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  • 1.
    Ademovski, S. Erovic
    et al.
    Kristianstad Univ, Sect Hlth & Soc, S-29188 Kristianstad, Sweden..
    Lingstrom, P.
    Univ Gothenburg, Sahlgrenska Acad, Inst Odontol, Dept Cariol, Gothenburg, Sweden..
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    The effect of different mouth rinse products on intra-oral halitosis2016In: International Journal of Dental Hygiene, ISSN 1601-5029, E-ISSN 1601-5037, Vol. 14, no 2, p. 117-123Article in journal (Refereed)
    Abstract [en]

    Aim: To evaluate the effect of different mouth rinses 12 h after rinsing on genuine intra-oral halitosis. Materials and Methods: Twenty-four adults with halitosis were included in a double-blind, crossover, randomized clinical trial. Halitosis was evaluated 12 h after rinsing with placebo and five mouth rinse products containing zinc acetate and chlorhexidine diacetate; zinc lactate, chlorhexidine and cetylpyridinium chloride; zinc acetate and chlorhexidine diacetate with reduced amounts of mint and menthol; zinc chloride and essential oil; and chlorine dioxide using the organoleptic method and a gas chromatograph. Test periods were separated by 1 week. Results: Hydrogen sulphide (H2S), methyl mercaptan (MM) and the organoleptic scores (OLS) were significantly reduced 12 h following rinsing with all substances compared to placebo (P < 0.05). H2S was more effectively reduced after rinsing with zinc acetate and chlorhexidine diacetate and zinc acetate and chlorhexidine diacetate with reduced amounts of mint and menthol compared to rinsing with zinc chloride and essential oil (P < 0.05), and significantly lower values of MM were obtained after rinsing with zinc acetate and chlorhexidine diacetate compared to zinc lactate, chlorhexidine and cetylpyridinium chloride (P < 0.05). The percentage effectively treated individuals (H2S (<112 ppb), MM (<26 ppb) and OLS score <2) varied from 58% percentage (zinc acetate and chlorhexidine diacetate) to 26% (zinc chloride and essential oil). Conclusion: All treatments resulted in reduction in halitosis 12 h after rinsing compared to placebo. H2S and MM were most effectively reduced by zinc acetate and chlorhexidine diacetate.

  • 2. Ademovski, Seida Erovic
    et al.
    Lingström, Peter
    Winkel, Edwin
    Tangerman, Albert
    Persson, Rutger
    Renvert, Stefan
    Blekinge Institute of Technology, School of Health Science.
    Comparison of different treatment modalities for oral halitosis2012In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 70, no 3, p. 224-233Article in journal (Refereed)
    Abstract [en]

    Objectives. To assess the effects on intra-oral halitosis by a mouth rinse containing zinc acetate (0.3%) and chlorhexidine diacetate (0.025%) with and without adjunct tongue scraping. Materials and methods. Twenty-one subjects without a diagnosis of periodontitis were randomized in a cross-over clinical trial. Organoleptic scores (OLS) were assessed to define intra-oral halitosis by total volatile sulfur compound (T-VSC) measurements and by gas chromatography. Results. Twenty-one subjects with a mean age of 45.7 years (SD: +/- 13.3, range: 21-66). The OLS were significantly lower following active rinse combined with tongue scraping (p < 0.001) at all time points. Immediately after, at 30 min, and at day 14, the T-VSC values were lower in the active rinse sequence than in the negative rinse sequence (p < 0.001, p < 0.001 and p < 0.05, respectively). At 30 min and at day 14, the hydrogen sulfide (H2S) and methyl mercaptan (MM) values were lower in the active rinse sequence compared to the inactive rinse sequence (p < 0.001). The inactive rinse sequence with tongue scraping reduced T-VSC at 30 min (p < 0.001) but not at 14 days. Similar reductions in T-VSC, H2S and MM were found in the active rinse sequence with or without tongue scraping. Conclusion. The use of a tongue scraper did not provide additional benefits to the active mouth rinse, but reduced OLS and tongue coating index.

  • 3.
    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.

  • 4. Ademovski, Seida
    et al.
    Persson, Gösta Rutger
    Winkel, Edwin
    Tangerman, Albert
    Lingström, Peter
    Renvert, Stefan
    Blekinge Institute of Technology, School of Health Science.
    The short-term treatment effects on the microbiota at the dorsum of the tongue in intra-oral halitosis patients-a randomized clinical trial2013In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 17, no 2, p. 463-473Article in journal (Refereed)
    Abstract [en]

    This study aims to assess the effects of rinsing with zinc- and chlorhexidine-containing mouth rinse with or without adjunct tongue scraping on volatile sulfur compounds (VSCs) in breath air, and the microbiota at the dorsum of the tongue. Material and methods: A randomized single-masked controlled clinical trial with a cross-over study design over 14 days including 21 subjects was performed. Bacterial samples from the dorsum of the tongue were assayed by checkerboard DNA-DNA hybridization. Results: No halitosis (identified by VSC assessments) at day 14 was identified in 12/21 subjects with active rinse alone, in 10/21with adjunct use of tongue scraper, in 1/21 for negative control rinse alone, and in 3/21 in the control and tongue scraping sequence. At day 14, significantly lower counts were identified only in the active rinse sequence (p < 0.001) for 15/78 species including, Fusobacterium sp., Porphyromonas gingivalis, Pseudomonas aeruginosa, Staphylococcus aureus, and Tannerella forsythia. A decrease in bacteria from baseline to day 14 was found in successfully treated subjects for 9/74 species including: P. gingivalis, Prevotella melaninogenica, S. aureus, and Treponema denticola. Baseline VSC scores were correlated with several bacterial species. The use of a tongue scraper combined with active rinse did not change the levels of VSC compared to rinsing alone. Conclusions: VSC scores were not associated with bacterial counts in samples taken from the dorsum of the tongue. The active rinse alone containing zinc and chlorhexidine had effects on intra-oral halitosis and reduced bacterial counts of species associated with malodor. Tongue scraping provided no beneficial effects on the microbiota studied. Clinical relevance: Periodontally healthy subjects with intra-oral halitosis benefit from daily rinsing with zinc- and chlorhexidine-containing mouth rinse.

  • 5. Aghazadeh, Ahmad
    et al.
    Persson, G. Rutger
    Renvert, Stefan
    Blekinge Institute of Technology, School of Health Science.
    A single-centre randomized controlled clinical trial on the adjunct treatment of intra-bony defects with autogenous bone or a xenograft: results after 12 months2012In: Journal of Clinical Periodontology, ISSN 0303-6979, Vol. 39, no 7, p. 666-673Article in journal (Refereed)
    Abstract [en]

    Background Limited evidence exists on the efficacy of regenerative treatment of peri-implantitis. Material and Methods Subjects receiving antibiotics and surgical debridement were randomly assigned to placement of autogenous bone (AB) or bovine-derived xenograft (BDX) and with placement of a collagen membrane. The primary outcome was evidence of radiographic bone fill and the secondary outcomes included reductions of probing depth (PD) bleeding on probing (BOP) and suppuration. Results Twenty-two subjects were included in the AB and 23 subjects in the BDX group. Statistical analysis failed to demonstrate differences for 38/39 variables assessed at baseline. At 12 months, significant better results were obtained in the BDX group for bone levels (p < 0.001), BOP (p = 0.004), PI (p = 0.003) and suppuration (p < 0.01). When adjusting for number of implants treated per subject, a successful treatment outcome PD = 5.0 mm, no pus, no bone loss and BOP at 1/4 or less sites the likelihood of defect fill was higher in the BDX group (LR: 3.2, 95% CI: 1.010.6, p < 0.05). Conclusions Bovine xenograft provided more radiographic bone fill than AB. The success for both surgical regenerative procedures was limited. Decreases in PD, BOP, and suppuration were observed.

  • 6.
    Andersson, P.
    et al.
    Kristianstad Univ, SWE.
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Sjogren, P.
    Oral Care AB, SWE.
    Zimmerman, M.
    Oral Care AB, SWE.
    Dental status in nursing home residents with domiciliary dental care in Sweden2017In: Community Dental Health, ISSN 0265-539X, Vol. 34, no 4, p. 203-207Article in journal (Refereed)
    Abstract [en]

    Objective: To describe the dental health status of elderly people in nursing homes receiving domiciliary dental care. Design: Case note review. Clinical setting: Nursing homes in 8 Swedish counties. Participants: Care dependent elderly people (>= 65 years). Methods: Clinical data, including the number of remaining natural teeth, missing and decayed teeth (manifest dental caries) and root remnants, recorded by dentists according to standard practices. Medical and dental risk assessments were performed. Results: Data were available for 20,664 patients. Most were women (69.1%), with a mean age of 87.1 years (SD 7.42, range 65-109). The mean age for men was 83.5 years (SD 8.12, range 65-105). Two or more medical conditions were present in most of the population. A total of 16,210 individuals had existing teeth of whom 10,974 (67.7%) had manifest caries. The mean number of teeth with caries was 5.0 (SD 5.93) corresponding to 22.8% of existing teeth. One in four individuals were considered to have a very high risk in at least one professional dental risk assessment category. Conclusions: Care dependent elderly in nursing homes have very poor oral health. There is a need to focus on the oral health-related quality of life for this group of frail elderly during their final period of life.

