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National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure–the Healthcare Quality and Access (HAQ) Index–on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0–42·8) in 1990 to 53·7 (52·2–55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Bill & Melinda Gates Foundation.

Purpose of Review To establish a link or causation between periodontitis and Alzheimer’s disease requires studies that first establish an association or correlation between these two diseases, followed by in vitro, animal model, and human studies to identify possible underlying biological mechanisms, and finally assessing the benefits of periodontal therapy in general and targeted therapies against the microbiota and inflammatory responses in periodontitis. This review presents an update on the current correlation and biological mechanisms that link these two diseases, with special emphasis on the keystone periodontal pathogen Porphyromonas gingivalis and its key family of gingipain enzymes. Recent Findings Recent evidence for slowing the progression of Alzheimer’s disease through periodontal therapy in general, as well as focused therapies directed against Porphyromonas gingivalis and its gingipains, are presented. Summary These intervention studies, together with the recent association and biological mechanism studies, strengthen the evidence for a direct link or causation between these two diseases. In addition, these recent studies support the special role of the dental practitioner in the management of patients with cognitive decline.

Purpose of Review The purpose of the present review was to discuss the success and predictability of vertical ridge augmentation (VRA) with the use of guided bone regeneration (GBR). Recent Findings Weighted mean gains in vertical heights of 8.04 mm (distraction osteogenesis), 4.18 mm (GBR), and 3.46 mm (block grafts) were reported for the specific VRA procedures; however, a superior technique was not identified. Summary VRA with GBR is a technique-sensitive procedure with the potential of regenerating significant heights of vital bone, which should be performed by highly experienced clinicians due to the potential for severe complications. Regardless of the technique used for VRA, two important factors for a successful and predictable outcome are (i) the defect morphology and (ii) the proper flap management/advancement to obtain and retain a tension-free primary closure.

Purpose of Review Pattern recognition receptors (PRRs) are important mediators of tissue homeostasis. Soluble forms of PRRs, including a novel group of molecules called peptidoglycan recognition proteins (PGRPs) have very important regulatory roles. However, they remain poorly understood compared to other forms of PRRs, particularly in the context of periodontitis. In this review, we discuss the different types of soluble PRRs, their functions, and the limited knowledge available about their regulation during periodontitis. We introduce PGRPs and the emerging data on their expression during periodontitis. Recent Findings Interest in soluble PRRs continues to grow due to their tremendous value in diagnostic and therapeutic application. Specific mechanisms of how soluble PRRs are generated have now been identified including alternative spicing, ectodomain shedding, and diffusion from membrane PRRs. Proteins that have PRR functions but no corresponding membrane PRR have also been identified. They are collectively termed as pattern recognition molecules (PRMs). PGRPs are the newest members of these human PRM. Four isoforms of PGRP, namely, PGRP1, PGRP2, PGRP3, and PGRP4, have been identified. Consensus is emerging that PRMs are generally elevated in serum, gingival crevicular fluid, and saliva during periodontitis, and the levels of PRMs reduce with non-surgical therapy. However, the relationship between periodontitis and levels of soluble isoforms of membrane-bound PRRs is much more complex. Conflicting reports have emerged on the levels of these proteins during periodontitis. Similarly, very few studies have examined the function and regulation of sPRRs in periodontitis. Limited available evidence suggests that PGRP1 may be a key regulator of gingival inflammation. However, not much is known about other isoforms of PGRPs. Recently, we reported increased levels of PGRP3 and PGPR4 in gingiva and saliva during periodontitis, suggesting an important but unknown regulation of these proteins in the periodontium. Summary Soluble PRRs, particularly PGRPs, have a contextual divalent function. They maintain homeostasis via mechanisms that dampen tissue inflammation. Contextually, they also aid in activating inflammation and antigen presentation. Understanding the function and regulation of soluble PRRs is vital for development of novel biologically mediated periodontal therapies and point of care diagnostics.

Purpose of Review 3D printing, or additive manufacturing, is an emerging technology in the dental field. As it continues to advance beyond diagnostic purposes, it shifts towards the fabrication of permanent prostheses utilizing existing and novel biomaterials. A review and comparison of the current research on materials, techniques, and applications of 3D printing available for restorative use was conducted. Recent Findings Currently, 3D printing used across the field of restorative dentistry, includes laboratory models and casting patterns, interim full and partial coverage restorations, surgical guides, occlusal splints, maxillofacial prosthetics, removable prostheses, and implants. Resins are most often used while ceramic and hybrid materials are currently under investigation and development. Summary While the current research available highlights 3D printing’s potential in the dental field, more research is needed on the existing and developing materials and printers, thus allowing for an exponential increase of this technology’s applications in restorative dentistry.

