1
|
Yamazaki-Takai M, Saito Y, Ito S, Ogihara-Takeda M, Katsumata T, Kobayashi R, Nakagawa S, Nishino T, Fukuoka N, Hosono K, Yamasaki M, Yamazaki Y, Tsuruya Y, Yamaguchi A, Ogata Y. Impact of COVID-19 spread on visit intervals and clinical parameters for patients with periodontitis in supportive periodontal therapy: a retrospective study. J Periodontal Implant Sci 2024; 54:75-84. [PMID: 37524383 PMCID: PMC11065538 DOI: 10.5051/jpis.2300620031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/08/2023] [Accepted: 04/30/2023] [Indexed: 08/02/2023] Open
Abstract
PURPOSE This study investigated the relationship between the number of days that hospital visits were postponed and changes in clinical parameters due to the spread of coronavirus disease 2019 (COVID-19), after the Japanese government declared a state of emergency in April 2020. METHODS Regarding the status of postponement of appointments, we analyzed the patients who had visited the Nihon University Hospital at Matsudo for more than 1 year for supportive periodontal therapy (SPT) and classified them into low-, moderate- and high-risk subgroups according to the periodontal risk assessment (PRA). Clinical parameters for periodontal disease such as probing depth (PD), full-mouth bleeding score (FMBS), full-mouth plaque score, periodontal inflamed surface area (PISA), and periodontal epithelial surface area (PESA) were analyzed in 2 periods, from October 2019 to March 2020 and after April 2020. Correlation coefficients between days of deferral and the degree of changes in clinical parameters were calculated. RESULTS The mean age of the 749 patients was 67.56±10.85 years, and 63.82% were female. Out of 749 patients, 33.24% deferred their SPT appointments after April 2020. The average total of postponement days was 109.49±88.84. The number of postponement days was positively correlated with changes in average PD (rs=0.474) and PESA (rs=0.443) in the high-risk subgroup of FMBS, and average PD (rs=0.293) and PESA (rs=0.253) in the high-risk subgroup of tooth number (TN). Patients belonging to the high-risk subgroups for both FMBS and TN had a positive correlation between postponement days and PISA (rs=0.56). CONCLUSIONS The findings, the spread of COVID-19 appears to have extended the visit interval for some SPT patients. Moreover, longer visit intervals were correlated with the worsening of some clinical parameters for SPT patients with high PRA.
Collapse
Affiliation(s)
- Mizuho Yamazaki-Takai
- Department of Periodontology, Nihon University School of Dentistry at Matsudo, Chiba, Japan
- Research Institute of Oral Science, Nihon University School of Dentistry at Matsudo, Chiba, Japan
| | - Yumi Saito
- Department of Periodontology, Nihon University School of Dentistry at Matsudo, Chiba, Japan
| | - Shoichi Ito
- Department of Periodontology, Nihon University School of Dentistry at Matsudo, Chiba, Japan
| | - Moe Ogihara-Takeda
- Department of Periodontology, Nihon University School of Dentistry at Matsudo, Chiba, Japan
| | - Tsuyoshi Katsumata
- Department of Periodontology, Nihon University School of Dentistry at Matsudo, Chiba, Japan
| | - Ryo Kobayashi
- Department of Periodontology, Nihon University School of Dentistry at Matsudo, Chiba, Japan
| | - Shuta Nakagawa
- Department of Periodontology, Nihon University School of Dentistry at Matsudo, Chiba, Japan
| | - Tomoko Nishino
- Department of Periodontology, Nihon University School of Dentistry at Matsudo, Chiba, Japan
| | - Namiko Fukuoka
- Department of Periodontology, Nihon University School of Dentistry at Matsudo, Chiba, Japan
| | - Kota Hosono
- Department of Periodontology, Nihon University School of Dentistry at Matsudo, Chiba, Japan
| | - Mai Yamasaki
- Department of Periodontology, Nihon University School of Dentistry at Matsudo, Chiba, Japan
| | - Yosuke Yamazaki
- Department of Periodontology, Nihon University School of Dentistry at Matsudo, Chiba, Japan
| | - Yuto Tsuruya
- Department of Periodontology, Nihon University School of Dentistry at Matsudo, Chiba, Japan
| | - Arisa Yamaguchi
- Department of Periodontology, Nihon University School of Dentistry at Matsudo, Chiba, Japan
| | - Yorimasa Ogata
- Department of Periodontology, Nihon University School of Dentistry at Matsudo, Chiba, Japan
- Research Institute of Oral Science, Nihon University School of Dentistry at Matsudo, Chiba, Japan.
