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Roemermann DL, Atout R, Pesun I, Kelekis-Cholakis A, Stavropoulou C, Renvert SN, França R. An In Vivo Investigation of Non-Metallic vs. Metallic Hand Scalers on Zirconia Implant-Supported Crowns: A Year-Long Analysis of Peri-Implant Maintenance. J Funct Biomater 2023; 15:9. [PMID: 38248676 PMCID: PMC10817302 DOI: 10.3390/jfb15010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
This study examined whether the degree of abutment surface modification that may occur with regular periodontal instrumentation has a clinical impact in terms of increased plaque accumulation and increased peri-implant tissue inflammation on zirconia implant abutments. Thirteen patients who had zirconia implant crowns were recruited in this randomized clinical trial. Each patient acted as their control and had either the buccal or lingual surface of their screw-retained implant restoration scaled with a metallic scaler and the other surface with a non-metallic scaler at 3, 6, 9, and 12 months. Cytokine testing of the peri-implant crevicular fluid was completed at 0, 3, and 12 months for IL-2, IL-4, IL-6, IL-8, IL-10, TNF-α, or IFNγ. Implant crowns were removed at 12 months and evaluated under an atomic force microscope for the average roughness (Ra). The implant crowns were polished and re-inserted. The results were analyzed using the Kruskal-Wallis test, and post hoc tests were conducted with a significance level of α = 0.05. Significant differences in surface roughness (Ra) were observed between the metallic and non-metallic scalers. The median Ra values were 274.0 nm for metallic scalers and 147.1 nm for non-metallic scalers. However, there were no significant differences between the type of scaler used and the amount of clinical inflammation or cytokine production. Metallic scalers produced deeper, more aggressive surface alterations to the abutment/crown zirconia surface, but there was no statistically significant difference between the degree of surface alterations, amount of BOP, and the amplitude of cytokine inflammation produced.
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Affiliation(s)
- Dayna L. Roemermann
- Department of Dental Diagnostic and Surgical Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3T 2N2, Canada; (D.L.R.); (R.A.); (A.K.-C.); (C.S.)
| | - Reem Atout
- Department of Dental Diagnostic and Surgical Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3T 2N2, Canada; (D.L.R.); (R.A.); (A.K.-C.); (C.S.)
| | - Igor Pesun
- Department of Restorative Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3T 2N2, Canada;
| | - Anastasia Kelekis-Cholakis
- Department of Dental Diagnostic and Surgical Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3T 2N2, Canada; (D.L.R.); (R.A.); (A.K.-C.); (C.S.)
| | - Chrysi Stavropoulou
- Department of Dental Diagnostic and Surgical Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3T 2N2, Canada; (D.L.R.); (R.A.); (A.K.-C.); (C.S.)
| | - Stefan N. Renvert
- Oral Health Sciences, Kristianstad University, 291 88 Kristianstad, Sweden;
| | - Rodrigo França
- Department of Restorative Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3T 2N2, Canada;
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Haque MM, Yerex K, Kelekis-Cholakis A, Duan K. Advances in novel therapeutic approaches for periodontal diseases. BMC Oral Health 2022; 22:492. [PMCID: PMC9664646 DOI: 10.1186/s12903-022-02530-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
AbstractPeriodontal diseases are pathological processes resulting from infections and inflammation affecting the periodontium or the tissue surrounding and supporting the teeth. Pathogenic bacteria living in complex biofilms initiate and perpetuate this disease in susceptible hosts. In some cases, broad-spectrum antibiotic therapy has been a treatment of choice to control bacterial infection. However, increasing antibiotic resistance among periodontal pathogens has become a significant challenge when treating periodontal diseases. Thanks to the improved understanding of the pathogenesis of periodontal disease, which involves the host immune response, and the importance of the human microbiome, the primary goal of periodontal therapy has shifted, in recent years, to the restoration of homeostasis in oral microbiota and its harmonious balance with the host periodontal tissues. This shift in therapeutic goals and the drug resistance challenge call for alternative approaches to antibiotic therapy that indiscriminately eliminate harmful or beneficial bacteria. In this review, we summarize the recent advancement of alternative methods and new compounds that offer promising potential for the treatment and prevention of periodontal disease. Agents that target biofilm formation, bacterial quorum-sensing systems and other virulence factors have been reviewed. New and exciting microbiome approaches, such as oral microbiota replacement therapy and probiotic therapy for periodontal disease, are also discussed.
