MBRU Theses & Dissertations

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Airflow for initial non-surgical treatment of peri-implantitis: a systematic review and meta-analysis
(2022) Almatrooshi, Aisha
Background: Non-surgical treatment of peri-implantitis may help in reducing microbial load and inflammatory parameters. The potential clinical benefits of using different treatment approaches, in the initial non-surgical treatment phase, particularly the airflow, are still not clear. The aim of this systematic review and meta-analyses was to evaluate the outcomes of non-surgical treatment of peri-implantitis using airflow method in terms of changes in periodontal parameters, peri-implant marginal bone level, postoperative pain/discomfort and patient satisfaction. Methods: Electronic databases were searched to identify randomized controlled trials (RCTs) that compared airflow with mechanical debridement using ultrasonic/curettes. The risk of bias was assessed using the Cochrane Collaboration’s Risk of Bias tool. Data were analyzed using a statistical software program. Results: A total of 316 studies were identified, of which, five RCTs with 288 dental implants in 174 participants were included. Overall meta-analysis showed more reduction in probing pocket depths at one to three months (mean difference (MD) -0.23; 95% confidence interval (CI) -0.50 to 0.05; P = 0.10) and six months (MD -0.04; 95% CI -0.34 to 0.27; P = 0.80) in favour of airflow, but the difference was not statistically significant. The use of airflow was associated with significant reduction in bleeding on probing and increase in peri-implant mucosal recession. The differences in plaque score, peri-implant marginal bone level changes, and patient reported outcomes between airflow and mechanical debridement were not statistically significant. Conclusions: The short-term clinical and radiographic outcomes following non-sugical treatment of peri-implantitis using airflow or mechanical debridement were comparable. The airflow has short-term positive effects on reducing bleeding on probing. Further evidence from RCTs are still required to substantiate the current findings.
Alveolar Ridge Preservation: a Cochrane Systematic Review and Metaanalysis
(2022) Ahmad, Sara Ali Hussain
Background: Alveolar bone changes following tooth extraction can compromise prosthodontic rehabilitation. Alveolar ridge preservation (ARP) has been proposed to limit these changes and improve prosthodontic and aesthetic outcomes when implants are used. Aim: To evaluate the effects of various materials and techniques for ARP after tooth extraction compared with extraction alone or other methods of ARP in patients requiring dental implant placement. Materials and Methods: Electronic databases were searched to identify randomized controlled trials (RCTs) on the use of ARP techniques with at least six months of follow-up. The risk of bias was assessed using the Cochrane Collaboration’s Risk of Bias tool. Data were analysed using a statistical software program. Results: A total of 16 RCTs with 524 extraction sockets in 426 participants were included. The meta-analysis showed a very low certainty evidence of a reduction in loss of alveolar ridge width (mean difference (MD) -1.18 mm, 95% confidence interval (CI) -1.82 to -0.54; P = 0.0003) and height (MD -1.35 mm, 95% CI -2.00 to -0.70; P < 0.0001) in favour of xenograft when compared to extraction alone. There are no significant differences in the need for additional augmentation or implant failure between xenograft and extraction alone. No serious adverse events were reported with most trials indicating that the procedure was uneventful. Conclusion: ARP techniques may minimise the overall changes in residual ridge height and width six months after extraction but the evidence is very uncertain. There is no evidence of any clinically significant difference between different grafting materials and barriers used for ARP.
