insignificant differences between groups or time points were observed for deficient area, gingival volume changes, bone level, and esthetic appearance. There were no differences in pain level between groups during injection, but discomfort after injection lasted longer in the test group. CONCLUSIONS: Injection of HY adjacent to maxillary anterior implant-supported crowns did not result in any clinical conspicuous volume augmentation of deficient papillae.

In the severely atrophied maxilla, implant anchorage in the zygomatic bone is considered a viable alternative to conventional dental implants with preceding bone augmentation procedures. The present microCT-based study compared the trabecular bone quality of the maxilla and zygomatic bone. MicroCT scanning was conducted in 12 halves of cadaver heads (5 male, 7 female) with edentulous, atrophied maxillae. Relevant trabecular bone quality parameters were determined in the anterior and posterior maxilla and in the zygomatic bone and compared by region and sex. Any difference in mean values between the anterior maxilla and the zygomatic bone was insignificant. Comparison of both with the posterior maxilla presented significantly higher values for bone volume fraction, surface density, and trabecular thickness and number, and significantly lower values for specific bone surface, structure model index, and trabecular separation. A significant sex-specific difference was not detected. The present microCT-based analysis is, to the best of our knowledge, the first intra-individual comparison of different implant anchorage sites for masticatory rehabilitation of the maxilla. The trabecular compartment of the zygomatic bone offered bone quality and, thus, an implant bed comparable with those of the anterior maxilla, and both were superior to the posterior maxilla.

Objectives: CT assessment of the entire course of the inferior alveolar artery (IAA) within the mandibular canal. Methods: After contrast medium injection (180 or 400 mg/ml iodine concentration) into the external carotid arteries of 15 fresh human cadaver heads, the main IAA’s position in the canal (cranial, buccal, lingual or caudal) was assessed in dental CT images of partially edentulous mandibles. Results: The course of the main IAA could be followed at both iodine concentrations. The higher concentration gave the ex- pected better contrast, without creating artefacts, and improved visibility of smaller arteries, such as anastomotic sections, dental branches and the incisive branch. The main IAA changed its position in the canal more often than so far known (mean 4.3 times, SD 1.24, range 2–7), but with a similar bilateral course. A cranial position was most often detected (42 %), followed by lingual (36 %), caudal (16 %) and buccal ( 6 %). Conclusions: With this non-invasive radiologic method, the entire course of the main IAA in the mandibular canal could be followed simultaneously with other bone structures on both sides of human cadaver mandibles. This methodology allows one to amend existing anatomical and histological data, which are important for surgical interventions near the mandibular canal.

Objective

To assess whether the impact of implantoplasty (IP) on the maximum implant failure strength depends on implant type/design, diameter, or material.

Methods

Fourteen implants each of different type/design [bone (BL) and tissue level (TL)], diameter [narrow (3.3 mm) and regular (4.1 mm)], and material [titanium grade IV (Ti) and titanium-zirconium alloy (TiZr)] of one company were used. Half of the implants were subjected to IP in a computerized torn. All implants were subjected to dynamic loading prior to loading until failure to simulate regular mastication. Multiple linear regression analyses were performed with maximum implant failure strength as dependent variable and IP, implant type/design, diameter, and material as predictors.

Results

Implants subjected to IP and TL implants showed statistically significant reduced implant failure strength irrespective of the diameter compared with implants without IP and BL implants, respectively. Implant material had a significant impact for TL implants and for regular diameter implants, with TiZr being stronger than Ti. During dynamic loading, 1 narrow Ti TL implant without IP, 4 narrow Ti TL implants subjected to IP, and 1 narrow TiZr TL implant subjected to IP were fractured.

Conclusion

IP significantly reduced the maximum implant failure strength, irrespective implant type/design, diameter, or mate- rial, but the maximum implant failure strength of regular diameter implants and of narrow BL implants remained high.

Clinical Relevance

IP seems to have no clinically relevant impact on the majority of cases, except from those of single narrow Ti TL implants, which may have an increased risk for mechanical complications. This should be considered for peri-implantitis treatment planning (e.g., communication of potential complications to the patient), but also in the planning of implant installation (e.g., choosing TiZr instead of Ti for narrow implants).

Objective: To map oral health-related standard of care in the context of head and neck cancer (HNC) treatment across the European Union (EU).

Materials and Methods: Six hundred and ninety centers across the European Union were contacted. The questionnaire contained questions focusing on the team/department structure, HNC treatment planning routines, and assessment and handling of dental treatment needs prior to cancer treatment.