  • 7.
    Bengtsson, Viveca Wallin
    et al.
    Univ Kristianstad, SE-29188 Kristianstad, Sweden..
    Persson, G. Rutger
    Univ Kristianstad, SE-29188 Kristianstad, Sweden.;Univ Washington, Dept Periodont, Seattle, WA 98195 USA.;Univ Washington, Dept Oral Med, Seattle, WA 98195 USA..
    Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health. Blekinge Inst Technol, Sch Hlth Sci, Karlskrona, Sweden..
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    A cross-sectional study of the associations between periodontitis and carotid arterial calcifications in an elderly population2016In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 74, no 2, p. 115-120Article in journal (Refereed)
    Abstract [en]

    Objective. To evaluate if the presence of periodontitis is associated with carotid arterial calcifications diagnosed on panoramic radiographs in an elderly population. Materials and methods. Study individuals were randomly selected from the Swedish civil registration database representing the aging population (60-96 years) in Karlskrona, Sweden. Bleeding on probing (BOP) and the deepest probing measurement at each tooth were registered. The proportions of teeth with a probing depth 5 mm and the proportion of teeth with bleeding on probing were calculated. Analog panoramic radiographs were taken and the proportion of sites with a distance 5 mm between the alveolar bone level and the cement-enamel junction (CEJ) were assessed. A diagnosis of periodontitis was declared if a distance between the alveolar bone level and the CEJ 5 mm could be identified from the panoramic radiographs at >10% of sites, probing depth of 5 mm at one tooth or more and with BOP at >20% of teeth. Results. Readable radiographs were obtained from 499 individuals. Carotid calcification was identified in 39.1%. Individuals were diagnosed with periodontitis in 18.4%. Data analysis demonstrated that individuals with periodontitis had a higher prevalence of carotid calcifications (Pearson (2) = 4.05 p < 0.05) and with a likelihood of 1.5 (95% CI = 1.0, 2.3, p < 0.05). Conclusions. Data analysis demonstrated a significant association between periodontitis and carotid calcification.

  • 8. Bengtsson, VW
    et al.
    Persson, Rutger
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Assessment of carotid calcifications on panoramic radiographs in relation to other used methods and relationship to periodontitis and stroke: a literature review2014In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 72, no 6, p. 401-412Article, review/survey (Refereed)
    Abstract [en]

    Objectives. To assess the literature on carotid calcifications defined from panoramic radiographs (PMX) and concurrent diagnosis of stroke and periodontitis. Materials and methods. A literature search screening for publications using search terms such as PMX and carotid calcification, stroke and periodontitis was performed in November 2012. Results. A total of 189 articles were retrieved, among which 30 were included in the review. The sensitivity for PMX findings of carotid calcifications (CC) compared to a diagnosis by Doppler sonography varied between 31.1-100%. The specificity for PMX findings of carotid calcifications compared to a diagnosis by Doppler sonography varied between 21.4-87.5%. Individuals with CC findings from PMX have more periodontitis and risk for stroke. Conclusions. There is a shortage of well-designed studies in older dentate individuals assessing the associations between periodontitis and radiographic evidence of CC and in relation to stroke or other cardiovascular diseases.

  • 9. Berglund, Johan
    et al.
    Persson, Rutger
    Renvert, Stefan
    Persson, Rigmor
    Osteoporosis and peridontitis in older subjects participating in the Swedish National Survey on Aging and Care (SNAC-Blekinge)2011In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 69, no 4, p. 201-207Article, review/survey (Refereed)
    Abstract [en]

    Abstract Objective. We assessed the relationships between (I) ultrasonography calcaneus T-scores (PIXI) and mandibular cortex characteristics on oral panoramic radiographs in older subjects; and (II) osteoporosis and periodontitis. Material and methods. We examined 778 subjects (53% women) aged 59-96 years. Periodontitis was defined by alveolar bone loss assessed from panoramic radiographs. Results. PIXI calcaneus T-values ≤-2.5 (osteoporosis) were found in 16.3% of women and in 8.1% of men. PIXI calcaneus T-values <-1.6 (osteoporosis, adjusted) were found in 34.2% of women and in 21.4% of men. The age of the subjects and PIXI T-values were significantly correlated in women (Pearson's r = 0.37, P < 0.001) and men (Pearson's r = 0.19, P < 0.001). Periodontitis was found in 18.7% of subjects defined by alveolar bone level ≥5 mm. Subjects with osteoporosis defined by adjusted PIXI T-values had fewer remaining teeth [mean difference 4.1, 95% confidence interval (CI) -1.1 to -6.5, P < 0.001]. The crude odds ratio (OR) of an association between the panoramic assessment of mandibular cortex erosions as a sign of osteoporosis and the adjusted T-value (T-value cut-off <-1.6) was 4.8 (95% CI 3.1-7.2, P < 0.001; Pearson χ(2) = 60.1, P < 0.001). A significant OR between osteoporosis and periodontitis was only found in women for the T-value cut-off ≤-2.5 (crude OR 1.8, 95% CI 1.1-3.3, P < 0.03). Conclusions. An association between osteoporosis and periodontitis was only confirmed in women. The likelihood that the mandibular cortex index agrees with adjusted PIXI T-values is significant.

  • 10.
    Dalago, Haline Renata
    et al.
    Fed Univ Santa Catarina UFSC, BRA.
    Schuldt Filho, Guenther
    Fed Univ Santa Catarina UFSC, BRA.
    Rodrigues, Monica Abreu
    Paulista Univ UNIP, BRA.
    Renvert, Sterfan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Bianchini, Marco Aurelio
    Fed Univ Santa Catarina UFSC, BRA.
    Risk indicators for Peri-implantitis: A cross-sectional study with 916 implants2016In: Clinical Oral Implants Research, ISSN 0905-7161, E-ISSN 1600-0501, Vol. 28, no 2, p. 144-150Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this study was to identify systemic and local risk indicators associated with peri-implantitis. Material and methods: One hundred eighty-three patients treated with 916 osseointegrated titanium implants, in function for at least 1 year, were included in the present study. The implants were installed at the Foundation for Scientific and Technological Development of Dentistry (FUNDECTO) - University of Sao Paulo (USP) - from 1998 to 2012. Factors related to patient’s systemic conditions (heart disorders, hypertension, smoking habits, alcoholism, liver disorders, hepatitis, gastrointestinal disease, diabetes mellitus I and II, hyperthyroidism or hypothyroidism, radiation therapy, chemotherapy, menopause, osteoporosis, active periodontal disease, history of periodontal disease and bruxism), implant’s characteristics (location, diameter, length, connection, shape, and antagonist), and clinical parameters (wear facets, periodontal status on the adjacent tooth, plaque accumulation on the adjacent tooth, modified plaque index, sulcus bleeding index, probing depth, bleeding on probing, width of keratinized tissue and marginal recession). Results: An increased risk of 2.2 times for history of periodontal disease (PD), 3.6 times for cemented restorations compared to screw-retained prostheses, 2.4 times when wear facets were displayed on the prosthetic crown and 16.1 times for total rehabilitations when compared to single rehabilitations were found. Logistic regression analysis did not show any association between the implant’s characteristics and peri-implantitis. Conclusions: A history of periodontal disease, cemented prostheses, presences of wear facets on the prosthetic crown and full mouth rehabilitations were identified as risk indicators for peri-implantitis. Implants’ characteristics were not related to the presence of peri-implantitis. © 2016 John Wiley & Sons A/S.

