Surgical and Non-Surgical Procedures Associated with Recurrence of Periodontitis in Periodontal Maintenance Therapy: 5-Year Prospective Study

Treatment of periodontal diseases: Latin America and the Caribbean Consensus 2024

The prevalence of periodontitis in Latin American and Caribbean countries (LACC) drew attention to a significant public health issue exacerbated by socio-economic disparities. This consensus report, based on the European Federation of Periodontology (EFP) S3 level clinical practice guidelines, proposed a multifaceted approach to periodontal health-care. The report highlighted the critical need for holistic, population-wide health policies and underscored the lack of documented community interventions in contemporary literature. The consensus advocated for a patient-centered approach to periodontal care, with non-surgical and surgical interventions, and a long-term commitment to supportive periodontal care (SPC). It emphasized the importance of patient engagement in biofilm control by means of home-care and professional interventions for long-term periodontal health. The report also stressed that subgingival instrumentation benefits even severely compromised teeth, by significantly reducing probing depths and gingival inflammation. Moreover, it emphasized the importance of personalized, long-term SPC for maintaining oral health post-treatment, and pointed out the need to identify factors influencing patient adherence. The aim of this report was to provide actionable guidance for clinicians and policymakers, focused on improving periodontal health outcomes and quality of life in LACC.

Supra- and sub-gingival instrumentation of periodontitis with the adjunctive treatment of a chloramine - a one-year randomized clinical trial study

Periodontitis is a bacterial-induced disease and for this reason controlling the microbiota is a necessity. Therapy includes self-performed daily oral hygiene in combination with supra- and sub-gingival instrumentation. An adjunctive antimicrobial agent may improve the outcome.

AIMS

To assess whether a chloramine (Perisolv®) has an adjunctive effect to non-surgical periodontal therapy and whether non-surgical periodontal therapy affects quality of life.

MATERIAL AND METHODS

Thirty-eight patients were randomized to a test or a control group. Clinical indices were performed at baseline and at three and twelve months. In the test group, Perisolv® was applied initially and after the sub-gingival instrumentation in pathological pockets. Oral health-related quality of life was measured with the Oral Health Impact Profile (OHIP) instrument at baseline and twelve months.

RESULTS

In both groups, an initial probing pocket depth (PPD) of > 4 mm and bleeding on probing (BOP) were statistically reduced (p < 0.002 and p < 0.002 respectively) at twelve months and after adjustment for Bonferroni. There were no significant differences between the test and the control group in terms of the number of PPD, BOP or plaque index, or in the mean OHIP score.

CONCLUSIONS

Chloramine did not have an adjunctive effect, but the overall therapy was significantly efficacious both clinically and in terms of quality of life.

TRIAL REGISTRATION

Registered at www.

CLINICALTRIALS

gov:NCT05757921.

New insights into inflammatory osteoclast precursors as therapeutic targets for rheumatoid arthritis and periodontitis

Rheumatoid arthritis (RA) and periodontitis are chronic inflammatory diseases leading to increased bone resorption. Preventing this inflammatory bone resorption is a major health challenge. Both diseases share immunopathogenic similarities and a common inflammatory environment. The autoimmune response or periodontal infection stimulates certain immune actors, leading in both cases to chronic inflammation that perpetuates bone resorption. Moreover, RA and periodontitis have a strong epidemiological association that could be explained by periodontal microbial dysbiosis. This dysbiosis is believed to be involved in the initiation of RA via three mechanisms. (i) The dissemination of periodontal pathogens triggers systemic inflammation. (ii) Periodontal pathogens can induce the generation of citrullinated neoepitopes, leading to the generation of anti-citrullinated peptide autoantibodies. (iii) Intracellular danger-associated molecular patterns accelerate local and systemic inflammation. Therefore, periodontal dysbiosis could promote or sustain bone resorption in distant inflamed joints. Interestingly, in inflammatory conditions, the existence of osteoclasts distinct from "classical osteoclasts" has recently been reported. They have proinflammatory origins and functions. Several populations of osteoclast precursors have been described in RA, such as classical monocytes, a dendritic cell subtype, and arthritis-associated osteoclastogenic macrophages. The aim of this review is to synthesize knowledge on osteoclasts and their precursors in inflammatory conditions, especially in RA and periodontitis. Special attention will be given to recent data related to RA that could be of potential value in periodontitis due to the immunopathogenic similarities between the two diseases. Improving our understanding of these pathogenic mechanisms should lead to the identification of new therapeutic targets involved in the pathological inflammatory bone resorption associated with these diseases.