| |
Collapse
|
2
|
Lafaurie GI, Sabogal MA, Contreras A, Castillo DM, Gualtero DF, Avila JD, Trujillo TG, Duque A, Giraldo A, Duarte S, Gutierrez SJ, Ardila CM. Factors Associated with the Extent of Clinical Attachment Loss in Periodontitis: A Multicenter Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7043. [PMID: 37998274 PMCID: PMC10671280 DOI: 10.3390/ijerph20227043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/30/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023]
Abstract
Periodontitis has significant public health implications, affecting individuals' overall health, well-being, and quality of life. This study aimed to assess the risk factors associated with the extent of clinical attachment loss (CAL) in a population diagnosed with periodontitis. Six hundred and sixty-seven patients with different degrees of CAL (mild, n = 223; moderate, n = 256; and advanced, n = 188) were enrolled. Socio-demographics, lifestyle, microbiological profiles, specific immune response, obesity, and single-nucleotide polymorphism of the IL1 gene were determined. Unconditional logistic regression models were conducted to determine the factors associated with the extent of CAL. Aging, smoking, microbial factors, plaque index, and IgG2 antibodies against Aggregatibacter actinomycetemcomitans were associated with advanced CAL. IgG2 antibodies against A. actinomycetemcomitans (OR 1.50; CI 95% 1.23-1.81), plaque accumulation (OR 2.69; CI 95% 2.20-3.29), Porphyromonas gingivalis (OR 1.93; CI 95% 1.35-2.76), Tanerella forsythia (OR 1.88; CI 95%1.30-2.70), and current smoking (OR 1.94; CI 95% 1.31-2.87) were associated with advanced CAL. Gene IL polymorphisms, obesity, and stress were not associated with the extent of CAL. Aging, plaque accumulation, smoking, and having antibodies against A. actinomycetemcomitans were the most critical factors associated with advanced CAL. In contrast, obesity, stress, and gene polymorphisms were not associated with the extent of CAL.
Collapse
Affiliation(s)
- Gloria Inés Lafaurie
- Unit of Oral Basic Investigation-UIBO, School of Dentistry, El Bosque University, Bogota 11001, Colombia or (G.I.L.); (M.A.S.); (D.M.C.); (D.F.G.); (J.D.A.); (T.G.T.)
| | - María Alejandra Sabogal
- Unit of Oral Basic Investigation-UIBO, School of Dentistry, El Bosque University, Bogota 11001, Colombia or (G.I.L.); (M.A.S.); (D.M.C.); (D.F.G.); (J.D.A.); (T.G.T.)
| | - Adolfo Contreras
- Periodontal Medicine Group, Universidad del Valle, Cali 760042, Colombia; (A.C.); (S.J.G.)
| | - Diana Marcela Castillo
- Unit of Oral Basic Investigation-UIBO, School of Dentistry, El Bosque University, Bogota 11001, Colombia or (G.I.L.); (M.A.S.); (D.M.C.); (D.F.G.); (J.D.A.); (T.G.T.)
| | - Diego Fernando Gualtero
- Unit of Oral Basic Investigation-UIBO, School of Dentistry, El Bosque University, Bogota 11001, Colombia or (G.I.L.); (M.A.S.); (D.M.C.); (D.F.G.); (J.D.A.); (T.G.T.)
| | - Juliette De Avila
- Unit of Oral Basic Investigation-UIBO, School of Dentistry, El Bosque University, Bogota 11001, Colombia or (G.I.L.); (M.A.S.); (D.M.C.); (D.F.G.); (J.D.A.); (T.G.T.)
| | - Tamy Goretty Trujillo
- Unit of Oral Basic Investigation-UIBO, School of Dentistry, El Bosque University, Bogota 11001, Colombia or (G.I.L.); (M.A.S.); (D.M.C.); (D.F.G.); (J.D.A.); (T.G.T.)
| | - Andrés Duque
- Research Group in Basic Sciences and Clinical Dentistry, CES University, Medellin 050021, Colombia; (A.D.); (A.G.)
| | - Astrid Giraldo
- Research Group in Basic Sciences and Clinical Dentistry, CES University, Medellin 050021, Colombia; (A.D.); (A.G.)
