Periodontitis has been independently associated with the chronic noncommunicable diseases that most frequently lead to death worldwide. The aim of the present systematic review was to study whether people with periodontitis/edentulism are at increased risk of all-cause and cause-specific mortality as compared with those without periodontitis/edentulism. Cohort studies were included that 1) evaluated periodontitis or edentulism as exposures in relation to all-cause or cause-specific mortality as an outcome and 2) reported effect estimates as hazard ratios, risk ratios, or odds ratios with 95% CIs or crude numbers. Two review authors independently searched for eligible studies, screened the titles and abstracts, did full-text analysis, extracted the data from the published reports, and performed the risk-of-bias assessment. In case of disagreement, a third review author was consulted. Study results were summarized through random effects meta-analyses. A total of 57 studies were included, involving 48 cohorts and 5.71 million participants. Periodontitis was associated with increased risk of all-cause mortality (risk ratio, 1.46 [95% CI, 1.15 to 1.85]) and mortality due to cardiovascular diseases (1.47 [1.14 to 1.90]), cancer (1.38 [1.24 to 1.53]), coronary heart disease (2.58 [2.20 to 3.03]), cerebrovascular diseases (3.11 [2.42 to 3.98]), but not pneumonia (0.98 [0.69 to 1.38]). Edentulism (all types) was associated with increased risk of all-cause mortality (1.66 [1.46 to 1.88]) and mortality due to cardiovascular diseases (2.03 [1.50 to 2.74]), cancer (1.55 [1.24 to 1.94]), pneumonia (1.72 [1.07 to 2.78]), coronary heart disease (2.98 [2.43 to 3.65]), and cerebrovascular diseases (3.18 [2.24 to 4.51]). Periodontitis and its ultimate sequela (edentulism) are associated with an increased risk of all-cause and cause-specific mortality (PROSPERO CRD42018100095).

AimTo evaluate the prevalence of peri‐implant diseases and to identify risk/protective indicators of peri‐implantitis.Materials and MethodsTwo hundred and forty randomly selected patients from a university clinic database were invited to participate. Those who accepted, once data from their medical and dental history were collected, were examined clinically and radiographically to assess the prevalence of peri‐implant health and diseases. Peri‐implantitis was defined as the presence of BoP/SoP together with radiographic bone levels (BL) ≧2 mm. An intermediate peri‐implant health category between peri‐implant mucositis and peri‐implantitis was also identified, defined by the presence of BoP/SoP together with 1 mm ≦BL < 2 mm. A multilevel multivariate logistic regression analysis was carried out to identify those factors associated either positively (risk) or negatively (protective) with peri‐implantitis.ResultsNinety‐nine patients with a total of 458 dental implants were analyzed. The prevalences of pre‐periimplantitis and of peri‐implantitis were, respectively, 31.3% and 56.6% at patient‐level, while 31.7% and 27.9% at implant level. The following factors were identified as risk indicators for peri‐implantitis: smoking (OR = 3.59; 95% CI: 1.52–8.45), moderate/severe periodontitis (OR = 2.77; 95% CI: 1.20–6.36), <16 remaining teeth (OR = 2.23; 95% CI: 1.05–4.73), plaque (OR = 3.49; 95% CI: 1.13–10.75), implant malposition (too vestibular: OR = 2.85; 95% CI: 1.17–6.93), implant brand (Nobel vs. Straumann: OR = 4.41;95% CI: 1.76–11.09), restoration type (bridge vs. single crown: OR = 2.47; 95% CI: 1.19–5.12), and trauma as reason of tooth loss (vs. caries: OR = 6.51; 95% CI: 1.45–29.26). Conversely, the following factors were identified as protective indicators: interproximal flossing/brushing (OR = 0.27; 95% CI: 0.11–0.68), proton pump inhibitors (OR = 0.08; 95% CI: 0.01–0.90), and anticoagulants (OR = 0.08; 95% CI: 0.01–0.56).ConclusionsPeri‐implant diseases are highly prevalent among patients with dental implants in this university‐based population. Several factors were identified as risk‐ and protective‐ indicators of peri‐implantitis.

Aim: This systematic review of randomized controlled trials (RCTs) aims to answer to the following question: "In patients undergoing dental implant placement, which is the best antibiotic prophylaxis protocol to prevent early failures?" Materials and Methods: The MEDLINE, SCOPUS, CENTRAL and Web of Knowledge electronic databases were searched in duplicate for RCTs up to July 2017. Additional relevant literature was identified through (i) handsearching on both relevant journals and reference lists, and (ii) searching in databases for grey literature. A network metaanalysis (NMA) was conducted, and the probability that each protocol is the "Best" was estimated.Results: Nine RCTs were included, with a total of 1,693 participants. Due to the few events reported, it was not possible to conduct a NMA for adverse events, therefore it was conducted only for implant failures (IF). The protocol with the highest probability (32.5%) of being the "Best" one to prevent IF was the single dose of 3 g of amoxicillin administered 1 hr pre-operatively. Even if the single pre-operative dose of 2 g of amoxicillin is the most used, it achieved only a probability of 0.2% to be the "Best" one. Conclusions:Basing on the available RCTs, the use of antibiotic prophylaxis is protective against early implant failures. Whenever an antibiotic prophylaxis is needed, there is still insufficient evidence to confidently recommend a specific dosage. The use of post-operative courses does not seem however to be justified by the available literature. Prospero registration number: CRD42015029708. K E Y W O R D S adverse events, antibiotic prophylaxis, early failures, early implant failures, implant placement, implant survival, network meta-analysis, penicillins, side effects, systematic review | 383 ROMANDINI et Al.

