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Aimetti M, Stasikelyte M, Mariani GM, Cricenti L, Baima G, Romano F. The flapless approach with and without enamel matrix derivatives for the treatment of intrabony defects: A randomized controlled clinical trial. J Clin Periodontol 2024; 51:1112-1121. [PMID: 38859627 DOI: 10.1111/jcpe.14028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/23/2024] [Accepted: 05/27/2024] [Indexed: 06/12/2024]
Abstract
AIM To compare the clinical and radiographic outcomes of flapless procedure alone or in combination with enamel matrix derivatives (EMD) in the treatment of deep intrabony defects. MATERIALS AND METHODS Forty-six patients re-evaluated after non-surgical therapy were randomly assigned to the test (flapless with EMD) or control group (flapless alone). Clinical measurements were recorded pre-surgery and at 6 and 12 months after surgery, and radiographic measurements were taken pre-surgery and after 12 months. RESULTS Forty-six patients completed the study. Improvements were observed in both groups at 12 months for mean clinical attachment level (CAL) gain, with significant differences between test (3.9 ± 1.1 mm) and control groups (3.0 ± 1.2) (p = .017). Probing pocket depth (PPD) reduction (4.0 ± 0.7 vs. 3.3 ± 1.4 mm) was also near to statistical significance (p = .051). Also, more sites achieved successful composite outcome measure (final PPD ≤ 4 mm and CAL gain ≥3 mm) for the regenerative treatment in the flapless + EMD group (82.6% vs. 52.2%; p = .028). In terms of radiographic outcomes, EMD yielded a greater defect bone fill than flapless treatment alone (3.0 ± 1.0 mm vs. 1.8 ± 1.5 mm; p < .001). CONCLUSIONS The additional application of EMD during the flapless procedure for intrabony defects slightly improved clinical and radiographic outcomes. CLINICALTRIALS gov identification number: NCT05456555.
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Affiliation(s)
- Mario Aimetti
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Morta Stasikelyte
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Giulia Maria Mariani
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Luca Cricenti
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Giacomo Baima
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Federica Romano
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
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Citterio F, Kanmaz B, Baima G, Romano F, Buduneli N, Aimetti M. Pocket closure in stage III-IV grade C periodontitis: A multilevel analysis following non-surgical periodontal therapy. Int J Dent Hyg 2024; 22:547-553. [PMID: 37154234 DOI: 10.1111/idh.12688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/30/2023] [Accepted: 04/02/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Risk of disease progression and tooth loss is higher in cases where deep probing pocket depths (PPDs) and bleeding on probing (BOP) persist after active periodontal treatment. This study aimed to investigate the efficacy of non-surgical periodontal therapy on pocket closure (PC), defined as PPD ≤4 mm without BOP (PC1) or PPD ≤4 mm solely (PC2) 3 months after non-surgical periodontal treatment and to compare PC between smokers and non-smokers. METHODS This cohort study is a secondary analysis from a controlled clinical trial consisting of systemically healthy patients with stage III or IV grade C periodontitis. All the sites with baseline PPD ≥5 mm are included as diseased sites and PC at 3 months after completion of non-surgical periodontal treatment was calculated. PC was compared between smokers and non-smokers at site and patient levels. Multilevel analysis is used to investigate factors at patient, tooth and site levels affecting PPD changes and the probability of PC. RESULTS A total of 1998 diseased sites in 27 patients were included in the analysis. The rates of PC1 and PC2 were 58.4% and 70.2% and were significantly correlated to smoking habits at site level (r (1) = 7.03, p = 0.008; r (1) = 36.17, p < 0.001). Tooth type, mobility, clinical attachment level (CAL) and PPD at baseline significantly affected PC. CONCLUSIONS The present findings indicate that non-surgical periodontal treatment is effective in PC, but its performance is influenced by baseline PPD and CAL and residual pockets may remain.
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Affiliation(s)
- Filippo Citterio
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Burcu Kanmaz
- Department of Periodontology, School of Dentistry, İzmir Demokrasi University, İzmir, Turkey
| | - Giacomo Baima
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Federica Romano
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Nurcan Buduneli
- Department of Periodontology, School of Dentistry, Ege University, İzmir, Turkey
| | - Mario Aimetti
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
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Barbato L, Noce D, Di Martino M, Castelluzzo W, Spoleti F, Rupe C, Nieri M, Cairo F. Non-surgical retreatment versus papillary preservation flap surgery for residual pockets: A randomized controlled trial with clinical and patient-reported outcomes. J Clin Periodontol 2024. [PMID: 39011585 DOI: 10.1111/jcpe.14047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 06/10/2024] [Accepted: 07/03/2024] [Indexed: 07/17/2024]
Abstract
AIM To compare the efficacy of non-surgical re-instrumentation (NSR) and papillary preservation flap (PPF) surgery at single-rooted teeth with residual pockets. MATERIALS AND METHODS Patients with at least a residual pocket depth (PD ≥ 5 mm) after Steps I and II were enrolled and randomly assigned to receive NSR or PPF surgery. The primary outcome was PD reduction, and secondary outcomes were clinical attachment level (CAL) change and patient-reported outcome measures (PROMs). Outcome variables were measured at baseline, 3 and 6 months. The examiner was blinded. Statistical analysis, one site for each patient, included descriptive statistics and analysis of covariance. RESULTS Forty-six participants were enrolled, and one patient dropped out in the PPF group. After 6 months, both treatments resulted in significant PD reduction (1.3 ± 1.2 mm, p = .009 NSR; 2.0 ± 0.7 mm, p < .001 PPF) and CAL gain (1.0 ± 2.4 mm, p = .031 NSR; 1.4 ± 0.8 mm, p < .001 PPF). PD reduction between groups was not statistically significant (diff: 0.6 mm; 95% confidence interval [CI] [-0.3 to 1.5]; p = .167). Pocket closure was 61% NSR versus 86% PPF (p = .091). Smoking was associated with less PD reduction of almost 1 mm in both treatments. Treatment time was longer for PPF surgery, but PROMs and post-operative pain were similar between groups. CONCLUSIONS Both NSR and PPF reduced PD without significant difference between treatments at 6 months. PPF surgery may offer faster PD reduction, but smoking habits reduce treatment efficacy.
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Affiliation(s)
- Luigi Barbato
- Department of Experimental and Clinical Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
- EFP Accredited Master Program in Periodontology and Implant Dentistry, University of Florence, Florence, Italy
| | - Desirée Noce
- Department of Experimental and Clinical Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
- EFP Accredited Master Program in Periodontology and Implant Dentistry, University of Florence, Florence, Italy
| | - Maria Di Martino
- Department of Experimental and Clinical Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
- EFP Accredited Master Program in Periodontology and Implant Dentistry, University of Florence, Florence, Italy
| | - Walter Castelluzzo
- Department of Experimental and Clinical Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
- EFP Accredited Master Program in Periodontology and Implant Dentistry, University of Florence, Florence, Italy
| | - Folco Spoleti
- Department of Experimental and Clinical Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
- EFP Accredited Master Program in Periodontology and Implant Dentistry, University of Florence, Florence, Italy
| | - Cosimo Rupe
- Department of Experimental and Clinical Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
- EFP Accredited Master Program in Periodontology and Implant Dentistry, University of Florence, Florence, Italy
| | - Michele Nieri
- Department of Experimental and Clinical Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
- EFP Accredited Master Program in Periodontology and Implant Dentistry, University of Florence, Florence, Italy
| | - Francesco Cairo
- Department of Experimental and Clinical Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
- EFP Accredited Master Program in Periodontology and Implant Dentistry, University of Florence, Florence, Italy
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4
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Saleh MHA, Dias DR, Mandil O, Oliveira RPD, Alrmali A, Araújo MG, Wang HL, Barath Z, Urban IA. Influence of residual pockets on periodontal tooth loss: A retrospective analysis. J Periodontol 2024; 95:444-455. [PMID: 38112067 DOI: 10.1002/jper.23-0448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/03/2023] [Accepted: 11/20/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Individuals enrolled in supportive periodontal therapy (SPT) can still present with tooth loss due to periodontitis (TLP). There is limited evidence on the influence of residual pockets (RPc) and a defined "threshold" at which a patient's profile is set to be at high risk for TLP in the literature. Therefore, this study aimed to assess the influence of RPc on TLP and determine the prognostic performance of RPc compared to the staging and grading of periodontitis on TLP risk. METHODS Clinical data from 168 patients (3869 teeth) treated for periodontitis and receiving SPT for at least 10 years were evaluated in this retrospective study. TLP and the percentage of sites with RPc ≥ 5 mm or ≥6 mm per patient were collected. The prognostic performance of RPc was compared to the staging and grading of the disease on TLP using a multilevel Cox proportional hazard regression model. RESULTS Over a median follow-up of 25 years, 13.7% of teeth were lost, 4.6% of which were due to periodontitis. Most patients with TLP had ≥1 site with RPc ≥5 mm (90.8%) or ≥6 mm (77.6%). Multivariate multilevel Cox regression revealed that patients with >15% of sites with RPc ≥5 mm had a hazard ratio of 2.34, and grade C had a hazard ratio of 4.6 for TLP compared to RPc ≤4 mm/grade A. Grading exhibited the best discrimination and model fit. CONCLUSION Patients with RPc ≥5 mm at >15% of the sites are at risk for tooth loss. Grading and RPc ≥5 mm displayed very good predictive capability of TLP.
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Affiliation(s)
- Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Debora R Dias
- Department of Dentistry, State University of Maringá, Maringá, Paraná, Brazil
- Department of Periodontics and Preventive Dentistry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Obada Mandil
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | | | - Abdusalam Alrmali
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Maurício G Araújo
- Department of Dentistry, State University of Maringá, Maringá, Paraná, Brazil
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Zoltan Barath
- Department of Prosthetic Dentistry, University of Szeged, Szeged, Hungary
| | - Istvan A Urban
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Department of Prosthetic Dentistry, University of Szeged, Szeged, Hungary
- Department of Oral Medicine, Infection Control and Immunity, Harvard University, Boston, Massachusetts, USA
- Urban Regeneration Institute, Budapest, Hungary
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Berglundh T, Mombelli A, Schwarz F, Derks J. Etiology, pathogenesis and treatment of peri-implantitis: A European perspective. Periodontol 2000 2024. [PMID: 38305506 DOI: 10.1111/prd.12549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 02/03/2024]
Abstract
Peri-implantitis is a plaque-associated pathological condition occurring in tissues around dental implants. It is characterized by inflammation in the peri-implant mucosa and progressive loss of supporting bone. Over the last 30 years, peri-implantitis has become a major disease burden in dentistry. An understanding of the diagnosis, etiology and pathogenesis, epidemiology, and treatment of peri-implantitis must be a central component in undergraduate and postgraduate training programs in dentistry. In view of the strong role of European research in periodontology and implant dentistry, the focus of this review was to address peri-implantitis from a European perspective. One component of the work was to summarize new and reliable data on patients with dental implants to underpin the relevance of peri-implantitis from a population perspective. The nature of the peri-implantitis lesion was evaluated through results presented in preclinical models and evaluations of human biopsy material together with an appraisal of the microbiological characteristics. An overview of strategies and outcomes presented in clinical studies on nonsurgical and surgical treatment of peri-implantitis is discussed with a particular focus on end points of therapy and recommendations presented in the S3 level Clinical Practice Guideline for the prevention and treatment of peri-implant diseases.
