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Marini L, Tomasi C, Gianserra R, Graziani F, Landi L, Merli M, Nibali L, Roccuzzo M, Sforza NM, Tonetti MS, Deli F, Papi P, Murro BD, Rojas MA, Pilloni A. Reliability assessment of the 2018 classification case definitions of peri-implant health, peri-implant mucositis, and peri-implantitis. J Periodontol 2023; 94:1461-1474. [PMID: 37322858 DOI: 10.1002/jper.23-0129] [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: 02/27/2023] [Revised: 04/24/2023] [Accepted: 05/09/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the reliability and accuracy in the assignment of the case definitions of peri-implant health and diseases according to the 2018 Classification of Periodontal and Peri-implant Diseases and Conditions. METHODS Ten undergraduate students, 10 general dentists, and 10 experts in implant dentistry participated in this study. All examiners were provided with clinical and radiographic documentation of 25 dental implants. Eleven out the 25 cases were also accompanied by baseline readings. Examiners were asked to define all cases using the 2018 classification case definitions. Reliability among examiners was evaluated using the Fleiss kappa statistic. Accuracy was estimated using percentage of complete agreement and quadratic weighted kappa for pairwise comparisons between each rater and a gold standard diagnosis. RESULTS The Fleiss kappa was 0.50 (95% CI: 0.48 to 0.51) and the mean quadratic weighted kappa value was 0.544. Complete agreement with the gold standard diagnosis was achieved in 59.8% of the cases. Expertise in implantology affected accuracy positively (p < 0.001) while the absence of baseline readings affected it negatively (p < 0.001). CONCLUSION Both reliability and accuracy in assigning case definitions to dental implants according to the 2018 classification were mostly moderate. Some difficulties arose in the presence of specific challenging scenarios.
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Affiliation(s)
- Lorenzo Marini
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Cristiano Tomasi
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | | | - Filippo Graziani
- Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Luca Landi
- Private Practice, Rome and Verona, Italy
| | - Mauro Merli
- Politecnico delle Marche, Ancona, Italy
- Private Practice, Rimini, Italy
| | - Luigi Nibali
- Periodontology Unit, Centre for Host-Microbiome Interactions, Faculty of Dental and Craniofacial Sciences, King's College London, London, UK
| | - Mario Roccuzzo
- Division of Maxillofacial Surgery, University of Torino, Torino, Italy
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Private Practice, Torino, Italy
| | | | - Maurizio S Tonetti
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillo-facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Centre for Oral Diseases, Shanghai Ninth People Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Federico Deli
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Piero Papi
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Bianca Di Murro
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Mariana A Rojas
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Andrea Pilloni
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
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Chetana, Sidharthan S, Dharmarajan G, Kale S, Dharmadhikari S, Chordia D. Comparison of the effectiveness of Gingival unit transfer and free Gingival graft in the management of localized Gingival recession - A systematic review. J Oral Biol Craniofac Res 2023; 13:130-137. [PMID: 36578558 PMCID: PMC9791029 DOI: 10.1016/j.jobcr.2022.11.007] [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: 06/10/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
Background Gingival Recession (GR) is defined as the displacement of the soft tissue margin apical to the cementoenamel junction which can lead to root exposure and hypersensitivity. Treatment of GR has become an important therapeutic issue due to the increasing number of cosmetic requests from patients. Several techniques exist for the management of GR that include Sub-Epithelial Connective Tissue Graft (SECTG), Pedicle Graft (lateral and coronal), and Free Gingival Graft (FGG) and more. FGG is a non-submerged grafting procedure carried out for the management of recession defects. However, FGG has limitations like aesthetic mismatch and bulky appearance. A relatively newer modification of FGG was introduced by Allen in 2004 wherein a palatal graft including the marginal gingiva and interdental tissue was used as donor tissue for recession coverage. This review aims to study and compare the use of Gingival