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Protudjer JLP, Billedeau C, Hurst K, Schroth R, Stavropoulou C, Kelekis-Cholakis A, Hitchon CA. Oral Health in Rheumatoid Arthritis: Listening to Patients. JDR Clin Trans Res 2021; 7:127-134. [PMID: 33949224 DOI: 10.1177/23800844211012678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Rates of periodontal disease and tooth loss are increased in individuals with rheumatoid arthritis (RA). Understanding factors that contribute to the increased burden of periodontal disease in RA is critical to improving oral health and arthritis outcomes. OBJECTIVES To determine the perceptions held by people with RA relating to their oral health, to identify patient-centered priorities for oral health research, and to inform optimal strategies for delivering oral health knowledge. METHODS Semistructured interviews were conducted with patients with RA. Recorded interview transcripts were iteratively reviewed to reveal surface and latent meaning and to code for themes. Constructs were considered saturated when no new themes were identified in subsequent interviews. We report themes with representative quotes. RESULTS Interviews were conducted with 11 individuals with RA (10 women [91%]; mean age, 68 y), all of whom were taking RA medication. Interviews averaged 19 min (range, 8 to 31 min) and were mostly conducted face-to-face. Three overall themes were identified: 1) knowledge about arthritis and oral health links; 2) oral health care in RA is complicated, both in personal hygiene practices and in professional oral care; and 3) poor oral health is a source of shame. Participants preferred to receive oral health education from their rheumatologists or dentists. CONCLUSIONS People with RA have unique oral health perceptions and experience significant challenges with oral health care due to their arthritis. Adapting oral hygiene recommendations and professional oral care delivery to the needs of those with arthritis are patient priorities and are required to improve satisfaction regarding their oral health. KNOWLEDGE TRANSLATION STATEMENT Patients living with long-standing rheumatoid arthritis described poor oral health-related quality of life and multiple challenges with maintaining optimal oral health. Study findings indicate a need for educational materials addressing oral health maintenance for patients with rheumatic diseases and their providers.
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Affiliation(s)
- J L P Protudjer
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.,Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | | | - K Hurst
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - R Schroth
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.,Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada.,Dr. Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, Canada
| | - C Stavropoulou
- Dr. Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, Canada
| | - A Kelekis-Cholakis
- Dr. Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, Canada
| | - C A Hitchon
- Department of Internal Medicine, Max Rady School of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada
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Renvert S, Hirooka H, Polyzois I, Kelekis-Cholakis A, Wang HL. Diagnosis and non-surgical treatment of peri-implant diseases and maintenance care of patients with dental implants - Consensus report of working group 3. Int Dent J 2019; 69:12-17. [PMID: 31478575 PMCID: PMC9379037 DOI: 10.1111/idj.12490] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The following consensus report is based on four background reviews. The frequency of maintenance visits is based on patient risk indicators, homecare compliance and prosthetic design. Generally, a 6-month visit interval or shorter is preferred. At these visits, peri-implant probing, assessment of bleeding on probing and, if warranted, a radiographic examination is performed. Diagnosis of peri-implant mucositis requires: (i) bleeding or suppuration on gentle probing with or without increased probing depth compared with previous examinations; and (ii) no bone loss beyond crestal bone level changes resulting from initial bone remodelling. Diagnosis of peri-implantitis requires: (i) bleeding and/or suppuration on gentle probing; (ii) an increased probing depth compared with previous examinations; and (iii) bone loss beyond crestal bone level changes resulting from initial bone remodelling. If diagnosis of disease is established, the inflammation should be resolved. Non-surgical therapy is always the first choice. Access and motivation for optimal oral hygiene are key. The patient should have a course of mechanical therapy and, if a smoker, be encouraged not to smoke. Non-surgical mechanical therapy and oral hygiene reinforcement are useful in treating peri-implant mucositis. Power-driven subgingival air-polishing devices, Er: YAG lasers, metal curettes or ultrasonic curettes with or without plastic sleeves can be used to treat peri-implantitis. Such treatment usually provides clinical improvements such as reduced bleeding tendency, and in some cases a pocket-depth reduction of ≤ 1 mm. In advanced cases, however, complete resolution of the disease is unlikely.
