Percorrer por autor "Alcoforado, Gil"
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- Association between periodontal disease and Alzheimer’s disease : a cross-sectional studyPublication . Rodrigues, Vanessa Rocha; Amorim, Mónica; Alcoforado, Gil; Noronha, SusanaObjectives: To evaluate whether periodontal disease is more prevalent in adults diagnosed with Alzheimer's disease compared to adults without the condition. Methods: A total of 72 individuals were included in the study: 36 patients diagnosed with Alzheimer's disease (test group) and 36 matched individuals without Alzheimer's disease (control group). The diagnosis of periodontal disease was established through a comprehensive periodontal assessment. Additionally, a microbiological analysis of subgingival plaque samples was conducted to detect the main periodontal pathogens. Results: Statistically significant differences were observed in periodontitis extent between the two groups: 82.4% of patients in the test group and 56.3% in the control group presented generalized periodontitis. No association was found between the stage and extent of periodontitis and the severity of Alzheimer's disease. Furthermore, no significant associations were observed between the number of years since Alzheimer's diagnosis and periodontal parameters, including the stage (p=0.659), extent (p=0.551), and grade of periodontitis (p=0.769). Prevotella intermedia was found in 25% of the test group and 5.6% of the control group (p=0.022). Campylobacter rectus appeared in 16.7% of the cases, with a significant difference between groups (p=0.011). Fusobacterium nucleatum was more common in the control group (75%) than in the test group (27.8%), with a significant difference (p<0.001). Eikenella corrodens was detected only in the control group (22.2%) (p=0.005). Conclusions: Although the overall prevalence of periodontitis was similar between groups, individuals with Alzheimer’s disease tended to present a greater extent of generalized periodontitis.
- Consensus Report of Group 1 of the 1st Global Consensus for Clinical Guidelines for the Rehabilitation of the Edentulous Maxilla : number of implants, timing of implant placement and loadingPublication . Donos, Nikos; Ng, Ethan; Pannuti, Claudio Mendes; Romito, Giuseppe Alexandre; Francisco, Helena Cristina Oliveira; Abou-Ayash, Samir; Avila-Ortiz, Gustavo; Carames, Joao Manuel Mendez; Casentini, Paolo; Chackartchi, Tali; Chappuis, Vivianne; Chen, Stephen; Fugazzotto, Paul; Giannobile, William V.; Hagiwara, Yoshiyuki; Hamilton, Adam; Ivanovski, Saso; Kahn, Sergio; Kan, Joseph; Lambert, France; Levine, Robert Alan; Navarro, Jose Manuel; Ornekol, Turker; Payer, Michael; Schoenbaum, Todd; Singh, Manish Kumar; Thacker, Sejal; Alcoforado, GilObjectives: The 1st Global Consensus for Clinical Guidelines (GCCG) in Implant Dentistry introduced an innovative, evidence-based approach to developing patient-centered and practical recommendations for the rehabilitation of the edentulous maxilla. Within this framework, Group 1 aimed to formulate clinical recommendations on the number of implants required, timing of implant placement, and timing of loading. Materials and Methods: Group 1 followed the S2k-level guideline framework of the Association of the Scientific Medical Societies in Germany (AWMF), using a structured nominal group technique. The evidence base included three systematic reviews evaluating clinician-reported outcomes (ClinROs) and patient-reported outcomes (PROs), supplemented by structured single-round international surveys involving expert clinicians, patients, and cross-disciplinary experts. Survey content covered diagnostics, treatment planning, clinical procedures, and maintenance care. Draft recommendations were discussed during the in-person consensus meeting in Boston (June 16–18, 2025) and finalized through anonymous plenary voting. Consensus was defined as ≥ 75% and ≤ 95% agreement and strong consensus as > 95% agreement. Results: Group 1 formulated 12 clinical recommendations across the workflow domains of diagnostic tools, treatment planning, and treatment procedure. During plenary voting, three of these recommendations reached strong consensus, and nine achieved consensus. The number of voters per recommendation ranged from 61 to 90, with an average of 83. Conclusions: This consensus report provides structured, evidence-based recommendations on implant number, placement timing, and loading protocols for rehabilitation of the edentulous maxilla. These guidelines are intended to support individualized, patient-centered care while also identifying priority areas for future research.