  • 11.
    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

  • 12. Figuero, Elena
    et al.
    Lindahl, Christel
    Marin, MJ
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Herrera, David
    Ohlsson, Ola
    Wetterling, Thomas
    Sanz, Mariano
    Quantification of Periodontal Pathogens in Vascular, Blood, and Subgingival Samples From Patients With Peripheral Arterial Disease or Abdominal Aortic Aneurysms2014In: Journal of Periodontology, ISSN 0022-3492, E-ISSN 1943-3670, Vol. 85, no 9, p. 1182-1193Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this investigation is to quantify periodontal pathogens (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Campylobacter rectus, and Tannerella forsythia) in vascular, blood, and subgingival samples. As a secondary objective, two molecular bacterial identification methods (nested polymerase chain reaction [PCR] and quantitative PCR [qPCR]) are compared. Methods: Seventy consecutive patients provided a vascular lesion, a blood sample, and 36 subgingival samples. Bacterial DNA was extracted, and qPCR was used to determine the prevalence and amounts of the target pathogens in each sample. Nested PCR was performed only in the samples from vascular lesions. Periodontal examination was performed in 42 patients. Mann-Whitney U or x(2) tests were used to compare microbiologic results according to periodontal diagnosis. Results: All targeted periodontal pathogens (A. actinomycetemcomitans, P. gingivalis, T. forsythia, or C. rectus) were detected in subgingival samples, with a prevalence rate of 72.2%, 47.2%, 74.3%, and 82.9%, respectively. In 7.1% and 11.4% of vascular and blood samples, bacterial DNA was detected. One patient was positive for A. actinomycetemcomitans in the three types of samples. No differences were found in the levels of targeted bacteria when comparing patients with and without periodontitis. Prevalence rates obtained with nested PCR were significantly higher than those obtained with qPCR. Conclusions: The presence of A. actinomycetemcomitans was demonstrated in vascular, blood, and subgingival samples in one of 36 patients. These results, although with a very low frequency, may support the hypothesis of a translocation of periodontal pathogens from subgingival microbiota to the bloodstream and then to atheromatous plaques in carotid or other peripheral arteries. Nested PCR is not an adequate method for identifying DNA of periodontal pathogens in low quantities because of the high number of false-negative results.

  • 13. Halling, Anders
    et al.
    Persson, Gösta Rutger
    Berglund, Johan
    Johansson, Owe
    Renvert, Stefan
    Comparison between the Klemetti index and heel DXA BMD measurements in the diagnosis of reduced skeletal bone mineral density in the elderly.2005In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 16, no 8, p. 999-1003Article in journal (Refereed)
    Abstract [en]

    Osteopenia/osteoporosis affect many elderly people and might not be detected until symptoms of fractures occur. Early detection of osteopenia/osteoporosis is important and would allow preventive measures and treatment. Access to screening for osteopenia/osteoporosis is often limited, whereas panoramic radiography is commonly used in dentistry. The aim of this study was to determine the validity of the Klemetti index (KI), measured on panoramic radiographs, in the diagnosis of osteopenia/osteoporosis as defined by a bone mineral density (BMD) measurement below -1.5 standard deviations (SDs) of a community based sample. In total, 211 consecutive participants (102 men and 109 women) 60-96 years in the SNAC-Blekinge study (Swedish National Study on Ageing and Care) underwent bone densitometry [by dual-energy X-ray absorptiometry (DXA)] of both heels. A panoramic radiograph was taken of each participant, and mandibular cortex on a panoramic radiograph was classified as '0' or normal (even and sharp endosteal margin), '1', moderately eroded (evidence of lacunar resorption or endosteal cortical residues), or '2', severely eroded (unequivocal porosity). From logistic regression, the odds ratio of having a BMD measurement below -1.5 SD was 8.04 (95% CI 2.39 to 27.12, P<0.001) in the 'osteopenic' (KI category 2), compared with the 'normal' group (KI categories 0 and 1). Receiver operating characteristic (ROC) curve analysis was used to measure the validity of the KI indicating osteopenia (KI category 2) in predicting reduced BMD. This point provided a sensitivity of 50% and a specificity of 89%. Positive and negative predictive values were 21% and 97%, respectively. There were 87% correctly classified subjects. The area under the ROC curve was 0.64. The present study demonstrated that a negative finding (KI category <2) is highly predictive of the absence of osteopenia/osteoporosis as defined by the DXA measurements.

  • 14. Hallström, H.
    et al.
    Lindgren, S.
    Widén, C.
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Twetman, S.
    Probiotic supplements and debridement of peri-implant mucositis: A randomized controlled trial2016In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 74, no 1, p. 60-66Article in journal (Refereed)
    Abstract [en]

    Objective. The aim of this double-blind randomized placebo-controlled trial was to evaluate the effects of probiotic supplements in adjunct to conventional management of peri-implant mucositis. Materials and methods. Forty-nine adult patients with peri-implant mucositis were consecutively recruited after informed consent. After initial mechanical debridement and oral hygiene instructions, the patients received a topical oil application (active or placebo) followed by twice-daily intake of lozenges (active or placebo) for 3 months. The active products contained a mix of two strains of Lactobacillus reuteri. Patients were clinically monitored and sampled at baseline and after 1, 2, 4, 12 and 26 weeks. The clinical end-points were pocket-probing depth (PPD), plaque index (PI) and bleeding on probing (BOP). In addition, the subgingival microbiota was processed with checkerboard DNA-DNA hybridization and samples of gingival crevicular fluid (GCF) were analyzed for selected cytokines with the aid of multiplex immunoassays. Results. After 4 and 12 weeks, all clinical parameters were improved in both the test and the placebo group. PPD and BOP were significantly reduced compared with baseline (p < 0.05), but no significant differences were displayed between the groups. The clinical improvements persisted 3 months after the intervention. No major alterations of the subgingival microflora were disclosed and the levels of inflammatory mediators in GCF did not differ between the groups. Conclusions. Mechanical debridement and oral hygiene reinforcement resulted in clinical improvement of peri-implant mucositis and a reduction in cytokine levels. Probiotic supplements did not provide added benefit to placebo. © 2015 Informa Healthcare.

  • 15. Hallström, Hadar
    et al.
    Persson, G. Rutger
    Stromberg, Ulf
    Twetman, Svante
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Reproducibility of subgingival bacterial samples from patients with peri-implant mucositis2015In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 19, no 5, p. 1063-1068Article in journal (Refereed)
    Abstract [en]

    Objective The aim of the present study was to investigate the reproducibility of bacterial enumeration from subsequent subgingival samples collected from patients with peri-implant mucositis. Material and methods Duplicate microbial samples from 222 unique implant sites in 45 adult subjects were collected with paper points and analyzed using the checkerboard DNA-DNA hybridization technique. Whole genomic probes of 74 preselected bacterial species were used. Based on the bacterial scores, Cohen's kappa coefficient was used to calculate the inter-annotator agreement for categorical data. The percentage agreement was considered as "good" when the two samples showed the same score or differed by 1 to the power of 10. Results Moderate to fair kappa values were displayed for all bacterial species in the test panel (range 0.21-0.58). There were no significant differences between Gram-positive and Gram-negative species. The percentage of good agreement between the first and second samples averaged 74.7 % (n=74; range 56-83 %), while the proportion of poor agreement ranged from 1 to 19 % for the various strains. Conclusion While an acceptable clinical agreement was obtained in most cases, diverging bacterial scores may appear in subgingival samples collected at the same time point from patients with peri-implant mucositis. Clinical relevance The broad bulky base of implant crowns may present an obstacle for the collection of reproducible subgingival samples with paper points.

  • 16.
    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

  • 17. Hallström, Hadar
    et al.
    Persson, Rutger
    Lindgren, Susann
    Olofsson, Maria
    Renvert, Stefan
    Blekinge Institute of Technology, School of Health Science.
    Systemic antibiotics and debridement of peri-implant mucositis. A randomized clinical trial2012In: Journal of Clinical Periodontology, ISSN 0303-6979, Vol. 39, no 6, p. 574-581Article in journal (Refereed)
    Abstract [en]

    Background This RCT compared non-surgical treatment of peri-implant mucositis with or without systemic antibiotics. Materials and Methods Forty-eight subjects received non-surgical debridement with or without systemic Azithromax (R) (4 similar to days), and were followed during 6 similar to months. The checkerboard DNA-DNA hybridization method was used to analyse the microbiological material. Results Five subjects were excluded due to antibiotic medication during follow-up. At baseline,1 and 3 similar to months no group differences were found. Statistical analysis failed to demonstrate differences in probing pocket depths (PPD) values at 6 similar to months (Mean diff PPD: 0.5 similar to mm, SE: +/- 0.4 similar to mm, 95% CI: -0.2, 1.3, p similar to 0.16). Mean% implant bleeding decreased between baseline and month 6 from 82.6% to 27.3% in the test, and from 80.0% to 47.5% in the control group (p similar to 0.02). Throughout the study, no study group differences in bacterial counts were found. Conclusion No short-term differences were found between study groups. The clinical improvements observed at 6 similar to months may be attributed to improvements in oral hygiene. The present study does not provide evidence for the use of systemic antibiotics in treatment of peri-implant mucositis.

  • 18.
    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.

