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The concept of using rotary tools to cut hard materials, such as granite, is at least 6,000 years old. As early as 25,000 BCE, our ancestors were using hand-held lithic borers to cut through shells without breaking them. These tools were generally made of flint, and pressed against the object to be perforated and then rotated back and forth at low speed and relatively high torque. Powerful modern handpieces have elevated the principle of variable speed and high torque to enable precise cuts into much harder materials like zirconia.

This study once more underlines that patients who do not regularly attend check-ups after receiving their implant-supported restoration have a very high risk of peri-implant diseases in general and specifically peri-implantitis; based on this data, at least two check-up visits per year are recommended.

Interdental cleaning with dental floss or interdental brushes significantly reduces interdental plaque build-up and even tends to lead to a reduced rate of tooth loss in the long term.

Patients with rheumatoid arthritis are at significantly higher risk of periodontitis and this risk increases further for patients with particularly active rheumatoid arthritis.

The fight for periodontally compromised teeth and therefore retaining these teeth usually also pays off for patients from a financial perspective and is usually cheaper than extraction and subsequent implantation.

Explore the complexities of dental implant care: This scientifically backed article summarises the critical aspects of diagnosis, oral hygiene, and expert strategies for the effective management of both, mucositis and peri-implantitis.

Untreated periodontal disease in parents can negatively influence the development of their children’s oral microbiome and promote the development of a dysbiotic oral microbiome.

A non-surgical periodontal treatment can reduce the long-term blood glucose level (HbA1c) in type 2 diabetics by 0.3% and this effect persisted even after six months following treatment.

The shape of an implant crown has a significant influence on how well it can be kept clean using home oral hygiene, and concave crown shapes appear to be easier to clean; it also seems that the underside of an implant crown in the molar area is easiest to access with dental floss.

Factors that can be categorised as a poor lifestyle, and primarily also a combination thereof, significantly increased the number of residual pocket probing depths with ≥ 6 mm and significantly reduced the likelihood of attaining the desired treatment outcome in periodontitis patients following non-surgical periodontal treatment (treatment step 1 and 2).

Commonly used definitions for successful periodontal treatment are extremely difficult to achieve, but are nevertheless associated with a lower rate of tooth loss; however, the tooth loss rate in patients who regularly attend supportive periodontal treatment sessions is generally very low.

Biofilm accumulation is the main aetiological factor in the development of peri-implant diseases; plaque control and supportive implant therapy are therefore crucial in preventing peri-implant diseases.

In this study, non-surgical treatment of peri-implantitis was only successful in 25% of cases and was adversely affected by a medical history involving periodontitis and smoking, inadequate oral hygiene and a wide implant diameter.

In old age, tooth loss leads to significantly reduced social participation in society, while maintaining a minimum of 20 teeth has the opposite effect and leads to a significant improvement and therefore more frequent social participation.

The prevention of peri-implant diseases is the best treatment and the peri-implant soft tissue can play a decisive role here; for this reason, the team should discuss if there is a need for treatment in patients with a lack of keratinised mucosa (i.e. < 2 mm width of keratinised mucosa).

A very high percentage of patients had a positive experience of implant treatment and most patients were very happy with the result; however, frequent points of criticism were the treatment costs and the cleansing ability.

Rehabilitation and replacement of missing teeth lead to a significant improvement in quality of life relating to oral health and also tend to improve general health.

Women who exercise regularly showed a significantly reduced risk of periodontitis and a significantly reduced severity of periodontitis.

A questionnaire-based survey showed that periodontitis significantly increases the risk of an impaired sense of taste and smell.

Smoking and increased probing depths at a young age (i.e. at an age of < 20 years) are significant risk factors for the early onset of periodontitis (i.e. at an age of < 30 years).

Automatic toothbrushing could have future potential, but still requires further technical developments to improve existing shortcomings with regard to customizsation for different jaw sizes and tooth positions, interdental spaces and choice of optimal brushing time.

Even when told to brush their teeth as well as possible, the quality of tooth brushing among young adults is poor; the main weaknesses are cleaning palatal/lingual surfaces and overall brushing technique.

Additional measures locally applied or taken systemically by the patient (e.g. antiseptics in the form of mouth-rinse solutions or probiotics) could have an additional positive effect in the treatment of peri-implant mucositis.