Unit Graft/Transfer (GUG/GUT) (palatal graft including the marginal gingiva and papillae) and FGG in the management of GR. Materials and Methods Randomized Clinical Trials, Non-Randomized Controlled Clinical Trials for the treatment of Miller Class I,II, and III of GRs by GUG with FGG were identified. Data sources included electronic databases and hand-searched journals. The primary outcome variables were complete root coverage, mean root coverage, vertical recession depth. The secondary outcome variables were keratinized tissue width gain, clinical attachment level and probing depth. Results Three Randomized Control Trials (RCTs) met the inclusion criteria and were evaluated in this systematic review. Both techniques showed significant improvement in clinical parameters. GUG procedure resulted in a greater percentage of sites achieving complete root coverage and vertical recession depth reduction when compared to FGG group in all the studies. Two studies reported significantly greater mean root coverage in GUG group compared to FGG group. GUG procedure revealed statistically significant greater gain in keratinized tissue width when compared to FGG group in all the studies. Conclusion Because of the limited number of selected studies, no conclusive statement could be made regarding the advantage of the GUG technique over FGG. However, the percentage of sites with complete root coverage obtained in the GUG technique is higher than FGG. More RCTs with aesthetic and patient satisfaction-related parameters are needed to provide definite evidence.
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Affiliation(s)
- Chetana
- Department of Periodontology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Sant Tukaram Nagar, Pimpri, Pune, 411 018, Maharashtra, India
| | - Sangamithra Sidharthan
- Department of Periodontology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Sant Tukaram Nagar, Pimpri, Pune, 411 018, Maharashtra, India,Corresponding author.
| | - Gopalakrishnan Dharmarajan
- Department of Periodontology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Sant Tukaram Nagar, Pimpri, Pune, 411 018, Maharashtra, India
| | - Sonal Kale
- Independent Researcher, Public Health Dentist, Pune, India
| | | | - Dhakshay Chordia
- Department of General Surgery, Mahaveer Health Care Center, Chennai, India
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Patient and professional use of the root coverage esthetic score (RES) and how it relates to patient satisfaction following periodontal plastic surgery. BMC Oral Health 2022; 22:295. [PMID: 35850680 PMCID: PMC9290205 DOI: 10.1186/s12903-022-02326-8] [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: 03/06/2022] [Accepted: 07/07/2022] [Indexed: 11/22/2022] Open
Abstract
Background Following periodontal plastic surgery in the treatment of recession defects, previous studies have reported that patients rate the esthetic outcomes more favorable than dental professionals. The root coverage esthetic score has been developed and suggested to serve as a comprehensive assessment instrument as it addresses several esthetic outcomes following root coverage procedures. However, no study has yet reported on patient use of this instrument. In the present study clinical, esthetic and patient-reported outcomes following periodontal plastic surgery were assessed. The primary objective was to compare the esthetic/clinical outcome as judged by the patient and by one dentist by using the root coverage esthetic score. The secondary objective was to evaluate the correlation between patient-reported outcomes, root coverage esthetic score and clinical parameters following treatment of recession defects. Materials and methods Subjects that had undergone periodontal plastic surgery were invited to score the treatment outcome according to the root coverage esthetic score, which subsequently also was professionally scored by a dentist. Thereafter, the subjects answered a questionnaire on patient satisfaction. All types of surgical root coverage procedures in canine or incisor teeth were included. Results A total of 34 subjects were included, presenting 46 treated recessions. No statistically significant different score was found comparing the root coverage esthetic score by the patient and the professional. The majority of subjects was satisfied with the treatment outcome, and most would have undergone the treatment again. Conclusion The root coverage esthetic score assessment can be conducted by patients and was not statistically significant different to that of the professional. Patient satisfaction is not always dependent on complete root coverage or the other clinical parameters included in the root coverage esthetic score.
