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  • 1.
    Ademovski, Seida Erovic
    et al.
    Kristianstad Univ, Sch Hlth & Soc, S-29188 Kristianstad, Sweden..
    Martensson, Carina
    Kristianstad Univ, Sch Hlth & Soc, S-29188 Kristianstad, Sweden..
    Persson, G. Rutger
    Kristianstad Univ, Sch Hlth & Soc, S-29188 Kristianstad, Sweden.;Univ Washington, Sch Dent, Dept Periodont, Seattle, WA 98195 USA..
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    The effect of periodontal therapy on intra-oral halitosis: a case series2016In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 43, no 5, p. 445-452Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to evaluate the effects of non-surgical periodontal therapy on intra-oral halitosis 3months after therapy. Material and methods: Sixty-eight adults with intra-oral halitosis were included in a case series. Intra-oral halitosis was evaluated at baseline, and at 3months after treatment using the organoleptic scores (OLS), Halimeter (R), and a gas chromatograph. Results: Significant reductions for OLS (p<0.01), total sum of volatile sulphur compounds (T-VSC) (p<0.01) and methyl mercaptan (MM) (p<0.05) values were found after treatment. Hydrogen sulphide (H2S) levels were not significantly reduced. The numbers of probing pockets 4mm, 5mm and 6mm were significantly reduced as a result of therapy (p<0.001). Bleeding on probing (BOP) and plaque indices were also significantly reduced (p<0.001). For the 34 individuals with successful periodontal treatment (BOP<20% and a 50% reduction of total pocket depth) reductions in OLS (p<0.01) and T-VSC scores (p<0.01) were found. Eleven individuals were considered effectively treated for intra-oral halitosis presenting with a T-VSC value <160ppb, a H2S value <112ppb and a MM value <26ppb. Conclusion: Non-surgical periodontal therapy resulted in reduction of OLS, MM and T-VSC values 3months after therapy. Few individuals were considered as effectively treated for intra-oral halitosis.

  • 2.
    Erovic Ademovski, Seida
    et al.
    Högskolan Kristianstad, SWE.
    Mårtensson, Carina
    Högskolan Kristianstad, SWE.
    Persson, Gösta Rutger
    Högskolan Kristianstad, SWE.
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    The long-term effect of a zinc acetate and chlorhexidine diacetate containing mouth rinse on intra-oral halitosis: A randomized clinical trial2017In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 44, no 10, p. 1010-1019Article in journal (Refereed)
    Abstract [en]

    Aim: To evaluate the long-term effects of a zinc acetate and chlorhexidine diacetate mouth rinse (Zn/CHX) on intra-oral halitosis. Materials and methods: Forty-six adults with intra-oral halitosis were randomized into a 6-month, double-blind, placebo-controlled clinical study. The presence of intra-oral halitosis was evaluated at baseline, 3 and 6 months after treatment by assessment of organoleptic score (OLS) and by total volatile sulphur compounds (T-VSC), hydrogen sulphide (H2S) and methyl mercaptan (MM) concentrations in exhaled air. Results: A Zn/CHX mouth rinse provided significantly better control of intra-oral halitosis than a placebo mouth rinse. At 3 and 6 months, individuals rinsing with the Zn/CHX rinse presented with reductions of the OLS, T-VSC (p &lt;.01, respectively), H2S (p &lt;.001), and MM (p &lt;.01) in subjects’ exhaled air. At 6 months, 68.2% of individuals using the Zn/CHX rinse experienced a 1 or 2 category improvement in OLS compared with 19.1% of placebo-treated subjects. 91% of subjects in the Zn/CHX group were categorized as being effectively treated for intra-oral halitosis (i.e. H2S &lt; 112 ppb), compared to 43% in the placebo group. Conclusion: Zn/CHX mouth rinse provides effective long-term efficacy against intra-oral halitosis, assessed both objectively and subjectively. With regular rinsing, the effect was sustained for 6 months. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

  • 3.
    Hallström, Hadar
    et al.
    Centre for Oral Health Sciences Malmö, SWE.
    Persson, Gösta Rutger
    Högskolan Kristianstad, SWE.
    Lindgren, Susanne
    Halland Hospital, SWE.
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Open flap debridement of peri-implantitis with or without adjunctive systemic antibiotics: A randomized clinical trial2017In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 44, no 12, p. 1285-1293Article in journal (Refereed)
    Abstract [en]