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Affiliation(s)
- Tord Berglundh
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Andrea Mombelli
- Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Werner N, Heck K, Walter E, Ern C, Bumm CV, Folwaczny M. Probing pocket depth reduction after non-surgical periodontal therapy: Tooth-related factors. J Periodontol 2024; 95:29-39. [PMID: 37436696 DOI: 10.1002/jper.23-0285] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND To investigate tooth-related factors that influence the reduction of probing pocket depths (PPD) after non-surgical periodontal therapy (NST). METHODS Seven hundred forty-six patients with a total of 16,825 teeth were included and retrospectively analyzed. PPD reduction after NST was correlated with the tooth-related factors; tooth type, number of roots, furcation involvement, vitality, mobility, and type of restoration; using logistic multilevel regression for statistical analysis. RESULTS NST was able to reduce probing depth overall stratified probing depths (1.20 ± 1.51 mm, p ≤ 0.001). The reduction was significantly higher at teeth with higher probing depths at baseline. At pockets with PPD ≥ 6 mm, PPD remains high after NST. Tooth type, number of roots, furcation involvement, vitality, mobility, and type of restoration are significantly and independently associated with the rate of pocket closure. CONCLUSIONS The tooth-related factors: tooth type, number of roots, furcation involvement, vitality, mobility, and type of restoration had a significant and clinically relevant influence on phase I and II therapy. Considering these factors in advance may enhance the prediction of sites not responding adequately and the potential need for additional treatment, such as re-instrumentation or periodontal surgery, to ultimately achieve the therapy end points.
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Affiliation(s)
- Nils Werner
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU, Munich, Germany
| | - Katrin Heck
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU, Munich, Germany
| | - Elias Walter
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU, Munich, Germany
| | | | - Caspar Victor Bumm
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU, Munich, Germany
- Private practice, Munich, Germany
| | - Matthias Folwaczny
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU, Munich, Germany
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Ferrarotti F, Baima G, Rendinelli M, Citterio F, Mariani GM, Mussano F, Romano F, Romandini M, Aimetti M. Pocket closure after repeated subgingival instrumentation: a stress test to the EFP guideline for stage III-IV periodontitis. Clin Oral Investig 2023; 27:6701-6708. [PMID: 37773418 PMCID: PMC10630226 DOI: 10.1007/s00784-023-05279-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/23/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVES To study the effects of one or two repeated subgingival instrumentations (RSI) in achieving the endpoints of therapy (EoT) in open pockets [residual probing pocket depth (PPD) ≥ 6 mm and PPD 4-5 mm with bleeding on probing (BoP)] after steps I-II of therapy. MATERIALS AND METHODS Twenty-five patients (3,552 total sites; 1,450 open pockets) with stage III-IV periodontitis received steps I-II of periodontal therapy and were re-evaluated after 4-6 weeks (T1). Residual pockets received RSI at T1 and at 3 months (T2). EoT (PPD < 4 or PPD < 6 BoP-) rate at T1, T2 and 6 months (T3) was computed. The number of needed surgeries and treatment costs were calculated. RESULTS At T1, 67.6% of open pockets achieved EoT. At residual PPD ≥ 6 mm at T1 (n = 172), one and two RSI resulted in 33.1% and 45.9% of EoT at T2 and T3, respectively. At residual PPD 4-5 mm with BoP at T1 (n = 298), one and two RSI resulted in 66.8% and 72.1% of EoT at T2 and T3, respectively. PPD at T1 predicted EoT after RSI in both cases, while tooth type only in residual PPD 4-5 mm BoP + . At T1, mean number of surgeries per patient and associated costs were significantly higher than after one/two RSI. CONCLUSIONS RSI may achieve EoT in residual PPD 4-5 mm BoP + and PPD ≥ 6 mm in a considerable number of cases. CLINICAL RELEVANCE These findings may support the administration of one/two cycles of RSI prior to surgical approach. PROTOCOL REGISTRATION ClinicalTrials.gov identification number: NCT04826926.
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Affiliation(s)
- Francesco Ferrarotti
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, Via Nizza 230, Turin, Italy
| | - Giacomo Baima
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, Via Nizza 230, Turin, Italy.
- Politecnico di Torino, Turin, Italy.
| | - Martina Rendinelli
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, Via Nizza 230, Turin, Italy
| | - Filippo Citterio
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, Via Nizza 230, Turin, Italy
| | - Giulia Maria Mariani
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, Via Nizza 230, Turin, Italy
| | - Federico Mussano
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, Via Nizza 230, Turin, Italy
| | - Federica Romano
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, Via Nizza 230, Turin, Italy
| | - Mario Romandini
- Department of Periodontology, Faculty of Dentistry, University of Oslo, Geitmyrsveien, 69, 0455, Oslo, Norway.
| | - Mario Aimetti
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, Via Nizza 230, Turin, Italy
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Abu-Ta'a M, Marzouka D. Enamel Matrix Derivative (EMD) as an Adjunct to Non-surgical Periodontal Therapy: A Systematic Review. Cureus 2023; 15:e43530. [PMID: 37719602 PMCID: PMC10500965 DOI: 10.7759/cureus.43530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
If left untreated, periodontitis is a chronic, irreversible disease that can contribute to tooth loss. The primary objective of periodontal treatment is to arrest the progression of the disease and restore the supporting structures of the tooth. Scaling and root planing (SRP) is a common non-surgical periodontal therapy (NSPT) used to reduce inflammation, pocket depth, and clinical attachment loss. However, NSPT has limitations, notably in difficult-to-access deep pockets and molar furcations. Deep pockets (greater than 4 mm) frequently retain calculus following NSPT. To attain direct access, surgical periodontal therapy (SPT) is recommended, particularly for pockets deeper than 5 mm. Enamel matrix derivative (EMD) has emerged in recent years as a tool for periodontal regeneration when used in conjunction with NSP for infrabony defects. EMD may also have advantageous effects when combined with NSPT. The purpose of this review is to provide a thorough understanding of the effects of EMD as an adjunct to NSPT. The databases Scopus, PubMed/MEDLINE, Google Scholar, Cochrane, and Embase were systematically searched to identify relevant studies on the benefits of EMD and its use as an adjunct to NSPT. Incorporating EMD into NSPT reduces chair time, and 60% of studies demonstrated considerable benefits compared to SRP alone, according to the findings. On the basis of research, it can be concluded that EMD can be used as an adjunct to NSPT, thereby reducing the amount of time spent in the operating chair. In some cases, it can, therefore, be regarded as an alternative to surgical treatment.
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Affiliation(s)
| | - Dina Marzouka
- Dental Sciences, Arab American University, Ramallah, PSE
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Karlsson K, Trullenque-Eriksson A, Tomasi C, Derks J. Efficacy of access flap and pocket elimination procedures in the management of peri-implantitis: A systematic review and meta-analysis. J Clin Periodontol 2023; 50 Suppl 26:244-284. [PMID: 36217689 DOI: 10.1111/jcpe.13732] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/16/2022] [Accepted: 10/04/2022] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the efficacy of access flap and pocket elimination procedures in the surgical treatment of peri-implantitis. MATERIALS AND METHODS Systematic electronic searches (Central/MEDLINE/EMBASE) up to March 2022 were conducted to identify prospective clinical studies evaluating surgical therapy (access flap or pocket elimination procedures) of peri-implantitis. Primary outcome measures were reduction of probing depth (PD) and bleeding on probing (BOP). Risk of bias was evaluated according to study design. Meta-analysis and meta-regression were performed. Results were expressed as standardized mean effect with 95% confidence interval (CI). RESULTS Evidence from studies directly comparing surgical with non-surgical therapy is lacking. Based on pre-post data originating from 13 prospective patient cohorts, pronounced reductions of PD (standardized mean effect: 2.2 mm; 95% CI 1.8-2.7) and BOP% (27.0; 95% CI 19.8-34.2) as well as marginal bone level gain (0.2 mm; 95% CI -0.0 to 0.5) were observed at evaluation time points ranging from 1 to 5 years. Wide prediction intervals suggested a high degree of heterogeneity. Reduction of mean PD increased by 0.7 mm (95% CI 0.5-0.9) for every millimetre in increase of mean PD at baseline. During the follow-up period ranging from 1 to 5 years, disease recurrence occurred frequently and implant loss was not uncommon. CONCLUSIONS Access flap and pocket elimination surgery are effective procedures in the management of peri-implantitis, although rates of disease recurrence during 5 years were high. Treatment outcomes were affected by baseline conditions.
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Affiliation(s)
- Karolina Karlsson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Anna Trullenque-Eriksson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Cristiano Tomasi
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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10
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Santos MS, Carvalho MS, Silva JC. Recent Advances on Electrospun Nanofibers for Periodontal Regeneration. NANOMATERIALS (BASEL, SWITZERLAND) 2023; 13:1307. [PMID: 37110894 PMCID: PMC10141626 DOI: 10.3390/nano13081307] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 06/19/2023]
Abstract
Periodontitis is an inflammatory infection caused by bacterial plaque accumulation that affects the periodontal tissues. Current treatments lack bioactive signals to induce tissue repair and coordinated regeneration of the periodontium, thus alternative strategies are needed to improve clinical outcomes. Electrospun nanofibers present high porosity and surface area and are able to mimic the natural extracellular matrix, which modulates cell attachment, migration, proliferation, and differentiation. Recently, several electrospun nanofibrous membranes have been fabricated with antibacterial, anti-inflammatory, and osteogenic properties, showing promising results for periodontal regeneration. Thus, this review aims to provide an overview of the current state of the art of these nanofibrous scaffolds in periodontal regeneration strategies. First, we describe the periodontal tissues and periodontitis, as well as the currently available treatments. Next, periodontal tissue engineering (TE) strategies, as promising alternatives to the current treatments, are addressed. Electrospinning is briefly explained, the characteristics of electrospun nanofibrous scaffolds are highlighted, and a detailed overview of electrospun nanofibers applied to periodontal TE is provided. Finally, current limitations and possible future developments of electrospun nanofibrous scaffolds for periodontitis treatment are also discussed.