Effect of supragingival plaque control on recurrent periodontitis and clinical stability among individuals under periodontal maintenance therapy: 10-year follow-up

BACKGROUND

The aim of this study was to evaluate the effect of supragingival plaque control on the recurrence of periodontitis (RP) and the achievement of a stable periodontal clinical endpoint after 10 years of periodontal maintenance therapy (PMT).

METHODS

The present retrospective cohort study included 225 individuals in continuous PMT. The plaque index (PI) determining the oral hygiene (OH) status, periodontal clinical parameters, and other variables of interest were collected at three time points: T1 (prior to active periodontal therapy [APT]), T2 (after APT), and T3 (10 years after T2). According to PI records at T3, participants were categorized into: (1) good OH (GOH; PI ≤ 30%, n = 63); (2) fair OH (FOH; PI > 30% and ≤40%, n = 73); and (3) poor OH (POH; PI > 40%, n = 88). Data were analyzed using the chi-square and Student t tests, analysis of variance (ANOVA), and mediation and regression analyses.

RESULTS

Significant differences in all periodontal clinical parameters between the GOH, FOH, and POH groups were observed at T3. The POH group exhibited higher mean bleeding on probing (BOP), periodontal probing depth (PD), and clinical attachment level (CAL), as well as higher tooth loss (POH > FOH > GOH; P < .001). There was an increased risk for RP in the FOH (odds ratio [OR] 2.02; CI, 1.10-4.38) and POH (OR 4.33; CI, 2.17-8.65) groups. Moreover, the FOH and POH groups had an approximately 2.5 and 6.0 times greater chance of not achieving a stable periodontal clinical endpoint, respectively.

CONCLUSIONS

After 10 years of monitoring in PMT, individuals with higher PI scores (>30%) presented an unhealthier periodontal status, a higher risk for RP, and a lower chance of achieving ≤4 sites with PD ≥ 5 mm.

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.

The loss of molars in supportive periodontal care: a 10-year follow-up for tooth- and patient-related factors

AIM

Determining the impact of the degree of furcation involvement (FI) on the longevity of molar teeth and assessing risk variables (tooth- and patients-related factors) associated with loss of molars (LM) in individuals treated for periodontitis and monitored in a private program of supportive periodontal care (SPC).

MATERIALS AND METHODS

The present retrospective cohort study included 222 individuals with 1,329 molars under a 10-year monitoring period in SPC. Periodontal clinical parameters, FI, type of molar, pulp vitality and other variables of interest were colleted at approximately 50 days after active periodontal therapy and after 10 years. The association of tooth- and patients-related factors with LM was assessed using a multilevel Cox regression analysis.

RESULTS

235 molars were extracted during the SPC period of 12.4(±1.9) years. Age >50 years old, male gender, diabetes, smoking and no compliance were identified as relevant patient-related factors for LM during SPC (p<0.05). Significant tooth-related factors for LM were bleeding on probing (BOP) and probing depth (PD) ≥5mm, tooth non-vitality and class II and III FI (p<0.05).

CONCLUSIONS

Class III FI, tooth non-vitality, higher mean PD and BOP, age, male gender, diabetes and smoking all strongly influenced the prognosis of molars during SPC. This article is protected by copyright. All rights reserved.

Recurrence and progression of periodontitis and methods of management in long-term care: A systematic review and meta-analysis

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.

A potential therapeutic strategy for prostatic disease by targeting the oral microbiome

Nowadays, human microbiome research is rapidly growing and emerging evidence has witnessed the critical role that oral microbiome plays in the process of human health and disease. Oral microbial dysbiosis has been confirmed as a contributory cause for diseases in multiple body systems, ranging from the oral cavity to the gastrointestinal, endocrine, immune, cardiovascular, and even nervous system. As research progressing, oral microbiome-based diagnosis and therapy are proposed and applied, which may represent potential drug targets in systemic diseases. Recent studies have uncovered the possible association between periodontal disease and prostatic disease, suggesting new prevention and therapeutic treatment for the disease by targeting periodontal pathogens. Thus, we performed this review to first explore the association between the oral microbiome and prostatic disease, according to current knowledge based on published articles, and then mainly focus on the underlying molecular and cellular mechanisms and the potential prevention and treatment derived from these mechanistic studies.