Results: Eighty-seven centers across the EU responded. Department structure and number of HNC patients treated per year varied widely and dental professionals are included as part of the team in about 25% of the centers. Standard of care, in terms of dental assessment and preventive dentistry routines, such as recording an orthopantomogram, offering dental treatment, and providing a radiation protection splint and splint for fluoride application, differed significantly among the European regions. Independent of the region, these aspects are positively affected if dental professionals are part of the interdisciplinary treatment team and if dental treatment is offered within the center.

Conclusion: Dental professionals are still only to a very limited extent included in interdisciplinary treatment planning teams of HNC patients. However, their inclusion and/or offering dental treatment within the same hospital/center appears to improve oral health-related standard of care.

Clinical Relevance: Inclusion of dental professionals in treatment planning teams of HNC patients appears to improve oral health-related standard of care within HNC treatment.

OBJECTIVES: To assess the timeframe between tooth extraction and radiographically detectable socket cortication in humans. METHODS: Two hundred and fifty patients with a CT scan ≤36 months after tooth extraction were included. First, three orthoradial multiplanar reconstruction slices, representing the major part of the extraction socket, were scored regarding the degree of bone healing as (i) healed, that is, complete/continuous cortication of the socket entrance, or (ii) non-healed. Thereafter, based on the results of all three slices, the stage of cortication of the extraction socket, as one unit, was classified as (i) non-corticated, that is, all three slices judged as non-healed, (ii) partially corticated, that is, 1 or 2 slices judged as non-healed, or (iii) completely corticated, that is, all three slices judged as healed. The possible effect of several independent parameters, that is, age, gender, timeframe between tooth extraction and CT scan, tooth type, extent of radiographic bone loss of the extracted tooth, tooth-gap type, smoking status, presence of any systemic disease, and medication intake, on cortication status was statistically evaluated. RESULTS: Three to 6 months after tooth extraction, 27% of the sockets were judged as non-corticated and 53% were judged as partially corticated. After 9-12 months, >80% of the sockets were corticated, while some incompletely corticated sockets were detected up to 15 months after extraction. Each additional month after tooth extraction contributed significantly to a higher likelihood of a more advanced stage of cortication, while radiographic bone loss ≥75% significantly prolonged cortication time; no other independent variable had a significant effect. CONCLUSIONS: The results indicate a considerably long timeframe until complete cortication of an extraction socket, that is, 3-6 months after tooth extraction 3 of 4 sockets were still not completely corticated, and only after 9-12 months, complete cortication was observed in about 80% of the sockets.

OBJECTIVES: This study aimed to assess the oral health status and dental care behaviours of patients treated for head and neck squamous cell carcinoma (HNSCC) in an Austrian tertiary hospital. MATERIALS AND METHODS: Dental care behaviours, oral hygiene level, caries, and periodontal parameters were assessed in 48 patients treated for HNSCC >6 months ago. RESULTS: Only 52 % requested a dental check-up after HNSCC diagnosis and prior to treatment, and of those, 80 % received some type of dental treatment. At time-point of clinical examination, 69 % of the patients had consulted a dentist within the last year, but 88 % still needed dental treatment; 75 % had at least one tooth with caries and 78 % had moderate to severe periodontitis. CONCLUSION: Although it was recommended, only half of the patients did consult a dentist prior to HNSCC treatment and oral health appeared, in general, low prioritized. CLINICAL RELEVANCE: About 90 % of the current group of head and neck squamous cell carcinoma cancer patients presented large treatment needs, both in regard with caries and periodontal disease, about 20 months after cancer treatment.

Objectives The present systematic review compared the effec- tiveness of soft tissue substitutes (STSs) and autogenous free gingival grafts (FGGs) in non-root-coverage procedures to increase keratinized tissue (KT) width around teeth. Materials and methods Included studies fulfilled the follow- ing main eligibility criteria: (a) preclinical in vivo or human controlled trials using FGG as control, (b) non-root-coverage procedures, and (c) assessment of KT width. Meta-analysis was performed on the gain in KT width (primary outcome variable) and several secondary variables. Results Eight human trials with short observation time evalu- ating five different STSs were identified. FGG yielded consis- tently significantly (p < 0.001) larger increase in KT width irrespective whether the comparison regarded an acellular ma- trix or a tissue-engineered STS. Further, FGG yielded consis- tently ≥2 mm KT width postoperatively, while use of STS did not, in the few studies reporting on this outcome. On the other hand, STSs resulted in significantly better aesthetic outcomes and received greater patient preference (p < 0.001). Conclusions Based on relatively limited evidence, in non- root-coverage procedures, FGG (1) resulted consistently in significantly larger increase in KT width compared to STS and (2) yielded consistently ≥2 mm KT width postoperatively, while STSs did not. STSs yielded significantly better aesthetic outcomes, received greater patient preference, and appeared safe. Clinical relevance Larger and more predictable increase in KT width is achieved with FGG, but STSs may be considered when aesthetics is important. Clinical studies reporting rele- vant posttreatment outcomes, e.g., postop KT width ≥2 mm, on the long-term (>6 months) are warranted.

