Objectives Periodontitis and diabetes are known to have a bidirectional relationship. Diabetic macular edema is a complication of diabetes that is strongly influenced by inflammatory pathways. However, it remains to be established whether inflammation at other locations, such as periodontitis, affects diabetic macular edema. Here, we investigated the prevalence of periodontitis in patients treated for diabetic macular edema. Materials and methods Patients with diabetic macular edema were recruited for this cross-sectional study at the Medical University of Graz. Macular edema was documented by optical coherence tomography. Periodontal status was assessed by computerized periodontal probing and panoramic X-ray imaging. Bleeding on probing, clinical attachment level, probing pocket depth, and plaque index were compared between different stages of diabetic retinopathy. Results Eighty-three eyes of 45 patients with diabetic macular edema were enrolled. Forty-four eyes (53.0%) had early stages of diabetic retinopathy (mild and moderate), and 39 eyes (47.0%) had late stages (severe and proliferative). Patients with mild or moderate DR were more likely to have more severe periodontal conditions than patients with severe or proliferative DR. Fourteen patients with mild DR (82.4%), 7 patients with moderate DR (87.5%), 4 patients with severe DR (100.0%), and 15 patients with proliferative DR (93.8%) had some degree of PD. The periodontal inflamed surface areas and the percentages of tooth sites that bled on probing were significantly higher in patients with early stages of diabetic retinopathy than in those with late stages of the disease (p < 0.05). Patients with periodontal inflamed surface areas of more than 500 mm2 required significantly more intravitreal injections in the last year than those with milder forms of periodontitis (n = 6.9 ± 3.1 versus n = 5.0 ± 3.5, p = 0.03). Conclusion In patients with diabetic macular edema, periodontitis is more prevalent in early stages of diabetic retinopathy. We suggest regular dental check-ups for diabetic patients, especially when diabetic macular edema is already present. Clinical relevance Patients with diabetic macular edema should be screened for periodontitis and vice versa, particularly early in the course of diabetes.

Background and aims:Observational studies support an association between periodontitis and cardiovascular diseases. The study objective was to assess vascular inflammation after periodontal treatment in patients with peripheral arterial disease. Methods: Ninety patients with peripheral arterial disease (PAD) and severe periodontitis were enrolled in a randomized, controlled trial. Thirty patients underwent non-surgical periodontal therapy and received additional systemic antibiotics (PT1 group), while 30 patients received the same therapy without antibiotics (PT2 group). The remaining thirty patients did not receive periodontal therapy (CG, control group). The primary outcome of this treatment was a reduction in vascular inflammation three months after periodontal treatment as determined by 18 F-FDG PET/CT values. Secondary outcomes were changes in the inflamed periodontal surface area (PISA) and other periodontal parameters, changes in vascular biomarkers, and adverse cardiovascular events. Results: After three months of treatment, a significant improvement in periodontal health was observed in the treatment groups. However, no difference in the primary outcome in the aorta was observed in the three study groups (median target to background ratio follow-up/baseline, PT1 1.00; 95% CI 0.97-1.10, PT2 1.00; 95% CI 0.98-1.1, CG 1.1; 95% CI 0.99-1.1, p = 0.75). No significant differences were detected in most diseased segments and active segments. In addition, no differences were observed in 18 F-FDG uptake in the carotid, iliac, femoral, and popliteal arteries. No differences with regard to relative changes in vascular biomarkers were noted, and no serious cardiovascular adverse events occurred. Conclusions: Periodontal treatment was effective and safe but did not reduce vascular inflammation in patients with PAD.

Objectives Periodontal disease occurs frequently in patients with limited cutaneous systemic sclerosis (lcSSc) while data about underlying pathways contributing to periodontal changes are scarce. The aim of this study was to evaluate periodontal disease and to investigate its association with endothelial dysfunction and clinical changes in patients with lcSSc. Methods In 38 lcSSc patients and 38 controls, periodontal status was evaluated by disease‐specific questionnaire, dental examination including bleeding on probing (BOP), pocket depth, and plaque index, and dental panoramic radiograph. Periodontopathogen bacteria were collected subgingivally using paper points and interleukin‐1 (IL‐1) gene polymorphisms were evaluated using buccal swabs. Endothelial dysfunction was measured by flow‐mediated dilatation, pulse‐wave velocity and biochemical analysis, including arginine metabolites and endothelial microparticles. Additionally, lcSSc‐specific clinical changes and parameters were recorded. Results Periodontitis was present in 31 patients with lcSSc (81.6%) and in 27 controls (71.1%) (p = .280). LcSSc patients had a lower teeth number (p = .039) and Eikenella corrodens was to a higher degree detectable in patients with lcSSc (p = .041) while the remaining periodontal parameters revealed no differences between both cohorts. Significant correlations between parameters of arterial stiffness, EUSTAR index, number of teeth and BOP were observed (all p < .05). Detection of Prevotella intermedia was associated with selected IL‐1 gene polymorphisms (p = .032) and Porphyromonas gingivalis was associated with severe periodontitis (p = .041). Conclusion Periodontal disease may occur frequently in patients with lcSSc and may be associated with arterial stiffness and with SSc activity.