Plasmid encoding microRNA-200c ameliorates periodontitis and systemic inflammation in obese mice

The present study was conducted to characterize microRNA-200c (miR-200c) and its regulators in adipogenic differentiation, obesity, and periodontitis in obese subjects (PiOSs), and to determine the therapeutic efficacy of plasmid DNA encoding miR-200c as a treatment for PiOSs. We report that highly expressed miR-200c in gingival tissues was downregulated in diet-induced obese (DIO) mice and during adipogenic differentiation of human bone marrow mesenchymal stromal cells (hBMSCs). Local injection of Porphyromonas gingivalis lipopolysaccharide (Pg-LPS) in the maxilla interdental gingiva of DIO mice reduced miR-200c in gingival and adipose tissues and induced periodontal inflammation associated with systemic elevation of interleukin-6 (IL-6) and impaired glucose tolerance. The inhibitory functions of Pg-LPS and IL-6 on miR-200c and their effectiveness on Zeb1 were confirmed in vitro. Injection of naked plasmid DNA encoding miR-200c into the gingiva effectively rescued miR-200c downregulation, prevented periodontal and systemic inflammation, and alleviated the impaired glucose metabolism in obese mice with LPS-induced periodontitis. Increased circulating exosomal miR-200c and its function on suppressing proinflammatory cytokines and adipogenesis explained the mechanism(s) of gingival application of miR-200c in attenuating systemic inflammation in PiOSs. These results demonstrated that miR-200c reduced by Pg-LPS and IL-6 in periodontitis and obesity might lead to the pathogenesis of PiOSs, and upregulation of miR-200c in the gingiva presents a therapeutic approach for PiOSs.

Effect of compliance during periodontal maintenance therapy on c-reactive protein levels: a 6-year follow-up

AIMS

To longitudinally evaluate the effects of compliance during periodontal maintenance therapy (PMT) on C-reactive protein (CRP) levels and its relation to periodontal status.

MATERIALS AND METHODS

A subsample comprising of 30 matched pairs was taken from a previous 6-year longitudinal study under PMT. Pairs were composed of one regular (RC) and one irregular (IC) compliers, matched by age and sex. Periodontal parameters and plasma samples were collected at 3 times: T1[prior to active periodontal therapy (APT)], T2(after APT), and T3(after 6 years). CRP plasma levels were quantified using ELISA.

RESULTS

RC presented better clinical periodontal status, lower recurrence of periodontitis (sites with PD ≥4 mm and CAL ≥3 mm, together with the persistence and/or presence of BOP and/or suppuration, during any of the subsequent recall evaluations) and significant reductions in CRP levels over time [(T1: RC = 3.64 ± 2.13 and IC = 3.92 ± 2.02 mg/L) and (T3: RC = 2.12 ± 1.39 mg/L and IC = 3.71 ± 1.82 mg/L)]. Logistic regression analysis demonstrated that individuals with periodontitis recurrence presented 2.19 higher chances of presenting altered CRP levels (values ≥3 mg/L- T2 to T3) than those without periodontitis recurrence (95%CI:1.16-3.27; p = 0.017).

CONCLUSIONS

Higher CRP plasma levels were associated with higher recurrence of periodontitis and worse clinical periodontal parameters among IC when compared to RC.

The efficacy of pocket elimination/reduction compared to access flap surgery: A systematic review and meta-analysis

AIM

To assess the efficacy and adverse effects of resective surgery compared to access flap in patients with periodontitis.

METHODS

Randomized controlled trials with a follow-up ≥6 months were identified in ten databases. Screening, data extraction, and quality assessment were conducted by two reviewers. The primary outcome was probing pocket depth, and the main secondary outcome was clinical attachment level. Data on adverse events were collected. Meta-analysis was used to synthesize the findings of trials.