Objective To provide an overview on "orthodontic therapy in periodontitis patients" by addressing the following three questions: (1) At which time point can orthodontic treatment start in periodontitis patients? (2) What should be considered during orthodontic treatment? (3) Can teeth with a reduced periodontium be maintained after orthodontic treatment? Results In general, the scientific evidence on this topic is mainly based on preclinical, retrospective studies, and case series; controlled clinical trials are scarce. Nevertheless, it is clear, that orthodontic tooth movement should be performed only in periodontally healthy (i.e., non-inflamed) tissues, otherwise further attachment loss might occur. Therefore, cause-related periodontal therapy should always precede orthodontic treatment and supportive periodontal treatment should be continuously provided during orthodontic therapy. Yet, up-to-now, there is no clear treatment recommendation regarding the time-point and type of any surgical intervention before orthodontic treatment. In relation to treatment of patients with vertical defects it is, however, not clear whether an open flap debridement is sufficient or application of any additional regenerative material will improve the prognosis. The results of orthodontic treatment can be successfully preserved on the long-term – also on a reduced periodontium – if sufficient stabilization and periodontal maintenance is provided. Conclusion Orthodontic therapy has no negative influence on teeth with a reduced but healthy periodontium and the results can be maintained for a large period of time. Hence, cause-related periodontal therapy should always precede orthodontic treatment to establish inflammation-free conditions, but up-to-now there is no clear recommendation regarding the time-point and type of periodontal surgical interventions. 

Background Maxillary sinus floor augmentation (MSFA) with autologous bone and/or bone substitutes is a reliable procedure to develop an implant site. Loss of augmentation volume during the healing period seems to be dependent on the type of graft material and possibly on the sinus dimensions/morphology, e.g. a larger distance between the buccal and palatal sinus wall (i.e. “wide” sinus) might delay graft consolidation due to a longer distance angiogenic/osteogenic factors and cells need to cover to populate the graft. Aim/Hypothesis To assess the bucco-palatal width of the maxillary sinus in the premolar and molar region and any possible differences due to tooth region, gender, tooth-gap extent, and residual alveolar bone dimensions. Further, to attempt a rational, simple sinus classification based on its bucco-palatal width. Material and Methods CTs of the posterior maxilla were divided depending on tooth-gap extent into (a) edentulous, and (b) 1- or 2-tooth gap. Sites presenting on the CT >5 mm of the maxillary sinus, no previous augmentation procedures and/or oro-antral communication were included. A central orthoradial multiplanar reconstruction slice from each edentulous tooth site was chosen by a calibrated examiner to record the following parameters: (i) alveolar bone height (ABH), (ii) alveolar bone area (ABA), (iii) alveolar bone width (ABW) 2 mm apical to the alveolar crest (ABW2), (iv) ABW at the sinus floor (ABWS), (v) bucco-palatal sinus width (SW) and (vi) sinus area (SA) at a level 2, 4, 6, 8 and 10 mm above the sinus floor (SW2/SA2, SW4/SA4, etc.) (Figure 1). Based on mean values (i.e. <25th, 25–75th, >75th percentile and <33rd, 33–67th, >67th percentile) the sinus was classified as narrow, average, and wide, respectively, to attempt a simple sinus classification. Results Eighty-six partially dentate and 76 edentulous quadrants contributed with 383 tooth sites (58 first and 97 second premolars, 129 first and 99 second molars). Alveolar bone and sinus parameters did not differ depending on tooth-gap extent and gender, but differed significantly depending on tooth site, i.e. ABH and ABA was smallest at the first molar, and ABW, ABWS, SW, and SA were significantly larger at the molars. Further, ABW correlated significantly with SW and SA. High variability in SW among the various levels within the same tooth site, as well as high variability among tooth sites within the same person was observed, i.e. in >50% of the cases, sinus classification (i.e., narrow, average, or wide) varied depending on SW height level (Table 1) and among tooth sites within each patient. Conclusions and Clinical Implications Maxillary sinus bucco-palatal width varies significantly among the various height levels within the same tooth site and among tooth sites within the same person. A rational, simple classification of each sinus as narrow, average, or wide was not applicable.