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Affiliation(s)
- Stefan Renvert
- Oral Health Sciences, Kristianstad University, Kristianstad, Sweden
- School of Dental Science, Trinity College, Dublin, Ireland
- Blekinge Institute of Technology, Karlskrona, Sweden
- Faculty of Dentistry, The University of Hong Kong, Hong Kong City, Hong Kong
| | - Hideaki Hirooka
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
- Sweden Dental Center, Tokyo, Japan
| | - Ioannis Polyzois
- Department of Restorative Dentistry and Periodontology, Trinity College, Dublin Dental University Hospital, Dublin, Ireland
| | - Anastasia Kelekis-Cholakis
- Division of Periodontics, Dr Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, MB, Canada
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Working Group 3
- Oral Health Sciences, Kristianstad University, Kristianstad, Sweden
- School of Dental Science, Trinity College, Dublin, Ireland
- Blekinge Institute of Technology, Karlskrona, Sweden
- Faculty of Dentistry, The University of Hong Kong, Hong Kong City, Hong Kong
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
- Sweden Dental Center, Tokyo, Japan
- Department of Restorative Dentistry and Periodontology, Trinity College, Dublin Dental University Hospital, Dublin, Ireland
- Division of Periodontics, Dr Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, MB, Canada
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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Bonnet C, Rabbani R, Moffatt MEK, Kelekis-Cholakis A, Schroth RJ. The Relation Between Periodontal Disease and Vitamin D. J Can Dent Assoc 2019; 84:j4. [PMID: 31199730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND There is conflicting evidence regarding the association between vitamin D and periodontal disease. The purpose of this study was to explore that relation. METHODS This cross-sectional study used data from the Canadian Health Measures Survey for respondents 13-79 years of age. Vitamin D status was determined by measuring plasma 25-hydroxyvitamin D (25(OH)D) concentrations. Periodontal disease was defined by gingival index (GI) and calculated loss of attachment (LOA). Statistical analyses included bivariate tests and multiple logistic regression. RESULTS At the bivariate level, 25(OH)D concentrations below the cutoff levels of 50 nmol/L and 75 nmol/L were associated with GI. However, multiple regression analyses for GI revealed no association with mean 25(OH)D level or either concentration. Although no significant association between LOA and 25(OH)D status was identified at the bivariate level, a statistically significant association was observed between LOA and 25(OH)D levels < 75 nmol/L on multiple regression analysis. However, mean 25(OH)D concentrations and those < 50 nmol/L were not associated with LOA on multiple regression analysis. CONCLUSION Vitamin D status was inversely associated with GI at the bivariate level, but not at the multivariate level. Conversely, vitamin D status was not associated with LOA at the bivariate level, but it was inversely associated with LOA at the multivariate level. These results provide modest evidence supporting a relation between low plasma 25(OH)D concentrations and periodontal disease as measured by GI and LOA.
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Hatzimanolakis P, Tsourounakis I, Kelekis-Cholakis A. Dental Implant Maintenance for the Oral Healthcare Team. Compend Contin Educ Dent 2019; 40:424-430. [PMID: 31478687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
As dental implants have become a popular treatment modality for edentulous sites, there is a need for a peri-implant maintenance protocol. This article reviews the anatomy of peri-implant tissues, examines the etiology and risk factors of peri-implant diseases, and outlines nonsurgical and surgical treatment of these diseases. The clinical and radiographic steps necessary to diagnose peri-implant diseases during the phase of peri-implant maintenance, along with available treatment protocols to maintain or recover peri-implant health will be discussed.