RESULTS

A total of 880 publications were identified. Fourteen publications from nine clinical trials met the inclusion criteria and were included for analysis. Meta-analysis was carried out using all available results. The results indicated superior pocket depth reduction following resective surgery compared to access flap after 6-12 months of follow-up (weighted mean difference 0.47 mm; confidence interval 0.7-0.24; p = .010). After 36-60 months of follow-up, no differences were found between the two treatments in pocket depth and attachment level. The prevalence of adverse effects was not different between the groups. Post-operative recession tended to be more severe for the resective approaches.

CONCLUSION

Resective surgical approach was superior to access flap in reducing pocket depth 6-12 months post-surgery, while no differences between the two modalities were found at 36-60 months of follow-up.

Periodontal condition and recurrence of periodontitis associated with alcohol consumption in periodontal maintenance therapy

Background

This study followed individuals in periodontal maintenance therapy (PMT) over 6 years and longitudinally evaluated the effects of the frequency of alcohol consumption on the recurrence of periodontitis (RP).

Material and Methods

From a 6-year follow-up cohort study with 268 individuals under PMT, 142 patients who attended at least one PMT visit within 12 months were determined to be eligible. Based on their alcohol consumption, participants were categorized into 3 groups: none or occasional alcohol use (NA; n=88), moderate alcohol use (MA; n=26) and intense alcohol use (IA; n=24). Complete periodontal examination and alcohol consumption were evaluated at 2 times, T1 (after active periodontal therapy) and T2 (6 years).

Results

The frequencies of RP in the NA, MA and IA groups were 46.5%, 57.6%, and 79.1%, respectively. The following variables were significantly associated with RP in final multivariate logistic regression model: age >50 years old (OR = 1.79; 95%CI 1.42-2.91; p=0.002), current smoking (OR = 2.42; 95%CI 1.33-4.31; p=0.001), and intensive alcohol use (OR = 1.96; 95%CI: 1.37-2.64; p=0.024). Interaction between intensive alcohol use and smoking showed a high OR estimate of 3.15 (95%CI 1.29-6.32) for RP.

Conclusions

IA individuals undergoing PMT presented worse periodontal condition, higher rates of RP and tooth loss when compared to NA individuals. Additionally, the interaction between intensive alcohol use and smoking significantly increased the risk for RP.

Key words:Periodontitis, alcohol consumption, maintenance, epidemiology.

Effect of compliance during periodontal maintenance therapy on levels of bacteria associated with periodontitis: A 6-year prospective study

BACKGROUND

It is well established that regular compliance during periodontal maintenance therapy (PMT) maintains the stability of periodontal clinical parameters obtained after active periodontal therapy (APT). However, compliance during PMT has not yet been related to subgingival bacterial levels. Thus, this study followed individuals in PMT over 6 years and longitudinally evaluated the effects of compliance on periodontitis-associated bacterial levels and its relation to periodontal status.

METHODS

From a 6-year prospective cohort study with 212 individuals in PMT, 91 were determined to be eligible. From this total, 28 regular compliers (RC) were randomly selected and matched for age and sex with 28 irregular compliers (IC). Complete periodontal examination and microbiological samples were obtained 5 times: T1 (prior to APT), T2 (after APT), T3 (2 years), T4 (4 years), and T5 (6 years). Total bacteria counts and levels of Actinomyces naeslundii, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola were evaluated through quantitative polymerase chain reaction.

RESULTS

RC had less tooth loss and better clinical and microbiological conditions over time when compared with IC. IC had higher total bacterial counts and higher levels of T. denticola. Moreover, among IC, total bacterial counts were positively associated with plaque index and bleeding on probing, while levels of A. naeslundii, T. forsythia, and T. denticola were negatively associated with clinical attachment loss (4 to 5 mm) among RC.

CONCLUSIONS

Compliance positively influenced subgingival microbiota and contributed to stability of periodontal clinical status. Regular visits during PMT sustained microbiological benefits provided by APT over a 6-year period.

