Dose- and time-dependent association of smoking and its cessation with risk of peri-implant diseases

Can narrow-diameter implants enhance patient-reported outcomes for mandibular implant-retained overdentures?

STUDY DESIGN

A systematic review and meta-analysis.

OBJECTIVE

To evaluate and compare stability and functionality between narrow and standard implant-retained mandibular overdentures in edentulous patients from multiple perspectives. Assessments included clinical parameters [survival rate (SR) and marginal bone loss (MBL)], along with patient-reported outcome measures (PROMs) including patient satisfaction and oral health-related quality of life (OHRQoL).

METHODS

The study protocol followed PRISMA criteria for reporting reviews and meta-analyses. Using appropriate keywords, electronic search was conducted in each of the following databases: Medline, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus, up to July 22, 2022. There were no restrictions based on language, publication type, or publication date. Additionally, ongoing studies were explored in ClinicalTrials.gov and WHO ICTRP, while cross-references in each selected study were manually examined. The eligible studies were randomized controlled trials (RCTs) or controlled clinical trials (CCTs) comparing narrow implants (diameter ≤ 3.5 mm) to standard implants (diameter > 3.5-4.5 mm) retaining mandibular overdentures in edentulous patients. Excluded were studies with unclear implant diameter information, fewer than 5 patients per group, observational studies, reviews, and laboratory studies. Two authors independently conducted study selection, data collection, and analysis, resolving any discrepancies through discussion with a third author. Methodological quality was assessed using RoB-2 and ROBINS-I tools. Implant SR and MBL measurements at final follow-up were recorded, while patient satisfaction and OHRQoL were evaluated using visual analogue scale (VAS-100) and oral health impact profile (OHIP) questionnaire, respectively.

RESULTS

After duplicate removal, 782 publications and 83 registered clinical trials were identified, of which 26 were eligible for full-text assessment. Ultimately, the quantitative evaluation included 12 publications from 8 independent studies: 4 parallel design RCTs and 4 CCTs. Risk of bias assessment revealed variations among the studies, with only one study being rated as having low risk. The follow-up periods ranged from 1 to 3 years. Meta-analysis showed no significant difference in SR and MBL between narrow and standard implant groups (p = 0.29 and p = 0.93, respectively), with considerable heterogeneity (I2 = 100% and I2 = 78%, respectively). Regarding PROMs, the narrow implant group showed significantly higher levels of patient satisfaction (mean difference (MD): 8.18; 95% CI: 5.83 to 10.53; p < 0.00001; I2 = 36%) and exhibited a significant improvement in OHRQoL (MD: -4.36; 95% CI: -6.83 to -1.89; p < 0.001; I2 = 55%) compared to the standard implant group.

CONCLUSION

For implant-retained mandibular overdentures, the use of narrow implants is associated with comparable SR and MBL, along with higher patient satisfaction and better OHRQoL improvement as compared to standard implants, offering a viable alternative option for patients with diminished alveolar bone width.

Preliminary evidence of impaired oral wound healing in e-cigarette users: a call for perioperative vaping cessation

DESIGN

A prospective, parallel-arm, age- and gender-matched clinical study.

OBJECTIVE

To assess and compare palatal wound healing of orally and systemically healthy e-cigarette users with a matched group of non-vapers.

METHODS

Included were healthy adult volunteers (18-50 years), either e-cigarette users or never smokers, who agreed to use a study-specific e-cigarette device and e-liquids, and were willing to provide consent from. Exclusion criteria were: hypersensitivity to lidocaine, ASA grade >2, recent antibiotic therapy, history of periodontal surgery, active oral lesions, and carious cavities. E-cigarette users were instructed to use the device 2 times daily for more than 1 hour each, with 20 puffs per session. Bilateral 5 mm punch biopsy wounds were made palatally opposite to the 2nd premolar, and subjects were followed up at 1, 2, 4, 7, 14 and 21 days post-operatively. Throughout this period, 3 mm punch biopsies were harvested from the right and left healing wounds at 1- and 3- weeks respectively. All surgical procedures were conducted by the same operator. Pre-wounding palatal biofilms were collected by swabs for metabolomic profiling. Wound healing was evaluated by clinical assessment, metabolite profile, histology, and immunohistochemistry to quantify the following proteins: vimentin, keratin and filaggrin.

RESULTS

A total of 16 individuals were recruited: 8 e-cigarette users and 8 non-vapers. The average age was 27 years, and there were 4 men and 4 women in each group. The e-cigarette group tended to show a slightly lower total score of healing index in all visits compared to the control subjects, but the differences were not statistically significant. No site exhibited suppuration at any point, and no differences between groups were observed in the parameters of granulation. However, statistically significant differences were observed between groups for bleeding and swelling (p < 0.0001 and p = 0.0083, respectively), but not for epithelialization and redness (p = 0.0834 and p = 0.0967, respectively). Pain on palpation and difficulty in achieving hemostasis were more prevalent in e-cigarette group. The metabolic analysis between week 1 and 3 revealed significantly elevated carbohydrate and lipid metabolism in e-cigarette users, while protein metabolism was over-represented in the control group. For immunohistochemistry, significantly lower scores of vimentin, keratin, and filaggrin were shown in the e-cigarette group compared to controls at 1 and 3 weeks (p < 0.05 and p < 0.01, respectively).