Optimal diabetes control, regular supportive implant therapy and augmentation of peri-implant soft tissue deficits have proven to be crucial features in primary prevention of peri-implant diseases.

Chemical additives for cleaning the implant surface as part of non-surgical peri-implantitis therapy may make sense, but there is a shortage of well-conducted studies with a sufficient number of patients and a long-enough follow-up period to really be able to recommend a specific method and/or a specific product.

Due to a continuing lack of well-conducted clinical studies, it is still not possible, based on the evidence, to give a clear treatment guideline for mechanical cleaning as part of non-surgical peri-implantitis treatment.

Electrically-powered interdental cleaning devices seem to have a comparable effectiveness to dental floss for gingivitis patients, but at the same time have the advantage that patients prefer them.

Based on the evidence, it is not possible to recommend professionally administered chemical adjunctive therapies in the treatment of peri-implant mucositis; the products tested to date did not demonstrate any significant benefits in comparison with debridement alone.

Chewing sugar-free xylitol chewing gum could have significantly positive effects in reducing gingival inflammation when used as an adjunct to traditional therapies for treating gingivitis (mechanical cleaning and optimisation of home oral hygiene), but further clinical studies are required in order to confirm this assumption.

Implementing the new classification for periodontal and peri-implant diseases takes time and is a question of experience and practice, but simple reference tools such as a flowchart can help with this process.

Oral health (gingivitis, periodontitis) influences the occurrence and the healing process of oral mucositis in patients with haematological disorders who are given high-dose chemotherapy.

As part of non-surgical periodontal treatment, the additional use of air-polishing treatment could be beneficial for deep baseline probing pocket depths (≥ 5.5 mm) in particular.

Treating gingivitis is not only the most effective option for preventing the occurrence of periodontitis, but also leads to a reduction in systemic inflammatory markers, whilst also improving the patient’s quality of life in terms of oral health.

The use of artificial intelligence with the aim of optimising home oral hygiene significantly improved the results in non-surgical periodontal therapy

Based on the available literature, the smoking of e-cigarettes seems to have a slightly less negative effect on periodontal health compared to traditional cigarettes.

Patients with inflammatory bowel disease have a higher risk of oral diseases (periodontitis and tooth loss) and these diseases appear in turn to increase the degree of activity of inflammatory bowel disease.

Periodontitis patients should always be integrated into supportive periodontitis treatment, as otherwise the rate of recurrence, and therefore a further episode of periodontal inflammation, is likely to be very high.

Tobacco consumption has a lasting negative effect on the peri-implant tissue and leads to an increased risk of developing periimplantitis. This negative effect continues for years, even after an individual has successfully stopped smoking.

We always endeavour to improve the health of our patients’ teeth, but are we actually successful in achieving this? Has oral health in Europe actually improved in recent years/decades and are our patients actually losing fewer teeth?

Emdogain is a product that consists of enamel matrix proteins and is obtained from porcine tooth germs. It has been successfully used in periodontal surgery for more than 20 years and, with the right indication and application, it can be used to achieve outstanding results including at least partial regeneration of periodontal defects.

As early as 2016 (Monsarrat et al. 2016), a study outlined a link between periodontitis and 57(!) systemic diseases, the most well-known of these being diabetes mellitus and cardiovascular diseases. Time and again, these links prompt a discussion about the need for positive cooperation between dentists and doctors in order to improve early diagnosis of specific systemic diseases.

Experiencing cervical tooth sensitivity following periodontal therapy? Here’s what you can do about it! Non-surgical periodontal therapy can unfortunately entail a number of disadvantages, which are the sources of some complaints from our patients time and again. For example, they complain about the longer appearance of their teeth and/or about increased sensitivity of the exposed tooth cervix. Studies have shown that around 60 to 90% of our patients suffer from cervical tooth sensitivity in the period immediately following non-surgical periodontal therapy and that from a third up to a quarter of patients still suffer from cervical tooth sensitivity after 4 to 8 weeks (Lin et al. 2012).

Periodontitis and the related attachment loss inevitably lead to increased tooth mobility after a certain period of time. This increased tooth mobility often makes patients aware that “something is not right,” but for many patients it is also a very unpleasant side effect of periodontal disease and one which can make them feel as if they are losing their teeth.