- Exploring AI-driven machine learning approaches for optimal classification of peri-implantitis based on oral microbiome data : a feasibility studyPublication . Pais, Ricardo Jorge; Botelho, João; Machado, Vanessa; Alcoforado, Gil; Mendes, José João; Alves, Ricardo; Bessa, Lucinda J.Background: Machine learning (ML) techniques have been recently proposed as a solution for aiding in the prevention and diagnosis of microbiome-related diseases. Here, we applied auto-ML approaches on real-case metagenomic datasets from saliva and subgingival peri-implant biofilm microbiomes to explore a wide range of ML algorithms to benchmark best-performing algorithms for predicting peri-implantitis (PI). Methods: A total of 100 metagenomes from the NCBI SRA database (PRJNA1163384) were used in this study to construct biofilm and saliva metagenomes datasets. Two AI-driven auto-ML approaches were used on constructed datasets to generate 100 ML-based models for the prediction of PI. These were compared with statistically significant single-microorganism-based models. Results: Several ML algorithms were pinpointed as suitable bespoke predictive approaches to apply to metagenomic data, outperforming the single-microorganism-based classification. Auto-ML approaches rendered high-performing models with Receiver Operating Characteristic–Area Under the Curve, sensitivities and specificities between 80% and 100%. Among these, classifiers based on ML-driven scoring of combinations of 2–4 microorganisms presented top-ranked performances and can be suitable for clinical application. Moreover, models generated based on the saliva microbiome showed higher predictive performance than those from the biofilm microbiome. Conclusions: This feasibility study bridges complex AI research with practical dental applications by benchmarking ML algorithms and exploring oral microbiomes as foundations for developing intuitive, cost-effective, and clinically relevant diagnostic platforms.
- Linking peri-implantitis to microbiome changes in affected implants, healthy implants, and saliva : a cross-sectional pilot studyPublication . Bessa, Lucinda J.; Egas, Conceição; Pires, Carolina; Proença, Luís; Mascarenhas, Paulo; Pais, Ricardo J.; Barroso, Helena; Machado, Vanessa; Botelho, João; Alcoforado, Gil; Mendes, José João; Alves, RicardoIntroduction: The rising use of dental implants is accompanied by an expected increase in peri-implant diseases, particularly peri-implantitis (PI), which poses a significant threat to implant success and necessitates a thorough understanding of its pathogenesis for effective management. Methods: To gain deeper insights into the role and impact of the peri-implant microbiome in the pathogenesis and progression of PI, we analyzed 100 samples of saliva and subgingival biofilm from 40 participants with healthy implants (HI group) or with co-occurrence of diagnosed PI-affected implants and healthy implants (PI group) using shotgun metagenomic sequencing. We identified the most discriminative species distinguishing healthy from diseased study groups through log ratios and differential ranking analyses. Results and discussion: Mogibacterium timidum, Schaalia cardiffensis, Parvimonas micra, Filifactor alocis, Porphyromonas endodontalis, Porphyromonas gingivalis and Olsenella uli were associated with the subgingival peri-implant biofilm. In contrast, Neisseria sp oral taxon 014, Haemophilus parainfluenzae, Actinomyces naeslundii, Rothia mucilaginosa and Rothia aeria were more prevalent in the healthy peri-implant biofilm. Functional pathways such as arginine and polyamine biosynthesis, including putrescine and citrulline biosynthesis, showed stronger correlations with PI-affected implants. In contrast, peri-implant health was characterized by the predominance of pathways involved in purine and pyrimidine deoxyribonucleotide de novo biosynthesis, glucose and glucose-1-phosphate degradation, and tetrapyrrole biosynthesis. Our findings reveal that healthy implants in PI-free oral cavities differ significantly in microbial composition and functional pathways compared to healthy implants co-occurring with PI-affected implants, which more closely resemble PI-associated profiles. This pattern extended to salivary samples, where microbial and functional biomarkers follow similar trends.