| | - Silvia Duarte
- Dental Research Center-CIO, Pontificia Universidad Javeriana, Bogota 110311, Colombia;
| | | | - Carlos Martín Ardila
- Biomedical Stomatology Research Group, Faculty of Dentistry, Universidad de Antioquia UdeA, Medellin 050010, Colombia
| |
Collapse
|
3
|
Comparing the Long-Term Success Rates of Tooth Preservation and Dental Implants: A Critical Review. J Funct Biomater 2023; 14:jfb14030142. [PMID: 36976066 PMCID: PMC10055991 DOI: 10.3390/jfb14030142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Implant therapy is considered a predictable, safe, and reliable rehabilitation method for edentulous patients in most clinical scenarios. Thus, there is a growing trend in the indications for implants, which seems attributable not only to their clinical success but also to arguments such as a more “simplified approach” based on convenience or the belief that dental implants are as good as natural teeth. Therefore, the objective of this critical literature review of observational studies was to discuss the evidence concerning the long-term survival rates and treatment outcomes, comparing endodontically or periodontally treated teeth with dental implants. Altogether, the evidence suggests that the decision between keeping a tooth or replacing it with an implant should carefully consider the condition of the tooth (e.g., amount of remaining tooth and degree of attachment loss and mobility), systemic disorders, and patient preference. Although observational studies revealed high success rates and long-term survival of dental implants, failures and complications are common. For this reason, attempts should be made to first save maintainable teeth over the long-term, instead of immediately replacing teeth with dental implants.
Collapse
|
4
|
Cosgarea R, Ramseier CA, Jepsen S, Arweiler NB, Jervøe-Storm PM, Batori-Andronescu I, Rößler R, Conrad T, Eick S, Sculean A. One-Year Clinical, Microbiological and Immunological Results of Local Doxycycline or Antimicrobial Photodynamic Therapy for Recurrent/Persisting Periodontal Pockets: A Randomized Clinical Trial. Antibiotics (Basel) 2022; 11:antibiotics11060738. [PMID: 35740145 PMCID: PMC9220761 DOI: 10.3390/antibiotics11060738] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/21/2022] [Accepted: 05/27/2022] [Indexed: 02/04/2023] Open
Abstract
We evaluated, in this study, the clinical, microbiological and immunological effects of local drug delivery (LDD) or photodynamic therapy (PDT), adjunctive to subgingival instrumentation (SI) in persistent or recurrent periodontal pockets in patients enrolled in supportive periodontal therapy (SPT) after one year. A total of 105 patients enrolled in SPT with persistent/recurrent pockets were randomly treated with SI +PDT or SI + LDD or SI (control). The number of treated sites with bleeding on probing (n BOP+), probing pocket depths (PPD), clinical attachment level (CAL), full-mouth plaque and bleeding scores (gingival bleeding index, %bleeding on probing-BOP) was evaluated at baseline and after 12 months. Additionally, eight periodontopathogens and the immunomarkers IL-1β (interleukin)and MMP-8 (matrix metalloprotease) were quantitatively determined using real-time PCR and ELISA, respectively. All three treatments resulted in statistically significant clinical improvements (p < 0.05) without statistically significant intergroup differences (p > 0.05), which were maintained up to 12 months. The presence of BOP negatively affected the PPD and CAL. Moreover, statistically significantly fewer bleeding sites at 12 months were observed in the test groups (p = 0.049). Several periodontopathogens were reduced after 12 months. In conclusion, the present data indicate that in periodontal patients enrolled in SPT, treatment of persistent/recurrent pockets with SI alone or combined with either PDT or LDD may lead to comparable clinical, microbiological and immunological improvements, which are maintained up to 12 months. Secondly, the presence of BOP directly impacts the PPD and CAL.
Collapse
Affiliation(s)
- Raluca Cosgarea
- Department for Periodontology, Operative and Preventive Dentistry, University of Bonn, 53111 Bonn, Germany; (S.J.); (P.M.J.-S.)