The links between diabetes mellitus and periodontitis are very well described and documented in the literature. A specific malfunction in the sugar metabolism can occur during pregnancy, which is referred to as gestational diabetes. In Austria, around 5–10% of all pregnant women are affected by gestational diabetes.

Every day we try to persuade our patients to brush their teeth twice a day and to brush the interdental spaces at least once a day as well. However, we all know how particularly difficult it is to persuade our patients to brush the interdental spaces, as this calls for a certain amount of skill on their part.

Many beneficial effects on our health are attributed to the consumption of dairy products. Research indicates that there is a lower risk of diabetes mellitus, metabolic syndrome and cardiovascular disease. It also describes beneficial effects specifically for the oral cavity thanks to the consumption of dairy products. Certain studies, for example, showed that high and regular consumption of dairy products led to a lower risk of periodontitis.

Coffee is clearly one of the world’s favourite drinks! For example, in 2019 around 160 million 60-kilo sacks of coffee were consumed worldwide, and Austria is also one of Europe’s biggest consumers of coffee. In Austria, annual consumption is around 162 litres or 7.2 kilos – this equates to an average of 2.6 cups of coffee per person per day!

The key to success in periodontal treatment is the cooperation of the patient. If the patient fails to comply every day of their life with good and efficient oral hygiene at home and fails to attend recalls consistently, we will unfortunately fail despite all our efforts.

The discussion on soft, medium or hard bristled toothbrushes is not a new one, and yet new literature on the subject is appearing all the time, so it is something we are keen to address.

The ‘new’, although also now almost five-year-old, classification for periodontal and peri-implant conditions included a definition for a successfully treated periodontitis patient for the first time.

The Covid-19 pandemic has posed and continues to pose major challenges for all of us – this includes our patients and their compliance in terms of attending regular dental check-ups. For example, already during the first few months of the pandemic, patients proved to be far more reluctant to attend medical check-ups and appointments (Makiyama 2020). Now that the pandemic has continued for far longer than initially anticipated, however, it is important for us to encourage our patients to begin attending regular appointments for check-ups and treatment again.

The optimal treatment result for periodontitis patients is for them to keep their own teeth in good condition for as long as possible. However, there are both patients and teeth with certain characteristics that make it significantly harder to actually achieve this objective!

Interdental cleaning is not a favourite activity for most patients. Furthermore, based on a survey of 2000 representative Americans, it was found that almost a third of patients lie to their dentist when asked about their teeth-cleaning habits and, in particular, about the use of dental floss. Having said that, it is our responsibility to recommend the best tool for effective interdental cleaning for each of our patients – in terms of effective plaque removal, but also in terms of long-term compliance.

According to the recently published S3 guidelines about treating patients with stage I–III periodontitis (Sanz 2020), the current evidence-based recommendation is to perform subgingival debridement as part of non-surgical periodontal treatment with hand instruments and/or (ultra)sound devices. But of course, the search continues to find options that will further improve the outcome of non-surgical periodontal treatment.

We are used to telling our patients, ‘Clean your teeth twice daily!’. But where does this idea come from, and is it really necessary to brush twice daily? What would happen if we only brushed our teeth once every two days?

To achieve a high level of compliance among periodontitis patients in the maintenance phase of treatment, it is important to make this maintenance therapy, including professional mechanical plaque removal, as pleasant as possible. Unfortunately, however, patients often experience pain during cleaning with (ultra)sonic devices, which could reduce their compliance later on and, in particular, in the long term.

In the previous article we summarized the results of a systematic review about manifestations of oral symptoms in patients with a Covid-19 infection (see: Covid-19 & oral symptoms). Another fascinating study was recently published in the Journal of Clinical Periodontology. In this study, Marouf et al. (2021) investigated the possible influence of periodontitis on the progression of Covid-19 infections.

According to data from the World Health Organization (WHO), almost 110,000,000 people have tested positive for Covid-19 since the pandemic began in December 2019, and 2,435,000 of these cases have had a fatal outcome. On account of this huge outbreak, our professional and social lives have also changed over the past twelve months, in some cases massively.

Are anxiety and depression caused by periodontitis? Or is periodontitis caused by anxiety and depression? According to the literature, the connection between periodontal disease and mental illness or mood disorders is probably bi-directional; this means that each illness can influence the other.