- Peri-implantitis : summary and consensus statements of group 3 : the 6th EAO Consensus conference 2021Publication . Schwarz, Frank; Alcoforado, Gil; Guerrero, Adrian; Jönsson, Daniel; Klinge, Björn; Lang, Niklaus; Mattheos, Nikos; Mertens, Brenda; Pitta, João; Ramanauskaite, Ausra; Sayardoust, Shariel; Sanz-Martin, Ignacio; Stavropoulos, Andreas; Heitz-Mayfield, LisaObjective: To evaluate the influence of implant and prosthetic components on peri-implant tissue health. A further aim was to evaluate peri-implant soft-tissue changes following surgical peri-implantitis treatment. Materials and methods: Group discussions based on two systematic reviews (SR) and one critical review (CR) addressed (i) the influence of implant material and surface characteristics on the incidence and progression of peri-implantitis, (ii) implant and restorative design elements and the associated risk for peri-implant diseases, and (iii) peri-implant soft-tissue level changes and patient-reported outcomes following peri-implantitis treatment. Consensus statements, clinical recommendations, and implications for future research were discussed within the group and approved during plenary sessions. Results: Data from preclinical in vivo studies demonstrated significantly greater radiographic bone loss and increased area of inflammatory infiltrate at modified compared to non-modified surface implants. Limited clinical data did not show differences between modified and non-modified implant surfaces in incidence or progression of peri-implantitis (SR). There is some evidence that restricted accessibility for oral hygiene and an emergence angle of >30 combined with a convex emergence profile of the abutment/prosthesis are associated with an increased risk for peri-implantitis (CR). Reconstructive therapy for peri-implantitis resulted in significantly less soft-tissue recession, when compared with access flap. Implantoplasty or the adjunctive use of a barrier membrane had no influence on the extent of peri-implant mucosal recession following peri-implantitis treatment (SR). Conclusions: Prosthesis overcontouring and impaired access to oral hygiene procedures increases risk for peri-implantitis. When indicated, reconstructive peri-implantitis treatment may facilitate the maintenance of post-operative peri-implant soft-tissue levels.
- Periodontitis impact in interleukin-6 serum levels in solid organ transplanted patients: a systematic review and meta-analysisPublication . Machado, Vanessa; Botelho, João; Lopes, Joana; Patrão, Mariana; Alves, Ricardo; Chambrone, Leandro; Alcoforado, Gil; Mendes, José JoãoThis systematic review aimed to investigate the influence of periodontitis on post-transplant IL-6 serum levels of solid organ transplanted patients as compared to healthy subjects. Four databases (PubMed, Scholar, EMBASE, and CENTRAL) were searched up to February 2020 (PROSPERO CRD42018107817). Case-control and cohort studies on the association of IL-6 serum levels with a periodontal status of patients after solid organ transplantation were included. The risk of bias of observational studies was assessed through the Newcastle-Ottawa Scale (NOS). Random effects meta-analyses were thoroughly conducted. GRADE assessment provided quality evidence. Four case-control studies fulfilled the inclusion criteria (274 transplant recipients and 146 healthy controls), all of low risk of bias. Meta-analyses revealed significantly higher IL-6 levels in transplanted patients than healthy individuals with low-quality evidence (Mean Difference (MD): 2.55 (95% confidence interval (CI): 2.07, 3.03)). Transplanted patients with periodontitis have higher serum IL-6 levels than transplanted patients without periodontitis with moderate quality evidence (MD: 2.20 (95% CI: 1.00, 3.39)). We found low-quality evidence of higher IL-6 levels than healthy patients in patients with heart and kidney transplant. In these transplanted patients, there was moderate quality evidence that periodontitis is associated with higher IL-6 serum levels. Future research should consider the impact of such a difference in organ failure and systemic complications.
- A prospective observational study on perioperative use of antibacterial agents in implant surgeryPublication . Dominiak, Marzena; Shuleva, Stanislava; Silvestros, Spiridon; Alcoforado, GilBackground: Dental implant surgery has become routine practice for replacing missing teeth. Little is known about the use of local antisepsis to control the development of bacterial plaque and to facilitate healing, as current practice guidelines do not address this issue. Objectives: The objectives of this study were to describe antiseptic practices for implant surgery and to assess plaque control at the operative site as well as the investigator’s satisfaction. Material and Methods: This prospective, observational study conducted in 4 European countries enrolled 911 adult patients receiving a single or multiple implant on the day of inclusion. Any medication prescribed during the preor postoperative periods was documented, particularly antibiotics, antiseptic mouthwashes and topical antiseptic gels. At a follow-up visit, the presence of plaque was documented on teeth adjacent to the implant and its extent determined using the Silness–Löe index. Results: Oral antibiotics were prescribed prior to surgery in 53.8% of the patients. Antiseptic mouthwashes were prescribed to patients (49.6–65.7%) according to country. Following dental implant placement, 84.1–94.7% of patients were prescribed oral antibiotics, 45.6–86.5% of patients were prescribed antiseptic mouthwash and 72.8–100% of patients were prescribed an antiseptic gel. At the follow-up visit, plaque was observed in 45.4% of the patients. The mean Silness–Löe plaque index was 0.7 or 0.8, indicating a low level of plaque accumulation. The Löe and Silness gingival index was 0.6 or 0.7, which is consistent with a low level of gingival inflammation. Conclusion: Use of antibiotics preand post-surgery is frequent in implant surgery, despite it being discouraged in practice guidelines. Use of antiseptic mouthwashes and topical antiseptic gels is widespread, although treatment paradigms vary widely. Practice guidelines covering antisepsis provision would be useful, since those products could be used as an alternative to antibiotics to facilitate wound healing.