Objectives The bucco-palatal sinus width (SW) appears as relevant factor for graft consolidation after maxillary sinus (MS) floor augmentation. The present study aimed to assess a) SW at different height levels of posterior teeth, b) possible factors influencing SW, and c) whether a simple/meaningful sinus classification based on SW is possible. Methods The following parameters were recorded on computed tomographies of 76 edentulous and 86 partially edentulous maxillary quadrants displaying 383 tooth sites in total: i) alveolar ridge height, ii) -area, iii) -width 2mm apical to the alveolar crest, iv) -width at the sinus floor, and v) SW and sinus area at a level 2, 4, 6, 8, and 10mm above the sinus floor. The possible influence of gender, tooth position [i.e., premolar (PM); molar (M)], tooth-gap extent, and residual alveolar ridge dimensions on SW was assessed. Further, based on percentiles of average values or on the frequency distribution of SW <10, 10-15, or >15mm, it was attempted to classify the sinus at each given site into narrow, average, or wide. Results Gender and tooth-gap extent presented no relevant impact on MS dimensions; however, significant differences were observed among the various tooth positions regarding all evaluated parameters. The lower the residual alveolar ridge, the wider the MS at 4-10mm height, while the wider the residual alveolar ridge, the wider the MS. Large variation in SW classes among the different height levels within the same tooth position and among tooth positions within the same person was observed, irrespective of the threshold applied. Further, at a MS height of 10mm at PM1, PM2, M1, and M2, SW was <10mm in 68%, 33%, 0%, and 7% of the cases, respectively, while in 3%, 21%, 65%, and 57%, respectively, SW was >15mm. Conclusions There is a large variation in SW depending on the height level within the sinus and on tooth position, which does not permit a simple/meaningful classification of each sinus as “narrow”, “average”, or “wide”. Nevertheless, narrow sinuses (<10mm) are rather prevalent in the premolar region, while wide sinuses (>15mm) in the molar region; further, a wider and shorter residual alveolar ridge is associated with a wider SW.

Background: Gingival clefts (GC) develop frequently during orthodontic space closure and may compromise the treatment outcome. This study assessed whether the time-point of orthodontic space closure initiation, after permanent tooth extraction, affects the incidence of GC. Methods: In 25 patients requiring bilateral premolar extraction due to orthodontic reasons, one premolar, chosen at random, was extracted 8 weeks before space closure initiation (“delayed movement”, DM), while the contralateral premolar was extracted one week before (“early movement”, EM) (“treatment group”). Presence/absence of GC after 3 and 6 months (“time-point”) was recorded and any association with various parameters (i.e., treatment group, time-point, gender, jaw, craniofacial growth, gingival biotype, buccal bone dehiscence after extraction, space closure) was statistically assessed. Results: Twenty-one patients contributing with 26 jaws were finally included in the analysis. Overall, GC were frequent after 3 (DM: 53.9%; EM: 69.2%) and 6 months (DM: 76.9%; EM: 88.5%). EM (p=0.014) and larger space closure within the study period (p=0.001) resulted in a significantly higher incidence of GC. Further, there was a tendency for GC development in the presence of buccal bone dehiscence (p=0.052) and thin gingival biotype (p=0.054). “Fast movers” (herein cases with a tooth movement ≥ 1mm per month) developed a GC in > 90% of the cases already after 3 months. “Slow movers” developed a GC only in 25 and 70% after 3m and FE, respectively. Conclusions: GC development is a frequent finding during orthodontic space closure and seems to occur more frequently with early tooth movement initiation and in “fast movers”.

Aim: To assess the importance of achieving a successfully treated stable periodontitis patient status (PPS) during long-term supportive periodontal care (SPC).

Methods: This retrospective cohort study included 100 periodontitis patients, who continued for ≥ 7.5 years after active periodontal treatment with SPC and were judged as overall adherent. The effect of various predictors on 3 patient-related outcome parameters was assessed: number of 1) diseased teeth at last SPC, 2) teeth lost due to periodontitis, and 3) teeth lost due to any reason.

Results: One fifth of the patients were classified as stable after active periodontal treatment. After a mean follow-up of 10.77 years, 24 patients lost 38 teeth due to periodontitis. An unstable PPS and a higher number of diseased teeth per patient at first SPC, and inadequate oral hygiene levels over time significantly increased the risk for a higher number of diseased teeth per patient at last SPC and for more lost teeth due to periodontitis. However, high adherence to SPC appeared to mitigate the negative effect of an unstable PPS, especially regarding tooth loss due to periodontitis. Further, tooth loss due to any reason was about 3-times higher than tooth loss due to periodontitis and was affected by a larger number of predictors.

Conclusions: Successfully treated patients with a stable PPS maintained a low number of diseased teeth and barely lost teeth during long-term SPC compared to patients not achieving a stable PPS after active periodontal therapy.