‘Tooth brushing and risk of stroke’ – are the two really connected? This hypothesis is based on the following theory: Poor and insufficient oral hygiene can lead to gingivitis and, in turn, to periodontitis. In periodontitis, oral bacteria can enter the bloodstream, resulting in a local and systemic inflammatory reaction. This inflammatory reaction is accompanied by an increase in inflammatory markers, and it is this mechanism that could in turn increase the risk of having a stroke.

Mechanical biofilm management at home is indispensable for preventing gingivitis and subsequent periodontitis. The German Society for Periodontology (DG Paro) recently published new guidelines on this topic: ‘Mechanical biofilm management at home for the prevention and treatment of gingivitis’

How can we demonstrate to our patients exactly how bad smoking is for the teeth? We already tackled this topic in one of the first scientific articles and were able to provide a very vivid example (Smoking & periodontitis): ‘Smoking substantially reduces the ability of the periodontium to heal during periodontal treatment – it is thought that the healing capacity of a 50-year-old smoker’s periodontium roughly corresponds to that of an 86-year-old non-smoker’s periodontium – that is a difference of 36 years!’

Periodontitis and pregnancy – it’s something we deal with regularly in our day-to-day work. But what can we do? And – most importantly – what are we allowed to do?

Diabetes mellitus and periodontitis are two of the most common chronic diseases. Diabetes mellitus affects approximately 415 million people worldwide, and periodontitis affects as many as 750 million. Furthermore, these two diseases mutually affect each other, and periodontitis constitutes one of the main complications of diabetes. But what exactly is the current situation among patients with periodontitis and/or type 2 diabetes mellitus?

We recently discussed the links between periodontitis and diabetes mellitus. But what do you need to watch out for when giving periodontal treatment to patients who also have diabetes?

The patient has received their new implant-supported prosthesis, but our work is not done yet. Now we have to help the patient enjoy their new implant and crowns for as long as possible, a task that includes keeping the implant and surrounding tissue healthy and free from inflammation. To enable prompt recognition of any peri-implant disease that may subsequently occur, it is important to perform a ‘baseline examination’ after the patient has received their implant-supported prosthesis.

Smoking and periodontitis – how bad is it really?

To be able to diagnose peri-implant diseases correctly, it is helpful to have good-quality, informative X-rays. However, periapical bitewing X-rays of implants in particular can often turn out blurry. There is, however, one very simple rule you can follow to correct these images and to depict implant threads clearly and precisely, thus enabling exact determination of the patient’s bone level. Furthermore, this rule is easy to remember and, above all, can be implemented rapidly in daily clinical practice.

In June 2018, as part of the EuroPerio 9 conference in Amsterdam, the long-awaited new classification scheme for periodontal and peri-implant diseases was presented publicly to dentists.

For the first time, the new classification scheme for periodontal diseases, which was presented in June 2018, contains a definition of the concept of clinical periodontal health (Lang & Bartold, 2018).

The new classification continues to differentiate between plaque-induced gingivitis and non-plaque-induced gingival diseases (Chapple et al., 2018).

Up to what point can an implant and its surrounding tissue be described as healthy? And at what point are caution and appropriate treatment required because the diagnosis of peri-implant mucositis already applies?

The article ‘How to correctly diagnose peri-implant mucositis’ discussed the criteria for peri-implant health and peri-implant mucositis. But how can you tell that the patient’s condition has already reached an advanced stage – in other words, how can I correctly diagnose peri-implantitis?

Regardless of whether you are treating a new patient or seeing an existing patient for a check-up, there is no doubt that implants (see article ‘The patient has their new implant-supported prosthesis – what now?’) need to be monitored right from the start, just as natural dentition does – and that includes measurement of pocket probing depths!

In June 2018, as part of the EuroPerio 9 conference in Amsterdam, the long-awaited new classification scheme for periodontal and peri-implant diseases was presented publicly to dentists.

It is important to fully update our patients’ general medical history and medication at regular intervals (at least once per year) – even for patients we have known ‘for years’.

Mechanical biofilm management should always be regarded as the basis for preventing periodontal diseases. It combines tooth brushing and interdental cleaning.

Affecting approximately 750 million people, periodontitis is the sixth most common disease worldwide. Apart from caries, it is the most common cause of tooth loss. Consequently, periodontitis patients often ask their dentist about implant-supported dentures.

