Leticia Algarves Miranda

Background: The purpose of alveolar ridge preservation (ARP) is to minimise the physiological alveolar ridge reduction occurring after dental extraction, which can prevent the need for future alveolar ridge augmentation. Biologic materials (biologics) promote tissue regeneration based on their effect on wound healing at a cellular level. By integrating biologics into ARP biomaterials, there is a potential to enhance the regeneration of both hard and soft tissues with greater efficacy. Aim: This narrative review aims to evaluate the clinical efficacy of the addition of biologics to existing ARP materials on the physiological changes following ARP of an extraction site. Methods: A search of the PubMed electronic database was conducted, and relevant articles were examined. Sixty-three articles met the inclusion and exclusion criteria and were included in this review. Results and Conclusions: A review of the existing literature found that the combination of biologics with ARP materials resulted in similar dimensional changes when compared to using ARP materials alone. Existing research has identified an enhancement in bone density, increased wound healing capacity of soft and hard tissue, and a reduction in post-operative pain. Whilst the addition of biologics to ARP materials has shown an increase in bone density, its effectiveness in improving implant outcomes and reducing the need for future alveolar ridge augmentation is unclear. Recognising the limitations within the existing literature, along with the risk of bias and heterogeneity, renders it unwise to make definite conclusions about the benefits of integrating biologics with ARP materials. This narrative review found possible benefits in the use of biologics in ARP to optimise patient-related and treatment outcomes, indicating the need for additional research.

Aim: The aim of the current investigation was to detect serotypes of Aggregatibacter actinomycetemcomitans in a cohort of Western Australians diagnosed with periodontitis. Materials and Methods: A total of 64 subjects were selected. Intra-oral samples were taken from every subject in the present investigation. Periodontal, radiographical, and microbiological analyses were conducted. A polymerase chain reaction was employed to investigate the presence of Aggregatibacter actinomycetemcomitans serotypes. Results: Only twelve (18.75%) patients were tested positive for Aggregatibacter actinomycetemcomitans. The most dominant serotypes of Aggregatibacter actinomycetemcomitans in this group were serotype e (80.55%), followed by serotype c (52.77%). Both serotypes b and d were absent in the present investigation. Serotype e presented in isolation or combined with other serotypes. The other serotypes tend to be present alone, but when they were isolated together, they were always combined with serotype e. It seems that serotype e of Aggregatibacter actinomycetemcomitans is associated with those who live in rural areas (p = 0.003), and those with low education (p = 0.041), and severe forms of periodontitis in this cohort. Conclusions: In patients diagnosed with severe periodontitis, serotype e was dominant in this population. Serotypes b and d did not appear in the present study.

Background: The purpose of alveolar ridge preservation (ARP) aims to minimize the physiological changes of ridge reduction occurring after dental extraction which can prevent the need for future alveolar ridge augmentation procedures. By integrating biologics into ARP biomaterials, there is a potential to enhance the regeneration of both hard and soft tissues with greater efficacy. Aim: This literature review aims to evaluate the clinical efficacy of the addition of biologics to currently used ARP materials. Methods: A search of the PubMed electronic database was conducted, and relevant articles were sifted through. Sixty-three articles met inclusion and exclusion criteria and were included in this review. Results and Conclusions: From this literature review, the combination of biologics with ARP materials resulted in similar dimensional changes when compared to using ARP materials alone. Nevertheless, the research has unveiled a noteworthy enhancement in bone density levels, increased wound healing capacity of soft and hard tissue, and a reduction in post-operative pain. Whilst adding biologics to ARP materials have shown an increase in bone density, its effectiveness in improving implant outcomes and reducing the need for future ridge reconstruction is uncertain. Currently, it is not possible to draw any definite inferences about the benefits of integrating biologics with ARP materials as the available studies are limited, and their findings are inconsistent due to potential bias and heterogeneity. Conducting further research is imperative as it has the potential to improve the results of ARP, thereby benefiting patient-related and implant treatment outcomes.

This case report describes the management of a palatoradicular groove on a lateral incisor tooth (#12) in a nonperiodontitis patient. Despite the commencement of endodontic treatment, the tooth showed no signs of resolution and was referred to the Oral Health Centre of Western Australia for specialist management. Tooth 12 presented with a periodontal probing depth of 7 mm at the mid‐palatal site with suppuration. Nonsurgical periodontal therapy adjunct with the application of 0.5% chlorhexidine gel was completed, followed by the completion of endodontic treatment one week prior to regenerative therapy. A minimal access papilla‐sparing regenerative technique (MAPSRT), a novel, site‐specific modification, was used for the management of the palatoradicular groove. Periodontal instrumentation, odontoradiculoplasty, placement of fissure sealant material and application of an enamel matrix derivative combined with bone grafting material were performed during regenerative therapy. Tooth 12 was restored with a full‐coverage monolithic zirconia crown 6 months after regenerative therapy. This procedure had a successful outcome with a reduction in probing depth on the mid‐palatal site of Tooth 12 to 3 mm, bone remodelling in the defect areas and minimum scarring at the 6‐month review appointment. This case highlights the importance of an interdisciplinary approach in the management of periodontal destruction associated with palatoradicular grooves.