ObjectivesPathways contributing to endothelial dysfunction in patients with limited cutaneous systemic sclerosis (lcSSc) are largely unknown. The aim of this study was to investigate potential associations of amino acids and parameters of bone metabolism with endothelial dysfunction and vasculopathy-related changes in patients with lcSSc and early-stage vasculopathy.MethodsAmino acids, calciotropic parameters, including 25-hydroxyvitamin D and parathyroid hormone (PTH), and bone turnover parameters, including osteocalcin and N-terminal peptide of procollagen-3 (P3NP), were measured in 38 lcSSc patients and 38 controls. Endothelial dysfunction was assessed by biochemical parameters, pulse-wave analysis, flow-mediated and nitroglycerine-mediated dilation. Additionally, vasculopathy-related and SSc-specific clinical changes including capillaroscopic, skin, renal, pulmonary, gastrointestinal and periodontal parameters were recorded.ResultsNo significant differences in amino acids, calciotropic and bone turnover parameters were observed between lcSSc patients and controls. In patients with lcSSc, several significant correlations were found between selected amino acids, parameters of endothelial dysfunction, vasculopathy-related and SSc-specific clinical changes (all with p &lt; 0.05). In addition, significant correlations were observed between PTH and 25-hydroxyvitamin D with homoarginine, and between osteocalcin, PTH and P3NP with modified Rodnan skin score and selected periodontal parameters (all with p &lt; 0.05). Vitamin D deficiency defined as 25-hydroxyvitamin D &lt; 20 ng/ml was associated with the presence of puffy finger (p = 0.046) and early pattern (p = 0.040).ConclusionSelected amino acids may affect endothelial function and may be associated to vasculopathy-related and clinical changes in lcSSc patients, while the association with parameters of bone metabolism seems to be minor.

Nutrition plays a crucial role in the pathophysiology and management of peripheral arterial disease (PAD) and periodontal disease (PD). As PD can have profound effects on an individual’s functional ability to eat and can affect nutrient intake, we aimed to evaluate the role of PD severity on dietary intake (DI) and quality in PAD patients and compare it with current dietary recommendations for CVD. PD stages of 421 consecutive PAD patients were determined according to a standardised basic periodontal examination (Periodontal Screening and Recording Index) (‘healthy’, ‘gingivitis’, ‘moderate periodontitis’ and ‘severe periodontitis’). Dietary intake (24-h recall), dietary quality (food frequency index (FFI)) and anthropometrical data were assessed. Nutritional intake was stratified according to the severity of PD. No significant differences in DI of macronutrients, nutrients relevant for CVD and FFI were seen between the PD stages. Only median alcohol intake was significantly different between gingivitis and severe periodontitis (P = 0·001), and positively correlated with PD severity (P = 0·001; r 0·159). PD severity and the patient’s number of teeth showed no correlation with investigated nutritional parameters and FFI. Few subjects met the recommended daily intakes for fibre (5 %), SFA (10 %), Na (40 %) and sugar (26 %). Macronutrient intake differed from reference values. In our sample of patients with PAD and concomitant PD, we found no differences in DI of macronutrients, nutrients relevant for CVD and diet quality depending on PD severity. The patients’ nutrition was, however, poor, deviating seriously from dietary guidelines and recommendations.

Background : Several studies have compared different materials with each other in order to find suitable materials for dental implants, abutments, healing abutments, and fixed dentures. Many of these have focused on biological complications and have compared titanium (Ti) and zirconia (ZrO2) as material. In addition to ZrO2-based and Ti-based materials, research is increasingly being conducted on polymethylmethacrylate (PMMA) as a material for fixed dentures or healing abutments.Aim/Hypothesis : Aim of this prospective study was to compare the effect of different abutments materials (Ti, Zr, PMMA) on marginal bone loss (MBL) one-year post-loading. The hypothesis was that there is no difference in MBL.Material and Methods : 30 subjects received two-piece titanium implants in single-tooth gaps and were randomized into 3 groups. After a submerged healing period of 3 months, healing abutments made of titanium, zirconia or PMMA (group 1-3) were placed. 3 months after implant exposure, Ti and Zr group received permanent all-ceramic restoration with Ti or Zr abutments. The PMMA group received a provisional PMMA restoration. 3 and 15 months after implant exposure (baseline), intraoral digital radiographs (Sirona D3507, Sirona Dental Systems GmbH, Bensheim, Germany) with rectangular collimation were obtained to measure the mesial and distal bone loss around each implant. All radiographs were investigated in twofold magnification for evaluability by two experienced investigators, not involved in the clinical procedure, and statistically analysed. MBL was calculated as the difference between the bone levels, where negative MBL values indicate a bone loss.Results : The titanium group (group 1) had a mean MBL of -0.09 ± 0.33 mm, whereas the bone losses of PMMA (group 3) resulted in -0.16 ± 0.22 mm and MBL of the Zr group (group 2) showed the highest results -0.38 ± 0.33 mm. MBL values showed differences between Ti group (group 1) and the two other groups. PMMA (group 3) showed slightly better values than Zr (group 2), whereby this difference is not significant (one-factorial analysis of variance with P = 0.106 for the change from 3 to 15 months). Marginal bone loss 12 month after loading is displayed as a boxplot graph, too. Conclusion and Clinical Implications: Only studies comparing Ti and Zr abutments exist. 1-year results of Hosseini et al. showed similar MBL for Ti and Zr abutments; De Albornoz et al. found minimal mean peri-implant bone level changes at 1 year. Our results showed that MBL were comparable to the results of other publications. Thus, all materials seem appropriate as healing abutments and abutments concerning MBL.Further long-term investigations are necessary prior to application of PMMA as abutment material.