  • 19. Jansåker, Ann-Marie Roos
    et al.
    Lindahl, Christel
    Persson, Rutger
    Renvert, Stefan
    Long-term stability of surgical bone regenerative procedures of peri-implantitis lesions in a prospective case-control study over 3 years2011In: Journal of Clinical Periodontology, ISSN 0303-6979 , Vol. 38, no 6, p. 590-597Article in journal (Refereed)
    Abstract [en]

    To evaluate the extent of bone fill over 3 years following the surgical treatment of peri-implantitis with bone grafting with or without a membrane. Material and Methods In a non-submerged wound-healing mode, 15 subjects with 27 implants were treated with a bone substitute (Algipore (R)) alone and 17 subjects with 29 implants were treated with the bone substitute and a resorbable membrane (Osseoquest (R)). Implants with radiographic bone loss >= 1.8 mm following the first year in function and with bleeding and/or pus on probing were included. Following surgery, subjects were given systemic antibiotics (10 days) and rinsed with chlorhexidine. After initial healing, the subjects were enrolled in a strict maintenance programme. Results Statistical analysis failed to demonstrate changes in bone fill between 1 and 3 years both between and within procedure groups. The mean defect fill at 3 years was 1.3 +/- (SD) 1.3 mm if treated with the bone substitute alone and 1.6 +/- (SD) 1.2 mm if treated with an adjunct resorbable membrane, (p=0.40). The plaque index decreased from approximately 40-10%, remaining stable during the following 2 years. Conclusion Defect fill using a bone substitute with or without a membrane technique in the treatment of peri-implantitis can be maintained over 3 years.

  • 20.
    Jepsen, K.
    et al.
    Univ Bonn, Dept Periodontol Operat & Prevent Dent, D-53111 Bonn, Germany..
    Jepsen, S.
    Univ Bonn, Dept Periodontol Operat & Prevent Dent, D-53111 Bonn, Germany..
    Laine, M. L.
    Univ Amsterdam, Dept Periodontol, Acad Ctr Dent Amsterdam, Amsterdam, Netherlands.;Vrije Univ Amsterdam, Amsterdam, Netherlands..
    Moin, D. Anssari
    Univ Amsterdam, Dept Periodontol, Acad Ctr Dent Amsterdam, Amsterdam, Netherlands.;Vrije Univ Amsterdam, Amsterdam, Netherlands..
    Pilloni, A.
    Univ Roma La Sapienza, Sect Periodont, Rome, Italy..
    Zeza, B.
    Univ Roma La Sapienza, Sect Periodont, Rome, Italy..
    Sanz, M.
    Univ Complutense Madrid, ETEP Etiol & Therapy Periodontal Dis Res Grp, Madrid, Spain..
    Ortiz-Vigon, A.
    Univ Complutense Madrid, ETEP Etiol & Therapy Periodontal Dis Res Grp, Madrid, Spain..
    Roos-Jansaker, A. M.
    Publ Dent Hlth Serv, Dept Periodontol, Kristianstad, Sweden.;Kristianstad Univ, Dept Oral Sci, Kristianstad, Sweden..
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health. Publ Dent Hlth Serv, Dept Periodontol, Kristianstad, Sweden.;Kristianstad Univ, Dept Oral Sci, Kristianstad, Sweden.;Blekinge Inst Technol, Karlskrona, Sweden.;Univ Dublin Trinity Coll, Sch Dent Sci, Dublin 2, Ireland..
    Reconstruction of Peri-implant Osseous Defects: A Multicenter Randomized Trial2016In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 95, no 1, p. 58-66Article in journal (Refereed)
    Abstract [en]

    There is a paucity of data for the effectiveness of reconstructive procedures in the treatment of peri-implantitis. The objective of this study was to compare reconstruction of peri-implant osseous defects with open flap debridement (OFD) plus porous titanium granules (PTGs) compared with OFD alone. Sixty-three patients (36 female, 27 male; mean age 58.4 y [SD 12.3]), contributing one circumferential peri-implant intraosseous defect, were included in a multinational, multicenter randomized trial using a parallel-group design. After OFD and surface decontamination using titanium brushes and hydrogen peroxide, 33 defects received PTGs. The implants were not submerged. All patients received adjunctive perioperative systemic antibiotics. The primary outcome variable (defect fill) was assessed on digitalized radiographs. Clinical measurements of probing depth (PPD), bleeding on probing (BoP), suppuration, and plaque were taken by blinded examiners. After 12 mo, the test group (OFD plus PTG) showed a mean radiographic defect fill (mesial/distal) of 3.6/3.6 mm compared with 1.1/1.0 in the control group (OFD). Differences were statistically significant in favor of the test group (P < 0.0001). The OFD plus PTG group showed a mean reduction in PPD of 2.8 mm compared with 2.6 mm in the OFD group. BoP was reduced from 89.4% to 33.3% and from 85.8% to 40.4% for the test and control groups, respectively. There was no significant difference in complete resolution of peri-implantitis (PPD <= 4 mm and no BoP at six implant sites and no further bone loss), because this finding was accomplished at 30% of implants in the test group and 23% of implants in the control group. Reconstructive surgery using PTGs resulted in significantly enhanced radiographic defect fill compared with OFD. However, limitations in the lack of ability to discern biomaterial from osseous tissue could not be verified to determine new bone formation. Similar improvements according to clinical measures were obtained after both surgical treatment modalities (ClinicalTrials.gov NCT02406001).

  • 21. Nilsson, Helena
    et al.
    Berglund, Johan
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Tooth loss and cognitive functions among older adults2014In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 72, no 8, p. 639-644Article in journal (Refereed)
    Abstract [en]

    Objective. To evaluate the association between the number of teeth and cognitive functions adjusted for age and education level in a cohort of older adults living in Sweden. Materials and methods. The study employed a cross-sectional design in which 1147 individuals between 60-96 years underwent a clinical oral examination. The cognitive functions were assessed using Mini-Mental State Examination (MMSE) and Clock-test. The level of education was obtained from a questionnaire. Data were subjected to Chi-square tests and multivariate logistic regression analyses were employed, grouping the different variables into pre-determined categories. Results. The co-variables age and education were significantly associated with the number of teeth (p < 0.05). The multivariate logistic regression analysis revealed that the association between the number of teeth and the cognitive functions persisted even after adjusting for age and level of education. Conclusions. The findings suggest that the presence of teeth may be of importance for cognitive abilities in older adults.

  • 22.
    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.
    Periodontitis, tooth loss and cognitive functions among older adults2018In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 22, no 5, p. 2103-2109Article in journal (Refereed)
    Abstract [en]

    Objective: This study aims to evaluate the potential association between periodontitis, the number of teeth and cognitive functions in a cohort of older adults in Sweden. Material and methods: In total, 775 individuals from 60 to 99 years of age were selected for the study. A clinical and radiographic examination was performed. The number of teeth and prevalence of periodontal pockets and bone loss was calculated and categorised. Cognitive functions were assessed using the Mini-Mental State Examination (MMSE) and clock test. The education level was obtained from a questionnaire. Data were analysed using chi-square tests and multivariate logistic regression. Results: Age and gender were associated with the prevalence of bone loss. Age and education were associated with lower number of teeth. Gender was also associated with the presence of pockets. The multivariate logistic regression analysis demonstrated a statistically significant association between prevalence of bone loss, the number of teeth and the outcome on MMSE test. This association remained even after adjustment for age, education and gender. Tooth loss was also associated with lower outcome on clock test. Presence of periodontal pockets ≥ 5 mm was not associated with cognitive test outcome. Conclusions: A history of periodontitis and tooth loss may be of importance for cognitive functions among older adults. Clinical relevance: Diseases with and inflammatory profile may have an impact on cognitive decline. © 2017 Springer-Verlag GmbH Germany, part of Springer Nature

  • 23. Persson, Gösta Rutger
    et al.
    Renvert, Stefan
    Blekinge Institute of Technology, School of Health Science.
    Cluster of Bacteria Associated with Peri-Implantitis2014In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 16, no 6, p. 783-893Article in journal (Refereed)
    Abstract [en]

    Information on the microbiota in peri-implantitis is limited. We hypothesized that neither gender nor a history of periodontitis/smoking or the microbiota at implants differ by implant status. Materials and Methods: Baseline microbiological samples collected at one implant in each of 166 participants with peri-implantitis and from 47 individuals with a healthy implant were collected and analyzed by DNA-DNA checkerboard hybridization (78 species). Clinical and radiographic data defined implant status. Results: Nineteen bacterial species were found at higher counts from implants with peri-implantitis including Aggregatibacter actinomycetemcomitans, Campylobacter gracilis, Campylobacter rectus, Campylobacter showae, Helicobacter pylori, Haemophilus influenzae, Porphyromonas gingivalis, Staphylococcus aureus, Staphylococcus anaerobius, Streptococcus intermedius, Streptococcus mitis, Tannerella forsythia, Treponema denticola, and Treponema socranskii (p<.001). Receiver operating characteristic curve analysis identified T. forsythia, P. gingivalis, T. socranskii, Staph. aureus, Staph. anaerobius, Strep. intermedius, and Strep. mitis in peri-implantitis comprising 30% of the total microbiota. When adjusted for gender (not significant [NS]), smoking status (NS), older age (p=.003), periodontitis history (p<.01), and T. forsythia (likelihood ratio 3.6, 95% confidence interval 1.4, 9.1, p=.007) were associated with peri-implantitis. Conclusion: A cluster of bacteria including T. forsythia and Staph. aureus are associated with peri-implantitis.