    Aims: To investigate clinical, radiographic and microbiological outcome over 12 months following open flap debridement of peri-implantitis with or without antibiotics. Materials and methods: Peri-implantitis was surgically treated with or without Zithromax® in 19 control and 20 test individuals. Probing pocket depth (PPD), gingival inflammation (BOP), intra-oral radiographs and microbial samples were studied. Per protocol and intent-to-treat analyses were performed. Results: The mean difference (reduction) in PPD values between baseline and month 12 in the test and control groups was 1.7 mm (SD ± 1.1, 95% CI: 1.1, 2.3, p &lt;.001) and 1.6 mm (SD ± 1.5, 95% CI: 0.8, 2,4, p &lt;.001), respectively. Data analysis failed to show study group differences for BOP, PPD, radiographic bone level and microbial load. Successful treatment (per protocol: PPD ≤ 5 mm, no BOP, no suppuration and no bone loss ≥0.5 mm) at 12 months in test and control groups was 7/15 (46.7%) and 4/16 (25.0%). Bacterial load reduction was similar in study groups with a temporary reduction following treatment. Conclusions: Surgical treatment of peri-implantitis with adjunctive systemic azithromycin did not provide 1-year clinical benefits in comparison with those only receiving open flap debridement. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

  • 4.
    Isehed, Catrine
    et al.
    Umeå universitet, SWE.
    Holmlund, Anders
    Uppsala Universitet, SWE.
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Svenson, Björn
    Postgraduate Dental Education Center Örebro, SWE.
    Johansson, Ingegerd
    Umeå universitet, SWE.
    Lundberg, Pernilla
    Umeå universitet, SWE.
    Effectiveness of enamel matrix derivative on the clinical and microbiological outcomes following surgical regenerative treatment of peri-implantitis: A randomized controlled trial2016In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 43, no 10, p. 863-873Article in journal (Refereed)
    Abstract [en]

    Objective: This randomized clinical trial aimed at comparing radiological, clinical and microbial effects of surgical treatment of peri-implantitis alone or in combination with enamel matrix derivative (EMD). Methods: Twenty-six subjects were treated with open flap debridement and decontamination of the implant surfaces with gauze and saline preceding adjunctive EMD or no EMD. Bone level (BL) change was primary outcome and secondary outcomes were changes in pocket depth (PD), plaque, pus, bleeding and the microbiota of the peri-implant biofilm analyzed by the Human Oral Microbe Identification Microarray over a time period of 12 months. Results: In multivariate modelling, increased marginal BL at implant site was significantly associated with EMD, the number of osseous walls in the peri-implant bone defect and a Gram+/aerobic microbial flora, whereas reduced BL was associated with a Gram−/anaerobic microbial flora and presence of bleeding and pus, with a cross-validated predictive capacity (Q2) of 36.4%. Similar, but statistically non-significant, trends were seen for BL, PD, plaque, pus and bleeding in univariate analysis. Conclusion: Adjunctive EMD to surgical treatment of peri-implantitis was associated with prevalence of Gram+/aerobic bacteria during the follow-up period and increased marginal BL 12 months after treatment.

  • 5.
    Nilsson, Helena
    et al.
    Halland Hospital, SWE.
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Longitudinal evaluation of periodontitis and development of cognitive decline among older adults2018In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 45, no 10, p. 1142-1149Article in journal (Refereed)
    Abstract [en]

    Aim: To determine whether having periodontitis is associated with cognitive decline among older adults. Material and Methods: A prospective population study of older adults, Swedish National Study on Ageing and Care, (SNAC) provided repeated registrations of cognitive functions. Cognitive decline was defined as ≥3-points deterioration from a predetermined level at baseline, using the Mini-Mental State Examination (MMSE). Between 2001 and 2003, 715 individuals had a medical as well as a clinical and radiographic dental examination. The individuals were re-examined after 6 years. Periodontitis was defined as ≥4 mm bone loss at ≥30% of tooth sites. Social variables were captured from questionnaires. Results: The multivariate logistic regression analysis demonstrated a statistically significant association between prevalence of periodontitis and cognitive decline after adjustments of confounding factors of importance. Conclusions: A history of periodontitis may be of importance for cognitive functions among older adults. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