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Fu L, Ling C, Jin Z, Luo J, Palma-Chavez J, Wu Z, Zhou J, Zhou J, Donovan B, Qi B, Mishra A, He T, Jokerst JV. Photoacoustic imaging of posterior periodontal pocket using a commercial hockey-stick transducer. JOURNAL OF BIOMEDICAL OPTICS 2022; 27:JBO-210363GR. [PMID: 35610752 PMCID: PMC9128833 DOI: 10.1117/1.jbo.27.5.056005] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/02/2022] [Indexed: 06/02/2023]
Abstract
SIGNIFICANCE Photoacoustic imaging has shown advantages over the periodontal probing method in measuring the periodontal probing depth, but the large size of conventional photoacoustic transducers prevents imaging of the more posterior teeth. AIM Our aim is to develop a photoacoustic imaging system to image the more posterior periodontal pocket. APPROACH We report a clinical "hockey-stick"-style transducer integrated with fibers for periodontal photoacoustic imaging. Cuttlefish ink labeled the periodontal pocket as the photoacoustic contrast agent. RESULTS We characterized the imaging system and then measured the pocket depth of 35 swine teeth. Three raters evaluated the performance of the hockey-stick transducer. The measurements between the Williams probing (gold standard) and the photoacoustic methods were blinded but highly correlated. We showed a bias of ∼0.3 mm for the imaging-based technique versus Williams probing. The minimum inter-reliability was over 0.60 for three different raters of varying experience, suggesting that this approach to measure the periodontal pocket is reproducible. Finally, we imaged three pre-molars of a human subject. We could access more upper and posterior teeth than conventional linear transducers. CONCLUSIONS The unique angle shape of the hockey-stick transducer allows it to image more posterior teeth than regular linear transducers. This study demonstrated the ability of a hockey-stick transducer to measure the periodontal pocket via photoacoustic imaging.
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Affiliation(s)
- Lei Fu
- University of California San Diego, Department of NanoEngineering, La Jolla, California, United States
| | - Chen Ling
- University of California San Diego, Department of NanoEngineering, La Jolla, California, United States
| | - Zhicheng Jin
- University of California San Diego, Department of NanoEngineering, La Jolla, California, United States
| | - Jessica Luo
- University of California San Diego, Department of NanoEngineering, La Jolla, California, United States
| | - Jorge Palma-Chavez
- University of California San Diego, Department of NanoEngineering, La Jolla, California, United States
| | - Zhuohong Wu
- University of California San Diego, Department of NanoEngineering, La Jolla, California, United States
| | - Jingcheng Zhou
- University of California San Diego, Department of NanoEngineering, La Jolla, California, United States
| | - Jiajing Zhou
- University of California San Diego, Department of NanoEngineering, La Jolla, California, United States
| | - Brian Donovan
- University of California San Diego, Department of NanoEngineering, La Jolla, California, United States
| | - Baiyan Qi
- University of California San Diego, Materials Science and Engineering Program, La Jolla, California, United States
| | - Aditya Mishra
- University of California San Diego, Materials Science and Engineering Program, La Jolla, California, United States
| | - Tengyu He
- University of California San Diego, Materials Science and Engineering Program, La Jolla, California, United States
| | - Jesse V. Jokerst
- University of California San Diego, Department of NanoEngineering, La Jolla, California, United States
- University of California San Diego, Materials Science and Engineering Program, La Jolla, California, United States
- University of California San Diego, Department of Radiology, La Jolla, California, United States
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Barootchi S, Mancini L, Heck T, Zucchelli G, Stefanini M, Kazarian E, Rasperini G, Wang H, Tavelli L. Reliability assessment of the classification on facial Peri‐implant Soft Tissue Dehiscence/deficiencies (PSTDs): A multi‐center inter‐rater agreement study of different skill‐level practitioners. J Periodontol 2022; 93:1173-1182. [DOI: 10.1002/jper.21-0606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/21/2021] [Accepted: 01/09/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Shayan Barootchi