- Clinic for Periodontology and Peri-Implant Diseases, Philipps University Marburg, 35033 Marburg, Germany;
- Department of Prosthodontics, Iuliu Hatieganu University Cluj-Napoca, 400006 Cluj-Napoca, Romania
- Correspondence: ; Tel.: +49-(0)-228-2872-2480; Fax: +49-(0)-228-2872-2161
| | - Christoph A. Ramseier
- Department of Periodontology, School of Dentistry, University of Bern, 3010 Bern, Switzerland; (C.A.R.); (S.E.); (A.S.)
| | - Søren Jepsen
- Department for Periodontology, Operative and Preventive Dentistry, University of Bonn, 53111 Bonn, Germany; (S.J.); (P.M.J.-S.)
| | - Nicole Birgit Arweiler
- Clinic for Periodontology and Peri-Implant Diseases, Philipps University Marburg, 35033 Marburg, Germany;
| | - Pia Merete Jervøe-Storm
- Department for Periodontology, Operative and Preventive Dentistry, University of Bonn, 53111 Bonn, Germany; (S.J.); (P.M.J.-S.)
| | | | - Ralf Rößler
- University for Digital Technologies in Medicine and Dentistry, 9516 Wiltz, Luxembourg; (R.R.); (T.C.)
| | - Torsten Conrad
- University for Digital Technologies in Medicine and Dentistry, 9516 Wiltz, Luxembourg; (R.R.); (T.C.)
- Clinic for Mouth, Jaw and Plastic Facesurgery, University of Frankfurt, 6059 Frankfurt, Germany
- Private Practice, 55411 Bingen am Rhein, Germany
| | - Sigrun Eick
- Department of Periodontology, School of Dentistry, University of Bern, 3010 Bern, Switzerland; (C.A.R.); (S.E.); (A.S.)
| | - Anton Sculean
- Department of Periodontology, School of Dentistry, University of Bern, 3010 Bern, Switzerland; (C.A.R.); (S.E.); (A.S.)
| |
Collapse
|
5
|
Kocher T, Holtfreter B, Priess HW, Graetz C, Jablonowski L, Grabe HJ, Völzke H, Raedel M, Walter MH. Tooth loss in periodontally treated patients: A registry- and observation-based analysis. J Clin Periodontol 2022; 49:749-757. [PMID: 35634709 DOI: 10.1111/jcpe.13668] [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: 11/02/2021] [Revised: 05/03/2022] [Accepted: 05/18/2022] [Indexed: 11/27/2022]
Abstract
AIM According to retrospective clinical studies, periodontal treatment retains teeth. However, evidence on the effectivity of periodontal treatment stemming from the general population is lacking. MATERIALS AND METHODS We analysed data of periodontally treated patients from routine data of a major German national health insurance (BARMER-MV; sub-sample of the Federal State of Mecklenburg-Vorpommern) and from a clinical cohort (Greifswald Approach to Individualized Medicine, GANI_MED), as well as periodontally untreated and treated participants of the Study of Health in Pomerania (SHIP-TREND) with either ≥2 or ≥4 teeth with pocket depths ≥4 mm. Yearly tooth loss (YTL) estimates and incidence rates were evaluated. RESULTS For moderately to severely affected groups, YTL and incidence rates were higher in BARMER-MV patients (0.35 and 0.18, respectively) than in untreated SHIP-TREND controls (0.19 and 0.08, respectively). In line, treated SHIP-TREND participants exhibited higher YTL rates than untreated SHIP-TREND controls (0.26 vs. 0.19). For severely affected groups, results with respect to tooth loss were inconclusive regarding the beneficial effects of periodontal treatment conducted either in the university (GANI_MED data) or in the general practice. CONCLUSION Until 2021, periodontal treatment performed in German general dental practices within the national health insurance system was probably not efficient in retaining more teeth in the short- to mid-term. Since reimbursement schemes were changed in 2021 and now cover periodontal treatment to a much larger extent, the future will show whether these new reimbursement codes will improve the quality of periodontal treatment and whether they will lead to more long-term tooth retainment.