  • 6.
    Renvert, Stefan
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Lindahl, Christel
    Kristianstad Univ., SWE.
    Persson, Gösta Rutger
    Kristianstad Univ., SWE.
    Occurrence of cases with peri-implant mucositis or peri-implantitis in a 21-26years follow-up study2018In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 45, no 2, p. 233-240Article in journal (Refereed)
    Abstract [en]

    AimTo determine the prevalence and development of peri-implant mucositis and peri-implantitis and to assess risk factors over time. Materials and MethodsThe study is a longitudinal case series assessing the occurrence and diagnosis of peri-implant mucositis and peri-implantitis. ResultsA total of 218 of 294 patients who had received dental implants between 1988 and 1992 were examined between 2000 and 2002 (examination II; 9-14years after the first examination). At examination III (20-26years after examination I, on average 23.3years), 86 individuals were re-examined. The diagnosis of peri-implant mucositis and peri-implantitis at examination III was 54.7% and 22.1%, respectively. Surgical treatment of peri-implantitis after examination II resulted in a bone gain for two of 12 individuals. Individuals with 3 implants at examination II were at risk for peri-implantitis at examination III (P< 0.05). Radiographic evidence of periodontitis (p=0.40), a diagnosis of peri-implant mucositis (p=.77) or smoking (p=.86) at examination II were not predictive of peri-implantitis at examination III. ConclusionsThe diagnosis and occurrence of peri-implantitis and peri-implant mucositis were high. Healthy conditions at implants after 9-14years were predictive of future implant health.

  • 7.
    Renvert, Stefan
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Persson, G. Rutger
    Kristianstad Univ, SWE.
    Pirih, Flavia Q.
    Univ Calif Los Angeles, USA.
    Camargo, Paulo M.
    Univ Calif Los Angeles, USA.
    Peri-implant health, peri-implant mucositis, and peri-implantitis: Case definitions and diagnostic considerations2018In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 45, p. S278-S285Article in journal (Refereed)
    Abstract [en]

    The objective of this review is to identify case definitions and clinical criteria of peri-implant healthy tissues, peri-implant mucositis, and peri-implantitis. The case definitions were constructed based on a review of the evidence applicable for diagnostic considerations. In summary, the diagnostic definition of peri-implant health is based on the following criteria: 1) absence of peri-implant signs of soft tissue inflammation (redness, swelling, profuse bleeding on probing), and 2) the absence of further additional bone loss following initial healing. The diagnostic definition of peri-implant mucositis is based on following criteria: 1) presence of peri-implant signs of inflammation (redness, swelling, line or drop of bleeding within 30 seconds following probing), combined with 2) no additional bone loss following initial healing. The clinical definition of peri-implantitis is based on following criteria: 1) presence of peri-implant signs of inflammation, 2) radiographic evidence of bone loss following initial healing, and 3) increasing probing depth as compared to probing depth values collected after placement of the prosthetic reconstruction. In the absence of previous radiographs, radiographic bone level 3 mm in combination with BOP and probing depths 6 mm is indicative of peri-implantitis.

  • 8.
    Renvert, Stefan
    et al.
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Polyzois, Ioannis
    Risk indicators for peri-implant mucositis: a systematic literature review2015In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 42, p. S172-S186Article in journal (Refereed)
    Abstract [en]

    ObjectivesTo examine the existing evidence in identifying risk indicators in the aetiology of peri-implant mucositis. Material and MethodsA search was performed in PubMed, Web of Science (WOS) and The Cochrane Library databases for articles published until June 2014. ResultsThis search gave 3135 results of which 15 studies fulfilled the inclusion criteria. The current review revealed that only a few studies provided data on risk indicators for the development of peri-implant mucositis. Based on the data available, there is evidence that plaque is a risk indicator for peri-implant mucositis. Smoking has also been identified as an independent risk indicator whereas the overall evidence for surface roughness, residual cement, the dimension of the keratinized tissue and time of implant in function is weak. There are limited data available to support systemic conditions as risk indicators for peri-implant mucositis. ConclusionsPlaque accumulation at implants will result in development of peri-implant mucositis. Smoking should also be considered as a risk indicator for the development of peri-implant mucositis.