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Affiliation(s)
- Mafalda S. Santos
- Department of Bioengineering, iBB-Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal;
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal
| | - Marta S. Carvalho
- Department of Bioengineering, iBB-Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal;
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal
| | - João C. Silva
- Department of Bioengineering, iBB-Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal;
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal
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Krajewski A, Perussolo J, Gkranias N, Donos N. Influence of periodontal surgery on the subgingival microbiome-A systematic review and meta-analysis. J Periodontal Res 2023; 58:308-324. [PMID: 36597817 DOI: 10.1111/jre.13092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/10/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The objective of this systematic review and meta-analysis was to evaluate the effect of periodontal surgery on the subgingival microbiome. BACKGROUND Periodontitis is a chronic inflammation of the tooth supporting tissues caused by the dysbiosis of the subgingival biofilm. It is managed through different non-surgical and surgical treatment modalities. Recent EFP S3 guidelines recommended performing periodontal surgery as part of Step 3 periodontitis treatment after Step 1 and Step 2 periodontal therapy, with the aim to achieve pocket closure of persisting sites. Changes in the sub-gingival microbiome may explain the treatment outcomes observed at different time points. Various microbiological detection techniques for disease-associated pathogens have been evolved over time and have been described in the literature. However, the impact of different types of periodontal surgery on the subgingival microbiome remains unclear. METHODS A systematic literature search was conducted in Medline, Embase, LILACS and Cochrane Library supplemented by manual search (23DEC2019, updated 21APR2022). RESULTS From an initial search of 3046 studies, 28 were included according to our specific inclusion criteria. Seven microbiological detection techniques were used to analyse disease-associated species in subgingival plaque samples: optical microscope, culture, polymerase chain reaction (PCR), checkerboard, enzymatic reactions, immunofluorescence and 16S gene sequencing. The included studies exhibited differences in various aspects of their methodologies such as subgingival plaque sample collection or treatment modalities. Clinical data showed a significant decrease in probing pocket depths (PPD) and clinical attachment loss (CAL) after periodontal surgery. Microbiological findings were overall heterogeneous. Meta-analysis was performed on a sub-cohort of studies all using checkerboard as a microbiological detection technique. Random effect models for Treponema denticola (T. denticola), Porphyromonas gingivalis (P. gingivalis) and Tannerella forsythia (T. forsythia) did not show a significant effect on mean counts 3 months after periodontal surgery. Notably, Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) showed a significant increase 3 months after periodontal surgery. 16S gene sequencing was used in one included study and reported a decrease in disease-associated species with an increase in health-associated species after periodontal surgery at 3 and 6 months. CONCLUSION This systematic review has shown that the effect of periodontal surgery on the changes in subgingival microbiome is heterogeneous and may not always be associated with a decrease in disease-associated species. The variability could be attributed to the microbiological techniques employed for the analysis. Therefore, there is a need for well-designed and adequately powered studies to understand how periodontal surgery influences the subgingival microbiome and how the individual's microbiome affects treatment outcomes after periodontal surgery.
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Affiliation(s)
- Anna Krajewski
- Centre for Oral Clinical Research, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jeniffer Perussolo
- Centre for Oral Clinical Research, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Nikolaos Gkranias
- Centre for Oral Clinical Research, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Nikos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Local drug delivery in the treatment of furcation defects in periodontitis: a systematic review. Clin Oral Investig 2023; 27:955-970. [PMID: 36729235 PMCID: PMC9985576 DOI: 10.1007/s00784-023-04871-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/22/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To evaluate the effect of subgingival administration of various antimicrobials and host-modulating agents in furcation defects as an adjunct to scaling and root planing (SRP) compared to SRP alone or combined with placebo. METHODS A systematic review was carried out using MEDLINE-PubMed, Embase, and Scopus for articles up to October 2022 in addition to hand searches. All longitudinal studies that evaluated the effect of subgingival application of antimicrobial and host-modulating agents in furcation defects as adjuncts to SRP compared to SRP alone or SRP + placebo with at least 3 months of follow-up were eligible for inclusion. RESULTS A total of eight studies were included. Superior clinical treatment outcomes were shown when alendronate, rosuvastatin, boric acid, simvastatin, and tetracycline (only at 3 months) were utilized in furcation defects in conjunction with SRP alone or SRP + placebo. Significant improvement was reported in radiographic bone defect depth and defect depth reduction when SRP was supplemented with alendronate, rosuvastatin, boric acid, and simvastatin. CONCLUSIONS Within the limitations of this review, the adjunctive subgingival administration of medications and host-modulating agents in furcation defects may confer additional clinical and radiographic benefits than non-surgical periodontal treatment alone. Future investigations are needed to confirm their long-term effectiveness. CLINICAL RELEVANCE Local host modulators and antimicrobials may be used supplementary to enhance the clinical and radiographic treatment outcomes of conventional periodontal therapy in furcation defects.
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Ju X, Mejia G, Chrisopoulos S, Luzzi L, Jamieson LM. A longitudinal assessment of chronic periodontitis in Australian adults. J Clin Periodontol 2023; 50:276-285. [PMID: 36330664 PMCID: PMC10947095 DOI: 10.1111/jcpe.13741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
AIM The study aimed to estimate the incidence/progression and reversal of chronic periodontitis and to identify factors associated with chronic periodontitis in Australian adults over a 12-year period. MATERIALS AND METHODS Data were obtained from the longitudinal component of the National Study of Adult Oral Health (NSAOH) in 2004-2006, and repeated data, among the same adults, in 2017-2018. NSAOH 2004-2006 was a population-based study of Australian adults aged 15+ years. The American Academy of Periodontology/European Federation of Periodontology case definitions were used, and then compared with two other case definitions. Multivariable Poisson regression models were used to estimate incidence rate ratios (IRRs) and reversal rate ratio (RRRs) of periodontitis. RESULTS A total of 775 dentate Australian adults had dental examinations at both times. The proportion of incidence/progression and reversal among Australian adults was 56.4% and 11.0%, respectively. Tobacco smokers presented with more than three times higher incidence (IRR: 3.32, 95% CI: 1.50-7.60) and lower reversals (RRR: 0.94, 95% CI: 0.39-0.98) than those who had never smoked. Cessation of smoking was positively associated with periodontitis reversal. The total incidence/progression was 471.7/10,000 person-years, with reversal being 107.5/10,000 person-years. The average number of teeth lost due to periodontal disease was 1.9 in 2017-2018. Being male and not having periodontal treatment were significant risk markers for the incidence/progression of periodontitis. CONCLUSION Smoking is a risk factor for periodontitis. Cessation of smoking is an effective means of reducing the incidence and progression of chronic periodontitis, to reduce the risk of tooth loss, and to improve overall periodontal health.
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Affiliation(s)
- Xiangqun Ju
- Australian Research Centre for Population Oral Health (ARCPOH)Adelaide Dental School, University of AdelaideAdelaideSouth AustraliaAustralia
| | - Gloria Mejia
- Australian Research Centre for Population Oral Health (ARCPOH)Adelaide Dental School, University of AdelaideAdelaideSouth AustraliaAustralia
| | - Sergio Chrisopoulos
- Australian Research Centre for Population Oral Health (ARCPOH)Adelaide Dental School, University of AdelaideAdelaideSouth AustraliaAustralia
| | - Liana Luzzi
- Australian Research Centre for Population Oral Health (ARCPOH)Adelaide Dental School, University of AdelaideAdelaideSouth AustraliaAustralia
| | - Lisa M. Jamieson
- Australian Research Centre for Population Oral Health (ARCPOH)Adelaide Dental School, University of AdelaideAdelaideSouth AustraliaAustralia
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14
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Shah C, Holtfreter B, Hughes FJ, Nibali L. Retrospective exploratory study of smoking status and e-cigarette use with response to non-surgical periodontal therapy. J Periodontol 2023; 94:41-54. [PMID: 35781714 PMCID: PMC10087441 DOI: 10.1002/jper.21-0702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND To compare periodontal treatment responses in electronic cigarette (e-cigarette) users, non-smokers, former and current smokers. METHODS In this retrospective clinical study, 220 patients with periodontitis were seen for baseline periodontal charting, professional-mechanical-plaque-removal (PMPR) and re-evaluation by postgraduate students. Sixty of these patients were former smokers, twenty were former smokers now using e-cigarettes, twenty current smokers, while all others (n = 120) were non-smokers. Effects of smoking status and treatment duration on clinical outcomes were analyzed by linear models using generalized least squares adjusted for known confounders. The primary outcome was "need for surgery" defined as number of sextants with ≥2 non-adjacent sites of probing depths (PD) ≥5 mm. RESULTS Compared with non-smokers, e-cigarette users had a less favorable treatment response after PMPR. This included statistically significant increased "need for surgery", as well as increased number of sextants with PD ≥5 mm, number of sites with PD >5 mm and mean PD. There were no statistically significant differences between e-cigarette users and current smokers. Former smokers responded statistically significantly better than e-cigarette users for the primary outcome as well as for the number of sextants and sites with PD ≥5 mm and mean PD. CONCLUSIONS Overall, e-cigarette users had a statistically significantly less favorable response to PMPR than non-smokers; their response was not statistically significantly different to those of current smokers. This, however, needs to be validated with further research in prospective clinical and observational studies in different populations.
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Affiliation(s)
- Chandni Shah
- Periodontology UnitCentre for Host Microbiome Interactions, Faculty of DentistryOral & Craniofacial SciencesKing's College LondonLondonUK
| | - Birte Holtfreter
- Department of Restorative DentistryPeriodontologyEndodontologyand Preventive and Pediatric DentistryUniversity Medicine GreifswaldGreifswaldGermany
| | - Francis J. Hughes
- Periodontology UnitCentre for Host Microbiome Interactions, Faculty of DentistryOral & Craniofacial SciencesKing's College LondonLondonUK
| | - Luigi Nibali
- Periodontology UnitCentre for Host Microbiome Interactions, Faculty of DentistryOral & Craniofacial SciencesKing's College LondonLondonUK
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Clinical efficacy of hand and power-driven instruments for subgingival instrumentation during periodontal surgical therapy: a systematic review. Clin Oral Investig 2023; 27:1-13. [PMID: 36565370 PMCID: PMC9789306 DOI: 10.1007/s00784-022-04759-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 10/15/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This systematic review aims to assess the available literature on the clinical efficacy of hand versus power-driven instruments for subgingival instrumentation during surgical periodontal therapy (ST). MATERIALS AND METHODS A search of the literature was carried out on MEDLINE via Ovid, Embase, Web of Science, the Cochrane Database, LILACS, and Scopus. RCTs comparing the use of powered instruments (test) to hand scalers (control) for subgingival instrumentation in terms of changes in probing pocket depth (PPD) after surgical periodontal treatment were included and screened in duplicate. Descriptive synthesis of the data and risk of bias assessment were undertaken. RESULTS Four RCTs met the inclusion criteria and were included in this systematic review. ST in all studies was performed by means of open flap debridement. Gracey curettes were the most commonly used hand instruments, while sonic and ultrasonic devices were used in the test group. Sites with initial PPD ≥ 6 mm had pocket reduction ranging from 2.93 to 4.89 mm in the control group and from 2.77 to 3.86 mm in the test group. All studies found no significant difference between the different types of instruments/devices in terms of PPD reduction. CONCLUSIONS Despite the limited number of studies, both manual and power-driven instruments appear to be effective in reducing PPD after surgical treatment of periodontitis. CLINICAL RELEVANCE Based on the findings of this systematic review, the clinician may make a decision whether to use manual or powered instruments during ST on a case-by-case basis and considering other factors, such as the risk of creating high concentrations of aerosols.