Collapse
Affiliation(s)
- Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Birte Holtfreter
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Heinz-Werner Priess
- AGENON, Gesellschaft für Forschung und Entwicklung im Gesundheitswesen, Berlin, Germany
| | - Christian Graetz
- Clinic of Conservative Dentistry and Periodontology, University of Kiel, Kiel, Germany
| | - Lukasz Jablonowski
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany.,German Centre for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, SHIP/Clinical-Epidemiological Research, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - Michael Raedel
- Prosthodontics, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Michael H Walter
- Prosthodontics, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
6
|
Bittencourt LF, Angst PDM, Oppermann RV, van der Velden U, Gomes SC. At least 3 years of self-responsibility for periodontal care after 2 years of supportive periodontal therapy. Clin Oral Investig 2022; 26:4987-4994. [PMID: 35355140 DOI: 10.1007/s00784-022-04466-1] [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: 01/27/2022] [Accepted: 03/17/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study aimed to investigate the periodontal condition when patients became self-responsible for the continuation of periodontal care, after non-surgical periodontal therapy and 2 years of Supportive Periodontal Therapy (SPT). MATERIALS AND METHODS Fifty-seven patients completed a previous 2-year SPT study and were afterward advised to seek for dental assistance for maintenance care. After 4.2 ± 0.45 years of self-responsibility for periodontal care (SRPC), 27 patients could be re-examined of which 9 patients had followed the advice to turn to a dental professional for SPT care. Visible Plaque (VPI), Gingival Bleeding (GBI), Periodontal Probing Depth (PPD), Bleeding on probing (BOP), and Clinical Attachment Loss (CAL) were obtained from SPT study: before and after non-surgical treatment, and after 2 years of SPT. The same parameters were reassessed for the present study. General linear models for repeated measures were used for data analysis. RESULTS At the end of the SRPC period, mean GBI, BOP, and PPD values (43.5%, 55.7%, 2.76 mm, respectively) were back to pre-treatment, whereas VPI (64.3%) and CAL (3.76 mm) became significantly higher. The percentage of sites with PPD ≥5 mm as well as sites with CAL ≥4 or ≥5 mm also returned to pre-treatment values. However, the percentage of sites with PPD ≥4 mm was still significantly lower compared to pre-treatment values but higher than after 2 years of SPT. CONCLUSIONS Self-responsibility for the continuation of periodontal care after professional treatment should be avoided. CLINICAL RELEVANCE Clinicians and specialists must be conscious of making all efforts to maintain the patient's frequent recalls.
Collapse
Affiliation(s)
- Liana F Bittencourt
- Post-graduate Program, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Patricia D M Angst
- Conservative Dentistry Department, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rui V Oppermann
- Conservative Dentistry Department, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Ubele van der Velden
- Department of Periodontology, Academic Centre for Dentistry Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.,VU University Amsterdam, Amsterdam, The Netherlands
| | - Sabrina C Gomes
- Conservative Dentistry Department, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
| |
Collapse
|
7
|
Trombelli L, Farina R, Pollard A, Claydon N, Franceschetti G, Khan I, West N. Efficacy of alternative or additional methods to professional mechanical plaque removal during supportive periodontal therapy: A systematic review and meta-analysis. J Clin Periodontol 2021; 47 Suppl 22:144-154. [PMID: 32060940 DOI: 10.1111/jcpe.13269] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 01/20/2020] [Accepted: 02/10/2020] [Indexed: 12/18/2022]
Abstract
AIMS To systematically review the literature addressing the following focused questions: "What is the efficacy of either (#1) alternative or (#2) additional methods to professional mechanical plaque removal (PMPR) on progression of attachment loss during supportive periodontal therapy (SPT) in periodontitis patients?". METHODS A systematic search for randomized clinical trials was performed. Change in clinical attachment level (CAL) from baseline was the primary outcome. RESULTS Routine PMPR performed with either a combination of ultrasonic/hand instruments or Er:Yag laser showed similarly effective in preventing CAL loss. Moreover, a routine SPT regimen based on PMPR led to stability of CAL irrespective of a daily sub-antimicrobial doxycycline dose (SDD). Finally, an adjunctive photodynamic therapy (PDT) did not enhance the magnitude of CAL gain when sites with probing depth ≥4 mm were repeatedly treated. After pooling all data, the results of the meta-analysis showed no statistical differences in CAL change from baseline: mean overall CAL change was -0.233 mm (95% confidence interval: -1.065, 0.598; p = .351). CONCLUSIONS Weak evidence indicate that in treated periodontitis patients enrolled in a 3-4 month SPT based on PMPR, Er:Yag laser (as alternative), SDD and PDT (as additional) do not produce a greater clinical effect on periodontal conditions compared to PMPR.