In light of the growing problem of antimicrobial resistance, any use of antibiotics in dentistry should be given careful consideration, and antibiotics should only be administered if they can genuinely lead to a clinically significant improvement in treatment outcome. It is therefore important to develop guidelines on this topic that are based on the available literature, and just such a guideline was recently drawn up by the German Society of Periodontology (DG Paro): ‘Use of systemic antibiotics as an adjuvant to subgingival instrumentation as part of systematic periodontal treatment’

It is a situation we are all too familiar with: following the active phase of treatment, nearly all the patient’s teeth are now unaffected by increased pocket probing depths. However, there are still 1 or 2 places where the treatment goal has unfortunately not been achieved.

A very common question after the active phase of periodontal therapy is how high the patient’s risk is of re-developing periodontal problems.

Whether manual, sonic or electric, a toothbrush on its own is unfortunately insufficient to achieve perfect oral hygiene, because it is simply unable to penetrate the interdental spaces deeply enough. But what advice should we give to our patients?

Bad breath (halitosis) can be extremely unpleasant for those affected, and it is estimated that approximately one person in four struggles with persistent bad breath. A Belgian study (Quirynen 2009) investigated 2000 patients whose main concern was unpleasant bad breath. The study showed that the oral cavity was the source of bad breath in 75% of patients and thus fell within the dentist’s remit. Only 10% of cases had an extraoral cause, and 15% of participants had what is known as pseudohalitosis, where a patient is convinced they have bad breath even though it can be neither detected nor perceived by other people.

Air polishing devices have become a firmly established part of periodontal treatment in recent years. But how efficient are they? What applications do they have? What should be considered when using them?

The previous article ‘Air-polishing devices in periodontal treatment’ has already discussed the effectiveness of air-polishing devices and the importance of using the right powder to avoid damaging the hard and soft tissues. But what else needs to be considered when using these devices?

Exposed dentine often leads to painful teeth and causes a short sharp pain. If this pain occurs regularly, it can substantially impair the patient’s quality of life. The prevalence of dentine hypersensitivity varies according to the population being investigated; as an example, however, one study found it affected 40% of individuals aged 18 to 35 (West et al. 2013). Any treatment should ideally be easy to use, effective, rapid and long-lasting.

The use of smart phones for ‘mHealth’ (mobile health) in prophylaxis is becoming more and more fashionable – but what does it involve exactly?

From the patient’s point of view in particular, having treatment for periodontal disease can seem tedious and stressful. Patients find one fact hard to deal with in particular: periodontal disease is a chronic condition that requires a life-time follow-up (every 3 months in severe cases) to ensure the patient’s periodontal status remains stable after the active phase of treatment and during maintenance therapy. Inevitably we are asked the following question again and again: ‘will periodontal treatment really make me feel better?’

The previous report discussed a question that patients frequently ask: ‘will periodontal treatment really make me feel better?’ And, based on the literature, this question should be answered with a resounding ‘yes!’ However, personal well-being and oral-health-related quality of life are not the only issues – for many patients, financial considerations are also of primary concern, prompting the question: ‘does periodontal treatment really pay off?’

The bidirectional links between periodontitis and diabetes are undisputed, and a big problem associated with diabetes is the relatively high number of unreported cases. To improve this number and to identify patients with pre-diabetes and diabetes sooner, the potential role of the dental surgery has been discussed more and more in recent years.

It is often very hard to persuade our patients to clean between their teeth. Patients are often still advised to use dental floss, despite the fact we know that in many cases floss is not their method of choice and, above all, is often rather unpopular.

Sowohl periimplantäre Mukositis als auch Periimplantitis sind leider häufig auftretende biologische Komplikationen rund um dentale Implantate. Bei fast jedem 2. beziehungsweise 4.Patienten/Patientin wird eine periimplantäre Mukositis beziehungsweise Periimplantitis diagnostiziert (Derks & Tomasi 2015)!

Both when treating peri-implant diseases and after fitting a new implant-supported restoration, our top priority should always be to provide patients with instructions regarding home oral hygiene. However, there is one thing we must not forget: It must be possible for the patient to actually clean their implant-supported restoration!

Whether preventative or curative, dental measures need to be individually tailored according to the risk factors identified for each patient. In this context, general health is significantly influenced by three risk factors.