A dual-action chitosan-based nanogel system of triclosan and flurbiprofen for localised treatment of periodontitis

This study aimed to develop a dual action, namely anti-inflammatory and antimicrobial, nanogels (NG) for the treatment of periodontitis using triclosan (TCS) and flurbiprofen (FLB). Triclosan, an antimicrobial drug, was prepared as nanoparticles (NPs) using poly-ε-caprolactone (PCL), while flurbiprofen, an anti-inflammatory drug, was directly loaded in a chitosan (CS) based hydrogel. The entwinement of both NPs and hydrogel loaded systems resulted in the NG. The characterisation data confirmed that the developed formulation consists of nanosized spherical structures and displays pH-dependent swelling/erosion and temperature-responsiveness. Besides, the NG exhibited adequate bioadhesiveness using the chicken pouch model and displayed antibacterial activity through the agar plate method. An in-vivo study of the NG on experimental periodontitis (EP) rats confirmed the dual antibacterial and anti-inflammatory effects which revealed an excellent therapeutic outcome. In conclusion, a dual action NG was successfully developed and proved to have superior therapeutic effects in comparison to physical mixtures of the individual drugs.

Fine-tuning multilevel modeling of risk factors associated with nonsurgical periodontal treatment outcome

This retrospective study evaluated the influence of known risk factors on nonsurgical periodontal treatment (NSPT) response using a pocket depth fine-tuning multilevel linear model (MLM). Overall, 37 patients (24 males and 13 females) with moderate-to-severe chronic periodontitis underwent NSPT. Follow-up visits at 3, 6, and 12 months included measurements of several clinical periodontal parameters. Data were sourced from a previously reported database. In a total of 1416 initially affected sites (baseline PD ≥ 4 mm) on 536 teeth, probing depth (PD) and clinical attachment loss (CAL) reductions after NSPT were evaluated against known risk factors at 3 hierarchical levels (patient, tooth, and site). For each post-treatment follow-up, the variance component models fitted to evaluate the 3-level variance of PD and CAL decrease revealed that all levels contributed significantly to the overall variance (p < 0.001). Patients who underwent NSPT and were continually monitored had curative results. All 3 hierarchical levels included risk factors influencing the degree of PD and CAL reduction. Specifically, the type of tooth, surfaces involved, and tooth mobility site-level risk factors had the strongest impact on these reductions and were highly relevant for the success of NSPT.

LncRNA AWPPH overexpression predicts the recurrence of periodontitis

Long non-coding RNA (LncRNA) AWPPH is a recently identified oncogenic lncRNA, while its role in other human diseases is still unknown. Blood samples from 80 periodontitis (periodontitis group) patients and 66 healthy controls (control group) who were admitted and treated by Peking University School and Hospital of Stomatology, expression levels of lncRNA AWPPH were detected by RT-PCR. In the present study, we showed that, before treatment, lncRNA AWPPH in plasma was up-regulated in periodontitis patients than in healthy controls. After treatment, expression levels of lncRNA AWPPH reduced significantly. Patients were followed up for 2 years to recorded recurrence. Compared with plasma levels of lncRNA AWPPH on the day of discharge, lncRNA AWPPH expression level increased significantly in patients with recurrence but not in patients without recurrence during follow-up. Based on Youden's index, patients were divided into high and low lncRNA AWPPH groups according to its expression level on the day of discharge. It was observed that the recurrence rate of periodontitis is significantly higher in high lncRNA AWPPH group than in low lncRNA AWPPH group. LncRNA AWPPH overexpression predicts the recurrence of periodontitis.

Impact of Modifiable Risk Factors on Bone Loss During Periodontal Maintenance

Objectives:

The aim of this study was to analyze modifiable patient risk factors from dental chart histories and radiographs for progressive mild-moderate periodontitis during periodontal maintenance (PM).

Methods and Materials:

Bitewing radiographs of 442 elderly periodontal maintenance patients were taken before and after two years of periodontal maintenance. Each progressive periodontitis (PP) patient (with at least one site of posterior interproximal bone loss of ≥2 mm, n=71) was matched to a periodontitis stable (PS) patient (no sites with bone loss, n=71) of the same gender and age (±five years) to control for these variables and was compared for measurements of general patient (medical history, smoking, hygiene and compliance habits) and tooth-related (bone loss, overhangs, interproximal dimensions) factors at baseline. Fisher exact and t-tests were used to compare groups.