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Ju X, Harford J, Luzzi L, Mejia G, Jamieson LM. A Longitudinal Study of Chronic Periodontitis in Two Cohorts of Community-Dwelling Elderly Australians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11824. [PMID: 36142097 PMCID: PMC9516963 DOI: 10.3390/ijerph191811824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/26/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
Background: The study aimed to estimate and compare the incidence and progression of chronic periodontitis among two generations of older Australian adults. Methods: Data were from two population-based cohort studies of Australian older adults aged 60+ years South Australian Dental Longitudinal Studies (SADLS), SADLS I (1991-1992) and SADLS II (2013-2014). American Academy of Periodontology/the U.S. Centres for Disease Control and Prevention (CDC/AAP), and the 2018 European Federation of Periodontology classification (EFP/AAP) case definitions were used to define and calculate the incidence and progression of chronic periodontitis. Multivariable Poisson regression models were used to estimate incidence risk ratios (IRRs) of periodontitis. Results: A total 567 and 201 dentate respondents had periodontal exams in SADLS I and II, respectively. The incidence rate was greater in SADLS II than in SADLS I, approximately 200 vs. 100/1000 person years, respectively. Current smokers had more than two times higher IRRs, 2.38 (1.30-4.34) and 2.30 (1.24-4.26), than their non-smoking counterparts in the previous generation under the CDC/AAP and EFP/AAP, respectively. Conclusions: The most recent generation of older adults has greater incidence and progression of periodontitis than the previous generation. Being a current tobacco smoker was a significant risk factor for both the incidence and progression of periodontitis.
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Affiliation(s)
- Xiangqun Ju
- Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, University of Adelaide, Adelaide 5000, Australia
| | - Jane Harford
- Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, University of Adelaide, Adelaide 5000, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide 5042, Australia
| | - Liana Luzzi
- Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, University of Adelaide, Adelaide 5000, Australia
| | - Gloria Mejia
- Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, University of Adelaide, Adelaide 5000, Australia
| | - Lisa M. Jamieson
- Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, University of Adelaide, Adelaide 5000, Australia
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Radulescu V, Boariu MI, Rusu D, Roman A, Surlin P, Voicu A, Didilescu AC, Jentsch H, Siciliano VI, Ramaglia L, Vela O, Kardaras G, Sculean A, Stratul SI. Clinical and microbiological effects of a single application of sodium hypochlorite gel during subgingival re-instrumentation: a triple-blind randomized placebo-controlled clinical trial. Clin Oral Investig 2022; 26:6639-6652. [PMID: 35829773 DOI: 10.1007/s00784-022-04618-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/05/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this study is to assess the clinical and microbiological effects of a single subgingival administration of sodium hypochlorite gel (NaOCl) and compare it with 1% chlorhexidine (CHX) gel and a placebo gel following mechanical re-instrumentation during supportive periodontal therapy (SPT). MATERIALS AND METHODS Sixty-two patients who had been treated for stage III-IV periodontitis and enrolled in SPT were included in the study based on following criteria: (1) active periodontal therapy completed at least 6 months before enrollment in the study, (2) presence of at least 4 non-adjacent sites with probing pocket depths (PPDs) ≥ 4 mm with bleeding on probing (BOP), or presence of 5-8 mm PPDs with or without BOP. All sites presenting PPD ≥ 4 mm and BOP at baseline and 3-, 6-, and 9-month follow-up timepoints were subgingivally re-instrumented with ultrasounds. Selected patients were randomly assigned into three groups and treated additionally with a single subgingival administration of NaOCl gel (group A); 1% CHX gel (group B); and placebo gel (group C). Main outcome variable was pocket closure at 12 months. Secondary outcome variables were changes in mean PPD, BOP, and clinical attachment level (CAL) along with changes in the numbers of the following five keystone bacterial pathogens: Aggregatibacter actinomycetemcomitans (A.a.), Porphyromonas gingivalis (P.g.), Prevotella intermedia (P.i.), Tannerella forsythia (T.f.), and Treponema denticola (T.d.). RESULTS At 12 months, pocket closure was obtained in 77.5% in the NaOCl treated sites. The reduction in PPD was higher with CHX than with NaOCl, although a statistically significant adjunctive effect for NaOCl (P = 0.028) was only observed in comparison with placebo only. Mean CAL improved in all groups and at all timepoints, compared to the baseline (P < 0.05). However, after 6 months, CAL gain was statistically significantly higher in the NaOCl treated group than following application of CHX (P = 0.0026). CONCLUSION In SPT patients, a single adjunctive use of a NaOCl gel may provide benefits in controlling inflammation and residual pockets. TRIAL REGISTRATION ISRCTN Registry of Clinical Trials (ISRCTN11387188). CLINICAL RELEVANCE A baseline single application of NaOCl gel in conjunction with mechanical debridement may achieve substantial pocket closure in patients enrolled in SPT; treatment time, cost, and applicability considerations should be taken into account when selecting this therapy.
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Affiliation(s)
- Viorelia Radulescu
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, Victor Babes University of Medicine and Pharmacy, , Timisoara, Romania
| | - Marius Ion Boariu
- Department of Endodontics, Faculty of Dental Medicine, TADERP Research Center, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
| | - Darian Rusu
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, Victor Babes University of Medicine and Pharmacy, , Timisoara, Romania
| | - Alexandra Roman
- Department of Periodontology, Faculty of Dental Medicine, Applicative Periodontal Regeneration Research Unit, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Petra Surlin
- Department of Periodontology, Faculty of Dental Medicine, University of Medicine and Pharmacy, Craiova, Romania
| | - Adrian Voicu
- Department of Informatics and Medical Biostatistics, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Andreea Cristiana Didilescu
- Department of Embryology, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania
| | - Holger Jentsch
- Department of Cariology, Endodontology and Periodontology, Centre for Periodontology, University Hospital of Leipzig, Leipzig, Germany
| | - Vincenzo Iorio Siciliano
- Department of Periodontology, School of Dental Medicine, University of Naples Federico II, Naples, Italy
| | - Luca Ramaglia
- Department of Periodontology, School of Dental Medicine, University of Naples Federico II, Naples, Italy
| | - Octavia Vela
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, Victor Babes University of Medicine and Pharmacy, , Timisoara, Romania
| | - Giorgios Kardaras
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, Victor Babes University of Medicine and Pharmacy, , Timisoara, Romania
| | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Stefan-Ioan Stratul
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, Victor Babes University of Medicine and Pharmacy, , Timisoara, Romania
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Iliopoulos JM, Layrolle P, Apatzidou DA. Microbial-stem cell interactions in periodontal disease. J Med Microbiol 2022; 71. [PMID: 35451943 DOI: 10.1099/jmm.0.001503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Periodontitis is initiated by hyper-inflammatory responses in the periodontal tissues that generate dysbiotic ecological changes within the microbial communities. As a result, supportive tissues of the tooth are damaged and periodontal attachment is lost. Gingival recession, formation of periodontal pockets with the presence of bleeding, and often suppuration and/or tooth mobility are evident upon clinical examination. These changes may ultimately lead to tooth loss. Mesenchymal stem cells (MSCs) are implicated in controlling periodontal disease progression and have been shown to play a key role in periodontal tissue homeostasis and regeneration. Evidence shows that MSCs interact with subgingival microorganisms and their by-products and modulate the activity of immune cells by either paracrine mechanisms or direct cell-to-cell contact. The aim of this review is to reveal the interactions that take place between microbes and in particular periodontal pathogens and MSCs in order to understand the factors and mechanisms that modulate the regenerative capacity of periodontal tissues and the ability of the host to defend against putative pathogens. The clinical implications of these interactions in terms of anti-inflammatory and paracrine responses of MSCs, anti-microbial properties and alterations in function including their regenerative potential are critically discussed based on literature findings. In addition, future directions to design periodontal research models and study ex vivo the microbial-stem cell interactions are introduced.
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Affiliation(s)
- Jordan M Iliopoulos
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Pierre Layrolle
- INSERM, ToNIC, Pavillon Baudot, CHU Purpan, University of Toulouse, Toulouse, UMR 1214, France
| | - Danae A Apatzidou
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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19
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Enamel matrix derivative as adjunctive to non-surgical periodontal therapy: a systematic review and meta-analysis of randomized controlled trials. Clin Oral Investig 2022; 26:4263-4280. [PMID: 35389113 PMCID: PMC9203394 DOI: 10.1007/s00784-022-04474-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/22/2022] [Indexed: 11/24/2022]
Abstract
Objectives To assess the potential additional benefit of the local application of enamel matrix derivative (EMD) on the clinical outcomes following non-surgical periodontal therapy (NSPT) (steps 1 and 2 periodontal therapy). Materials and Methods A systematic literature search was performed in several electronic databases, including Medline/PubMed, Embase, The Cochrane Register of Central Trials (CENTRAL), LILACS, and grey literature. Only randomized controlled clinical trials (RCTs) were eligible for inclusion. Clinical attachment level (CAL) change (primary outcome), probing pocket depth (PPD), and bleeding on probing (BoP) reductions (secondary outcomes) were evaluated. The Cochrane Risk of Bias tool (RoB 2.0) was used to assess the quality of the included trials. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) between test and control sites were estimated using a random-effect model for amount of mean CAL and PPD change. Results Six RCTs were included for the qualitative analysis, while data from 4 studies were used for meta-analysis. Overall analysis of CAL gain (3 studies) and PPD reduction (4 studies) presented WMD of 0.14 mm (p = 0.74; CI 95% − 0.66; 0.94) and 0.46 mm (p = 0.25; CI 95% − 0.33; 1.26) in favor of NSPT + EMD compared to NSPT alone respectively. Statistical heterogeneity was found to be high in both cases (I2 = 79% and 87%, respectively). Conclusions Within their limitations, the present data indicate that the local application of EMD does not lead to additional clinical benefits after 3 to 12 months when used as an adjunctive to NSPT. However, due to the high heterogeneity among the studies, additional well-designed RCTs are needed to provide further evidence on this clinical indication for the use of EMD. Clinical relevance The adjunctive use of EMD to NSPT does not seem to additionally improve the clinical outcomes obtained with NSPT alone. Supplementary Information The online version contains supplementary material available at 10.1007/s00784-022-04474-1.