CONCLUSION

E-cigarettes may significantly impair oral wound healing by impacting keratinization of epithelium and modifying the metabolic composition of the oral microbiome. Therefore, vaping cannot be regarded as safe for patients undergoing oral surgery.

Salivary lipid changes in young adult tobacco smokers and e-cigarette users: a hidden risk to oral health?

STUDY DESIGN

A cross-sectional, age- and gender-matched study was conducted to investigate the effects of different forms of nicotine delivery on salivary lipid profiles among young adult novice smokers compared to non-smokers.

OBJECTIVE

To assess the effect of smoking traditional cigarettes, e-cigarettes, and heated tobacco products (HTPs) on the levels of specific sphingolipids (sphingosine, sphinganine, and sphingosine-1-phosphate), various ceramides, and lipid peroxidation products [malondialdehyde (MDA) and 4-hydroxynonenal (4-HNE)] in both unstimulated and stimulated saliva samples collected from healthy young adults who had been smoking for 1-3 years and used only 1 of the 3 nicotine delivering methods.

METHODS

Selection criteria included healthy young adults under 30 years old, with normal BMI and typical diet composition, and with no oral inflammatory lesions, orthodontic/dental appliances, or recent intake of medications or supplements. A total of 75 smokers and 25 non-smokers were enrolled in the study. Smokers were categorized into three groups, each comprising 25 individuals: traditional cigarette smokers, e-cigarette users, and HTPs smokers. Saliva samples were collected and analyzed for sphingolipid concentrations using ultra-high-performance liquid chromatography-tandem mass spectrometry. The concentrations of MDA and 4-HNE were measured using colorimetric and ELISA assays, respectively.

RESULTS

The average smoking intensity in the traditional cigarette group was 10 cigarettes per day. Salivary sphingolipid and ceramides concentrations were significantly lower in smokers compared to non-smokers across all nicotine delivery methods (p < 0.0001). Moreover, traditional cigarette smokers exhibited higher levels of 4-HNE and MDA in both stimulated and unstimulated saliva, compared to non-smokers (p < 0.01). In stimulated saliva, both MDA and 4-HNE in e-cigarette users, and MDA in HTPs users, showed significantly lower concentrations than their comparators in traditional cigarette smokers (p < 0.01).

CONCLUSION

Different nicotine delivery methods impact salivary lipid profile during the initial period of smoking habit. Reduced sphingolipids and elevated lipid peroxidation products suggest a disturbed lipid balance in the oral cavity due to enhanced oxidative stress within the salivary glands of novice smokers.

How far does feedback on oral malodor assessment influence the decision to quit smoking?

DESIGN

A retrospective, uncontrolled, questionnaire-based, pre-post study involving adult male smoker volunteers who were invited to attend a one-day smoking cessation event at their workplace.

OBJECTIVE

To assess the effect of feedback on motivation for smoking cessation using oral-malodor measurements.

METHODS

At baseline, the participants attended a brief video presentation regarding various oral health-specific effects of smoking, joined a group introduction to smoking-cessation aids, and were given questionnaires that inquired information about smoking status including type, daily consumption, and duration. Subsequently, respiratory function and oral-malodor assessment were conducted using exhaled and oral cavity air, respectively. To measure oral-malodor, hydrogen sulfide, methyl mercaptan, and dimethyl sulfide concentrations were determined. Participants' intention for smoking cessation was evaluated through questionnaire before and after the event, classifying their intentions as aiming to quit within the next month, within the next 6 months, or having no intention to quit smoking. Immediate feedback on respiratory function and oral malodor measurements was provided by medical and dental blinded examiners, respectively.

RESULTS

A total of 241 men, aged 20-54 years, were enrolled and included: 169 (70.1%) exclusive cigarette smokers, 39 (16.2%) exclusive heated-tobacco product users, and 33 (13.7%) users of both. Prior to the health event, 8.7%, 17.0%, and 74.3% of smokers expressed intentions to quit within the next month, the next 6 months, or had no intention to quit, respectively. After the event, the corresponding percentages shifted to 17.8%, 26.6%, and 55.6%. In multivariable logistic regression analysis, the association with intention to quit in the next month was significant only for methyl mercaptan concentration in oral cavity air, with an adjusted odds ratio (AOR) of 4.24 (95% CI: 1.52-11.84; p = 0.006). Sensitivity analysis revealed that this association was concentration-dependent. On the other hand, higher daily tobacco consumption (≥ 15 pieces) was significantly associated with less likely intention to quit in the next 6 months (AOR = 0.37; 95% CI: 0.15-0.92, p = 0.032).

CONCLUSION

Feedback on oral malodor measurement may support the motivation of men to quit smoking within the next month, rather than waiting for the next 6 months.

CEMENTED AND SCREW-RETAINED IMPLANT-SUPPORTED RESTORATIONS MAY HAVE A COMPARABLE RISK FOR PERI-IMPLANT MUCOSITIS AND PERI-IMPLANTITIS

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Reis INRD, Fukuoka GL, Nagay BE, Pannuti CM, Spin-Neto R, Silva EVFD. Incidence of peri-implant disease associated with cement- and screw-retained implant-supported prostheses: A systematic review and meta-analysis. J Prosthet Dent. 2023 Oct 2:S0022-3913(23)00563-2. doi:10.1016/j.prosdent.2023.08.030. Epub ahead of print. PMID: 37793953.

SOURCE OF FUNDING

None declared.

TYPE OF STUDY/DESIGN

Systematic review and meta-analysis.