Purpose of Review To provide a comprehensive review of the practical implementations of the 2018 classification of periodontitis using the staging and grading system. Recent Findings The 2018 World Workshop Classification (2018 WWC) of periodontitis introduced the novel staging and grading system. This individualized framework combines the severity and complexity of each clinical case (Stage) with the risk of disease progression (Grade). The 2018 WWC has been validated in the literature as an accurate diagnostic assessment to classify the disease as well as to predict tooth loss. The agreement among clinicians on how to implement it, however, is still moderate. This is not unexpected however since any new system involves a learning curve. While the optimal solution is universal uptake of the 2018 classification system in its entirety, it has been necessary in some healthcare systems to implement a simplified version such as via the British Society of Periodontology. Summary The 2018 Classification of periodontitis is a valuable system that links diagnosis with prevention and treatment, providing an individual patient assessment.

Purpose of Review The aim of this narrative review was to present relevant evidence regarding the onset and patterns of disease progression of peri-implantitis lesions based on current experimental and observational studies. Recent Findings The conversion from peri-implant mucositis to peri-implantitis continues to be not fully elucidated. In vivo studies revealed that peri-implantitis displays a progressive destructive nature dependent to the experimental model. Human peri-implantitis lesions follow a non-linear but accelerating pattern of disease progression occurring mostly within the first 3 years of function. Based on the available scientific evidence, histopathological differences between peri-implantitis and periodontitis lesions might be responsible for the dissimilarities in the onset and progression of these two conditions. Future research evaluating the pathogenesis and longitudinal disease attributes of peri-implant diseases is necessary to fill gaps in knowledge. Summary Scarce scientific evidence remains available in relation to the onset and progression of peri-implant diseases.

Purpose of Review Peri-implant diseases are becoming a major problem in modern dentistry. A clear understanding of the pathogenesis of peri-implant diseases may provide key aspects for decision-making on their approach and obtaining predictable results. The purpose of the present article is to provide a narrative review of current protocols (2015–present) used for treatment of peri-implantitis. Recent Findings Current evidence reflects the level of diagnostic and therapeutic complexity; and multifactorial effect of conditions associated with peri-implant mucositis and peri-implantitis. Non-surgical therapy, by means of mechanical detoxification with or without adjuncts, has proven somehow effective for the treatment of mild forms of peri-implantitis. Conversely, open flap mechanical debridement with resective and/or regenerative treatment modalities have been advocated more towards moderate-to-severe forms. There is a lack of evidence to support the use of adjuncts (e.g. systemic/locally-delivered antibiotics, antimicrobial mouth rinses, biologic agents, laser therapy, antimicrobial photodynamic therapy, soft tissue augmentation) with conventional mechanical therapy upon the long-term outcomes after the peri-implantitis treatment. Summary Emerging long-term results found surgical outcomes after peri-implantitis therapy to remain unpredictable in arresting inflammation, but effective in preventing further bone destruction and implant loss. In the presence of further peri-implant breakdown, the need for rescue therapy and implant removal was observed in retrospective and prospective studies. To the present date, inconclusive evidence exists to support a gold standard protocol for an effective surgical implant detoxification.

Purpose of Review Alveolar boundaries dictate the limitations of orthodontic tooth movement. Evaluation of the hard and soft tissues in terms of quality and quantity in conjunction with a sound orthodontic treatment plan that includes the amount and direction of desired tooth movement is essential. Prophylactic intervention may be required to support orthodontic goals and objectives without undesired iatrogenic periodontal consequences. The purpose of this article is to provide a review on current methods utilized for augmentation procedures prior to orthodontic treatment. Recent Findings Orthodontic treatment can have a significant impact on periodontal health. Increased demands by patients for non-extraction treatment and for camouflaged treatment of skeletal discrepancies to avoid orthognathic surgery can place challenges on orthodontists. Dental arch expansion and placing teeth beyond biologically acceptable limits can result in unfavorable periodontal outcomes, such as the development of fenestrations and dehiscences. Summary Phenotype modification therapy via soft and/or hard tissue augmentation may expand the range of orthodontic movement without the risk of undesired periodontal outcomes during orthodontic treatment.

Purpose of Review CAD/CAM and 3D-printing are emerging manufacturing technologies in dentistry. In the field of alveolar ridge augmentation, graft customization utilizing these technologies can result in significant reduction of surgical time. A review of the literature on materials, techniques, and applications of CAD/CAM and 3D-printing available for alveolar ridge augmentation was performed. Recent Findings CAD/CAM applications for milling of customized block grafts of allogeneic, xenogeneic, and alloplastic origins have been reported, and currently only limited products are commercially available. 3D-printing applications are limited to alloplastic graft materials and containment shells, and have been mostly used in animal studies for optimizing biomaterials’ properties. Summary While current data support the potential use of CAD/CAM and 3D-printing for graft customization for alveolar ridge augmentation procedures, additional research is needed on predictability and long-term stability of the grafted sites.