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Klokkevold PR, Damian A, Pham C, Mallya SM, Lux R. Clinical evaluation of Er,Cr:YSGG laser therapy used as an adjunct to non-surgical treatment of periodontitis: Twelve-month results from a pilot study. J Periodontol 2022; 93:1314-1324. [PMID: 35239185 DOI: 10.1002/jper.21-0443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the results of adjunctive Er,Cr:YSGG laser therapy with scaling and root planing (SRP) as compared to SRP alone in the treatment of moderate-severe periodontitis. METHODS Fifteen adults (aged 27 to 65 years) with ninety non-adjacent sites probing ≥ 5 mm were treated in split-mouth design with SRP and laser therapy versus SRP alone. Probing pocket depth (PPD), gingival recession (GR), clinical attachment level (CAL), plaque, and bleeding on probing were collected at baseline, 1, 3, 6, 9, and 12 months. Patient reported outcomes were measured to assess pain, sensitivity and satisfaction. RESULTS Clinical improvements were similar for test and control sites with no statistically significant difference. At twelve months, the average PPD reduced from 6.1mm to 4.2mm for test and 6.2mm to 4.3mm for control sites. GR increased by 0.4mm at test and control sites. CAL increased from 6.8 mm to 5.3mm for test and 6.9mm to 5.5mm for control sites. Clinical outcomes were stratified by baseline PPD ( = 5mm, = 6mm and ≥7mm) and analyzed for number of sites that reduced (≤4mm). No significant difference was observed when the baseline PPD was 5mm or 6mm. Test sites with baseline PPD ≥7mm demonstrated a statistically significant difference in the percentage of reduced sites when compared to controls at 9 (p = 0.001) and 12 months (p = 0.044). CONCLUSIONS Adjunctive Er,Cr:YSGG laser therapy with SRP provides similar clinical improvement in the treatment of moderate-severe periodontitis as SRP alone and may offer some advantage for deeper (≥7mm) pockets. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Perry R Klokkevold
- Professor of Clinical Dentistry, Section of Periodontics, UCLA School of Dentistry, USA
| | - Arianna Damian
- Former Periodontics Resident, Current Lecturer, Section of Periodontics, UCLA School of Dentistry, Private Practice, Brentwood, California, USA
| | - Charlene Pham
- Former Periodontics Resident, Section of Periodontics, UCLA School of Dentistry, Private Practice, Menifee, California, USA
| | - Sanjay M Mallya
- Associate Professor, Section of Oral and Maxillofacial Radiology, UCLA School of Dentistry, USA
| | - Renate Lux
- Section of Periodontics, UCLA School of Dentistry, USA
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21
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Chatzopoulos GS, Anastasopoulos M, Zarenti S, Doufexi AE, Tsalikis L. Flapless application of enamel matrix derivative in non-surgical periodontal treatment: A systematic review. Int J Dent Hyg 2022; 20:422-433. [PMID: 35143704 DOI: 10.1111/idh.12591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/23/2021] [Accepted: 02/06/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE To assess the effects of the flapless application of enamel matrix derivative (EMD) in combination with non-surgical periodontal treatment (NSPT) when compared to non-surgical periodontal treatment alone in adult patients. MATERIAL AND METHODS An electronic literature search was conducted in MEDLINE, Scopus and Cochrane Library up to March 2021 complemented by a manual search. Human longitudinal studies of >5 participants and at least 3 months follow-up were eligible for inclusion in the review. Clinical outcomes were extracted and pooled. Meta-analysis of the included studies was not possible due to methodological differences. RESULTS A total of 1199 publications were identified and reviewed for eligibility. Nine of them fulfilled the inclusion criteria. Eight studies were randomized clinical trials. The clinical findings of the majority of the included studies demonstrated that the adjunctive use of EMD with NSPT could lead to significantly improved treatment outcomes including higher PPD reduction, more CAL gain, more robust BOP reduction, higher number of sites with PPD < 5 mm and more frequent pocket closure which reduces the need for further periodontal surgical treatment. Limited biological, microbiological and histological findings were reported. Minimal adverse events were observed. CONCLUSION The flapless application of EMD during NSPT leads to an improved clinical outcome in regards to CAL gain and PPD reduction when compared to conventional treatment alone. The potential effect on the biological and microbiological outcome is unclear.
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Affiliation(s)
- Georgios S Chatzopoulos
- Division of Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Greece
| | - Menelaos Anastasopoulos
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Greece
| | - Sofia Zarenti
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Greece
| | - Aikaterini-Elisavet Doufexi
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Greece.,Private Practice Limited to Periodontics and Implant Dentistry, Thessaloniki, Greece
| | - Lazaros Tsalikis
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Greece
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22
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Collins JR, Ogando G, González R, Figuero E, Marín MJ, Sanz M, Herrera D. Adjunctive efficacy of systemic metronidazole in the surgical treatment of periodontitis: a double-blind parallel randomized clinical trial. Clin Oral Investig 2022; 26:4195-4207. [PMID: 35122549 DOI: 10.1007/s00784-022-04392-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/11/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the clinical and microbiological impact of adjunctive metronidazole to periodontal surgery. MATERIALS AND METHODS Systemically healthy patients, with stages III-IV, grades B-C periodontitis, were randomly assigned to receive metronidazole or placebo adjunctive to periodontal surgery, after subgingival instrumentation. Clinical variables were recorded at the initial visit, 6 weeks after subgingival instrumentation, and 3, 6, and 12 months after surgery. Microbiological samples were taken at initial and final visits and analyzed by quantitative polymerase chain reaction. RESULTS Our results showed no statistically significant differences in the reduction of probing depth between the initial and final (1 year) visits in the two treatment groups. Additionally, no statistically significant differences were observed between study groups when comparing the post-subgingival instrumentation and final visits. However, 3 months after surgery, probing depth (mean difference, MD = 0.31 mm, 95% confidence interval, CI [0.13; 0.49]; p = 0.001) and clinical attachment level (MD = 0.64 mm, 95% CI [0.02; 1.27]; p = 0.044) were significantly lower in the test group. CONCLUSIONS The adjunctive use of systemic metronidazole to periodontal surgery has a limited clinical and microbiological impact in the present study, and therefore, its use is not recommended. CLINICAL RELEVANCE There are no studies that have evaluated the clinical and microbiological impact of the adjunctive use of systemic metronidazole to periodontal surgery (step 3 of periodontal therapy). The results of the present study do not support the adjunctive use of systemic metronidazole to periodontal surgery.
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Affiliation(s)
- James Rudolph Collins
- Department of Periodontology, School of Dentistry, Pontificia Universidad Católica Madre y Maestra (PUCMM), Santo Domingo, Dominican Republic.
| | - Gabriel Ogando
- Department of Periodontology, School of Dentistry, Pontificia Universidad Católica Madre y Maestra (PUCMM), Santo Domingo, Dominican Republic
| | - Rolando González
- Department of Periodontology, School of Dentistry, Pontificia Universidad Católica Madre y Maestra (PUCMM), Santo Domingo, Dominican Republic
| | - Elena Figuero
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - María José Marín
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
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23
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Effects of Periodontal Endoscopy-Assisted Nonsurgical Treatment of Periodontitis: Four-Month Results of a Randomized Controlled Split-Mouth Pilot Study. Int J Dent 2022; 2022:9511492. [PMID: 35082847 PMCID: PMC8786552 DOI: 10.1155/2022/9511492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/03/2022] [Indexed: 11/18/2022] Open
Abstract
Objective. Although the therapeutic effects of nonsurgical periodontal therapy (NSPT) are well established, the clinical benefits of the additional use of periodontal endoscopy (PE) remain controversial. Therefore, this randomized controlled split-mouth pilot study evaluated the effect of NSPT using PE versus NSPT without nPE on bleeding on probing (BOP) in sites with probing depth (PD)≥4 mm (primary outcome), PD, clinical attachment level (CAL), number of hard deposits (HDs), and treatment time per tooth (TrT). Methods. Two calibrated operators performed NSPT in twenty periodontitis patients, randomized into two quadrants for PE or nPE treatment. BOP, PD, and CAL were recorded at the first visit for NSPT (T0) and during reevaluation (T1: mean (SD) 119.7 (24.6) days after T0). The average TrT and the number of sites with HDs were documented at T0. Results. For BOP, no significant differences were found at the patient’s level (10/10 (male/female); aged 54.3 (10.9) years) neither within or between the groups. At tooth surface level, a lower number of surfaces with BOP
was observed in nPE. CAL and PD improved significantly during NSPT in both groups
, with higher PD reduction
and CAL gain
in nPE. There are significantly longer TrT
and more surfaces with subgingival HDs evident in PE at T0
. Conclusion. Whereas subgingival HDs can be visually detected with PE during NSPT, no additional clinical benefits regarding BOP, PD, or CAL were notable compared to conventional systematic periodontal instrumentation. Additionally, PE-assisted NSPT required a longer treatment time.
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24
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Thamaraiselvan M, Narayan S, Soundarajan S. Minimally invasive surgery periodontal therapy for the treatment of intrabony periodontal defects: A systematic review. Contemp Clin Dent 2022; 13:101-107. [PMID: 35846580 PMCID: PMC9285832 DOI: 10.4103/ccd.ccd_1046_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 12/26/2020] [Accepted: 03/02/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Minimally invasive therapeutic approaches have become the standard of care for many medical procedures. Conventional periodontal surgical therapies involve extensive tissue reflection, resulting in increased morbidity which stands to reason out that Minimally invasive surgery (MIS) approach for periodontal therapy would result in less morbidity and better esthetics for the patient. Thus, the aim of this review is to assess the clinical efficacy of MIS periodontal therapy compared to conventional access flap surgery for the treatment of intrabony periodontal defects. Materials and Methods: An electronic and manual search was done to identify and collect studies evaluating MIS periodontal therapy for the treatment of intrabony periodontal defects in terms of periodontal probing depth (PPD) reduction, clinical attachment level (CAL) gain, and gingival recession (REC) with a minimum of 6 month follow-up published in English. Six studies which satisfied the inclusion criteria were included for the review and the data extracted. Results: The six included studies contributed to a total of 193 patients who underwent 93 MIS therapies for treating intrabony defects with at least a 6-month follow-up. Clinical evaluation showed a PPD reduction ranging from 3.55 ± 0.88 mm to 5.2 ± 1.6 mm, while CAL gain ranged from 2.82 ± 1.19 mm to 4.5 ± 1.1 mm, while the change in gingival margin level ranged from 0.06 mm to 0.5 mm. Only one study directly compared single flap approach (SFA) (a type of MIS) to double flap approach (papilla preservation flap) which reported PPD reduction and CAL gain to be better in SFA. Conclusion: Even though the above evidence compels us to believe that minimally invasive periodontal surgery is less invasive, less time consuming, and less morbid, the lack of enough studies directly comparing MIS with conventional access flap surgeries suggest that these conclusions are arbitrary. Thus, there is currently an absence of adequate evidence to substantiate the beneficial effect of minimally invasive periodontal surgical approach compared to a conventional access flap surgery for the treatment of intrabony periodontal defects.