  • 24. Persson, Rutger
    et al.
    Berglund, Johan
    Persson, Ringmor
    Renvert, Stefan
    Prediction of hip and hand fractures in older persons with or without a diagnosis of periodontitis2011In: Bone, ISSN 8756-3282, E-ISSN 1873-2763, Vol. 48, no 3, p. 552-556Article in journal (Refereed)
    Abstract [en]

    PURPOSE: In a prospective study, we assessed if a diagnosis of osteoporosis and periodontitis could predict hip and hand fractures in older persons. MATERIALS AND METHODS: Bone density was assessed by a Densitometer. Periodontitis was defined by evidence of alveolar bone loss. RESULTS: 788 Caucasians (52.4% women, overall mean age: 76years, S.D.±9.0, range: 62 to 96) were enrolled and 7.4% had a hip/hand fracture in 3years. Calcaneus PIXI T-values<-1.6 identified osteoporosis in 28.2% of the older persons predicting a hip/hand fracture with an odds ratio of 3.3:1 (95% CI: 1.9, 5.7, p<0.001). Older persons with osteoporosis had more severe periodontitis (p<0.01). Periodontitis defined by ≥30% of sites with ≥5mm distance between the cemento-enamel junction (CEJ) and bone level (ABL) was found in 18.7% of the older persons predicting a hip/hand fracture with an odds ratio of 1.8:1 (95% CI: 1.0, 3.3, p<0.05). Adjusted for age, the odds ratio of a hip/hand fracture in older persons with osteoporosis (PIXI T-value<-2.5) and periodontitis was 12.2:1 (95% CI: 3.5, 42.3, p<0.001). CONCLUSIONS: Older persons with osteoporosis and periodontitis have an increased risk for hip/hand fractures.

  • 25. Persson, Rutger
    et al.
    Jansåker, Ann-Marie Roos
    Lindahl, Christel
    Renvert, Stefan
    Microbiologic results after Non-surgical Erbium-doped:Yttrium, aluminum, and garnet laser or Air-abrasive treatment of Peri-implantitis: A randomized clinical trial2011In: Journal of Periodontology, ISSN 0022-3492, E-ISSN 1943-3670, Vol. 82, no 9, p. 1267-1278Article in journal (Refereed)
    Abstract [en]

    Background: The purpose of this study is to assess clinical and microbiologic effects of the non-surgical treatment of peri-implantitis lesions using either an erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser or an air-abrasive subgingival polishing method. Methods: In a 6-month clinical trial, 42 patients with periimplantitis were treated at one time with an Er:YAG laser or an air-abrasive device. Routine clinical methods were used to monitor clinical conditions. Baseline and 6-month intraoral radiographs were assessed with a software program. The checkerboard DNA-DNA hybridization method was used to assess 74 bacterial species from the site with the deepest probing depth (PD) at the implant. Non-parametric tests were applied to microbiology data. Results: PD reductions (mean - SD) were 0.9 - 0.8 mm and 0.8 - 0.5 mm in the laser and air-abrasive groups, respectively (not significant). No baseline differences in bacterial counts between groupswere found. In the air-abrasive group, Pseudomonas aeruginosa, Staphylococcus aureus, andStaphylococcus anaerobius were found at lower counts at 1 month after therapy (P <0.001) and with lower counts in the laser group for Fusobacteriumnucleatumnaviforme( P = 0.002), and Fusobacterium nucleatum nucleatum (P = 0.002). Both treatments failed to reduce bacterial counts at 6 months. Porphyromonas gingivalis counts were higher in cases with progressive peri-implantitis (P <0.001). Conclusions: At 1 month, P. aeruginosa, S. aureus, and S. anaerobius were reduced in the air-abrasive group, and Fusobacterium spp. were reduced in the laser group. Six-month data demonstrated that both methods failed to reduce bacterial counts. Clinical improvements were limited.

  • 26. Persson, Rutger
    et al.
    Samuelsson, Emelie
    Lindahl, Christel
    Renvert, Stefan
    Mechanical non-surgical treatment of peri-implantitis: a single-blinded randomized longitudinal clinical study. II. Microbiological results2010In: Journal of Clinical Periodontology, ISSN 0303-6979 , Vol. 37, no 6, p. 563-573Article in journal (Refereed)
    Abstract [en]

    Peri-implantitis is common in patients with dental implants. We performed a single-blinded longitudinal randomized study to assess the effects of mechanical debridement on the peri-implant microbiota in peri-implantitis lesions. Materials and Methods: An expanded checkerboard DNA-DNA hybridization assay encompassing 79 different microorganisms was used to study bacterial counts before and during 6 months following mechanical treatment of peri-implantitis in 17 cases treated with curettes and 14 cases treated with an ultrasonic device. Statistics included non-parametric tests and GLM multivariate analysis with p < 0001 indicating significance and 80% power. Results: At selected implant test sites, the most prevalent bacteria were: Fusobacterium nucleatum sp., Staphylococci sp., Aggregatibacter actinomycetemcomitans, Helicobacter pylori, and Tannerella forsythia. 30 min. after treatment with curettes, A. actinomycetemcomitans (serotype a), Lactobacillus acidophilus, Streptococcus anginosus, and Veillonella parvula were found at lower counts (p < 0.001). No such differences were found for implants treated with the ultrasonic device. Inconsistent changes occurred following the first week. No microbiological differences between baseline and 6-month samples were found for any species or between treatment study methods in peri-implantitis. Conclusions: Both methods failed to eliminate or reduce bacterial counts in peri-implantitis. No group differences were found in the ability to reduce the microbiota in peri-implantitis.

  • 27. Prendergast, Virginia
    et al.
    Jakobsson, Ulf
    Renvert, Stefan
    Blekinge Institute of Technology, School of Health Science.
    Hallberg, Ingalill
    Effects of a Standard Versus Comprehensive Oral Care Protocol Among Intubated Neuroscience ICU Patients: Results of a Randomized Controlled Trial2012In: Journal of Neuroscience Nursing, ISSN 0888-0395, E-ISSN 1945-2810, Vol. 44, no 3, p. 134-146Article in journal (Refereed)
    Abstract [en]

    The purpose of the study was to compare changes in oral health during intubation until 48 hours after extubation in neuroscience intensive care unit (ICU) patients enrolled in a standard or a comprehensive oral care protocol. The effects of manual toothbrushing (standard group, n = 31) were compared with those of tongue scraping, electric toothbrushing, and moisturizing (comprehensive group, n = 25) in intubated patients in a neuroscience ICU in a 2-year randomized clinical trial. Oral health was evaluated based on the Oral Assessment Guide (OAG) on enrollment, the day of extubation, and 48 hours after extubation. There were no significant differences in the frequency of the oral care protocol. Protocol compliance exceeded 91% in both groups. The total OAG score and all eight categories significantly deteriorated (Friedman test, p < .001, Bonferroni corrected) in the standard oral care group and did not return to baseline after extubation. Large effect sizes were present at all three points in this group. The total OAG score deteriorated during intubation within the comprehensive protocol group (Friedman test, p < .004) but returned to baseline status after extubation. In four categories, the ratings on tongue, mucous membranes, gingiva, and teeth did not deteriorate significantly over time. Published oral care protocols are substandard in promoting and maintaining oral health in intubated patients. A comprehensive oral care protocol, using a tongue scraper, an electrical toothbrush, and pharmacological moisturizers, was more effective for oral hygiene throughout intubation and after extubation than manual toothbrushing alone.