The objective was to evaluate using unstimulated saliva in detecting Aggregatibacter actinomycetemcomitans and to compare the saliva and subgingival and mucosa membrane occurrence of this periodontal pathogen in patients diagnosed with advanced periodontitis. Patients with advanced forms of periodontitis (n = 220; mean age: 54.03 ± 03 years) at stage III/IV were sampled. Unstimulated saliva, buccal cheek mucosa, and pooled subgingival plaque samples were collected. The identification of A. actinomycetemcomitans was performed using qPCR. A descriptive analysis and Wilcoxon test and analysis of variance were performed. A. actinomycetemcomitans was isolated from 28.18% of the subjects. A total of 660 samples were obtained, 220 from unstimulated saliva, 220 from buccal cheek mucosa surfaces, and 220 from pooled subgingival plaque samples. A. actinomycetemcomitans was isolated from 21.80% of unstimulated saliva, 19.50% of buccal cheek swabs, and 17.70% of subgingival samples. There was a statistically significant difference between the presence of A. actinomycetemcomitans in the unstimulated saliva samples and in the buccal cheek mucosa swab samples and pooled subgingival plaque samples (p < 0.001). These results suggest that in advanced periodontitis, unstimulated saliva is representative of pooled subgingival plaque/buccal cheek mucosa samples and its use is adequate in the oral detection of A. actinomycetemcomitans in a cohort of patients with stage III and IV periodontitis.

Aim: The main purpose of the present study was to investigate the carrier rate of Aggregatibacter actinomycetemcomitans and its JP2 genotype in a cohort of 200 Western Australians diagnosed with periodontitis. Materials and Methods: In this descriptive cross-sectional study, 220 consecutive patients with periodontitis, aged 18 years and older, were recruited to a specialist periodontal practice in Perth City. Every patient included in this study contributed three different intra-oral samples. Periodontal, radiographical, and microbiological assessments were performed. The samples were analysed using a polymerase chain reaction for the detection of Aggregatibacter actinomycetemcomitans and its JP2 genotype using the primers and conditions described previously. A Chi-square test and logistic regression analysis were performed to evaluate the results. Results: The prevalence of Aggregatibacter actinomycetemcomitans was 28.18%. The carrier rates of A. actinomycetemcomitans in the unstimulated saliva, cheek swabs, and pooled subgingival plaque samples were 21.80%, 19.50%, and 17.70%, respectively. There was a significant correlation between the severe form of periodontitis (stage IV, grade C) and younger age (p = 0.004), positive family history of periodontitis (p < 0.001), oral hygiene method (p < 0.001), and irregular dental visit attendance (p < 0.001). The binary logistic regression analysis revealed that having severe periodontitis risk increased almost three times in those who were young (OR: 2.812) and came from a family with a history of periodontal disease (OR: 3.194). However, the risk of severe periodontitis was five times higher in those patients with tooth loss due to periodontal disease (OR: 5.071). The highly leukotoxic JP2 genotype of Aggregatibacter actinomycetemcomitans was not detected. Conclusions: This study of a Western Australian cohort confirmed the low presence of Aggregatibacter actinomycetemcomitans and the complete absence of its JP2 genotype. Young age, family history of periodontal disease, lack of flossing, irregular dental visits, and tooth loss due to periodontitis were identified as potential risk factors for periodontitis stage IV, grade C in this cohort.

This paper aims to investigate the presence of Aggregatibacter actinomycetemcomitans and to assess potential indicators of the risk of severe form(s) of periodontitis. A descriptive cross-sectional study of 156 consecutive patients with periodontitis was conducted. Subgingival plaque samples were collected from the participants. The identification of A. actinomycetemcomitans was performed using quantitative polymerase chain reaction. A descriptive analysis, a chi-square test, and a binary logistic regression statistical evaluation were performed. The prevalence of A. actinomycetemcomitans in this population of 156 participants was 17.30% (27 patients). The prevalence of stage-III periodontitis was 75.6% and greater in older men, while the prevalence of stage-IV periodontitis was 22.4% and greater in younger women. We observed a significant relation between the risk of severe periodontitis (stage-IV) and poor oral hygiene (p = 0.006), attendance at dental appointments (p ≤ 0.001), and familial history of periodontitis (p = 0.032). In conclusion, twenty-seven individuals were positive for A. actinomycetemcomitans. Poor oral hygiene, family history of periodontitis, and irregular attendance at dental appointments were identified as potential risk factors for severe periodontitis in this cohort.