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25
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Leow NM, Moreno F, Marletta D, Hussain SB, Buti J, Almond N, Needleman I. Recurrence and progression of periodontitis and methods of management in long-term care: A systematic review and meta-analysis. J Clin Periodontol 2021; 49 Suppl 24:291-313. [PMID: 34761412 DOI: 10.1111/jcpe.13553] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/02/2021] [Indexed: 12/13/2022]
Abstract
AIM To systematically review the literature to evaluate the recurrence of disease of people in long-term supportive periodontal care (SPC), previously treated for periodontitis, and determine the effect of different methods of managing recurrence. The review focused on stage IV periodontitis. MATERIALS AND METHODS An electronic search was conducted (until May 2020) for prospective clinical trials. Tooth loss was the primary outcome. RESULTS Twenty-four publications were retrieved to address recurrence of disease in long-term SPC. Eight studies were included in the meta-analyses for tooth loss, and three studies for disease progression/recurrence (clinical attachment level [CAL] loss ≥2 mm). For patients in SPC of 5-20 years, prevalence of losing more than one tooth was 9.6% (95% confidence interval [CI] 5%-14%), while experiencing more than one site of CAL loss ≥2 mm was 24.8% (95% CI 11%-38%). Six studies informed on the effect of different methods of managing recurrence, with no clear evidence of superiority between methods. No data was found specifically for stage IV periodontitis. CONCLUSIONS A small proportion of patients with stage III/IV periodontitis will experience tooth loss in long-term SPC (tendency for greater prevalence with time). Regular SPC appears to be important for reduction of tooth loss. No superior method to manage disease recurrence was found.
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Affiliation(s)
- Natalie M Leow
- Unit of Periodontology, University College London, Eastman Dental Institute, London, UK
| | - Federico Moreno
- Unit of Periodontology, University College London, Eastman Dental Institute, London, UK
| | | | - Syed Basit Hussain
- Unit of Periodontology, University College London, Eastman Dental Institute, London, UK
| | - Jacopo Buti
- Unit of Periodontology, University College London, Eastman Dental Institute, London, UK
| | - Neil Almond
- British Society of Periodontology Patient Forum, UK
| | - Ian Needleman
- Unit of Periodontology, University College London, Eastman Dental Institute, London, UK
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26
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Citterio F, Gualini G, Chang M, Piccoli GM, Giraudi M, Manavella V, Baima G, Mariani GM, Romano F, Aimetti M. Pocket closure and residual pockets after non-surgical periodontal therapy: A systematic review and meta-analysis. J Clin Periodontol 2021; 49:2-14. [PMID: 34517433 PMCID: PMC9298904 DOI: 10.1111/jcpe.13547] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 11/29/2022]
Abstract
Aim To analyse the efficacy of non‐surgical therapy (NST) in terms of pocket closure (PC) and changes in percentage and number of pockets. Materials and Methods Three databases (PubMed, EMBASE, and Scopus) were searched up to January 2020. Prospective studies with a minimum follow‐up of 12 months and presenting data in terms of PC or number or percentage of pocket depths (PDs) before and after NST on systemically healthy patients were included. Random‐effect meta‐analyses were performed. Results After screening 4610 titles and abstracts, 27 studies were included. Of these, 63.9% of PC was reported by one study. The percentage of PDs ≤3 mm changed from 39.06% to 64.11% with a weighted mean difference (WMD) of 26.14% (p < .001). This accounted for a relative increase of healthy sites of 64.13%. The mean percentage of PD ≥5 mm was 28.23% and 11.71% before and after treatment, respectively, with a WMD of 15.50% (p < .001). The WMD in the number of PDs ≥5 mm before and after treatment was 24.42 (p = .036). The mean number of residual PPD ≥5 after NST was 14.13. Conclusions NST is able to eradicate the majority of the pockets. However, residual pockets after NST may remain and should be considered cautiously for further treatment planning.
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Affiliation(s)
- Filippo Citterio
- Department of Periodontology, Università di Torino, C.I.R. Dental School, Turin, Italy
| | - Giacomo Gualini
- Department of Periodontology, Università di Torino, C.I.R. Dental School, Turin, Italy
| | - Moontaek Chang
- Department of Periodontology, Università di Torino, C.I.R. Dental School, Turin, Italy.,Department of Periodontology, School of Dentistry and Institute of Oral Bioscience, Chonbuk National University, Jeonju, South Korea.,Research Institute of Clinical Medicine, Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, South Korea
| | - Gian Marco Piccoli
- Department of Periodontology, Università di Torino, C.I.R. Dental School, Turin, Italy
| | - Marta Giraudi
- Department of Periodontology, Università di Torino, C.I.R. Dental School, Turin, Italy
| | - Valeria Manavella
- Department of Periodontology, Università di Torino, C.I.R. Dental School, Turin, Italy
| | - Giacomo Baima
- Department of Periodontology, Università di Torino, C.I.R. Dental School, Turin, Italy
| | - Giulia Maria Mariani
- Department of Periodontology, Università di Torino, C.I.R. Dental School, Turin, Italy
| | - Federica Romano
- Department of Periodontology, Università di Torino, C.I.R. Dental School, Turin, Italy
| | - Mario Aimetti
- Department of Periodontology, Università di Torino, C.I.R. Dental School, Turin, Italy
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27
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Adda G, Aimetti M, Citterio F, Consoli A, Di Bartolo P, Landi L, Lione L, Luzi L. Consensus report of the joint workshop of the Italian Society of Diabetology, Italian Society of Periodontology and Implantology, Italian Association of Clinical Diabetologists (SID-SIdP-AMD). Nutr Metab Cardiovasc Dis 2021; 31:2515-2525. [PMID: 34238654 DOI: 10.1016/j.numecd.2021.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 12/21/2022]
Abstract
Periodontitis has been defined as the Sixth complication of Diabetes Mellitus. Since both diabetes mellitus and periodontitis have a high prevalence in the general population, the Italian Society of Diabetology, the Italian Society of Periodontology and Implantology and the Italian Association of Clinical Diabetologists revised the present scientific literature in the present consensus report. A bi-directional interaction was demonstrated: Patients affected by type 1 and type 2 diabetes have a higher prevalence of periodontitis than the general population, due to several metabolic factors (e.g. chronic hyperglycemia, autoimmunity, dietary and life-style factors); similarly, periodontitis predisposes to type 2 diabetes mellitus mainly via the increase of systemic cytokines release. Conversely, improvement of metabolic control of diabetic patients delay the progression of periodontitis as well as periodontitis treatment reduces glycosylated hemoglobin levels in blood. Due to the bi-directional causal interaction between periodontitis and diabetes mellitus, a strict collaboration among dentists and diabetologists is required and strongly recommended. The inter-societies consensus proposes specific flow-diagrams to improve the treatment of patients and management of the general population regarding the issue of periodontitis and diabetes.
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Affiliation(s)
- Guido Adda
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Mario Aimetti
- Department of Surgical Sciences, University of Turin, Italy
| | - Filippo Citterio
- Department of Medicine and Sciences of Aging, University of Chieti, Italy
| | - Agostino Consoli
- Department of Medicine and Sciences of Aging, University of Chieti, Italy
| | | | - Luca Landi
- President Italian Society of Periodontology and Implantology, Firenze, Italy
| | - Luca Lione
- Azienda Sociosanitaria Ligure 2, Savona, Italy
| | - Livio Luzi
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy.
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28
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De Ry SP, Roccuzzo A, Lang NP, Sculean A, Salvi GE. Long-term clinical outcomes of periodontal regeneration with Enamel Matrix Derivative (EMD): a retrospective cohort study with a mean follow-up of 10 years. J Periodontol 2021; 93:548-559. [PMID: 34258767 PMCID: PMC9373923 DOI: 10.1002/jper.21-0347] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/10/2021] [Accepted: 07/10/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Despite the large body of evidence on the efficacy of Enamel Matrix Derivative (EMD) in the treatment of periodontal intrabony defects, few studies reported long-term data (≥ 10-year). METHODS Periodontal patients treated with regenerative surgery with EMD between 1999 and 2012 were invited to participate in a clinical examination. The following clinical parameters were recorded and compared at baseline (T0), 6 months after surgery (T1) and after at least 8 years of follow-up (T2): probing depth (PD), gingival recession (GR), clinical attachment level (CAL), plaque and bleeding scores. The primary outcome variable was CAL change. RESULTS Forty-one patients with 75 treated teeth were available for analysis. Out of these, 68 (tooth survival rate: 90.7%) reached the latest follow-up with a mean observation period of 10.3 years (range: 8.0-21.3). The most frequent reason for tooth loss was recurrence of periodontal disease. Tooth survival curves showed a statistically significant difference between smokers and non-smokers (p = 0.028). Mean CAL changed from 8.43 ± 1.86 (T0) to 6.47 ± 1.70 (T1) (p<0.001) and to 5.91 ± 1.83 (T2) (p<0.001). At T1, a CAL gain of ≥3 mm was measured in 35% of the defects while at T2 it was detected in 51% of cases. CONCLUSIONS Within their limitations, the present results have shown that in intrabony defects, the clinical improvements obtained following regenerative surgery with EMD can be maintained on a mean period of 10 years. Smoking status and maxillary molars were correlated with an increased risk for tooth and CAL loss, respectively. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Siro P De Ry
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Niklaus P Lang
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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29
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Ng E, Tay JRH, Ong MMA. Minimally Invasive Periodontology: A Treatment Philosophy and Suggested Approach. Int J Dent 2021; 2021:2810264. [PMID: 34257659 PMCID: PMC8245214 DOI: 10.1155/2021/2810264] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 01/20/2023] Open
Abstract
Severe periodontitis is a highly prevalent dental disease. With the advent of implant dentistry, teeth are often extracted and replaced. Periodontal surgery, where indicated, could also result in increased trauma to the patient. This literature review discusses different treatment modalities for periodontitis and proposes a treatment approach emphasizing maximum preservation of teeth while minimizing morbidity to the patient. Scientific articles were retrieved from the MEDLINE/PubMed database up to January 2021 to identify appropriate articles that addressed the objectives of this review. This was supplemented with hand searching using reference lists from relevant articles. As tooth prognostication does not have a high predictive value, a more conservative approach in extracting teeth should be abided by. This may involve repeated rounds of nonsurgical periodontal therapy, and adjuncts such as locally delivered statin gels and subantimicrobial-dose doxycycline appear to be effective. Periodontal surgery should not be carried out at an early phase in therapy as improvements in nonsurgical therapy may be observed up to 12 months from initial treatment. Periodontal surgery, where indicated, should also be minimally invasive, with periodontal regeneration being shown to be effective over 20 years of follow-up. Biomarkers provide an opportunity for early detection of disease activity and personalised treatment. Quality of life is proposed as an alternative end point to the traditional biomedical paradigm focused on the disease state and clinical outcomes. In summary, minimally invasive therapy aims to preserve health and function of the natural dentition, thus improving the quality of life for patients with periodontitis.