  • 28.
    Renvert, Stefan
    et al.
    Blekinge Institute of Technology, School of Health Science.
    Aghazadeh, Ahmad
    Hallström, Hadar
    Persson, Gösta Rutger
    Factors related to peri-implantitis: a retrospective study2014In: Clinical Oral Implants Research, ISSN 0905-7161, E-ISSN 1600-0501, Vol. 25, no 4, p. 522-529Article in journal (Refereed)
    Abstract [en]

    Retrospectively, we assessed the likelihood that peri-implantitis was associated with a history of systemic disease, periodontitis, and smoking habits. Methods: Data on probing pocket depth (PPD), bleeding on probing (BOP), and radiographic bone levels were obtained from individuals with dental implants. Peri-implantitis was defined as described by Sanz & Chapple 2012. Control individuals had healthy conditions or peri-implant mucositis. Information on past history of periodontitis, systemic diseases, and on smoking habits was obtained. Results: One hundred and seventy-two individuals had peri-implantitis (mean age: 68.2 years, SD ± 8.7), and 98 individuals (mean age: 44.7 years, SD ± 15.9) had implant health/peri-implant mucositis. The mean difference in bone level at implants between groups was 3.5 mm (SE mean ± 0.4, 95% CI: 2.8, 4.3, P < 0.001). A history of cardiovascular disease was found in 27.3% of individuals with peri-implantitis and in 3.0% of individuals in the implant health/peri-implant mucositis group. When adjusting for age, smoking, and gender, odds ratio (OR) of having peri-implantitis and a history of cardiovascular disease was 8.7 (95% CI: 1.9, 40.3 P < 0.006), and odds ratio of having a history of periodontitis was 4.5 (95% CI 2.1, 9.7, P < 0.001). Smoking or gender did not significantly contribute to the outcome. Conclusions: In relation to a diagnosis of peri-implantitis, a high likelihood of comorbidity was expressed by a history of periodontitis and a history of cardiovascular disease.

  • 29. Renvert, Stefan
    et al.
    Berglund, Johan
    Opalainska, Teresa
    Persson, Ringmor
    Persson, Rutger
    Heel DXA T-scores and panoramic radiographs in the prediciton of hip and hand fractures2009In: Journal of Clinical Periodontology, wiley , 2009, Vol. 36, no suppl. 9Conference paper (Refereed)
  • 30.
    Renvert, Stefan
    et al.
    Blekinge Institute of Technology, School of Health Science.
    Ioannis, Polyzois
    Persson, Rutger
    Treatment modalities for peri-implant mucositis and peri-implantitis2013In: American Journal of Dentistry, ISSN 0894-8275, Vol. 26, no 6, p. 313-318Article, review/survey (Refereed)
    Abstract [en]

    To review treatment modalities used for pen-implant mucositis and peri-implantitis. Methods: A literature search was performed in PubMed for articles published until May 2013 using peri-implantitis and pen-implant mucositis and different modalities of treatment as search terms. The search was limited to the English literature. Titles and abstracts were searched in order to find studies eligible for the review. Results: The present review reported that treatment of pen-implant mucositis lesions using mechanical therapy is possible. The additional use of professionally delivered antimicrobials has commonly failed to show additional benefits as compared to mechanical debridement alone. The scientific evidence on the efficacy of non-surgical and surgical therapies in the treatment of peri-implantitis is limited. Complete resolution of peri-implantitis using mechanical, laser, or photodynamic therapy does not seem to result in a predictable outcome. Following surgical interventions around implants diagnosed with peri-implantitis, clinical improvements as judged by reductions of probing depths and bleeding on probing have been reported. Bone or bone substitutes have been used in attempts to regenerate bone loss around implants. When regenerative modalities have been employed, radiographic evidence of defect fill has been reported. Few long term follow up studies on the treatment of peri-implantitis are available. Positive treatment results can be maintained over a period of 3-5 years. Regardless of the treatment performed, adequate plaque control by the patient is fundamental to treatment success. If the patient cannot obtain an adequate level of oral hygiene, the infection around the implants will reoccur.

  • 31. Renvert, Stefan
    et al.
    Lindahl, Christel
    Jansåker, Ann-Marie Roos
    Lessem, Jan
    Short-Term Effects of an Anti-Inflammatory Treatment on Clinical Parameters and Serum Levels of C-Reactive Protein and Proinflammatory Cytokines in Subjects With Periodontitis2009In: Journal of Periddontology, ISSN 0022-3492 , Vol. 80, no 6, p. 892-900Article in journal (Refereed)
    Abstract [en]

    Background: Periodontal disease is the most common multifactorial disease, afflicting a very large proportion of the adult population. Periodontal disease secondarily causes increases in the serum levels of C-reactive protein (CRP) and other markers of inflammation. An increased level of CRP reflects an increased risk for cardiovascular disease. The aim of the current randomized clinical trial was to evaluate the short-term effect of a combination of dipyridamole and prednisolone (CRx-102) on the levels of high-sensitivity (hs)-CRP, proinflammatory markers in blood, and clinical signs of periodontal disease. Methods: Fifty-seven patients with >= 10 pockets with probing depths >= 5 mm were randomized into two groups in this masked single-center placebo-controlled study: CRx-102 (n = 28) and placebo (n = 29). hs-CRP levels, inflammatory markers (interleukin [IL]-6, -1 beta, -8, and -12, tumor necrosis factor-alpha, and interferon-gamma [IFN-gamma]), bleeding on probing (BOP), and changes in probing depths were evaluated. The subjects received mechanical non-surgical therapy after 42 days, and the study was completed after 49 days. Results: At day 42, the differences in the hs-CRP, IFN-gamma, and IL-6 levels between the two groups were statistically significant (P<0.05), whereas no difference was found for the other inflammatory markers. There was no change in probing depth or BOP between the two groups. Conclusion: The administration of CRx-102 resulted in significant decreases in hs-CRP, IFN-gamma, and IL-6, but it did not significantly change BOP or probing depths.

  • 32.
    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.

  • 33.
    Renvert, Stefan
    et al.
    Blekinge Institute of Technology, School of Health Science.
    Lindahl, Christel
    Persson, Rutger
    The incidence of peri-implantitis for two different implant systems over a period of thirteen years2012In: Journal of Clinical Periodontology, ISSN 0303-6979, Vol. 39, no 12, p. 1191-1197Article in journal (Refereed)
    Abstract [en]

    Objectives To study the incidence of peri-implantitis over 13 years between two types of dental implants. Materials and methods Peri-implantitis incidence was defined as bone loss ≥ 1.0 mm after 1 year, and with BOP or suppuration. Results Nineteen subjects with TioBlast AstraTech™ (AT) and 22 subjects with machine-etched Brånemark Nobel Biocare® (NB) implants were studied. The incidences of peri-implantitis between years 1 and 7 and between years 7 and 13 were 26.2% and 7.1% for AT implants, and 30.4% and 11.5% for NB implants (NS). A history of periodontitis was a risk for future incidence of peri-implantitis (Likelihood ratio: 4.1, 95% CI: 2.0, 8.4, p < 0.001). Subjects with a history of systemic disease had a higher incidence of peri-implantitis (p < 0.05). Conclusions No difference in the incidence of peri-implantitis over a period of 13 years as an effect implant surface and design was found. Bone loss during the first 7 years after implant installation was greater than thereafter. Microbiological information at year 7 did not predict incidence of peri-implantitis at year 13. Subjects with a previous history of periodontitis and with systemic disease were at higher risk for future incidence of peri-implantitis.

  • 34.
    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.

  • 35.
    Renvert, Stefan
    et al.
    Blekinge Institute of Technology, School of Health Science.
    Persson, Rigmor E.
    Persson, Rutger G.
    Tooth loss and periodontitis in older individuals: results from the Swedish national study on aging and care.2013In: Journal of Periodontology, ISSN 0022-3492, E-ISSN 1943-3670, Vol. 84, no 8, p. 1134-1144Article in journal (Refereed)
    Abstract [en]

    Background: Due to the increasing number of older people, there is a need for studies focused on this population. The aims of the present study are to assess oral and systemic conditions in individuals aged 60 to 95 years with access to dental insurance. Methods: Probing depths (PDs), tooth loss, alveolar bone levels, and systemic health were studied among a representative cohort of older individuals. Results: A total of 1,147 individuals in young-old (aged 60 or 67 years), old (aged 72 or 78 years), and old-old (aged ≥81 years) age groups were enrolled, including 200 individuals who were edentulous, in this study. Annual dental care was received by 82% of dentate individuals. Systemic diseases were common (diabetes: 5.8%; cardiovascular diseases: 20.7%; obesity: 71.2%; elevated C-reactive protein [CRP]: 98.4%). Serum CRP values were unrelated to periodontal conditions. Rates of periodontitis, defined as ≥30% of sites with a distance from cemento-enamel junction to bone of ≥5 mm, were 11.2% in women in the young-old age group and 44.9% in men in the old-old age group. Individuals in older age groups had a higher likelihood of periodontitis defined by bone loss and cutoff levels of PD ≥5 mm (odds ratio: 1.8; 95% confidence interval: 1.2 to 2.5; P <0.01). A total of 7% of individuals in the old-old age group had ≥20 teeth and no periodontitis. Systemic diseases, dental use, or smoking were not explanatory, whereas age and sex were explanatory for periodontitis. Conclusions: The prevalence of periodontitis increased with age. Sex seems to be the dominant explanatory factor for periodontitis in older individuals. Despite frequent dental visits, overall oral health in the oldest age cohort was poor.