- Department of Periodontics & Oral Medicine University of Michigan School of Dentistry Ann Arbor MI USA
- Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION) Ann Arbor & Boston USA
| | - Leonardo Mancini
- Department of Life, Health and Environmental Sciences University of L'Aquila L'Aquila 67100 Italy
| | - Teresa Heck
- Department of Periodontics & Oral Medicine University of Michigan School of Dentistry Ann Arbor MI USA
| | - Giovanni Zucchelli
- Department of Periodontics & Oral Medicine University of Michigan School of Dentistry Ann Arbor MI USA
- Department of Biomedical and Neuromotor Sciences University of Bologna Bologna Italy
| | - Martina Stefanini
- Department of Biomedical and Neuromotor Sciences University of Bologna Bologna Italy
| | | | - Giulio Rasperini
- Department of Periodontics & Oral Medicine University of Michigan School of Dentistry Ann Arbor MI USA
- University of Milan, Department of Biomedical, Surgical and Dental Sciences, Foundation IRCCS Ca’ Granda Polyclinic Milan Italy
| | - Hom‐Lay Wang
- Department of Periodontics & Oral Medicine University of Michigan School of Dentistry Ann Arbor MI USA
| | - Lorenzo Tavelli
- Department of Periodontics & Oral Medicine University of Michigan School of Dentistry Ann Arbor MI USA
- Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION) Ann Arbor & Boston USA
- Department of Oral Medicine, Infection, and Immunity Division of Periodontology, Harvard School of Dental Medicine Boston MA USA
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Srividya I, Penmetsa GS, Subbareddy BV, Lahari K. Analysis of root coverage esthetic score in patients treated for gingival recession: An interexaminer reliability. J Indian Soc Periodontol 2021; 25:133-137. [PMID: 33888945 PMCID: PMC8041080 DOI: 10.4103/jisp.jisp_626_19] [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: 12/18/2019] [Revised: 09/24/2020] [Accepted: 10/04/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Awareness about pink esthetics among dentists in general needs to be assessed as root coverage procedures are the mainstay of treatment for gingival recession. Concordance among the dentists in figuring out the esthetic outcomes after root coverage procedures is inconsistent. Hence, this study aims to evaluate inter- and intra-examiner reliability of root coverage esthetic scores (RES) between periodontists and nonperiodontists. Materials and Methods: The study was conducted using twenty baseline and 6-month posttreatment photographs of Miller's Class I and Class II gingival recessions. The participants that constituted ten periodontists and ten nonperiodontists were assembled in the seminar hall to receive training on protocol and procedures for RES by the investigator. All the participants were shown twenty projections of side-by-side baseline and 6-month outcomes of root coverage procedures. Each projection was shown for 30 s during which the participants were made to use RES system to evaluate the surgical outcomes. Results: Periodontists showed the highest reliability in the scores of marginal tissue contour with an overall intraexaminer reliability to be perfect among periodontists. Intraexaminer reliability among nonperiodontists was fair, and gingival margin was the parameter with the highest reliability among them. Interexaminer reliability between periodontists and nonperiodontists showed slight reliability concerning gingival margin, and fair reliability was found for marginal tissue contour, soft-tissue texture, mucogingival junction, and gingival color. Conclusion: Satisfying the esthetic component of gingiva is the duty of every dentist in general and not only the periodontists. Significant variability was found in esthetic scores between the groups, which can probably be attributed to the lack of sufficient knowledge regarding pink esthetics among the nonperiodontists, which needs to be improved.