Objectives To evaluate the effect of local and/or systemic statin use as an adjunct to non-surgical and/or surgical periodontal therapy. Data Literature search according to PRISMA guidelines with the following eligibility criteria: (a) English or German language; (b) interventional studies; (c) statins as monotherapy or as an adjunct to non-surgical and/or surgical treatment of periodontitis; (d) clinical and/or radiographic treatment effect size of statin intake reported. Sources Medline (PubMed), Embase (Ovid), CENTRAL (Ovid). Study selection Thirteen clinical studies regarding local application and 2 with systemic administration of statins as an adjunct to non-surgical treatment (SRP) and 4 studies regarding intrasurgical statin application with a maximum follow-up of 9 months could be included; simvastatin, atorvastatin, and rosuvastatin were used. Local but not systemic statin application as an adjunct to SRP yielded significantly larger probing pocket depth (PD), radiographic defect depth (RDD), and bleeding index reduction, and larger clinical attachment level gain, and less residual PD and RDD (p≤0.016); rosuvastatin appeared as the most efficacious. Three of 4 studies reported a significant positive effect of intrasurgical statin application. No adverse events were reported after statin use. The vast majority of the included studies were from the same research group. Conclusions Significant additional clinical and radiographic improvements are obtained after local, but not systemic, statin use as an adjunct to SRP in deep pockets associated with intrabony defects and seemingly with furcation defects; intrasurgical statin application seems similarly beneficial. Confirmation of these results, and especially of the effect size, from other research groups is warranted.

Osteoimmunology describes the cross-talk of cells of the musculoskeletal and the immune system during the pathogenesis of various diseases; among the most prevalent ones is periodontitis, a chronic infectious inflammatory disease of the tooth-supporting structures, i.e., the periodontium consisting of the gingiva, alveolar bone, periodontal ligament, and root cementum. Periodontal disease is initiated by oral pathogens that accumulate at the gingival margin of the teeth and thereby trigger a response of the innate and adaptive immunity. In contrast to other osteoimmunological disorders (e.g., osteoporosis, rheumatoid arthritis), the immune system plays a two-sided role in the pathogenesis of periodontitis: it controls the infection and protects the organism from bacterial invasion but also propagates the destruction of the soft and hard tissues surrounding the tooth. Periodontitis, if left untreated, finally results in tooth loss.

BACKGROUND: Whether the composition of palatal connective tissue grafts (CTGs) varies depending on donor site or harvesting technique in terms of relative amounts of fibrous connective tissue (CT) and fatty/glandular tissue (FGT) is currently unknown and is histologically assessed in the present study. METHODS: In 10 fresh human cadavers, tissue samples were harvested in the anterior and posterior palate and in areas close to (marginal) and distant from (apical) the mucosal margin. Mucosal thickness, lamina propria thickness (defined as the extent of subepithelial portion of the biopsy containing ≤25% or ≤50% FGT), and proportions of CT and FGT were semi-automatically estimated for the entire mucosa and for CTGs virtually harvested by split-flap (SF) preparation minimum 1 mm deep or after deepithelialization (DE). RESULTS: Palatal mucosal thickness, ranging from 2.35 to 6.89 mm, and histologic composition showed high interindividual variability. Lamina propria thickness (P >0.21) and proportions of CT (P = 0.48) and FGT (P = 0.15) did not differ significantly among the donor sites (anterior, posterior, marginal, apical). However, thicker palatal tissue was associated with higher FGT content (P <0.01) and thinner lamina propria (P ≤0.03). Independent of the donor site, DE-harvested CTG contained a significantly higher proportion of CT and a lower proportion of FGT than an SF-harvested CTG (P <0.04). CONCLUSION: Despite high interindividual variability in terms of relative tissue composition in the hard palate, DE-harvested CTG contains much larger amounts of CT and much lower amounts of FGT than SF-harvested CTG, irrespective of the harvesting site.