  • 36. Renvert, Stefan
    et al.
    Persson, Ringmor
    Persson, Rutger
    A history of frequent dental care reduces the risk of tooth loss but not periodontitis in older subjects2011In: Swedish Dental Journal, ISSN 0347-9994, Vol. 35, no 2, p. 69-75Article, review/survey (Refereed)
    Abstract [en]

    Objectives: Information on the significance of dental care in older adults is limited. We hypothesized that regular dental visits has an effect on the number of remaining teeth and periodontal conditions in older subjects. Materials and Methods:1020 randomly selected individuals age 60-96 from the Swedish National Study on Aging and Care Blekinge received a comprehensive oral health examination. Results: Dentate women and men had, on average 18.4 teeth (SD +7.6,) and 18.9 teeth (SD + 7.5) respectively (NS). In the youngest group (60 and 66 years old) with less than one dental visit per year, 37 % had <20 teeth, compared with 73 % among those with at least annual visits. Among the old-old, comparable figures were 1.8 % and 37 % respectively. Across age groups, bleeding on probing was 23 %. When adjusting for age, and number of teeth GLM univariate analysis failed to demonstrate an effect of dental visit frequency on alveolar bone loss (p = 0.18), the number of periapical lesions (p = 0.65), or the number of endodontically treated teeth (p = o.41). Frequent dental visitors had more teeth than infrequent visitors (p = 0.001). Conclusions: Tooth loss and alveolar bone loss severity increase with age. Individuals with regular dental visits retained more teeth but the frequency of dental visits had no impact on plaque deposits, gingival inflammation, or alveolar bone levels.

  • 37. Renvert, Stefan
    et al.
    Persson, Rutger
    Resebo, Jan
    Berglund, Johan
    Blekinge Institute of Technology, School of Health Science.
    Forskning pågår: Fokus på sambandet munhälsa - allmänhälsa.2009In: Tandläkartidningen, ISSN 0039-6982, Vol. 101, no 7, p. 48-50Article, review/survey (Refereed)
  • 38.
    Renvert, Stefan
    et al.
    Blekinge Institute of Technology, School of Health Science.
    Polyzoi, Ioannis
    Claffey, Noel
    Surgical therapy for the control of peri-implantitis2012In: Clinical Oral Implants Research, ISSN 0905-7161, E-ISSN 1600-0501, Vol. 23, no Suppl. 6, p. 84-94Article, review/survey (Refereed)
    Abstract [en]

    Material and methods Articles on surgical treatment of peri-implantitis in humans published up to December 2011 were included. ResultsTwenty-six studies were selected, thus limiting the available evidence. There is marked heterogeneity between study designs and case definitions for peri-implantitis in the studies cited, limiting the generalization of the reported results. Adjunctive systemic antibiotics were used in most studies, but no study evaluated the adjunctive benefit of systemic antibiotics. Access flap surgery, removal of granulation tissue and implant surface decontamination has been demonstrated to decrease plaque index, BOP, suppuration, probing depths and to arrest bone loss for 58% of implant sites over 5 years. Laser treatment of the exposed implant surface during surgery was not shown to be beneficial. Available data indicate that it is possible to obtain defect fill of peri-implantitis defects following surgical-treatment modalities with concomitant placement of bone or bone substitutes in such defects. However, there is lack of evidence that placement of membranes in addition to grafting procedures provides any additional defect fill. Conclusions Surgical therapy for treating peri-implantitis is a predictable method for treating peri-implant disease and patients receiving this therapy have benefited from it in the short term.

  • 39.
    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.

  • 40. Renvert, Stefan
    et al.
    Polyzois, Ioannis
    Claffey, Noel
    How do implant surface characteristics influence peri-implant disease?2011In: Journal of Clinical Periodontology, ISSN 0303-6979 , Vol. 38, no 11, p. 214-222Article in journal (Refereed)
    Abstract [en]

    To review the literature on how implant surface characteristics influence peri-implant disease. Material and Methods A search of PubMed and The Cochrane Library of the Cochrane Collaboration (CENTRAL) as well as a hand search of articles were conducted. Publications and articles accepted for publication up to March 2010 were included. Results Thirteen studies were selected for the review. Human studies: To date, few studies have investigated if such differences occur. Limited data suggest that smooth surfaces may be less affected by peri-implantitis than rough surface implants. Animal studies: In ligature-induced peri-implantitis studies, no difference between surfaces has been reported. In a spontaneous progression model of peri-implantitis, there was a suggestion that the progression was more pronounced at implants with a porous anodized surface. Conclusion The current review revealed that only a few studies provided data on how implant surfaces influence peri-implant disease. Based on the limited data available, there is no evidence that implant surface characteristics can have a significant effect on the initiation of peri-implantitis.

  • 41. Renvert, Stefan
    et al.
    Polyzois, Ioannis
    Maguire, Rory
    Re-osseointegration on previously contaminated surfaces: a systematic review2009Conference paper (Refereed)
    Abstract [en]

    The aim of this review was to search the literature for the existing evidence of re-osseointegration after treatment of peri-implantitis at contaminated implant surfaces. Material and Methods A search of PubMed as well as additional hand search of articles were conducted. Publications and articles accepted for publication up to November 2008 were included. Results A total of 25 animal studies fulfilled the inclusion criteria for this review. Access surgery with closed healing has been observed to positively influence the rate of re-osseointegration when compared with non-surgical decontamination of the implant surface with open healing. Open debridement including surface decontamination may result in re-osseointegration and this integration was more pronounced on rougher than on smooth implant surfaces. The adjunctive use of regenerative procedures resulted in varying amounts of re-osseointegration. Conclusions Re-osseointegration is possible to obtain on a previously contaminated implant surface and can occur in experimentally induced peri-implantitis defects following therapy. The amount of re-osseointegration, varied considerably within and between studies. Implant surface characteristics may influence the degree of re-osseointegration. Surface decontamination alone can not achieve substantial re-osseointegration on a previously contaminated implant surface. No method predictably accomplished complete resolution of the peri-implant defect.

  • 42.
    Renvert, Stefan
    et al.
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Quirynen, M.d
    Risk indicators for peri-implantitis: A narrative review2015In: Clinical Oral Implants Research, ISSN 0905-7161, E-ISSN 1600-0501, Vol. 26, p. 15-44Article in journal (Refereed)
    Abstract [en]

    Aim: To examine the existing evidence in identifying risk indicators in the etiology of peri-implantitis. Material and methods: A literature search was performed in MEDLINE via PubMed database of the US National Library of Medicine, for articles published until October 2014 using Medical Subject Heading search terms + free text terms and in different combinations. Results: The microbiota associated with peri-implantitis is complex, demonstrating differences and similarities to the one seen at periodontitis sites. Plaque accumulation at dental implants triggers the inflammatory response leading to peri-implant mucositis/peri-implantitis. Individuals with a history of periodontal disease and smokers have an increased risk of developing peri-implantitis. There is some evidence to support the role of genetic polymorphism, diabetes, and excess cement as risk indicators for the development of peri-implantitis. There is also evidence to support that individuals on regular maintenance are less likely to develop peri-implantitis and that successful treatment of periodontitis prior to implant placement lowers the risk of peri-implantitis. Conclusions: Plaque accumulation at implants will result in the development of an inflammation at implants. A history of periodontal disease, smoking, excess cement, and lack of supportive therapy should be considered as risk indicators for the development of peri-implantitis. © 2015 John Wiley & Sons A/S.