Background : Poly-ether-ether-ketone (PEEK) a semi-crystalline linear polycyclic thermoplastic has been proposed as substitute for metals and ceramics in biomaterials. PEEK has recently also been introduced in implant dentistry as material for superstructures and implant abutments. Aim/Hypothesis : The aim of this randomized clinical trial was to compare three different abutment materials-customized ceramic reinforced PEEK, titanium and zirconia abutments-and their effect on peri-implant tissue healing over an observation period of 3 years. Materials and Methods : In this randomized clinical trial 60 patients are treated in three different treatment groups. A block randomization sequence was used to assign the abutments. Twelve weeks after implant insertion (baseline) all implants are restored with screw retained individual CAD/CAM abutments (ceramic reinforced PEEK n = 20, titanium n = 20, zirconia n = 20) and CAD/CAM designed High Impact Polymer Composite (HIPC) crowns. Assessments of bleeding on probing (BOP), plaque INDIAx (PI), probing depths (PD), recessions, technical complications and mean marginal bone levels are recorded after 0, 3, 6, 12, 24 and 36 months. Results : So far, no significant differences (P > 0.05) in any of the evaluated parameters could be detected between the three different treatment groups. Conclusions and Clinical Implications : Thus, it seems ceramic reinforced PEEK maybe a promising alternative material for the fabrication of dental implant abutments evolving comparable clinical short-term results as the standard materials titanium and zirconia. However long-term results are necessary for its final approval.

Background : In addition to zirconia-based and titanium-based materials, research is increasingly being conducted on polymethylmethacrylate (PMMA) as a material for fixed dentures or healing abutments. Studies showed that the mechanical properties of PMMA fixed dentures have superior mechanical properties compared to conventional fixed dentures (Alt et al. 2011, Stawarczyk et al. 2012). The effects of healing abutments with PMMA surfaces on parameters of peri-implant infections have not been investigated Aim/Hypothesis : Aim of this prospective study was to compare the effect of different abutments materials (Ti, Zr, PMMA) on parameters of peri-implant infections. The hypothesis was that there is no difference in clinical and histological parameters. Material and Methods : In the present clinical study, 30 two-piece titanium implants were inserted in single-tooth gaps of 30 patients. After a submerged healing period of 3 months, the subjects received healing abutments made of titanium, zirconia or PMMA (group 1-3). Permanent allceramic restoration was performed 6 months after surgery for the Ti and Zr group. The PMMA group received a provisional PMMA restoration. The following parameters were evaluated. The inflammatory response mediated by MMP-8 level in peri-implant sulcus fluid adjacent to the different materials. Sensitive and reliable parameters of peri-implant infections as pocket probing depths (PPD), bleeding on probing (BOP), plaque index (PI), and radiographic interpretation of single-tooth x-ray for measuring marginal bone loss (MBL). Patient satisfaction. Results : Assessment at baseline (placement of healing abutments) and follow-ups after 2 weeks, 2, 3, 6, 12, and 15 months revealed no significant differences in MMP-8 level and in clinical parameters (PPD, BOP, PI, MBL) between the three groups. Patient satisfaction revealed that zirconia and PMMA as abutment material were favorable over titanium. The MMP-8 levels showed that titanium had the highest values at each examination date followed by PMMA and zirconia. All mean values were below 10 ng/mL, whereas values of 8 ng/mL are considered as healthy. In all groups, PPD, BOP, PI, and MBL were similar. Conclusions and Clinical Implications : The results showed that clinical parameters were comparable to the results of other publications. Thus, all materials seem appropriate as healing abutments concerning biological complications. Further long-term investigations are necessary prior to application of PMMA as abutment material.