Assessment of Anterior Maxillary Labial Bone Thickness Using Cone-Beam Computed Tomography: A Retrospective Analysis
(2022) Al Ali, Fawaghi
Background: The morphological variations observed in labial bone thickness (LBT) around maxillary anterior teeth can affect the three-dimensional placement of dental implants and its long-term outcomes; making it imperative for clinicians to thoroughly examine the LBT prior to tooth extraction. Aim: To measure LBT in relation to the six anterior maxillary teeth at different levels along the long axis and the distance between cemento-enamel junction and bone crest (CEJ-BC) based on Cone-Beam Computed Tomography (CBCT) scans retrieved from patients’ records and identify any association with patients’ characteristics. Materials and Methods: A total of 100 CBCT scans were evaluated by one calibrated examiner. The thickness of the labial bone was measured perpendicular to the long axis of the tooth at 1, 3 and 5 mm from the alveolar crest (LBT-1, LBT-3, LBT-5, respectively) and CEJBC using medical imaging viewer. Results: CBCT scans of 58 females and 42 males with a mean age of 39.7 ± 9.5 years were included. A high variation of CEJ-BC was observed (range 0.55 – 3.90 mm). Statistically significant higher CEJ-BC values were associated with males and increased age (> 50 years). The overall means of LBT-1 were 0.76 ± 0.26, 0.79 ± 0.26 and 0.83 ± 0.37 mm; LBT-3: 0.92 ± 0.36, 1.05 ± 0.46 and 1.03 ± 0.48 mm; LBT-5: 1.17 ± 0.52, 0.80 ± 0.45 and 0.81 ± 0.40 mm for central-, lateral incisors and canines, respectively. The LBT was less than 1 mm in 74.2% ii of all maxillary anterior teeth with central incisor being the thinnest site (85%). No significant association between LBT and patient characteristics was observed. Conclusion: The CEJ-BC distance is greater in males and increases with age, particularly in those older than 50 years. The LBT in the six maxillary anterior teeth is predominantly thin (< 1 mm) and has no correlation to age or gender. An increased LBT was observed at 3 mm level when compared with LBT-1 and LBT-5. Such variability should be taken into consideration when planning for immediate implant placement.
Diode laser as an adjunctive treatment for peri-implant mucositis: a systematic review and meta-analysis
(2022) Fadhel, Israa Amir
Background: The early detection and treatment of peri-implant mucositis may help in reducing inflammatory parameters and arrest disease progression to peri-implantitis. The potential clinical benefits of using different adjunctive therapies, such as the diode laser, are still not clear. Aim: The aim of this systematic review and meta-analyses was to evaluate the outcomes of using diode laser on the treatment of peri-implant mucositis in terms of changes in periodontal parameters. Materials and Methods: Electronic databases were searched to identify randomized controlled trials (RCTs) that compared the combined use of mechanical debridement and diode laser with mechanical debridement alone. The risk of bias was assessed using the Cochrane Collaboration’s Risk of Bias tool. Data were analyzed using a statistical software program. Results: A total of 149 studies were identified, of which, three RCTs with 311 dental implants in 311 participants were included. Overall meta-analysis showed more reduction in probing pocket depths (mean difference (MD) -0.36; 95% confidence interval (CI) -0.88 to 0.16; P = 0.18) and bleeding on probing (MD -0.71; 95% CI -1.58 to 0.16; P = 0.11) at three months in favour of diode laser, but the differences were not statistically significant. Conclusion: In the management of peri-implant mucositis, the combined use of diode laser and mechanical debridement have positive short-term effect on periodontal parameters but any additional clinical advantage over mechanical debridement alone is still not clear. Long-term, well-designed RCTs are still needed to substantiate the clinical benefits of using diode laser as an adjunctive therapy in the management of peri-implant mucositis.
The Prevalence of Periodontal Disease among Diabetic Patients in Local Health Centers in Bahrain
(2018-08) Abdulla, Taha
Introduction: The occurrence and progression of periodontal disease is associated with poor diabetic control. To date there have been no studies to assess the prevalence of periodontal disease in diabetic patients attending health centers in Bahrain. Aims: 1. To compare the prevalence of periodontal disease among diabetic patients with and without diabetic complications. 2. To determine if there is a difference in prevalence of severe periodontitis in controlled and uncontrolled diabetic patients. 3. To determine if there is a difference in prevalence of severeperiodontitis in patients with history of diabetes more than five years and five years or less Material and Methods Ethical approval and patient consent were obtained. Within the 5 health regions in Bahrain there are 24 non communicable disease clinics. A systematic stratified sampling technique was used to randomly select one clinic from each region and examine diabetics from each clinic for periodontal disease. The calculated sample size was 89. Two examiners screened for gingivitis or periodontitis using the Basic Periodontal Examination (BPE). Demographic and medical data including co-morbidities such as BMI, glycemic control level and diabetic complications were recorded. Results A total of 243 diabetic subjects with an overall mean age of 55.4 years (±11.4) met the inclusion criteria. There were 109 males, mean age 56.6 years (±12.2) and 134 females, mean age 54.3 years (±10.8) with no statistically significant age difference. Most subjects were obese according to the BMI (61%) and had type 2DM (95.5%). 91 (46%) subjects had at least 1 co-morbidity, most commonly nephropathy. BPEcodes 3 or 4 were found in over 93% of subjects (n=228) indicative of a high point prevalence of periodontitis in this sample of diabetic patients attending health centersin Bahrain. Furthermore, a significantly greater proportion of uncontrolled diabetics (HbA1c≥64 mmol/mol) had severe periodontitis, OR=1.64 (95%CI 1.0-2.8) compared to controlled diabetes. Diabetic complications and duration of diabetes showed no significant association with severity of periodontal disease. Conclusions Periodontitis was very prevalent in this sample of diabetics (93.8%). Uncontrolled diabetics were more likely to have severe periodontitis than well controlled diabetics. Nephropathy and obesity were the most common co-morbidities. Periodontal care should be an integral part of DM management.
