Background: Dental plaque has been proven to initiate and promote gingival inflammation. Histologically, various stages of gingivitis may be characterized prior to progression of a lesion to periodontitis. Clinically, gingivitis is well recognized. Material & Methods: Longitudinal studies on a patient cohort of 565 middle class Norwegian males have been performed over a 26‐year period to reveal the natural history of initial periodontitis in dental‐minded subjects between 16 and 34 years of age at the beginning of the study. Results: Sites with consistent bleeding (GI=2) had 70% more attachment loss than sites that were consistenly non‐inflamed (GI=0). Teeth with sites that were consistently non‐inflamed had a 50‐year survival rate of 99.5%, while teeth with consistently inflamed gingivae yielded a 50‐year survival rate of 63.4%. Conclusion: Based on this longitudinal study on the natural history of periodontitis in a dentally well‐maintained male population it can be concluded that persistent gingivitis represents a risk factor for periodontal attachment loss and for tooth loss.

This study has shown that, as men approach 60 years of age, gingival sites that throughout the 26 years of observation bled on probing had approximately 70% more attachment loss than sites that were consistently non-inflamed (GI = 0). Before 40 years of age, there was a slight increase in periodontal attachment loss due to pocket formation, but after this, the frequency increased significantly. Loss of attachment due to gingival recession was very small in all three groups. The fact that sites with non-inflamed gingiva also exhibited some loss of attachment and pocket formation may be explained by fluctuation in the variations of tissue status during long observation intervals combined with the presence of subclinical inflammation.

Abstract:Aim: The purpose of this study was to systematically review the literature on survival rates of palatal implants, Onplants®, miniplates and mini screws. Material and Methods:An electronic MEDLINE search supplemented by manual searching was conducted to identify randomized clinical trials, prospective and retrospective cohort studies on palatal implants, Onplants®, miniplates and miniscrews with a mean follow-up time of at least 12 weeks and of at least 10 units per modality having been examined clinically at a follow-up visit. Assessment of studies and data abstraction was performed independently by two reviewers. Reported failures of used devices were analyzed using random-effects Poisson regression models to obtain summary estimates and 95% confidence intervals of failure and survival proportions. Results:The search up to January 2009 provided 390 titles and 71 abstracts with full-text analysis of 34 articles, resulting in 27 studies that met the inclusion criteria. In meta-analysis, the failure rate for Onplants® was 17.2% (95% confidence interval: 5.9% -35.8%), for palatal implants 10.5% (95% CI: 6.1% -18.1%), for miniscrews 16.4% (95% CI: 13.4% -20.1%) and 7.3% for miniplates (95% CI: 5.4% -9.9%). Miniplates and palatal implants, representing torque resisting temporary anchorage devices, when grouped together, showed a 1.92 fold (95% CI: 1.06 -2.78) lower clinical failure rate than miniscrews. Conclusions:Based on the available evidence in the literature, palatal implants and miniplates showed comparable survival rates of ≥90% over a period of at least 12 weeks, and yielded superior survival than miniscrews. Palatal implants and miniplates for temporary anchorage provide reliable absolute orthodontic anchorage. If the intended orthodontic treatment would require multiple miniscrew placement to provide adequate anchorage, the reliability of such systems is questionable. For patients who are undergoing extensive orthodontic treatment, force vectors may need to be varied or roots of the teeth to be moved may need to slide past the anchors. In this context, palatal implants or miniplates should be the TADs of choice.3

These results highlight the importance of treating early periodontitis along with smoking cessation, in those under 30 years of age. They further show that calculus removal, plaque control, and the control of gingivitis are essential in preventing disease progression, further loss of attachment and ultimately tooth loss.

The study confirmed the long held concept that restorations placed below the gingival margin are detrimental to gingival and periodontal health. In addition, this study suggests that the increased loss of attachment found in teeth with subgingival restorations started slowly and could be detected clinically 1 to 3 years after the fabrication and placement of the restorations. A subsequent "burn-out" effect was suggested.

Over a 26-year period, 25% of the subjects went through adult life with healthy and stable periodontal conditions. The remaining 75% developed slight to moderately progressing periodontal disease with progression rates varying between 0.02 and 0.1 mm/year with a cumulative mean of loss of attachment of 2.44 mm as they approached 60 years of age. The annual mean rate and the mean annualized risk of initial attachment loss were highest between 16 and 34 years of age. Only 20% of the sites continued to lose further attachment during the remainder of the observation period, and less than 1% of the sites showed substantial loss of attachment (> 4 mm).

Aim: The purpose of this investigation was to examine the long‐term relationship between dental restorations and periodontal health. Material and Methods: The data derived from a 26‐year longitudinal study of a group of Scandinavian middle‐class males characterized by good to moderate oral hygiene and regular dental check‐ups. At each of 7 examinations between 1969 and 1995, the mesial and buccal surfaces were scored for dental, restorative and periodontal parameters. The mesial sites of premolars and molars of 160 participants were observed during 26 years (1969–1995). A control group with 615 sound surfaces or filling margins located more than 1 mm from the gingival margin in all 7 surveys was compared with a test cohort with 98 surfaces which were sound or had filling margins located more than 1 mm from the gingival margin at baseline (1969) and had a subgingival filling margin 2 years after (1971). Results and conclusions: The study confirmed the long held concept that restorations placed below the gingival margin are detrimental to gingival and periodontal health. In addition, this study suggests that the increased loss of attachment found in teeth with subgingival restorations started slowly and could be detected clinically 1 to 3 years after the fabrication and placement of the restorations. A subsequent “burn‐out” effect was suggested.

CBCT should not be recommended for use in all orthodontic patients as a substitute for a conventional set of radiographs. In CBCT, reducing the height of the field of view and shielding the thyroid are advisable methods and must be implemented to lower the exposure dose.