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Affiliation(s)
- Ethan Ng
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore 168938, Singapore
| | - John Rong Hao Tay
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore 168938, Singapore
| | - Marianne Meng Ann Ong
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore 168938, Singapore
- Oral Health Academic Clinical Programme, Duke-NUS Medical School, Singapore 169857, Singapore
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30
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Martin C, Celis B, Ambrosio N, Bollain J, Antonoglou GN, Figuero E. Effect of orthodontic therapy in periodontitis and non-periodontitis patients: a systematic review with meta-analysis. J Clin Periodontol 2021; 49 Suppl 24:72-101. [PMID: 33998045 DOI: 10.1111/jcpe.13487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 11/29/2022]
Abstract
AIM To answer these PICO questions: #1: In adult patients with malocclusion, what are the effects of orthodontic tooth movement (OTM) on clinical attachment level (CAL) changes in treated periodontitis patients with a healthy but reduced periodontium compared to non-periodontitis patients? #2: In adult patients with treated periodontitis and malocclusion, which is the efficacy of skeletal anchorage devices compared to conventional systems in terms of orthodontic treatment outcomes? MATERIAL AND METHODS Seven databases were searched until June 2020 looking for randomized, non-randomized trials and case series. Mean effects (ME) and 95% confidence intervals (CIs) were calculated. RESULTS Twenty-six studies with high risk of bias were included. PICO#1: In 26 patients without periodontitis and in 69 treated periodontitis patients, minimal changes in periodontal outcomes were reported after orthodontic therapy (p>0.05). A significant CAL gain (mm) (ME=3.523; 95% CI [2.353; 4.693]; p<0.001) was observed in 214 patients when periodontal outcomes were retrieved before a combined periodontal and orthodontic therapy. PICO#2: Orthodontic variables were scarcely reported and objective assessment of the results on orthodontic therapy were missing. CONCLUSIONS Based on a small number of low-quality studies, in non-periodontitis and in stable treated periodontitis patients, OTM had no significant impact on periodontal outcomes.
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Affiliation(s)
- Conchita Martin
- Department of Dental Clinical Specialties, Complutense University of Madrid, Madrid, Spain.,BIOCRAN (Craniofacial Biology: Orthodontics and Dentofacial Orthopedics) Research Group, Complutense University of Madrid, Madrid, Spain
| | - Beatriz Celis
- Department of Dental Clinical Specialties, Complutense University of Madrid, Madrid, Spain
| | - Nagore Ambrosio
- Department of Dental Clinical Specialties, Complutense University of Madrid, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, Complutense University of Madrid, Madrid, Spain
| | - Juan Bollain
- Department of Dental Clinical Specialties, Complutense University of Madrid, Madrid, Spain
| | - Georgios N Antonoglou
- Department of Dental Clinical Specialties, Complutense University of Madrid, Madrid, Spain
| | - Elena Figuero
- Department of Dental Clinical Specialties, Complutense University of Madrid, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, Complutense University of Madrid, Madrid, Spain
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31
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Probst M, Burian E, Robl T, Weidlich D, Karampinos D, Brunner T, Zimmer C, Probst FA, Folwaczny M. Magnetic resonance imaging as a diagnostic tool for periodontal disease: A prospective study with correlation to standard clinical findings-Is there added value? J Clin Periodontol 2021; 48:929-948. [PMID: 33745132 DOI: 10.1111/jcpe.13458] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/25/2021] [Accepted: 02/28/2021] [Indexed: 12/11/2022]
Abstract
AIM To evaluate the correlation between standard clinical findings, radiographic (OPT) and magnetic resonance imaging (MRI) as well as to assess whether MRI is capable of providing additional information related to the severity and extent of periodontal disease. METHODS 42 patients with generalized periodontitis received pre-interventional MRI scans. These were compared to MR images of a periodontal healthy control group (n = 34). The extent of the osseous oedema, detected by MRI, was set in correlation with clinical periodontitis-associated findings. RESULTS A highly significant correlation between bone oedema and clinical testings such as probing depth (p < 0.0001) and bleeding on probing (p < 0.0001) was revealed. The oedema exceeded the extent of demineralized bone. Patients with a positive BOP test showed a 2.51-fold increase in risk of already having a bone oedema around the respective tooth even if probing depth was ≤3 mm (logistic binary regression analysis, OR 2.51; 95% CI: 1.54-4.11; p < 0.0001). CONCLUSION MRI findings correlated with standard clinical findings, and MRI was able to depict intraosseous changes before any osseous defect had occurred.
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Affiliation(s)
- Monika Probst
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - Egon Burian
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - Teresa Robl
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - Dominik Weidlich
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - Dimitrios Karampinos
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - Teresa Brunner
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - Florian Andreas Probst
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Matthias Folwaczny
- Department of Restorative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University, Munich, Germany
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Jentsch HFR, Roccuzzo M, Pilloni A, Kasaj A, Fimmers R, Jepsen S. Flapless application of enamel matrix derivative in periodontal retreatment: A multicentre randomized feasibility trial. J Clin Periodontol 2021; 48:659-667. [PMID: 33529381 DOI: 10.1111/jcpe.13438] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/04/2021] [Accepted: 01/26/2021] [Indexed: 01/16/2023]
Abstract
AIM To investigate the potential benefit of enamel matrix derivative (EMD) as adjunct to re-instrumentation of residual pockets persisting after steps 1 and 2 of periodontal therapy. MATERIAL AND METHODS 44 adult patients participated in a multicentre feasibility randomized clinical trial with split-mouth design. They had presented at re-evaluation after initial non-surgical periodontal therapy (steps 1 and 2 of periodontal therapy) for generalized periodontitis with at least 2 teeth with residual probing pocket depths (PPD) ≥5 and ≤8 mm, with bleeding on probing (BOP). Two teeth with similar PPD were randomized to receive re-instrumentation either with (test) or without (control) adjunctive flapless administration of EMD. Differences in the changes of PPD and BOP from baseline to 6 and 12 months were analysed, and the frequencies of pocket closure (PPD ≤4 mm and no BOP) compared. RESULTS For the primary outcome "change of mean PPD after 6 months," a significant additional benefit of 0.79 ± 1.3 mm (p < .0001) could be observed for the test group. At 12 months, this difference could be maintained (0.85 ± 1.1 mm; p < .0001). The frequency of pocket closure in the test group was 69% at 6 and 80% at 12 months and significantly higher than in the control group with 34% and 42%, respectively (p < .01). CONCLUSIONS The results of the present feasibility study indicate a benefit of adjunctive EMD during non-surgical retreatment (step 3 of periodontal therapy) of residual deep pockets.
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Affiliation(s)
- Holger F R Jentsch
- Centre of Periodontology, Department for Cariology, Endodontology and Periodontology, University Hospital of Leipzig, Leipzig, Germany
| | | | - Andrea Pilloni
- Sapienza, Department of Dental and Maxillo-Facial Sciences - Section of Periodontology, University of Rome, Rome, Italy
| | - Adrian Kasaj
- Department of Periodontology and Conservative Dentistry, University of Mainz, Mainz, Germany
| | - Rolf Fimmers
- Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
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Hassan FW, Mohd N. Periodontal management in a primary polycythemia rubra vera patient: A case report. SPECIAL CARE IN DENTISTRY 2020; 41:92-97. [PMID: 33125720 DOI: 10.1111/scd.12537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIM Polycythemia rubra vera (PRV) is a myeloproliferative disease, which is characterized by the proliferation of all three major hematopoietic groups (erythrocytes, leucocytes and platelets). This hematological condition presented with different clinical manifestations depending on the thrombohemorrhagic status of the patient. It is suggested patient with preexisting PRV may suffer complication during periodontal treatment. Thus, this case would therefore demonstrate periodontal management outcome in PRV patient. CASE PRESENTATION A 60-year-old Malay gentleman presented to the Periodontic Clinic, Universiti Kebangsaan Malaysia. He was a known case of primary PRV for the past 5 years. Intraoral examination showed generalized periodontal deep pockets ranging from 5 to 10 mm. He was diagnosed as Stage III Grade C periodontitis. Nonsurgical periodontal therapy was provided, followed by surgical correction of residual periodontal deep pockets on teeth 17, 11, and 23. He was reviewed at 4-month intervals for supportive periodontal therapy after stabilization of his periodontal condition. CONCLUSION Polycythemia rubra vera (PRV) patients should have preoperative therapeutic control for more than 4 months and have been treated with myelosuppressive agents prior to periodontal surgery. Good oral hygiene and periodical supportive periodontal therapy are the key factors for successful periodontal treatment outcomes in well-controlled PRV patients.
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Affiliation(s)
- Farah Wahida Hassan
- Periodontic Unit, Cahaya Suria Dental Clinic, Ministry of Health, Kuala Lumpur, Malaysia
| | - Nurulhuda Mohd
- Unit of Periodontology, Department of Restorative Dentistry, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Malaysia
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Evidence-based, personalised and minimally invasive treatment for periodontitis patients - the new EFP S3-level clinical treatment guidelines. Br Dent J 2020; 229:443-449. [PMID: 33037364 DOI: 10.1038/s41415-020-2173-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/21/2020] [Indexed: 12/20/2022]
Abstract
The 2017 international classification system for periodontal diseases characterises periodontitis patients based upon disease extent, severity and past experience, and in stage IV includes a treatment complexity component. In addition, taking into account well-established risk factors, it aims to estimate the risk for future attachment loss. This classification system draws upon current understanding of disease pathobiology and reflects the complex, multifactorial nature of the periodontitis. It also acknowledges individual patients' risk profiles.Classification and diagnosis are distinct but linked entities, and the inclusion of established risk factors in the system helps signpost the clinician and patient towards a more personalised approach to care provision. The European Federation of Periodontology (EFP) has recently developed an S3-level clinical treatment guideline for stages I to III periodontitis, based upon a rigorous standardised process involving 15 systematic reviews of current evidence and their synthesis by a representative group of experts and stakeholders. The aim is to guide the practitioner through the complex plethora of periodontal management options and to facilitate pragmatic decision-making in full knowledge of the evidence base.Here, we present the structured, stepwise treatment protocols developed by the EFP guideline group and highlight selected specific clinical recommendations. The adapted guidelines for the UK healthcare system will be published in early 2021.