Purpose Miller's is the most commonly used classification of gingival tissue recessions. However, data on the reliability of this classification are missing so far, although reliability, which reflects the consistency of repeated measurements, is regarded as a prerequisite for judging the utility of a classification. The primary aim of the present study was to determine inter- and intra-observer agreement on Miller’s classification. Second, 3 additional parameters, associated with gingival tissue recessions, were evaluated. Methods Two hundred photographs (50 of each region: maxillary/mandibular anterior/posterior teeth) of gingival tissue recessions were evaluated twice (interval of one month) by 4 observers in Miller's classification (classes I to IV), gingival phenotype (thin&high or thick&low scalloping), tooth shape (long-narrow or short-wide), and identifiability of the cemento-enamel junction (CEJ). The level of agreement was assessed according to a 6-level nomenclature: poor <0.0, slight 0.0-0.2, fair 0.21-0.4, moderate 0.41-0.6, substantial 0.61-0.8, almost perfect 0.81-1.0. Results The inter- and intra-observer agreements on the assessed parameters are summarised in the table. The inter-observer agreement on Miller's classification was substantial, with the highest values for anterior teeth. The intra-observer agreement was substantial to almost perfect, with the highest values for maxillary anterior teeth. The differences between the first and second ratings as well as among the different observers were mainly among Miller’s classes I, II, and III, but never between classes I and IV. The inter-observer agreement on the gingival phenotype was slight to moderate, with higher values for anterior mandibular teeth. Similar results were seen for intra-observer agreements. In general, the intra-observer agreements for all regions were moderate for each observer. The inter-observer agreement on tooth shape was fair to moderate, with higher values for the anterior mandibular teeth. Similar results are presented for intra-observer agreement. In general, intra-observer agreement for all regions was moderate for each observer. Inter-observer agreement on the identifiability of the CEJ was slight to fair, with values just slightly higher for anterior teeth. Intra-observer agreement was poor to almost perfect. The anterior mandibular teeth presented slightly higher values. Gingival phenotype (thin-high scalloping) significantly correlated with tooth shape (long-narrow) (rho=0.662, p<0.001). Anterior teeth presented a higher correlation, with the mandibular anterior teeth presenting an almost perfect correlation (rho=0.954). Conclusions Miller’s classification of gingival tissue recessions was evaluated by 4 examiners using 200 photographs and yielded substantial to almost perfect agreement, with higher agreement for anterior teeth. The present study offers the so far missing proof on the sufficient inter- and intra-observer agreement of this classification.

Miller’s is the most commonly used classification of gingival tissue recessions, defined as the displacement of the soft tissue margin apical to the cemento-enamel junction. However, data on the reliability of this classification are missing so far, although reliability, which reflects the consistency of repeated measurements, is regarded as a prerequisite for judging the utility of a classification. The aim of the present study was to evaluate inter- and intra-observer agreement on Miller’s classification of gingival tissue recessions. Two hundred photographs (50 of each region: maxillary/mandibular anterior/posterior teeth) of gingival tissue recessions were evaluated twice by four observers with different degrees of experience in Miller’s classification, gingival phenotype, tooth shape, and identifiability of the cemento- enamel junction. The following inter- and intra-observer agreements were found: Miller’s classification, 0.72 and 0.73–0.95; gingival phenotype, 0.29 and 0.45–0.58; tooth shape, 0.39 and 0.44–0.59; and identifiability of the cemento-enamel junction, 0.21 and 0.30–0.59. A higher agreement was detected for anterior teeth. Further, gingival phenotype (thin-high scalloping) significantly correlated with tooth shape (long-narrow) (ρ = 0.662, p < 0.001). Miller’s classification of gingival tissue recessions was evaluated by four examiners using 200 clinical photographs and yielded substantial to almost perfect agreement, with higher agreement for anterior teeth. Although limited to photographic assessment, the present study offers the so far missing proof on the sufficient inter- and intra-observer agreement of this classification.

Purpose Miller's is the most commonly used classification of gingival tissue recessions. However, data on the reliability of this classification are missing so far, although reliability, which reflects the consistency of repeated measurements, is regarded as a prerequisite for judging the utility of a classification. The primary aim of the present study was to determine inter- and intra-observer agreement on Miller’s classification. Second, 3 additional parameters, associated with gingival tissue recessions, were evaluated. Methods Two hundred photographs (50 of each region: maxillary/mandibular anterior/posterior teeth) of gingival tissue recessions were evaluated twice (interval of one month) by 4 observers in Miller's classification (classes I to IV), gingival phenotype (thin&high or thick&low scalloping), tooth shape (long-narrow or short-wide), and identifiability of the cemento-enamel junction (CEJ). The level of agreement was assessed according to a 6-level nomenclature: poor <0.0, slight 0.0-0.2, fair 0.21-0.4, moderate 0.41-0.6, substantial 0.61-0.8, almost perfect 0.81-1.0. Results The inter- and intra-observer agreements on the assessed parameters are summarised in the table. The inter-observer agreement on Miller's classification was substantial, with the highest values for anterior teeth. The intra-observer agreement was substantial to almost perfect, with the highest values for maxillary anterior teeth. The differences between the first and second ratings as well as among the different observers were mainly among Miller’s classes I, II, and III, but never between classes I and IV. The inter-observer agreement on the gingival phenotype was slight to moderate, with higher values for anterior mandibular teeth. Similar results were seen for intra-observer agreements. In general, the intra-observer agreements for all regions were moderate for each observer. The inter-observer agreement on tooth shape was fair to moderate, with higher values for the anterior mandibular teeth. Similar results are presented for intra-observer agreement. In general, intra-observer agreement for all regions was moderate for each observer. Inter-observer agreement on the identifiability of the CEJ was slight to fair, with values just slightly higher for anterior teeth. Intra-observer agreement was poor to almost perfect. The anterior mandibular teeth presented slightly higher values. Gingival phenotype (thin-high scalloping) significantly correlated with tooth shape (long-narrow) (rho=0.662, p<0.001). Anterior teeth presented a higher correlation, with the mandibular anterior teeth presenting an almost perfect correlation (rho=0.954). Conclusions Miller’s classification of gingival tissue recessions was evaluated by 4 examiners using 200 photographs and yielded substantial to almost perfect agreement, with higher agreement for anterior teeth. The present study offers the so far missing proof on the sufficient inter- and intra-observer agreement of this classification.

