The effect of first molar loss on the dentition and periodontium

Effect of combined periodontal and orthodontic treatment of tilted molars and of teeth with intra-bony and furcation defects in stage-IV periodontitis patients: A systematic review

AIM

To assess the effect of combined periodontal and orthodontic treatment (OT) in stage-IV periodontitis patients.

MATERIALS AND METHODS

Three focused questions were addressed using the Population, Intervention, Comparison, Outcome, and Study Design criteria. Randomized controlled trials (RCTs), controlled clinical trials, follow-up studies, case series, and controlled/uncontrolled before/after studies were assessed for inclusion. Primary outcomes included mean changes in pocket probing depth (PPD) and clinical attachment level (CAL). Qualitative synthesis of results was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

Out of 916 records, 1 retrospective case series study reported the effect of OT of tilted molars, 2 RCTs and 10 prospective and 2 retrospective case series studies reported the effect of OT of treated intra-bony defects and 0 articles reported the effect of OT of treated furcation defects. Mean PPD changes were reported in 14 articles, and mean CAL changes were reported in 8 articles. Risk of bias was high in both included RCTs, critical in nine articles, and serious in four articles. No articles included patient-reported outcomes, and three articles reported harms/adverse effects.

CONCLUSIONS

Evidence is limited by (i) the lack or low number of included studies, (ii) the apparent methodological and clinical heterogeneity, and (iii) the high risk of bias of the retrieved studies. No solid conclusions could be drawn concerning OT in stage-IV periodontitis patients with respect to tilted molars, teeth with treated intra-bony defects, and teeth with treated furcation defects.

Eruption of third permanent molars after the extraction of second permanent molars. Part 2: Functional occlusion and periodontal status

Functional occlusion and periodontal health were investigated after orthodontic treatment that involved extraction of second molars and after eruption of the third molars in 37 patients (25 female, 12 male). The mean age was 21 years 9 months (range, 16 years 1 month-30 years 5 months). The third permanent molars invariably erupted into a position that maintained good functional occlusion. Sixty-three percent of patients had canine guidance in lateral excursion; the remainder of patients had satisfactory group function. There were only 2 non-working side interferences in the sample, 1 from a recently erupted mandibular third molar. The periodontal health of the sample was generally excellent. Plaque score and bleeding on probing was very low (1.7% of sites). Periodontal health around both maxillary and mandibular teeth was extremely good. When attachment loss was assessed, 2238 of 2240 sites were clinically healthy. One patient, who had generally poor oral hygiene, had a 4-mm probing depth interproximally on the maxillary first and third molar contact. There was no correlation between periodontal health and mandibular third molar position. Therefore, both functional occlusion and periodontal health in the sample were good after loss of second permanent molars and eruption of the third molars.

Periodontal diagnosis in treated periodontitis. Why, when and how to use clinical parameters

The objective of clinical periodontal diagnosis in maintenance patients is to monitor the risk for periodontal disease progression. Risk for progression should be continuously monitored at the patient, tooth and site level at each recall appointment. At the patient level, the significance of systemic diseases, cigarette smoking, compliance with the recall program, loss of support in relation to the patient's age, full mouth plaque and/or bleeding scores, and prevalence of residual pockets are of key importance. At the tooth and tooth-site levels, residual periodontal support, inflammatory parameters and their persistence, presence of ecological niches with difficult access such as furcations, and presence of iatrogenic factors have to be put into proportion with the patient's overall risk profile. The information gathered by clinical monitoring and continuous multilevel risk assessment facilitates an immediate appreciation of the periodontal health status of an individual and the possible risk for further infection and/or disease progression in the dentition and at a particular tooth or site.