A novel, direct and independent association between sleep duration and the prevalence of periodontitis was found. However, it needs to be investigated how the factors influencing the sleep duration affect this association.

Within the limitations of this study, periodontitis-especially severe-is independently associated with a considerable increase in platelet count which is explained, at least in part, by an increase in the systemic inflammation.

Aim. To evaluate the prevalence of peri-implant diseases and to identify risk/protective indicators of peri-implantitis. Materials and Methods. 240 randomly selected patients from a university clinic database were invited to participate. Those who accepted, once data from their medical and dental history was collected, were examined clinically and radiographically to assess the prevalence of peri-implant health and diseases. A multilevel multivariate logistic regression analysis was carried out to identify those factors associated either positively (risk) or negatively (protective) with peri-implantitis defined as BoP/SoP and bone levels ≥2 mm. Results. 99 patients with a total of 458 dental implants were analyzed. The prevalence of pre-periimplantitis and of peri-implantitis were respectively 56.6% and 31.3% at patient-level, while 27.9% and 31.7% at implant-level. The following factors were identified as risk indicators for peri-implantitis: smoking (OR=3.59; 95%CI:1.52-8.45), moderate/severe periodontitis (OR=2.77; 95%CI:1.20-6.36), <16 remaining teeth (OR=2.23; 95%CI:1.05-4.73), plaque (OR=3.49; 95%CI:1.13-10.75), implant malposition (too vestibular: OR=2.85; 95%CI:1.17-6.93), implant brand (Nobel vs. Straumann: OR=4.41;95% CI:1.76-11.09), restoration type (bridge: OR=2.47; 95%CI:1.19-5.12), and trauma as reason of tooth loss (OR=6.51;95% CI:1.45-29.26). Conversely, the following factors were identified as protective indicators: interproximal flossing/brushing (OR=0.27; 95%CI:0.11-0.68), proton pump inhibitors (OR=0.08; 95%CI:0.01-0.90) and anticoagulants (OR=0.08; 95%CI:0.01-0.56). Conclusions. Peri-implant diseases are highly prevalent among patients with dental implants in this university-based population. Several factors were identified as risk- and protective-indicators of peri-implantitis.

Aim There are no nationally representative epidemiological studies available reporting on the different recession types according to the 2018 classification system or focusing on the aesthetic zone. The aims of this cross‐sectional study were (a) to provide estimates on the prevalence, severity and extent of mid‐buccal GRs according to the 2018 classification and (b) to identify their risk indicators in the adult U.S. population from the NHANES database. Materials and Methods Data from 10,676 subjects, representative of 143.8 millions of adults, were retrieved from the NHANES 2009–2014 database. GR prevalence was defined as the presence of at least one mid‐buccal GR ≥1 mm. GRs were categorized following the 2018 World Workshop classification system (RT1, RT2, RT3) and according to different severity cut‐offs. An analysis for GR risk indicators was also performed, selecting subjects without periodontitis. Results The patient‐level prevalence of mid‐buccal GRs (all types) was 91.6%, while it decreased to 70.7% when considering only the aesthetic zone. When focusing on RT1 GRs, the patient‐level prevalence (whole mouth) was 12.4%, while it was 5.8% considering only the aesthetic zone. The majority of RT1 GRs were considered as mild (1–2 mm). The whole‐mouth patient‐level prevalence of RT2 and RT3 GRs was 88.8% and 55.0%, respectively. Age (35–49 years), gender (female), ethnicity (non–Hispanic Whites), last dental visit (>6 months before), tooth type (incisors) and the arch (mandible) resulted as risk indicators associated with the presence of RT1 GR. Conclusions Mid‐buccal GRs affect almost the entire US population. Age, gender, ethnicity, dental care exposure, tooth type and arch were identified as risk indicators for RT1 GRs.

Traumas, malformative or dysplastic pathologies, atrophy, osteoradionecrosis, and benign or malignant neoplasm can cause bone deficits in the mandible. Consequent mandibular defects can determine aesthetic and functional problems; therefore, being able to perform a good reconstruction is of critical importance.Several techniques have been proposed for mandibular reconstruction over the years. In this article, we present and discuss the evolution during the time of the methods of mandible reconstruction as well as pros and cons of each procedure on the basis of experience of 10 years in the maxillofacial department of the Catholic University of Sacred Heart of Rome.Free flaps represent the gold standard method of reconstruction of large mandibular defects: the fibula bone flap represents the best choice for large defects involving the arch and the mandibular ramus, whereas the deep circumflex iliac artery represents a valid alternative for mandibular defects involving the posterior region.In cases where free flap reconstructions are contraindicated, the use of regional pedicle flap combined with autologous bone grafts still represents a valid choice. Patients who are not deemed suitable for long and demanding surgery can still be treated using alloplastic materials in association with regional pedicle flap or, when adjuvant radiation therapy is needed, by simple locoregional pedicle flap. Finally, in selected cases, the bone transporting technique should be considered as a valid alternative to the more "traditional" reconstructive methods because of the extraordinary potential and its favorable cost-benefit ratio.