Objective

To assess in a cross-sectional study the impact of including dental professionals in the multidisciplinary treatment team of head and neck squamous cell carcinoma (HNSCC) patients on the long-term oral health status.

Materials and methods

Oral health status, dental care behaviours, and oral health-related quality of life were assessed based on a clinical and radiographic examination, interview, and medical records in patients treated for HNSCC ≥ 6 months ago. This patient group (‘cohort 2’) was treated in a multidisciplinary treatment team including dental professionals and compared to a group of HNSCC patients previously treated at the same university, but without dental professionals included in the multidisciplinary treatment team (‘cohort 1’).

Results

Cohort 2 consisted of 34 patients, who had received a dental check-up and if necessary, treatment by dental profes- sionals prior to the initiation of cancer treatment. This cohort showed significantly improved oral hygiene habits and a better periodontal health status compared to cohort 1. However, cohort 2 still presented high demand for treatment due to active carious lesions; only a few, statistically insignificant improvements were detected compared to cohort 1.

Conclusion

Including dental professionals in the multidisciplinary treatment team of HNSCC patients has a positive impact on patient oral health status — primarily in terms of periodontal disease — 6 months and longer after finishing cancer therapy.

Clinical relevance

A team-based approach including dental professionals specialised in head and neck cancer improves oral health status.

Background: In cases of a missing maxillary lateral incisor, an implant-supported crown is often the treatment of choice in order to avoid affecting intact adjacent teeth; however, proper implant placement requires a specific minimum amount of alveolar ridge bone volume. In general, alveolar ridge development is depended on tooth development and eruption; consequently, tooth loss has major impact on alveolar ridge dimensions and tooth agenesis seems to impair proper alveolar ridge development. It seems thus reasonable to consider that the impact of tooth agenesis on alveolar ridge development might depend on the gap width, i.e. the distance between the neighboring – regularly erupted – teeth. In particular, the influence from the adjacent teeth on alveolar ridge development would be diminished with an increasing mesio-distal gap distance, which in turn might result in deficient alveolar ridge dimensions, i.e. reduced height and bucco-palatal width in the center of the edentulous alveolar ridge. Aim/Hypothesis: This study aimed (a) to evaluate whether there is a correlation between the mesio-distal gap size and alveolar ridge dimension in patients missing the maxillary lateral incisor either due to agenesis or loss; (b) to determine the edentulous alveolar ridge dimension in the region of the missing maxillary lateral incisor and simulate straightforward implant placement; and (c) to assess any effect of tooth agenesis on the alveolar ridge dimension at the adjacent teeth (i.e. central incisor, canine). Material and Methods: Per protocol, 3 groups (n = 40 per group) were planned, including patients (1) with agenesis of one permanent maxillary lateral incisor (TA); (2) with the maxillary permanent lateral incisors regularly erupted but lost >3 months prior to the CT scan (TL); and (3) with the maxillary permanent lateral incisors regularly erupted and in situ (control; C). The following parameters were manually recorded by a single calibrated examiner: (1) mesio-distal gap width between the central incisor and the canine; (2) average bucco-palatal alveolar ridge width in the coronal (1st to 5th mm) and apical (6th to 10th mm) part of the alveolar ridge; (3) alveolar ridge bone area from a level 1 mm below the top of the alveolar ridge and 10 mm apically; (4) alveolar ridge height; and (5) possibility of straightforward implant placement (10 mm long x 3 or 3.5 mm in diameter). Further, clinical data regarding the actual treatment performed, i.e. bone grafting prior to- or in association with implant installation, were retrieved from the dental records of the patients of TA. Differences in alveolar ridge dimensions (i.e., bucco-palatal width, area, height) among groups [TA vs. TL vs. C) groups were assessed by One-way-ANOVA with LSD post-hoc test; correlations between the alveolar ridge dimension and the mesio-distal gap width were tested by the Spearman correlation coefficient. Results: Altogether 104 maxillary CT-scans were evaluated; the intended sample size of 40 was not achieved for TL due to frequently uncertain history of tooth loss. The area and bucco-palatal width of the alveolar ridge at the lateral incisor and at the adjacent teeth was significantly reduced in TA compared to TL and C (Table 1). Further, in TA, but not TL, an increasing mesio-distal distance between the adjacent teeth resulted in a significantly reduced bucco-palatal width of the coronal part of the edentulous alveolar ridge (r = −0.464, P = 0.003). This impeded simulated straightforward implant placement in >50% of the cases in TA, even with a reduced implant diameter of 3 mm. This simulation had good agreement with the actual treatment performed. Based on clinical data from 26 patients of the TA group, straightforward implant placement was not possible in 58% of the cases. Conclusions and Clinical Implications: The present results indicate that the wider the mesio-distal gap is in maxillary lateral incisor agenesis sites, the thinner bucco-palatally should the alveolar ridge be expected to be. In particular, a mesio-distal gap of >6 mm precluded straightforward implant placement in 60–80% of the cases. These results are relevant for treatment planning, since additional hard and/or soft tissue augmentation procedures should be frequently expected for optimal functional and aesthetic outcomes.