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Affiliation(s)
- Inti Srividya
- Department of Periodontics and Implantology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
| | - Gautami Subhadra Penmetsa
- Department of Periodontics and Implantology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
| | | | - Karuturi Lahari
- Department of Periodontics and Implantology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
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Zucchelli G, Barootchi S, Tavelli L, Stefanini M, Rasperini G, Wang HL. Implant soft tissue Dehiscence coverage Esthetic Score (IDES): A pilot within- and between-rater analysis of consistency in objective and subjective scores. Clin Oral Implants Res 2021; 32:349-358. [PMID: 33420729 DOI: 10.1111/clr.13706] [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: 07/01/2020] [Revised: 10/09/2020] [Accepted: 01/03/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To introduce an esthetic index for assessing the outcomes of peri-implant soft tissue dehiscence/deficiency (PSTD) coverage and test its within- and between-reviewer reliability. MATERIALS AND METHODS Photographs of 51 single PSTDs at baseline and after treatment were provided to four periodontists from three centers. The examiners were asked to rate each case at two timepoints with the Implant soft tissue Dehiscence/deficiency coverage Esthetic Score (IDES) that involved the evaluation of the post-treatment level of the soft tissue margin, peri-implant papillae height, mucosa color, and mucosa appearance (summing up to a total score of 10). Variance components analysis was conducted using multilevel regression fit in a Bayesian framework for obtaining uncertainty intervals for fractional variance contributions and intraclass correlation values (ICC) of the IDES, and for each of its four clinical variables. RESULTS Regression models showed reproducible esthetic evaluation among the examiners (inter-reliability) and negligible intra-reviewer variability (assessment of the same case at different timepoints). The ICC for the variability in the assessment of the overall IDES was 0.86, and for the individual components ranged from 0.78 to 0.87. Additionally, there was a strong similarity between the raters' IDES values, and their subjective esthetic response, by the same raters. CONCLUSION The IDES showed persistent judgment among the 4 reviewers, and only a slight intra-reviewer variability across timepoints. Within its limitations, this study suggests that the proposed novel score can be a reliable tool for evaluating the esthetic outcomes of PSTD coverage, which can aid in standardization of esthetic assessments following the treatment of a PSTD.
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Affiliation(s)
- Giovanni Zucchelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Shayan Barootchi
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Lorenzo Tavelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Martina Stefanini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giulio Rasperini
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Foundation IRCCS Ca' Granda Polyclinic, Milan, Italy
| | - Hom-Lay Wang
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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Marini L, Tonetti MS, Nibali L, Rojas MA, Aimetti M, Cairo F, Cavalcanti R, Crea A, Ferrarotti F, Graziani F, Landi L, Sforza NM, Tomasi C, Pilloni A. The staging and grading system in defining periodontitis cases: consistency and accuracy amongst periodontal experts, general dentists and undergraduate students. J Clin Periodontol 2020; 48:205-215. [PMID: 33260273 DOI: 10.1111/jcpe.13406] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/28/2020] [Accepted: 11/24/2020] [Indexed: 12/29/2022]
Abstract
AIM The objective of this study was to evaluate consistency and accuracy of the periodontitis staging and grading classification system. METHODS Thirty participants (10 periodontal experts, 10 general dentists and 10 undergraduate students) and a gold-standard examiner were asked to classify 25 fully documented periodontitis cases twice. Fleiss kappa was used to estimate consistency across examiners. Intraclass correlation coefficient (ICC) was used to calculate consistency across time. Quadratic weighted kappa and percentage of complete agreement versus gold standard were computed to assess accuracy. RESULTS Fleiss kappa for stage, extent and grade were 0.48, 0.37 and 0.45 respectively. The highest ICC was provided by students for stage (0.91), whereas the lowest ICC by general dentists for extent (0.79). Pairwise comparisons against gold standard showed mean value of kappa >0.81 for stage and >0.41 for grade and extent. Agreement with the gold standard for all three components of the case definition was achieved in 47.2% of cases. The study identified specific factors associated with lower consistency and accuracy. CONCLUSIONS Diagnosis was highly consistent across time and moderately between examiners. Accuracy was almost perfect for stage and moderate for grade and extent. Additional efforts are required to improve training of general dentists.