  • 43. Renvert, Stefan
    et al.
    Samuelsson, Emelie
    Lindahl, Christel
    Persson, Gösta Rutger
    Mechanical non-surgical treatment of peri-implantitis: a double-blind randomized longitudinal clinical study. I: clinical results2009In: Journal of Clinical Periodontology, ISSN 0303-6979 , Vol. 36, no 7, p. 604-609Article in journal (Refereed)
    Abstract [en]

    Peri-implantitis is a frequent finding in patients with dental implants. The present study compared two non-surgical mechanical debridement methods of peri-implantitis. Material and Methods Thirty-seven subjects (mean age 61.5; S.D +/- 12.4), with one implant each, demonstrating peri-implantitis were randomized, and those treated either with titanium hand-instruments or with an ultrasonic device were enrolled. Data were obtained before treatment, and at 1, 3, and 6 months. Parametric and non-parametric statistics were used. Results Thirty-one subjects completed the study. The mean bone loss at implants in both groups was 1.5 mm (SD +/- 1.2 mm). No group differences for plaque or gingival indices were found at any time point. Baseline and 6-month mean probing pocket depths (PPD) at implants were 5.1 and 4.9 mm (p=0.30) in both groups. Plaque scores at treated implants decreased from 73% to 53% (p < 0.01). Bleeding scores also decreased (p < 0.01), with no group differences. No differences in the total bacterial counts were found over time. Higher total bacterial counts were found immediately after treatment (p < 0.01) and at 1 week for ultrasonic-treated implants (p < 0.05). Conclusions No group differences were found in the treatment outcomes. While plaque and bleeding scores improved, no effects on PPD were identified.

  • 44.
    Renvert, Stefan
    et al.
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Wallin-Bengtsson, Viveca
    Berglund, Johan
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    G Persson, Rutger
    Peridontitis in older Swedish individuals fails to predict mortality2015In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 19, no 2, p. 193-200Article in journal (Refereed)
    Abstract [en]

    This study aims to assess mortality risk and its association to health aspects in dentate individuals 60 years of age and older. Medical and periodontal data from 870 dentate individuals (age range 60-96) participating in the Swedish National Study on Aging and Care in Blekinge (SNAC-Blekinge) with survival statistics over 6 years were studied. During 6 years of follow-up, 42/474 of the individuals (8.9 %), who at baseline were between age 60 and 75, and 134/396 individuals of the individuals (33.9 %), who at baseline were ≥75 years, died. Surviving dentate individuals had more teeth (mean 19.3, S.D. ± 7.9) than those who died (mean 15.9, S.D. ± 7.3; mean diff 3,3; S.E. mean diff 0.7; 95 % CI 2.0, 4.6; p = 0.001). A self-reported history of high blood pressure (F = 15.0, p < 0.001), heart failure (F = 24.5, p < 0.001, observed power = 0.99), older age (F = 34.7, p < 0.001), male gender (F = 6.3, p < 0.01), serum HbA1c with 6.5 % as cutoff level (F = 9.3, p = 0.002) were factors associated with mortality. A medical diagnosis of heart disease, diabetes, any form of cancer, or periodontitis failed to predict mortality. A self-reported history of angina pectoris, chronic heart failure, elevated serum HbA1c, and few remaining teeth were associated with mortality risk. A professional diagnosis of cardiovascular disease, diabetes, cancer, or periodontitis was not predictive of mortality. Self-health reports are important to observe in the assessment of disease and survival in older individual.

  • 45.
    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.

  • 46.
    Renvert, Stefan
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Widén, Cecilia
    Kristianstad Univ., SWE.
    Persson, Rutger
    Kristianstad Univ., SWE.
    Cytokine and microbial profiles in relation to the clinical outcome following treatment of peri-implantitis2017In: Clinical Oral Implants Research, ISSN 0905-7161, E-ISSN 1600-0501, Vol. 28, no 9, p. 1127-1132Article in journal (Refereed)
    Abstract [en]

    Aim: To study whether cytokine levels and bacterial counts in p atients with peri-implantitis reflect clinical treatment outcome following non-surgical management. Materials and Methods: Luminex magnet bead technology and checkerboard DNA-DNA hybridization were used to assess treatment outcome after treatment at the implant with the most severe peri-implantitis in 41 participants. Results: Study group mean age was 40.3 years (SD ± 9.9). Stable treatment outcome after 6 months (no further bone loss, probing pocket depth decrease ≥0.5 mm, no bleeding/suppuration) was identified in 9 of 41 (22%) participants. Peri-implant crevicular fluid (PICF) levels were also lower for Il-1β (P &lt; 0.01), and with trends of lower cytokine levels in PICF for TNF-α (P = 0.071), PDGFBB (P = 0.071), as well as for VEGF (vascular endothelial growth factor) (P = 0.071), and bacterial counts for Actinomyces israelii, Aggregatibacter actonomycetemcomitans (Y4), Campylobacter gracilis, Echerichia coli, Fusobacterium periodonticum, Leptotrichia buccalis, Parvimonas micra, Staphylococcus haemolyticus, Streptococcus anginosus, and Tannerella forsythia. Increasing levels of IL-1 β and S. aureus (r2 = 0.856) were found only at implants with non-stable outcome. A reduction of PICF levels for selected cytokines and bacteria studied had a sensitivity of 0.77, and a specificity of 0.80 against the clinical outcome as gold standard. Data analysis failed to differences in treatments (PerioFlow® versus YAG: ER laser) for changes in the expression of cytokines and bacteria studied. Conclusions: At 6 months, clinically stable treatment outcome of peri-implantitis is associated lower levels of putative pathogens total bacterial load with ≥30% reduction of IL1-β, L-6, and VEGF levels in PICF.

  • 47. 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.

  • 48. Roos-Jansaker, Ann-Marie
    et al.
    Persson, Rutger
    Lindahl, Christel
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Surgical treatment of peri-implantitis using a bone substitute with or without a resorbable membrane: a 5-year follow-up2014In: Journal of Clinical Periodontology, ISSN 0303-6979, Vol. 41, no 11, p. 1108-1114Article in journal (Refereed)
    Abstract [en]

    AimTo compare two regenerative surgical treatments for peri-implantitis over 5years. Material & MethodsTwenty-five individuals with peri-implantitis remained at study endpoint. They were treated with a bone substitute and a resorbable membrane (13 individuals with 23 implants) [Group 1], or with bone substitute alone (12 individuals with 22 implants) [Group 2]. All study individuals were kept on a strict maintenance programme every third month. ResultsFive-year follow-up demonstrated clinical and radiographic improvements in both groups. No implants were lost due to progression of peri-implantitis. Probing depths were reduced by 3.02.4mm in Group 1, and 3.3 +/- 2.09mm in Group 2 (NS). In both groups, radiographic evidence of bone gain was significant (p<0.001). At year 5, the average defect fill was 1.3mm (SD +/- 1.4mm) in Group 1 and 1.1mm (SD +/- 1.2mm) in Group 2 (mean diff; 0.4 95% CI -0.3, 1.2, p=0.24). Bleeding on probing decreased in both groups. Baseline and year 5 plaque scores did not differ between groups and was reduced from 50% to 15%. ConclusionBoth procedures resulted in stable conditions. Additional use of a membrane does not improve the outcome.

  • 49.
    Schwarz, Frank
    et al.
    Univ Klinikum Dusseldorf, DEU.
    Becker, Kathrin
    Univ Klinikum Dusseldorf, DEU.
    Bastendorf, Klaus-Dieter
    PROED, ITA.
    Cardaropoli, Daniele
    PROED, ITA.
    Chatfield, Christina
    Dent Hlth Spa, GBR.
    Dunn, Ian
    Univ Liverpool, GBR.
    Fletcher, Paul
    Columbia Univ, USA.
    Einwag, Johannes
    Ctr Continuing Dent Educ, DEU.
    Louropoulou, Anna
    Univ Amsterdam, NLD.
    Mombelli, Andrea
    Univ Geneva, CHE.
    Ower, Philip
    Univ Zurich, CHE.
    Pavlovic, Pedja
    Univ Bern, CHE.
    Sahrmann, Philipp
    Univ Bern, CHE.
    Salvi, Giovanni E.
    Univ Bern, CHE.
    Schmage, Petra
    Univ Hamburg, DEU.
    Takeuchi, Yasuko
    Univ Amsterdam, NLD.
    Van Der Weijden, Fridus
    Univ Amsterdam, NLD.
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Recommendations on the clinical application of air polishing for the management of peri-implant mucositis and peri-implantitis2016In: QUINTESSENCE INTERNATIONAL, ISSN 0033-6572, Vol. 47, no 4, p. 293-296Article in journal (Refereed)
    Abstract [en]

    Air polishing was introduced as an alternative approach for the supra- and submucosal biofilm management at dental implants. An international expert meeting involving competent clinicians and researchers took place during the EUROPERIO 8 conference in London, UK, on 4 June 2015. Prior to this meeting a comprehensive systematic review dealing with the efficacy of air polishing in the treatment of peri-implant mucositis and peri-implantitis was prepared and served as a basis for the group discussions. This paper summarizes the consensus statements and practical recommendations on the clinical application of air polishing for the management of peri-implant mucositis and peri-implantitis.

  • 50.
    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.

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  • text
  • asciidoc
  • rtf