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Cosgarea R, Jepsen S, Fimmers R, Bodea A, Eick S, Sculean A. Clinical outcomes following periodontal surgery and root surface decontamination by erythritol-based air polishing. A randomized, controlled, clinical pilot study. Clin Oral Investig 2020; 25:627-635. [PMID: 32839833 PMCID: PMC7820077 DOI: 10.1007/s00784-020-03533-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/14/2020] [Indexed: 12/11/2022]
Abstract
Aim To evaluate the outcomes following surgical periodontal treatment and root surface decontamination by means of air polishing using an erythritol powder or conventional mechanical root debridement. Material and methods Thirty systemically healthy patients (44.38 ± 8.2 years old, 11 smokers, 19 women) diagnosed with periodontitis stages III–IV were included. Each patient, with one single-rooted tooth, with one probing pocket depth (PD) ≥ 6 mm associated with horizontal bone loss, was treated by means of simplified papilla preservation flap (SPPF) and randomized to either test treatment (careful removal of the calculus with the tip of a blade, air polishing of the root surfaces with erythritol) or to the control group (scaling and root planing with hand curettes, ultrasonic instruments). PD, clinical attachment (CAL), bone sounding (BS), and radiographic bone level (BL) were evaluated at baseline and 12 months postsurgically. Results Twenty-seven patients completed the 12-month follow-up (test: n = 14, control: n = 13). In both groups, statistically significant improvements were obtained (p < 0.05, mean CAL gain/PD reduction: test, 2.50 ± 1.60 mm/3.00 ± 0.96 mm; control, 2.85 ± 1.21 mm/3.38 ± 1.12 mm). No statistically significant differences were observed between the groups for any of the investigated parameters (p < 0.05). Conclusion Within their limits, the present results indicate that the use of air polishing with an erythritol powder during periodontal surgery may represent a valuable minimally invasive adjunct following calculus removal by means of hand and ultrasonic instruments or a valuable alternative to these, for root surfaces without calculus. Clinical relevance The use of air polishing with an erythritol powder during periodontal surgery appears to represent a valuable minimally invasive adjunct following calculus removal by means of hand and ultrasonic instruments or a valuable alternative to these, for root surfaces without calculus.
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Affiliation(s)
- Raluca Cosgarea
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Welschnonnenstr. 17, 53111, Bonn, Germany. .,Department of Prosthetic Dentistry, University Iuliu-Hatieganu, Str. Clinicilor nr 32, 400006, Cluj-Napoca, Romania. .,Department of Periodontology and Peri-implant Diseases, Philipps University of Marburg, Georg-Voigt Str. 3, 35033, Marburg, Germany.
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Welschnonnenstr. 17, 53111, Bonn, Germany
| | - Rolf Fimmers
- Institute for Medical Biometry, Informatics and Epidemiology, University Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Aura Bodea
- Periodontal Private Practice for Periodontology, Gheorghe Doja Str. 9, 400068, Cluj-Napoca, Romania
| | - Sigrun Eick
- Department of Periodontology, University Bern, Bern, Switzerland, Freiburgstrasse 7, CH-3010, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, University Bern, Bern, Switzerland, Freiburgstrasse 7, CH-3010, Bern, Switzerland
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Sanz M, Herrera D, Kebschull M, Chapple I, Jepsen S, Berglundh T, Sculean A, Tonetti MS. Treatment of stage I-III periodontitis-The EFP S3 level clinical practice guideline. J Clin Periodontol 2020; 47 Suppl 22:4-60. [PMID: 32383274 PMCID: PMC7891343 DOI: 10.1111/jcpe.13290] [Citation(s) in RCA: 653] [Impact Index Per Article: 163.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 04/03/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The recently introduced 2017 World Workshop on the classification of periodontitis, incorporating stages and grades of disease, aims to link disease classification with approaches to prevention and treatment, as it describes not only disease severity and extent but also the degree of complexity and an individual's risk. There is, therefore, a need for evidence-based clinical guidelines providing recommendations to treat periodontitis. AIM The objective of the current project was to develop a S3 Level Clinical Practice Guideline (CPG) for the treatment of Stage I-III periodontitis. MATERIAL AND METHODS This S3 CPG was developed under the auspices of the European Federation of Periodontology (EFP), following the methodological guidance of the Association of Scientific Medical Societies in Germany and the Grading of Recommendations Assessment, Development and Evaluation (GRADE). The rigorous and transparent process included synthesis of relevant research in 15 specifically commissioned systematic reviews, evaluation of the quality and strength of evidence, the formulation of specific recommendations and consensus, on those recommendations, by leading experts and a broad base of stakeholders. RESULTS The S3 CPG approaches the treatment of periodontitis (stages I, II and III) using a pre-established stepwise approach to therapy that, depending on the disease stage, should be incremental, each including different interventions. Consensus was achieved on recommendations covering different interventions, aimed at (a) behavioural changes, supragingival biofilm, gingival inflammation and risk factor control; (b) supra- and sub-gingival instrumentation, with and without adjunctive therapies; (c) different types of periodontal surgical interventions; and (d) the necessary supportive periodontal care to extend benefits over time. CONCLUSION This S3 guideline informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to treat periodontitis and to maintain a healthy dentition for a lifetime, according to the available evidence at the time of publication.
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Affiliation(s)
- Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri‐implant Diseases) Research GroupUniversity Complutense of MadridMadridSpain
| | - David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri‐implant Diseases) Research GroupUniversity Complutense of MadridMadridSpain
| | - Moritz Kebschull
- Periodontal Research GroupInstitute of Clinical SciencesCollege of Medical and Dental SciencesThe University of BirminghamBirminghamUK
- Birmingham Community Healthcare NHS TrustBirminghamUK
- Division of PeriodonticsSection of Oral, Diagnostic and Rehabilitation SciencesCollege of Dental MedicineColumbia UniversityNew YorkNYUSA
| | - Iain Chapple
- Periodontal Research GroupInstitute of Clinical SciencesCollege of Medical and Dental SciencesThe University of BirminghamBirminghamUK
- Birmingham Community Healthcare NHS TrustBirminghamUK
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive DentistryUniversity Hospital BonnBonnGermany
| | - Tord Berglundh
- Department of PeriodontologyInstitute of OdontologyThe Sahlgrenska AcademyUniversity of GothenburgGöteborgSweden
| | - Anton Sculean
- Department of PeriodontologySchool of Dental MedicineUniversity of BernBernSwitzerland
| | - Maurizio S. Tonetti
- Division of Periodontology and Implant DentistryFaculty of DentistryThe University of Hong KongHong KongHong Kong
- Department of Oral and Maxillo‐facial ImplantologyShanghai Key Laboratory of StomatologyNational Clinical Research Centre for StomatologyShanghai Ninth People HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghaiChina
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Trombelli L, Simonelli A, Quaranta A, Tu Y, Li H, Agusto M, Jiao X, Farina R. Effect of Flap Design for Enamel Matrix Derivative Application in Intraosseous Defects. JDR Clin Trans Res 2020; 6:184-194. [DOI: 10.1177/2380084420934731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective: To systematically review the literature addressing the focused question: What is the effectiveness of different surgical and nonsurgical procedures combined with enamel matrix derivative (EMD) on clinical, radiographic, and patient-centered outcomes in intraosseous defects? Methods: Electronic (Medline, Scopus, and Cochrane databases) and hand literature searches were performed for studies including at least 1 treatment arm where EMD had been applied according to 1 of the following procedures: modified Widman flap; papilla preservation variants (PPVs), including papilla preservation technique, modified papilla preservation technique, and simplified papilla preservation technique; minimally invasive variants, including minimally invasive surgical approach and minimally invasive surgical technique; single-flap variants (SFVs), including single-flap approach and modified minimally invasive surgical technique; or nonsurgical application (flapless approach). Data from 42 selected articles were used to perform a network meta-analysis, and a hierarchy of surgical and nonsurgical applications of EMD was built separately for EMD and EMD + graft based on 6- to 12-mo clinical and radiographic outcomes. Results: Among surgical approaches, EMD was associated with best regenerative outcomes when applied through SFVs, with a mean clinical attachment level gain of 3.93 mm and a reduction in the intrabony component of the defect of 3.35 mm. For EMD + graft, limited differences in regenerative outcomes were observed among surgical procedures. PPVs were associated with the highest residual probing depth for EMD (4.08 mm) and EMD + graft (4.32 mm). Conclusions: In the treatment of periodontal intraosseous defects, 1) SFVs appear to optimize the regenerative outcomes of EMD; 2) substantial regenerative outcomes can be obtained with SFVs and conservative double flaps (i.e., PPVs and minimally invasive variants) when EMD is combined with a graft; and 3) residual probing depth was higher following PPVs for EMD and EMD + graft. Knowledge Transfer Statement: The results of the present systematic review and meta-analysis can be used by clinicians to identify the most effective surgical or nonsurgical procedure to treat an intraosseous defect with EMD or EMD + graft. The main findings indicate that when EMD application is indicated, surgical access based on a single flap seems the most appropriate to optimize clinical outcomes. The application of EMD + graft can be effectively combined with single flaps and conservative double flaps.
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Affiliation(s)
- L. Trombelli
- Research Centre for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Ferrara, Italy
- Operative Unit of Dentistry, Azienda Unità Sanitaria Locale, Ferrara, Italy
| | - A. Simonelli
- Research Centre for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Ferrara, Italy
| | - A. Quaranta
- School of Dentistry, Università Politecnica delle Marche, Ancona, Italy
| | - Y.K. Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - H. Li
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - M. Agusto
- Department of Periodontics, West Virginia University, Morgantown, WV, USA
| | - X.J. Jiao
- Private practice, Qingdao, Mainland China
| | - R. Farina
- Research Centre for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Ferrara, Italy
- Operative Unit of Dentistry, Azienda Unità Sanitaria Locale, Ferrara, Italy
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