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Affiliation(s)
- Penny Hatzimanolakis
- Clinical Associate Professor, Department of Oral Biological and Medical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ioannis Tsourounakis
- Part-time Clinical Instructor, Dr. Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, Manitoba, Canada; Private Practice, Winnipeg, Manitoba, Canada
| | - Anastasia Kelekis-Cholakis
- Division Head of Periodontics and Director of Graduate Periodontal Program, Dr. Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, Manitoba, Canada
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Kelekis-Cholakis A, Perry JB, Pfeffer L, Millete A. Successful treatment of generalized refractory chronic periodontitis through discontinuation of waxed or coated dental floss use: A report of 4 cases. J Am Dent Assoc 2016; 147:974-978. [PMID: 27423761 DOI: 10.1016/j.adaj.2016.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/02/2016] [Accepted: 06/04/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OVERVIEW Generalized refractory chronic periodontitis is a periodontal condition that is resistant to conventional therapy. Management of this condition often is frustrating to both the patient and the clinician. CASE DESCRIPTIONS The authors present 4 cases of generalized refractory chronic periodontitis characterized by an inflammatory gingival response and progressive bone loss that did not respond to extensive periodontal treatments and regular periodontal care. Histologic examination of affected gingival tissue revealed an abundance of plasma cells, a feature seen in certain oral contact hypersensitivity reactions. The authors suspected that waxed or coated dental floss was the offending contactant, and its removal from the patients' oral hygiene regimens resulted in a dramatic improvement of the periodontal characteristics. CONCLUSIONS AND PRACTICAL IMPLICATIONS In cases of periodontal disease as described in this report, dental practitioners should consider the possibility of a contact hypersensitivity reaction to waxed or coated dental floss, whereby the floss exacerbates the condition instead of assisting in its resolution.
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Hitchon C, Mookherjee N, Larcombe L, Newkirk M, Meng X, Buttar G, Kelekis-Cholakis A, Schroth R, El-Gabalawy H. AB0042 Human Host Defense Peptide Cathelicidin (LL37) Serum Levels Are Increased in Anti-Cyclical Citrullinated Peptide Positive Patients with Recent Onset Inflammatory Arthritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Todescan S, Lavigne S, Kelekis-Cholakis A. Guidance for the maintenance care of dental implants: clinical review. J Can Dent Assoc 2012; 78:c107. [PMID: 23306040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
As implant treatment becomes part of mainstream dental therapy, dental offices should implement protocols for individualized, systematic and continuous supportive care of the peri-implant tissues. This review article suggests guidelines for maintenance care of dental implants. The preliminary assessment should begin with updating the patient's medical and dental histories. The clinical implant should be examined to evaluate the following: condition of the soft tissues, plaque index, clinical probing depth, bleeding on probing, suppuration, stability of soft-tissue margins, keratinized tissue, mobility and occlusion. If the clinical signs suggest the presence of peri-implantitis, radiography of the site is advisable, to confirm the diagnosis. Appropriate treatment should be pursued according to any diagnosis reached during the examination, including (but not limited to) instructions on oral hygiene, removal of supra- and sub-gingival plaque and calculus, occlusal adjustment, relining of a removable prosthesis or surgery.
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Affiliation(s)
- Sylvia Todescan
- Dental Diagnostic & Surgical Sciences, Faculty of Dentistry, University of Manitoba, Winnipeg, Manitoba, Canada.
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Kelekis-Cholakis A, Wiltshire WA, Birek C. Treatment and long-term follow-up of a patient with hereditary gingival fibromatosis: a case report. J Can Dent Assoc 2002; 68:290-4. [PMID: 12019039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
This report addresses the complex nature of oral diagnosis, treatment and long-term case management in the hereditary form of recurrent gingival fibromatosis. Case management is discussed in relation to a 13-year-old girl who presented with recurrent, progressive gingival enlargement requiring consecutive periodontal and orthodontic treatment. The initial course of treatment included 4-quadrant gingivectomy with reverse bevel incisions, followed by orthodontics. Microscopic examination of the gingivectomy specimens supported the clinical diagnosis. Three years later, recurrence of the condition was observed in all quadrants. To facilitate orthodontic tooth movement and to achieve optimal esthetics, another full-mouth gingivectomy was performed. There was no recurrence of the condition a year later. It is recommended that patients with this condition be monitored closely after gingivectomy, so that the treatment requirements of localized areas can be addressed as needed.
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