  • 9.
    Renvert, Stefan
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Roos-Jansåker, Anne-Marie
    Public Dental Health Service, Department of Periodontology, Karlskrona, SWE.
    Persson, Göstta
    Hogskolan Kristianstad, SWE.
    Surgical treatment of peri-implantitis lesions with or without the use of a bone substitute: a randomized clinical trial2018In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 45, no 10, p. 1266-1274Article in journal (Refereed)
    Abstract [en]

    Aim: To assess whether the treatment outcome differed between surgical debridement, with or without a bone substitute. Materials and Methods: Forty-one adults with three- or four-wall peri-implant bone defects were enrolled in a 1-year RCT. Surgical debridement (control group), or in combination with a bone substitute (Endobon®) (test group) was performed. Results: Radiographic evidence of defect fill (primary outcome) was only significant in the test group (P = 0.004). At year 1, no bleeding on probing (BOP) in the control and test groups were 7/20 (35%) and 10/21 (47.6%), respectively (χ2= 0.67, P = 0.41). Plaque scores did not differ by study group at baseline (P = 0.31), or at year 1 (P = 0.08). Mid-buccal soft tissue recession changes did not differ by groups (P = 0.76). Successful treatment outcome (defect fill ≥1.0 mm, PPD values at implant ≤5 mm, no BOP, and no suppuration was identified in 1/20 (5.0%) control, and 9/21 (42.9%) test individuals (F = 7, 9, P &lt; 0.01). Number needed to treat analysis identified an absolute risk reduction of 32.8% in benefit of the test procedure. (F = 7, 9, P &lt; 0.01). Conclusions: Successful treatment outcome using a bone substitute was more predictable when a composite therapeutic endpoint was considered. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

  • 10.
    Renvert, Stefan
    et al.
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Widen, Cecilia
    Persson, Gösta Rutger
    Cytokine expression in peri-implant crevicular fluid in relation to bacterial presence2015In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 42, no 7, p. 697-702Article in journal (Refereed)
    Abstract [en]

    Aim:The aim was to assess clinical inflammatory parameters, cytokine levels and bacterial counts in samples from implant crevicular fluid in cases with untreated peri-implantitis. Material and Methods: Several bacterial species known to up-regulate pro-inflammatory cytokines have been associated with peri-implantitis. The Luminex magnet bead technology was used to study cytokines in crevicular fluid. The checkerboard DNA-DNA hybridization method was used to study bacterial counts in samples from 41 implants (41 individuals). Results: Profuse bleeding and suppuration was found in 25/41 (61.0%) of the implants. The reliability of duplicate cytokine processing was high. In the presence of profuse bleeding, higher pg/ml levels of IL-1 (p=0.02), IL-8 (p=0.04), TNF- (p=0.03) and VEGF (p=0.004) were found. Higher concentrations of IL-1 were found in the presence of suppuration, and if Escherichia coli (p=0.001) or Staphylococcus epidermidis (p=0.05) could be detected. Conclusion: Profuse bleeding and/or suppuration in untreated peri-implantitis can be associated with higher concentrations of IL-1, IL-8, TNF- and VEGF in peri-implant crevicular fluid. A higher concentration of IL-1 in peri-implant crevicular fluid was found in samples that were positive for E.coli or S.epidermidis.

  • 11. Riben-Grundstrom, C.
    et al.
    Norderyd, O.
    André, U.
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Treatment of peri-implant mucositis using a glycine powder air-polishing or ultrasonic device: A randomized clinical trial2015In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 42, no 5, p. 462-469Article in journal (Refereed)
    Abstract [en]

    Aim To evaluate the clinical treatment effects of a glycine powder air-polishing or ultrasonic device on peri-implant mucositis. Materials and methods Thirty-seven patients with one implant diagnosed with peri-implant mucositis (probing depth ≥4 mm (0.2N) and bleeding on probing (BOP) (primary outcome)) were randomly assigned to treatment with either glycine powder air-polishing (GPAP) or ultrasonic (US) debridement. Treatment was performed at baseline and at 3 and 6 months. Professional supra gingival cleaning was performed at 9 and 12 months. Oral hygiene instructions were reinforced at each visit. Results At 12 months there was a statistically significant reduction in mean plaque score, bleeding on probing and number of periodontal pockets ≥4 mm within the treatment groups compared to baseline. The percentages of diseased sites were significantly reduced for both groups. Conclusions Treatment with a glycine powder air-polishing or an ultrasonic device is effective in non-surgical treatment of peri-implant mucositis. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  • 12.
    Schwarz, Frank
    et al.
    Univ Klinikum Dusseldorf, Dept Oral Surg, D-40225 Dusseldorf, Germany..
    Becker, Kathrin
    Univ Klinikum Dusseldorf, Dept Orthodont, D-40225 Dusseldorf, Germany..
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Efficacy of air polishing for the non-surgical treatment of peri-implant diseases: a systematic review2015In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 42, no 10, p. 951-959Article, review/survey (Refereed)
    Abstract [en]