Results:

While the elderly PM patients with mild-moderate periodontitis were generally stable, 71 of 442 were PP patients. No significant differences from PS patients were observed at baseline with regard to the systemic factors measured. However, the PP group had less cementoenamel junction to bone length (bone loss p&lt;0.0001) and more interproximal width (2.3±1.0 mm) than did the PS group (1.7±0.6 mm, p=0.0016). This was reflected in more open sites without adjacent tooth contact in PP (42% vs 15%, p=0.0006).

Conclusions:

In the short term, systemic and behavior factors are of limited value in identifying mild-moderate periodontitis patients on PM at increased risk of bone loss. However, interproximal width and lack of adjacent tooth contacts are related to the likelihood of losing interproximal bone during periodontal maintenance, suggesting the need for restorative therapy.

Long non-coding RNAs mortal obligate RNA transcript regulates the proliferation of human periodontal ligament stem cells and affects the recurrence of periodontitis

OBJECTIVE

The aim of this study is to investigate the role of long non-coding RNAs (lncRNA), mortal obligate RNA transcript (MORT), in human periodontal ligament stem cells.

DESIGN

Periodontal ligament tissues were collected from 48 periodontitis patients underwent tooth extraction and 38 people in similar age and gender distributions who experienced orthodontic treatment. After treatment, periodontitis patients were followed up for 2 years. MORT in periodontal ligament stem cells (PDLSCs) was detected by qRT-PCR. Proliferation of PDLSCs was detected by CCK-8 assay.

RESULTS

The proliferation rate of PDLSCs isolated from periodontitis-affected teeth was significantly higher than PDLSCs from healthy teeth. Overexpression of MORT inhibited the proliferation of both types of periodontal ligament stem cells. After treatment, periodontitis patients were followed up for 2 years and patients with high level of MORT expression showed relatively lower recurrence rate comparing to low expression group.

CONCLUSION

MORT is involved in the proliferation of human PDLSCs and affects the recurrence of periodontitis.

Long-term assessment of periodontal disease progression after surgical or non-surgical treatment: a systematic review

The primary aim of this systematic review was to assess the evidence on periodontal disease progression after treatment in patients receiving supportive periodontal therapy (SPT) and to identify predictors of clinical attachment level (CAL) loss. A protocol was developed to answer the following focused question: In adult patients treated for periodontitis, what is the disease progression in terms of CAL loss after surgical or non-surgical treatment? Randomized controlled clinical trials, prospective cohort studies, and longitudinal observational human studies with a minimum of 5 years of follow-up after surgical or non-surgical treatment that reported CAL and probing depth changes were selected. Seventeen publications reporting data from 14 investigations were included. Data from 964 patients with a follow-up range of 5-15 years was evaluated. When the CAL at the latest follow-up was compared to the CAL after active periodontal therapy, 10 of the included studies reported an overall mean CAL loss of ≤0.5 mm, 3 studies reported a mean CAL loss of 0.5-1 mm, and 4 studies reported a mean CAL loss of >1 mm. Based on 7 publications, the percentage of sites showing a CAL loss of ≥2 mm varied from 3% to 20%, and a high percentage of sites with CAL loss was associated with poor oral hygiene, smoking, and poor compliance with SPT. The outcomes after periodontal therapy remained stable over time. Disease progression occurred in a reduced number of sites and patients, mostly associated with poor oral hygiene, poor compliance with SPT, and smoking.

Cumulative smoking exposure and cessation associated with the recurrence of periodontitis in periodontal maintenance therapy: A 6-year follow-up

BACKGROUND

This study followed individuals in periodontal maintenance therapy (PMT) over 6 years and longitudinally evaluated the effects of cumulative smoking exposure and duration of smoking cessation on the recurrence of periodontitis.

