Efficacy and risks of tooth-supported prostheses in the treatment of partially edentulous patients with stage IV periodontitis. A systematic review and meta-analysis

A Retrospective Study of Stabilizing Bridges in Patients With Stages III and IV Periodontitis: Up to 35 Years of Clinical Audit

BACKGROUND/AIM

Studies on large cross-arch bridges in patients with severe periodontitis show that such bridges can stabilize the periodontal condition. However, it is not known if these bridges will reduce long-term tooth loss and what factors are important for their long-term survival. The aim of the study was to study all patients with Stages III/IV periodontitis who received cross-arch bridges for up 35 years in a private practice.

MATERIALS AND METHODS

All patients referred for periodontal treatment from 1986 who received cross-arch bridges with observation period of minimum 7 years were assessed. All dropouts were accounted for.

RESULTS

Ninety-eight patients (1.7% of the patient population) with 111 bridges were observed (57 females and 37 males). Age at bridge construction was 55.4 years (SD = 7.1, range 39-79). Failure rate was 14.4% at 16.1 years (SD = 4.0 range 10-22). Reasons for failure were poor oral hygiene (p = 0.0093) and complications such as caries, endontics, porcelain fractures and gingival retractions during maintenance therapy (p = 0.0059). Fewer abutment teeth were lost from the bridges than teeth from the same and opposing arches (8.8% vs. 34.4% and 25.4%) (p < 0.0001).

CONCLUSION

Cross-arch bridges constructed for patients with Stages III and IV periodontitis were successful in terms of longevity, low failure rates, tooth preservation and patient satisfaction.

Global, regional, and national temporal trends of edentulism burden from 1990to 2021 and predictions to 2050: an age-period-cohort analysis, decompositionanalysis and frontier analysis

OBJECTIVES

Edentulism affects not only chewing function but also oral health, facial morphology, and mental health. It's crucial to conduct an overview and in - depth analysis of the prevalence of edentulism and Disability - Adjusted Life Years (DALYs) at global, regional, and national levels from 1990 to 2021.

METHODS

This study sourced edentulism data from the 2021 Global Burden of Disease (GBD) database, spanning 1990 - 2021. A Joinpoint regression model, with annual percentage change (APC) and average annual percentage change (AAPC) as indicators, identified inflection points in the time - series. The slope index of inequality (SII) and concentration index (CI) were calculated to evaluate global health inequalities. Das Gupta's decomposition method and frontier analysis evaluated the link between edentulism burden and sociodemographic development. Finally, a Bayesian age-period-cohort (BAPC) model predicted future prevalence and incidence trends over the next decades.

RESULTS

In 2021, the global prevalence of edentulism was reported at 353,000,621 cases (95% uncertainty interval [UI]: 300,591,593-416,167,869), with 9,590,987 DALY (95% UI: 6,202,444-13,470,473), nearly double the figures from 1990. Decomposition analysis highlighted population aging and growth made significant contributions. Health inequality analysis revealed that the SII for DALYs was 93.497 (95% CI: 71.486-115.508) in 1990 and -18.412 (95% CI: -92.144-55.320) in 2021. From 1990 to 2021, the CI for DALYs showed an upward trend, changing from -0.202 in 1990 to 0.353 in 2021. BAPC model projects age-standardized prevalence rates(ASPR) decline by 2050, with higher burden in over 60 years old.

Clinical decision-making and management of stage IV periodontitis: A survey

OBJECTIVE

To investigate the clinical management of stage IV periodontitis patients among clinicians within the Italian Society of Periodontology and Implantology.

METHODS

A cross-sectional study was designed on a web-based anonymous survey. Comparison between ordinary members (OMs) versus active and certified members (ACMs) and comparison between members with at least 10 years of experience in periodontology (Ov10) and members with less than 10 years of experience in periodontology (Un10) were performed.

RESULTS

A total of 324 out of 1362 members (response rate of 24%) responded to the questionnaire. ACMs and Ov10 more often reported their teams hold adequate skills to manage cases. Step I and II periodontal therapy took more time in the ACMs and Ov10 groups. ACMs used different strategies to perform step I-II therapy, and antibiotics were used less frequently than OMs. Unresponsive sites were treated more often with surgery by ACMs compared to OMs. ACMs adopted different treatment sequences compared to OMs. Ov10 group used more often CBCT, lateral cephalogram, and wax-up while Un10 group tend to avoid orthodontic therapy.

CONCLUSIONS

More experienced members spent more time in step I and II of periodontal therapy, used more diagnostic tools, and performed more often surgery and orthodontics in the treatment of stage IV periodontitis patients.

Multidisciplinary approach involving strategic implant placement before orthodontic (SIMBO) treatment for generalized stage IV grade C periodontitis: A case report with 10-year follow-up

OBJECTIVE

The aim of this case report was to demonstrate the long-term effects of a multidisciplinary approach involving periodontal reconstructive surgery and strategic implant placement before orthodontic (SIMBO) treatment in a patient with severe periodontitis (e.g., stage IV/grade C).

CLINICAL CONSIDERATIONS

The patient presented with severe periodontitis and pathologic tooth migration (PTM) without stable occlusion or occlusal support. After performing cause-related therapy, periodontal regenerative surgery, pre-orthodontic posterior implant placement, and orthodontic treatment involving anterior implant placement with papilla reconstruction, the patient achieved full-mouth rehabilitation and improvement of dental and smile esthetics. The clinical and radiographic results obtained were maintained over a 10-year period.

CONCLUSION

Within the limits of this as a single case, multidisciplinary treatment involving the SIMBO approach appeared to allow long-term improvement of periodontal condition, stability of the dental arches and occlusion, and esthetics in a patient with severe periodontitis, PTM and posterior bite collapse. Future studies with more subjects are needed to evaluate and validate this approach.