OBJECTIVES: To evaluate (i) a possible correlation between the mesio-distal gap width and the alveolar ridge (AR) dimensions in patients missing the maxillary lateral incisor (I2) either due to agenesis or loss and (ii) the possibility of straightforward implant placement based on simulation. METHODS: The bucco-palatal width, area, and height of the AR at the position of I2, and the mesio-distal gap width between the central incisor and the canine, were assessed in maxillary CT scans of three groups: Patients with (i) agenesis of I2 (TA ; n = 40); (ii) I2 regularly erupted but extracted (TL ; n = 24); (iii) I2 regularly erupted and in situ (C; n = 40). Further, the possibility of straightforward placement of an implant 3 or 3.5 mm in diameter ×10 mm in length, with 1 mm distance from the buccal and palatal plate of the alveolar ridge was simulated and compared to the actual treatment delivered. RESULTS: Bucco-palatal width and area of the AR at I2 and the adjacent teeth was significantly reduced in TA compared to TL and C. Further, in TA , but not TL , an increasing mesio-distal gap width between the central incisor and canine resulted in a significantly reduced bucco-palatal width of the edentulous AR. This impeded a simulated straightforward implant placement in >50% of the cases in TA , even with a reduced implant diameter. CONCLUSIONS: In patients congenitally missing I2, an increased mesio-distal gap width correlates significantly with reduced edentulous AR dimensions. A mesio-distal gap of >6 mm was associated with thin bucco-palatal alveolar ridges, precluding straightforward implant placement in 60-80% of the cases.

Objectives:  To systematically assess the long-term outcome (≥5 years) of root coverage procedures reported in controlled clinical trials.

Material and methods:  Literature search was performed according to the PRISMA guidelines with the following eligibility criteria: (a) English or German language; (b) controlled (CT) or randomised controlled clinical trials (RCT); (c) root coverage procedure with ≥5 years follow-up; and (d) clinical treatment effect size and/or patient-related outcome measures (PROMs) reported.

Results:  Four CT and 14 RCT with a follow-up of 5-20 years fulfilled the eligibility criteria; sample size per study ranged from 8 to 70 patients contributing with 18-149 sites. Coronally advanced flap (CAF) and CAF + connective tissue graft (CTG) were the prevalent treatments (i.e., in 24 and 38% of the groups, respectively), while other flap designs and adjuncts (i.e., enamel matrix derivative, bone graft, collagen membrane) were represented only once. For single Miller class I/II gingival recessions (GR), CAF + CTG appeared advantageous compared to other techniques, and provided low residual recession depths (i.e., ≤0.5 mm), and complete root coverage in ≥2/3 of the patients; similar tendency was observed for multiple GR. No data on Miller class III/IV GR is available. No meta-analysis was feasible due to lack of similarity in the clinical and methodological characteristics across the trials and observed comparisons of interventions.

Conclusions:  CAF + CTG appears to be the 'gold standard' technique for the treatment of single and multiple Miller class I/II GR also in regard to long-term (i.e., ≥5 years of follow-up) treatment outcomes. There is little information regarding the performance, on the long-term, of other techniques and adjuncts.