METHODS

From a 6-year follow-up cohort study with 212 individuals in PMT, 142 patients who attended at least one PMT visit within 12 months were determined to be elegible. According to smoking habits they were categorized into three groups: non-smokers (NS; n = 95), former smokers (FS; n = 22), and current smokers (CS; n = 25). Complete periodontal examination and smoking habits were evaluated at two instances: T1 (first time, after active periodontal therapy) and T2 (second time, 6 years). Associations between the recurrence of periodontitis (RP; probing depth ≥4 mm and clinical attachment loss ≥3 mm, together with the presence of bleeding on probing and/or suppuration), smoking status, and potential risk variables were analyzed by univariate and multivariate analysis, when appropriate.

RESULTS

The RP in NS, FS, and CS groups was 44.2%, 68.2%, and 80.0%, respectively. After adjusting for confounders, odds ratios (95% confidence interval) for the RP in T2 was 2.80 (2.11 to 5.14) for FS and 5.97 (3.58 to 9.88) for CS. There was a significant dose-response relationship between pack-years of smoking and the RP, as well as a significant decrease in the risk for the RP as the years of smoking cessation increased.

CONCLUSION

During 6 years of PMT, cumulative smoking exposure and shorter time since smoking cessation were significantly associated with the RP.

Impact of compliance during periodontal maintenance therapy on oral health-related quality of life: A 6-year follow-up

OBJECTIVE

To evaluate the effects of compliance during periodontal maintenance therapy (PMT) in the oral impact on daily performance (OIDP) measures, as well as to determine and compare the periodontal condition of acceptable and irregular compliers.

MATERIAL AND METHODS

From a 6-year prospective cohort study with 268 individuals under PMT, 232 individuals had complete periodontal clinical data and OIDP questionnaires completed between T1 (data was recorded after the first PMT appointment) and T2 (final data at the last PMT appointment), were determined to be eligible. Individuals were divided into two groups: 124 acceptable compliers (AC) and 108 irregular compliers (IC). Full-mouth periodontal examination and questionnaires were evaluated in 2 times, at T1 and T2.

RESULTS

At T2, the periodontal status of the AC group was significantly better than the IC group. The IC group also presented with higher OIDP scores (63.31 ± 19.11) compared to the AC group (57.72 ± 15.30, p = 0.005). On analyzing the OIDP dimensions independently, both groups (AC and IC) presented with high scores in the functional, psychological and social performances; however, the impacts were significantly higher in IC group.

CONCLUSION

The AC group presented with better periodontal conditions and lower OIDP, compared to the IC group. The discomfort and dissatisfaction with appearance, showed more influence on these daily impacts.

CLINICAL SIGNIFICANCE

Acceptable compliers showed lower scores of OIDP when compared to erratic ones. Thus, clinicians could take the chance to gain advantage from the positive impacts of acceptable compliance in the OHRQL for subsequent patient-centred motivation during PMT.

Effect of a comprehensive plan for periodontal disease care on oral health-related quality of life in patients with periodontal disease in Taiwan

A comprehensive plan for periodontal disease (PD) care in Taiwan provides non-surgical and supportive periodontal treatment. The aim of this study was to determine whether the care plan could improve the oral health-related quality of life of patients with PD.This study was conducted by purposive sampling and a quasi-experimental design. Patients with PD were assigned to either comprehensive periodontal treatment (n = 32) or a simple cleaning regimen (n = 32). Their oral health-related quality of life (OHRQoL) was measured using the Taiwanese version of the Brief World Health Organization Quality of Life (WHOQOL-BREF) scale (general QoL) and the Oral Health Impact Profile (OHIP-14) (OHRQoL). Both scales were completed 14, 28, and 90 days after the initial assessment. The extent of PD in the experimental group was determined again at the end of the study.On the 28-item WHOQOL-BREF scale, the scores of the experimental group were higher than those of the control group on 5 items and the environmental domain at 14 days. There was a significant improvement in the experimental group on 2 items at 28 days and at 90 days after periodontal treatment (both P < .05). No difference was found between the 2 groups in score on the OHIP-14; however, there was a significant improvement in the experimental group in total score at 28 and 90 days after periodontal treatment (both P < .05). The number of teeth with probing depth ≥5 mm and the percentage of dental plaque were both significantly reduced after the intervention (both P < .001).Patients with a comprehensive plan for PD care showed some improvement in QoL, including in the environmental domain, and on the total score for OHRQoL. Comprehensive periodontal treatment also alleviated periodontal symptoms.