- Prosthetic outcomes of implant-assisted maxillary restorations in the edentulous maxilla : a systematic review and meta-analysisPublication . Ng, Ethan; Tay, John Rong Hao; Rahmat, Maria; Mezzomo, Luis; Alcoforado, Gil; Donos, NikosObjectives: To evaluate the prosthetic outcomes of implant-assisted maxillary full-arch restorations with ≥ 3 years of follow-up. Materials and Methods: A systematic electronic literature search was conducted in five databases to identify randomised controlled trials and prospective clinical studies involving patients who received full-arch rehabilitation in the maxilla. The primary outcome was prosthesis loss; secondary outcomes included complication-free prosthesis survival, complication-free implant survival, implant loss, technical complications, patient-reported outcome measures (PROMS), and marginal bone loss. Meta-analyses of proportions using random-effects models were performed to estimate pooled rates of prosthetic survival, success, and complications. Results: A total of 20 studies involving 913 patients were included. Among these, 542 patients received fixed prostheses and 371 received removable prostheses. Most of the studies had an observation period in the range of 3 to 6 years, with only two studies (overdentures) reaching 10 years. Overall prosthesis loss was 4.6% (95% CI: 1.2%–10.1%) and complication-free prosthesis survival was 61.9% (95% CI: 48.4%–74.5%). Overall complication-free implant survival was 46.5% and technical complications were 62.9%. Pooled implant loss was 5.5% after adjusting for clustering effects and mean marginal bone loss was < 0.8 mm. Subgroup analysis of fixed and removable prosthesis over a similar observation period revealed similar outcomes. Conclusions: Implant-assisted maxillary full-arch restorations have low rates of prosthesis and implant loss. However, complication-free survival is moderate, underscoring the importance of maintenance and patient education.
- Unveiling the resistome landscape in peri-Implant health and diseasePublication . Bessa, Lucinda J.; Egas, Conceição; Botelho, João; Machado, Vanessa; Alcoforado, Gil; Mendes, José João; Alves, RicardoBackground: The human oral microbiome is a critical reservoir for antibiotic resistance; however, subgingival peri-implant biofilms remain underexplored in this context. We aimed to explore the prevalence and distribution of antibiotic resistance genes (ARGs) in metagenomes derived from saliva and subgingival peri-implant biofilms. Methods: A total of 100 metagenome datasets from 40 individuals were retrieved from the Sequence Read Archive (SRA) database. Of these, 20 individuals had exclusively healthy implants and 20 had both healthy and affected implants with peri-implantitis. ARGs and their taxonomic assignments were identified using the ABRicate tool, and plasmid detection was performed with PlasmidFinder. Results: Four plasmid replicons were identified in 72 metagenomes, and 55 distinct ARGs from 13 antibiotic classes were detected in 89 metagenomes. ARGs conferring resistance to macrolides–lincosamides–streptogramins, tetracyclines, beta-lactams, and fluoroquinolones were the most prevalent. The msr(D) and mef(A) genes showed the highest prevalence, except in saliva samples from individuals with healthy implants, where mef(A) ranked fourth. A pairwise PERMANOVA of principal coordinate analysis based on Jaccard distances revealed that saliva samples exhibited significantly greater ARG diversity than subgingival biofilm samples (p < 0.05). However, no significant differences were observed between healthy and peri-implantitis-affected subgingival biofilm groups (p > 0.05). The taxonomic origins of ARGs were also analyzed to understand their distribution and potential impact on oral microbial communities. Conclusions: Resistome profiles associated with both peri-implant health and disease showed no significant differences and higher salivary abundance of ARGs compared to subgingival biofilm samples.
- The use of autogenous teeth for alveolar ridge preservation : a literature reviewPublication . Cenicante, João; Botelho, João; Machado, Vanessa; Mendes, José João; Mascarenhas, Paulo; Alcoforado, Gil; Santos, AlexandreAlveolar ridge resorption is a natural consequence of teeth extraction, with unpleasant aesthetic and functional consequences that might compromise a future oral rehabilitation. To minimize the biological consequences of alveolar ridge resorption, several surgical procedures have been designed, the so-called alveolar ridge preservation (ARP) techniques. One important characteristic is the concomitant use of biomaterial in ARP. In the past decade, autogenous teeth as a bone graft material in post-extraction sockets have been proposed with very interesting outcomes, yet with different protocols of preparation. Here we summarize the available evidence on autogenous teeth as a biomaterial in ARP, its different protocols and future directions.