    Focused Question: In patients suffering from peri-implant diseases, what is the efficacy of air polishing on changing signs of inflammation compared with control treatments (i.e. alternative measures for plaque removal with or without adjunctive antiseptic and/or antibiotic therapy)? Material & Methods: After electronic database and hand search, 10 full-text articles were independently screened by two reviewers. Finally, a total of five studies (six publications) fulfilled the inclusion criteria. The weighted mean difference (WMD) [p; 95% CI] in bleeding on probing-(BOP) (primary outcome) and probing pocket depth-(PD) reductions was estimated using a random effect model. Results: All studies reported on residual BOP scores after therapy. A narrative data synthesis did not reveal any major improvement of bleeding index/BOP or disease resolution following air polishing over mechanical debridement at mucositis sites. At peri-implantitis sites, WMD in BOP reduction between test and control (mechanical debridement with or without local antiseptic therapy, Er:YAG laser) groups was -23.83% [p = 0.048; 95% CI (-47.47, -0.20)] favouring air polishing over control measures. Conclusions: While glycine powder air polishing is as effective as the control treatments at mucositis sites, it may improve the efficacy of non-surgical treatment of peri-implantitis over the control measures investigated. A complete disease resolution was commonly not obtained.

  • 13.
    Widen, Cecilia
    et al.
    Kristianstad Univ, Sch Hlth & Soc, SE-29188 Kristianstad, Sweden..
    Holmer, Helene
    Kristianstad Cent Hosp, Kristianstad, Sweden..
    Coleman, Michael
    Aston Univ, Birmingham, W Midlands, England..
    Tudor, Marian
    Kristianstad Cent Hosp, Kristianstad, Sweden..
    Ohlsson, Ola
    Kristianstad Univ, Sch Hlth & Soc, SE-29188 Kristianstad, Sweden.;Kristianstad Cent Hosp, Kristianstad, Sweden..
    Sattlin, Susanna
    Kristianstad Univ, Sch Hlth & Soc, SE-29188 Kristianstad, Sweden..
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Persson, Gösta Rutger
    Kristianstad Univ, Sch Hlth & Soc, SE-29188 Kristianstad, Sweden.;Univ Washington, Seattle, WA 98195 USA..
    Systemic inflammatory impact of periodontitis on acute coronary syndrome2016In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 43, no 9, p. 713-719Article in journal (Refereed)
    Abstract [en]

    AimA causative relationship between acute coronary syndrome (ACS) and periodontitis has yet to be defined. The aim of this study was to assess differences in levels of serum cytokines between individuals with or without ACS or periodontal comorbidity. Material and MethodsIn a case-control study, individuals with ACS (78 individuals, 10.3% females) and matching healthy controls (78 individuals, 28.2% females) were included. Medical and dental examinations were performed to diagnose ACS and periodontitis. Serum levels of cytokines were assessed, using Luminex technology. ResultsA diagnosis of periodontitis in the ACS and control group was diagnosed in 52.6% and 12.8% of the individuals, respectively. The unadjusted odds-ratio that individuals with ACS also had periodontitis was 7.5 (95% CI: 3.4, 16.8, p<0.001). Independent of periodontal conditions, individuals with ACS had significantly higher serum levels of IL8 (mean: 44.3 and 40.0pg/ml) and vascular endothelial growth factor (VEGF) (mean: 82.3 and 55.3pg/ml) than control individuals. A diagnosis of periodontitis made no difference in serum cytokine expressions. ConclusionElevated serum levels of VEGF were associated with ACS. Serum cytokine expression in individuals with ACS is unrelated to periodontal conditions.

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