The Prevalence of Periodontitis in Obese Adults In The Kingdom Of Bahrain
(2018-08) Al Salihi, Leena
Background: Adult obesity in Bahrain is an increasing problem and evidence suggests obesity could be a novel risk factor for periodontitis.This study aimed to assess prevalence of periodontitis in overweight/obese adults attending Ministry of Health (MOH)clinics in Bahrain and to determine which measure of obesity, body mass index (BMI)or waist circumference (WC),is associated with periodontitis. Materials and Methods: This was a cross-sectional study of a convenience sample of overweight subjects attending MOH Nutrition Clinics at primary health centers. Ethical approval and patient consent were obtained prior to the study. A range of demographic and anthropometric data, including BMI and WC using WHO thresholds for severity of obesity, were recorded. Dental assessments of periodontal status were based on CPI probing depths at six sites per tooth and the extent of periodontal disease was categorized according to the number of sextants with CPI codes 3 and 4. Results: A total of 372 participated with a mean age 44.0 (±10.5) years for males, and 42.5 (±11.2) years for females. Periodontitis was present in 361 (97%) of participants. Hypertension and diabetes were the most prevalent co-morbidities at 23.4% and 16% respectively. Mean WC was significantly greater in males at 114cm (±15.6) compared to females 109.5cm (±12.5) (p<0.001). BMI was not associated with severity or extent of periodontitis but WC was weakly correlated in males but not in females (Spearman rho=+0.2, p<0.05). In the logistic regression model using overall WC to predict the severity of periodontitis, the adjusted OR was 1.02 (95%CI 1.00-1.04) and for age it was 1.05 (95%CI 1.00-1.07). Conclusion: The prevalence of periodontitis was high in this sample of overweight Bahrainis. BMI was not correlated with periodontitis but WC had a weak positive correlation. Implementation of a periodontal health screening as a routine part of a Nutrition Clinic program is required as a preventive approach.
Study to Evaluate Gingival Crevicular Blood as a Screening Tool for Blood Glucose Concentration
(2018-08) Alhamoudi, Asmaa
Introduction: There is a high prevalence of type 2 diabetes mellitus (DM) in the UAE. Recent national guidelines advise screening for undiagnosed diabetes in all adults aged ≥ 30 years. This study assessed the feasibility of identifying undiagnosed diabetes and prediabetes using gingival crevicular blood in patients with periodontitis. Material and Methods: Twenty healthy controls (Group I) and twenty known diabetics (Group II) were recruited from the Periodontics Department in a cross-sectional study of 40 adults with chronic periodontitis. Gingival crevicular blood and capillary finger blood glucose concentration obtained during routine periodontal examination were analyzed by an Accu–Chek® Performa self-monitoring device. Diurnal effects were controlled. Results: The mean age for Group I was 39.5 years (9.8) and for Group II it was 45.5 (10.2) with no significant difference by age between the two groups. The mean duration of diabetes in Group II was 5.7 (3.2) years. Mean blood glucose concentration from gingiva and finger within each group were not significantly different. Mean finger blood glucose concentration in Group II was significantly higher at 172(47) mg/dL than for Group I, 115.1(17) mg/dL (t=5.03, p<0.001). Similarly, mean gingival blood glucose was significantly higher in Group II compared to Group I, 173.2 (47.7) mg/dL and 116.3 (16.7) mg/dL respectively (p<0.001). There was a very strong correlation between mean blood glucose from finger capillaries and IIIgingiva (0.996; p<0.001) within each group irrespective of gender, age, periodontitis and duration of diabetes. The duration of diabetes was highly predictive for both gingival and finger blood glucose concentration (p<0.001). Within Group I, 5 of the 20 patients were identified as pre-diabetic with a blood glucose concentration above 140 mg/dL. Conclusions: Gingival crevicular blood glucose can be measured with the Accu-Chek® Performa safely and easily to screen for the diabetic status of patients with bleeding on probing.

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