At least three phenotypes exist among periodontitis patients

AIM

To identify phenotypes of periodontitis patients by the use of an unsupervised modelling technique (clustering), based on pre-treatment radiographic and microbiological characteristics.

MATERIALS AND METHODS

This retrospective study included data from 392 untreated periodontitis patients. Co-regularized spectral clustering algorithm was used to cluster the patients. The resulting clusters were subsequently characterized based on their demographics, radiographic bone loss patterns and microbial data.

RESULTS

The vast majority of patients fitted into one of the three main clusters (accuracy 90%). Cluster A (n = 18) was characterized by high prevalence and high proportions of Aggregatibacter actinomycetemcomitans, a trend for a more localized pattern of alveolar bone loss and young individuals. Clusters B (n = 200) and C (n = 135) differed clearly in disease severity patterns and smoking habits, but not in microbiological characteristics.

CONCLUSION

On the basis of alveolar bone loss patterns and microbiological data, untreated periodontitis patients can be clustered into at least three phenotypes. These results should be validated in other cohorts, and the clinical utility needs to be explored on the basis of periodontal treatment outcomes and/or disease progression.

Esthetic Assessment of Implants Placed into Fresh Extraction Sockets for Single-Tooth Replacements Using a Flapless Approach

BACKGROUND

To validate the concept of immediate implant placement and nonfunctional loading for use in the esthetically sensitive anterior maxilla, clinical trials should ideally include objective esthetic criteria.

PURPOSE

This study analyzed procedural results as graded by the pink esthetic score and white esthetic score (PES/WES).

METHODS

Thirty-nine suitable patients (mean follow-up 44.82 ± 28 months) were evaluated.

RESULTS

Thirty-eight implants fulfilled stringent criteria for successful osseointegration: absence of peri-implant radiolucency, implant mobility, suppuration, and pain. The mean total PES/WES was 15.50 ± 2.67 (range: 10-20). The mean total PES of 7.92 ± 1.60 (range: 5-10) indicated favorable overall peri-implant soft-tissue conditions. Root convexity and texture (1.63 ± 0.54) and curvature of the facial mucosa (1.68 ± 0.47) and distal papilla (1.66 ± 0.48) had the highest mean values, whereas acceptable levels of facial tissue (1.53 ± 0.73) and mesial papilla (1.42 ± 0.64) were the most difficult to fully achieve. The mean mesial and distal bone loss at data collection was, was 1.19 ± 0.54 and 1.15 ± 0.51, respectively. Periodontal disease severity (advanced chronic and aggressive periodontitis) was significantly associated with a low total PES (p = .048).

CONCLUSIONS

Objective PES/WES assessment validated immediate anterior maxillary single-tooth replacement and restoration as being a successful and esthetically predictable treatment modality in sites where the buccal bone had been preserved during the extraction at 1 year of follow-up.

Radiological and Biological Assessment of Immediately Restored Anterior Maxillary Implants Combined with GBR and Free Connective Tissue Graft

OBJECTIVES

Radiologic and biologic assessment of immediately restored Implants combined with guided bone regeneration (GBR) and free connective tissue graft.

METHODS

1-4 year retrospective study involving 34 patients treated with maxillary immediately restored anterior single-implants. Soft tissue dimensions, radiographic bone loss, and biological and prosthetic complications were assessed.

RESULTS

During the mean follow up period of 29 months the study group presented a mean mesial bone loss of 1.10 ± 0.39 mm (range: 0.5-2.4 mm), and mean distal bone loss of 1.19 ± 0.41 mm (range: 0.4-2.1 mm). Mean periimplant probing depth of 3.49 mm (SD ± 1.06) and 2.35 (SD ± 0.52) for the contralateral tooth (highly significant p < 0.001). Bleeding on probing was present in 29.4% of the examined implant supported crown sites and 10.4% of the contralateral teeth (p < 0.001).

CONCLUSIONS

Anterior maxillary single-tooth replacement, using GBR and connective tissue graft according to the concept of immediate implant placement, and non-functional restoration is an accepted treatment modality achieving favorable peri-implant soft tissue condition.