The aim of the present study is to assess the knowledge and attitudes towards periodontal health among rheumatologists and rheumatoid arthritis (RA) patients. Two questionnaires comprising questions on demographics, knowledge, and attitudes towards periodontal health were created via Qualtrics survey software. A link to the survey was sent via email to rheumatologists registered under the Australian Rheumatology Association (ARA) practising in Western Australia, and a separate survey was distributed to patients via Arthritis and Osteoporosis WA social media pages. Seven and 76 responses were received from rheumatologists and RA patients, respectively. Statistically significant results (p < 0.05) were found between the length of RA diagnosis and signs of periodontal disease, as well as the type of RA diagnosis and knowledge levels. Employed and retired participants attended the dentist more regularly, and a higher percentage believed that maintaining good oral hygiene is important for overall health. A significant correlation was found between patients who thought improving oral hygiene would impact their RA and whether they received periodontal treatment. No significant differences were found for rheumatologists; however, younger practitioners more frequently asked about their patients’ oral health and performed oral exams. There is a deficit in knowledge about the relationship between periodontal disease and RA among both rheumatoid patients and rheumatologists. The high prevalence of periodontitis and the two-way relationship between RA and periodontal disease would benefit from improved knowledge in relation to their association and could have significant benefits in their clinical and public health implications.

Background: Immediate implant placement (IIP) or Type I implants have become more attractive than conventional implant placements as it reduces the number of surgical procedures and allows faster delivery of the final restoration compared to conventional implant placements. However, the survival of Type I implants varies depending on multiple factors. Purpose: To evaluate the survival rate of Type I implants, and to describe the factors influencing their failure. Materials and methods: A developed search strategy was applied to identify randomised controlled trials on single-unit immediate implants including at least six human participants with a minimum follow-up time of 12 months and published between 1 January 1999 and 1 January 2020 in several databases. The data were extracted independently using validated data extraction forms. Information on survival rates, number of implants placed, loading protocols, setting of the study, location of implants in the jaw, antibiotic protocol, grafting methods, and implant geometry were obtained and assessed. Results: Twenty-six randomised controlled trials with an average follow-up time of 24 months (range = 12–120 months) were included and analysed to give a survival rate ranging between 83.7 and 100%. Fifteen studies reported implant failures, of which twelve reported early losses (loss before definitive restoration). Nine early losses were due to lack of osseointegration, two did not report the reason for implant failure, and one was reported as iatrogenic. Of the eleven studies with 100% survival rates, the common trend observed was the use of titanium implants and an antibiotic regimen using amoxicillin. Conclusions: The survival rate for immediate single implant placement ranged from 83.7 to 100%. Implant failure was not consistently reported and when reported, failure due to lack of osseointegration prior to placement of the definitive restoration was the most common descriptor. Other attributed reasons included infection abscess, mobility after immediate loading, and iatrogenic complications.

C5a is a powerful complement effector molecule that is considered to be an important proinflammatory mediator in several systemic chronic inflammatory diseases. However, its levels in periodontal diseases are yet to be assessed. We aimed to analyse the secretion of C5a in gingival crevicular fluid (GCF) and saliva of patients with periodontal disease. Twenty-eight patients diagnosed with stage 3–4 periodontitis and 16 periodontally healthy subjects participated in this study. GCF was collected from sites with the deepest probing depth of each patient, and volume was measured using a Periotron 8000^®. One mL of unstimulated saliva was also collected. Samples were analysed using a commercially available ELISA kit. The data were analysed using the Mann–Whitney U test, Pearson’s bivariate testing, and receiver operating characteristic curve. C5a was present in GCF from patients with periodontitis (1.06 ± 0.25 ng/mL) whilst it was undetected in controls. Saliva concentration was also significantly higher in periodontitis (1.82 ± 2.31 ng/mL) than controls (0.60 ± 0.72 ng/mL, p = 0.006). C5a levels were more pronounced in periodontitis in both oral fluids assessed by the present pilot study. These results suggest that the more pronounced levels of C5a in oral fluids from periodontitis patients indicate a potential role of this molecule in this disease pathogenesis, deserving to be better explored in subsequent studies.