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Affiliation(s)
- Lorenzo Marini
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Maurizio S Tonetti
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, the University of Hong Kong, Hong Kong, China.,Department of Oral and Maxillo-facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Centre for Stomatology, Shanghai Ninth People Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Luigi Nibali
- Periodontology Unit, Centre for Host-Microbiome Interactions, Faculty of Dental and Craniofacial Sciences, King's College London, London, UK
| | - Mariana A Rojas
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Mario Aimetti
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, Turin, Italy
| | - Francesco Cairo
- Research Unit in Periodontology and Periodontal Medicine, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Raffaele Cavalcanti
- Section of Periodontology, Department of General Surgery and Medical-Surgical Specialties, School of Dentistry, University of Catania, Catania, Italy
| | | | - Francesco Ferrarotti
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, Turin, Italy
| | - Filippo Graziani
- Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Luca Landi
- Private Practice, Rome and Verona, Italy
| | | | - Cristiano Tomasi
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Andrea Pilloni
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
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Gil S, de la Rosa M, Mancini E, Dias A, Barootchi S, Tavelli L, Mendoza-Azpur G. Coronally advanced flap achieved higher esthetic outcomes without a connective tissue graft for the treatment of single gingival recessions: a 4-year randomized clinical trial. Clin Oral Investig 2020; 25:2727-2735. [PMID: 32974775 DOI: 10.1007/s00784-020-03587-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/14/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Limited long-term data are available when comparing the esthetic outcomes of coronally advanced flap (CAF) with or without a connective tissue graft (CTG). The aim of this study was to compare the 4-year esthetic outcomes of CAF vs CAF + CTG for the treatment of isolated maxillary gingival recessions. MATERIAL AND METHODS Forty-eight patients were randomly assigned for treatment either with CAF (control; N = 24) or to CAF + CTG (test group; N = 24). Patients were followed after the surgery until the final evaluation. A professional esthetic evaluation was performed using the Root coverage Esthetic Score (RES). Recession reduction, mean root coverage, and complete root coverage were also evaluated. RESULTS Forty-two patients completed the study at the 4-year recall. A significant recession reduction was evident at 4 years, without significant intergroup differences. The CAF group showed a statistically significant higher final RES compared with the CAF + CTG group (9.14 ± 1.08 vs 7.25 ± 1.29, respectively, p < 0.001). Regarding the individual components of RES, gingival margin and marginal tissue contour were significantly higher in the CAF group compared with that in the CAF + CTG group. CONCLUSIONS CAF presented with a significantly higher overall esthetic score than CAF + CTG, and in the individual RES components of marginal tissue contour and gingival margin after 4 years. CLINICAL RELEVANCE CAF without the addition of CTG provided higher esthetic outcomes for the treatment of isolated gingival recessions.
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Affiliation(s)
- Stephany Gil
- Department of Periodontology, School of Dentistry, Universidad Científica del Sur, Calle Cantuarias 398, Miraflores, 15074, Lima, Peru
| | - Manuel de la Rosa
- Department of Periodontics, AME University Monterrey, Monterrey, Mexico
| | | | - Antonio Dias
- Department of Periodontology, School of Dentistry, Universidad Científica del Sur, Calle Cantuarias 398, Miraflores, 15074, Lima, Peru
| | - Shayan Barootchi
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Lorenzo Tavelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Gerardo Mendoza-Azpur
- Department of Periodontology, School of Dentistry, Universidad Científica del Sur, Calle Cantuarias 398, Miraflores, 15074, Lima, Peru.