CLINICAL SIGNIFICANCE

When addressing periodontal disease, SIMBO approach-based multidisciplinary treatment appears safe and effective as a clinical protocol for establishing esthetic and functional rehabilitation in generalized stage IV/grade C periodontitis.

Knowledge, attitudes, and interest in orthodontic treatment: a cross-sectional study in adults with stage III-IV periodontitis and secondary malocclusions

BACKGROUND

An increasing number of patients with advanced stages of periodontitis are seeking for treatment options. The study aimed to determine interest in orthodontic treatment (OT) and its association with oral health status and knowledge about the disease in adult subjects with stage III-IV periodontitis.

METHODS

96 subjects ≥ 30 years, with stage III-IV periodontitis agreed to fill in a questionnaire and undergo a comprehensive periodontal-orthodontic examination. The questionnaire included 44 questions: demographic, dental, health related habits, self-perceived overall and oral health, knowledge of periodontitis, and attitude toward OT. The statistical analysis was performed using a paired-sample T-test, Receiver Operating Characteristic (ROC) and binary logistic regression analysis (LRA).

RESULTS

Stage IV periodontitis was observed in 32.3% of subjects and Class II malocclusion was most prevalent (53.1%). More than half of subjects were interested in OT. Oral health, knowledge about periodontitis and age were significant predictors for interest in OT.

CONCLUSIONS

Knowledge spread about OT possibilities in advanced stages of periodontitis is very important both for the dental community and older subjects to save natural dentition.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2022 dental literature to briefly touch on several topics of interest to modern restorative dentistry. Each committee member brings discipline-specific expertise in their subject areas that include (in order of the appearance in this report): prosthodontics; periodontics, alveolar bone, and peri-implant tissues; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence the daily dental treatment decisions of the reader with an emphasis on innovations, new materials and processes, and future trends in dentistry. With the tremendous volume of literature published daily in dentistry and related disciplines, this review cannot be comprehensive. Instead, its purpose is to update interested readers and provide valuable resource material for those willing to subsequently pursue greater detail on their own. Our intent remains to assist colleagues in navigating the tremendous volume of newly minted information produced annually. Finally, we hope that readers find this work helpful in managing patients.

The association between periodontitis patients' chief complaints and the stage of periodontitis: A clinical retrospective study

OBJECTIVES

The purposes of this retrospective study were to investigate the prevalence of various periodontal chief complaints (pCCs) of patients, diagnosed with periodontitis, as well as to identify the association between pCCs and periodontal parameters or periodontitis staging according to AAP/EFP 2017 classification.

MATERIALS AND METHODS

Five hundred eighty-nine patients, applied to the clinic with pCCs, were screened. The demographic characteristics, smoking status, brushing behaviors, history of periodontal therapy, medical data, and periodontal parameters were obtained. A multinomial logistic regression analysis was performed to determine the most common pCCs and co-variables among the indicators of Stage III and IV periodontitis.

RESULTS

In Stage IV periodontitis, patients with pCC of mobility were observed the most (26.8%), and pCC of halitosis were the least (7.3%). Among all pCCs of patients, those with the pCC of gingival enlargement and tooth mobility had the highest percentage of sites with PPD ≥ 4 mm and CAL ≥ 5 mm, respectively (p < .001). According to regression analysis, those with pCC of gingival bleeding, recession and mobility were more likely to be in Stage IV than those in Stage I/II.

CONCLUSION

Among pCCs, only patients with pCCs of mobility, gingival recession and bleeding are related to periodontitis staging. Moreover, the extent of periodontal pockets in patients with pCC of gingival enlargement, and the extent of attachment loss in patients with pCC of mobility are greater than other patients.

CLINICAL RELEVANCE

New machine-learning technology models can be developed with the aim of classifying the patients based on their chief complaints, to support diagnosing the severity of periodontal diseases.

Treatment of stage IV periodontitis: The EFP S3 level clinical practice guideline

BACKGROUND

The recently published clinical practice guideline (CPG) for the treatment of periodontitis in stages I-III provided evidence-based recommendations for the treatment of periodontitis patients, defined according to the 2018 classification. Stage IV periodontitis shares the severity and complexity characteristics of stage III periodontitis, but includes the anatomical and functional sequelae of tooth and periodontal attachment loss (tooth flaring and drifting, bite collapse, etc.), which require additional interventions following completion of active periodontal therapy.

AIM

To develop an S3 Level CPG for the treatment of stage IV periodontitis, focusing on the implementation of inter-disciplinary treatment approaches required to treat/rehabilitate patients following associated sequelae and tooth loss.

MATERIALS AND METHODS

This S3 Level CPG was developed by the European Federation of Periodontology (EFP), following methodological guidance from the Association of Scientific Medical Societies in Germany and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process. A rigorous and transparent process included synthesis of relevant research in 13 specifically commissioned systematic reviews, evaluation of the quality and strength of evidence, the formulation of specific recommendations and a structured consensus process with leading experts and a broad base of stakeholders.

RESULTS

The S3 Level CPG for the treatment of stage IV periodontitis culminated in recommendations for different interventions, including orthodontic tooth movement, tooth splinting, occlusal adjustment, tooth- or implant-supported fixed or removable dental prostheses and supportive periodontal care. Prior to treatment planning, it is critically important to undertake a definitive and comprehensive diagnosis and case evaluation, obtain relevant patient information, and engage in frequent re-evaluations during and after treatment. The periodontal component of therapy should follow the CPG for the treatment of periodontitis in stages I-III.

CONCLUSIONS

The present S3 Level CPG informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to treat patients with stage IV periodontitis and to maintain a healthy dentition over lifetime, according to the available evidence at the time of publication.