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10
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Cairo F, Barootchi S, Tavelli L, Barbato L, Wang HL, Rasperini G, Graziani F, Tonetti M. Aesthetic-And patient-related outcomes following root coverage procedures: A systematic review and network meta-analysis. J Clin Periodontol 2020; 47:1403-1415. [PMID: 32654220 DOI: 10.1111/jcpe.13346] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/20/2020] [Accepted: 07/07/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Aim of this systematic review (SR) of randomized controlled trials (RCTs) was to evaluate effect of different flap designs and graft materials for root coverage, in terms of aesthetics, patient satisfaction and self-reported morbidity (post-operative pain/discomfort). MATERIAL AND METHODS A comprehensive literature search was performed. A mixed-modelling approach to network meta-analysis was utilized to formulate direct and indirect comparisons among treatments for Root Coverage Esthetic Score (RES), with its individual components, and for subjective patient-reported satisfaction and post-operative pain/discomfort (visual analogue scale (VAS) of 100). RESULTS Twenty-six RCTs with a total of 867 treated patients (1708 recessions) were included. Coronally Advanced Flap (CAF) + Connective Tissue Graft (CTG) (0.74 (95% CI [0.24, 1.26], p = .005)), Tunnel (TUN) + CTG (0.84 (95% CI [0.15, 1.53]), p = .01) and CAF + Graft substitutes (GS) (0.55 (95% CI [0.006, 1.094], p = .04)) were significantly associated with higher RES than CAF. No significant difference between CAF + CTG and TUN + CTG was detected (0.09 (95% CI [-0.54, 0.72], p = .77)). Addition of CTG resulted in less natural tissue texture (-0.21 (95% CI [-0.34, -0.08]), p = .003) and gingival colour (-0.06 (95% CI [-0.12, -0.03], p = .03)) than CAF. CTG techniques were associated with increased morbidity. CONCLUSIONS Connective tissue graft procedures showed highest overall aesthetic performance for root coverage, although graft integration might impair soft tissue colour and appearance. Additionally, CTG-based techniques were also correlated with a greater patient satisfaction and morbidity.
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Affiliation(s)
- Francesco Cairo
- Research Unit in Periodontology and Periodontal Medicine, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Shayan Barootchi
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Lorenzo Tavelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Luigi Barbato
- Research Unit in Periodontology and Periodontal Medicine, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Hom-Lay Wang
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Giulio Rasperini
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Department of Biomedical Surgical and Dental Sciences Foundation IRCCS Ca' Granda Policlinic, University of Milan, Milan, Italy
| | - Filippo Graziani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Maurizio Tonetti
- European Research Group on Periodontology (ERGOPERIO), Genova, Italy.,Division of Periodontology, Faculty of Dentistry, Hong Kong University, Hong Kong, China.,Department of Oral and Maxillo-Facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Centre for Stomatology, Shanghai Ninth People Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Early Wound Healing Score (EHS): An Intra- and Inter-Examiner Reliability Study. Dent J (Basel) 2019; 7:dj7030086. [PMID: 31480586 PMCID: PMC6784738 DOI: 10.3390/dj7030086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/15/2019] [Accepted: 08/29/2019] [Indexed: 01/26/2023] Open
Abstract
The early wound healing score (EHS) was introduced to assess early wound healing of periodontal soft tissues after surgical incision. The purpose of this study is to evaluate the intra- and inter-examiner reliability of the EHS. Six examiners with different levels of training and clinical focus were enrolled. Each examiner was trained on the use of the EHS before starting the study. Thereafter, 63 photographs of three different types of surgical incisions taken at day 1, 3 or 7 post-operatively were independently evaluated according to the proposed assessment method. A two-way random intra-class correlation coefficient (ICC) and 95% confidence interval (CI) were used to analyze the intra- and inter-examiner reliability for the EHS. The inter-examiner reliability for the EHS was 0.828 (95% CI: 0.767–0.881). The intra-examiner reliability ranged between 0.826 (95% CI: 0.728–0.891) and 0.915 (95% CI: 0.856–0.950). The results therefore show an “almost perfect agreement” for intra- and inter-examiner reliability. The EHS provides a system for reproducible repeated ratings for the early healing assessment of incisions of periodontal soft tissues. Even when used by examiners with different clinical experience and specialty, it shows a high correlation coefficient.
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