Collapse
Affiliation(s)
- Leonardo 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 (AUSL), Ferrara, Italy
| | - Roberto 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 (AUSL), Ferrara, Italy
| | - Alexander Pollard
- Periodontology, Clinical Trials Unit, Bristol Dental School, Bristol, UK
| | - Nicholas Claydon
- Periodontology, Clinical Trials Unit, Bristol Dental School, Bristol, UK
| | - Giovanni Franceschetti
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy
| | - Iftekhar Khan
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Nicola West
- Periodontology, Clinical Trials Unit, Bristol Dental School, Bristol, UK
| |
Collapse
|
8
|
West N, Chapple I, Claydon N, D'Aiuto F, Donos N, Ide M, Needleman I, Kebschull M. BSP implementation of European S3 - level evidence-based treatment guidelines for stage I-III periodontitis in UK clinical practice. J Dent 2021; 106:103562. [PMID: 33573801 DOI: 10.1016/j.jdent.2020.103562] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/16/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To adapt the supranational European Federation for Periodontology (EFP) S3-Level Clinical Practice Guideline for treatment of periodontitis (stage I-III) to a UK healthcare environment, taking into account the views of a broad range of stakeholders, and patients. SOURCES This UK version is based on the supranational EFP guideline (Sanz et al., 2020) published in the Journal of Clinical Periodontology. The source guideline was developed using the S3-level methodology, which combined the assessment of formal evidence from 15 systematic reviews with a moderated consensus process of a representative group of stakeholders, and accounts for health equality, environmental factors and clinical effectiveness. It encompasses 62 clinical recommendations for the treatment of stage I-III periodontitis, based on a step-wise process mapped to the 2017 classification system. METHODOLOGY The UK version was developed from the source guideline using a formal process called the GRADE ADOLOPMENT framework. This framework allows for the adoption (unmodified acceptance), adaptation (acceptance with modifications) and the de novo development of clinical recommendations. Using this framework and following the S3-process, the underlying systematic reviews were updated and a representative guideline group of 75 delegates from 17 stakeholder organisations was assembled into three working groups. Following the formal S3-process, all clinical recommendations were formally assessed for their applicability to the UK and adoloped accordingly. RESULTS AND CONCLUSION Using the ADOLOPMENT protocol, a UK version of the EFP S3-level clinical practice guideline was developed. This guideline delivers evidence- and consensus-based clinical recommendations of direct relevance to the dental community in the UK. CLINICAL SIGNIFICANCE The aim of S3-level guidelines is to combine the evaluation of formal evidence, grading and synthesis with the clinical expertise of a broad range of stakeholders to form clinical recommendations. Herein, the first major international S3-level guideline in dentistry, the EFP guideline, was implemented for direct clinical applicability in the UK healthcare system.
Collapse
Affiliation(s)
- Nicola West
- Periodontology, Bristol Dental School, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY, UK.
| | - Iain Chapple
- Periodontal Research Group, Institute of Clinical Sciences, College of Medical & Dental Sciences, The University of Birmingham, Birmingham, UK; Birmingham Community Healthcare NHS Trust, Birmingham, UK.
| | - Nick Claydon
- Periodontology, Bristol Dental School, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY, UK.
| | - Francesco D'Aiuto
- Periodontology, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Nikos Donos
- Periodontology, Institute of Dentistry, Barts and The London School of Medicine & Dentistry, Queen Mary University, Turner Street, London E1 2AD, UK.
| | - Mark Ide
- Periodontology, Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, Kings College London, London SE1 9RT, UK.
| | - Ian Needleman
- Periodontology, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Moritz Kebschull
- Periodontal Research Group, Institute of Clinical Sciences, College of Medical & Dental Sciences, The University of Birmingham, Birmingham, UK; Birmingham Community Healthcare NHS Trust, Birmingham, UK; Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, NY, USA.
| |
Collapse
|
9
|
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: 587] [Impact Index Per Article: 146.8] [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.
Collapse
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
| |
Collapse
|
10
|
Murakami S, Mealey BL, Mariotti A, Chapple ILC. Dental plaque-induced gingival conditions. J Periodontol 2019; 89 Suppl 1:S17-S27. [PMID: 29926958 DOI: 10.1002/jper.17-0095] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 08/08/2017] [Accepted: 08/19/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This review proposes revisions to the current classification system for gingival diseases and provides a rationale for how it differs from the 1999 classification system. IMPORTANCE Gingival inflammation in response to bacterial plaque accumulation (microbial biofilms) is considered the key risk factor for the onset of periodontitis. Thus, control of gingival inflammation is essential for the primary prevention of periodontitis. FINDINGS The clinical characteristics common to dental plaque-induced inflammatory gingival conditions include: a) clinical signs and symptoms of inflammation that are confined to the gingiva: b) reversibility of the inflammation by removing or disrupting the biofilm; c) the presence of a high bacterial plaque burden to initiate the inflammation; d) systemic modifying factors (e.g., hormones, systemic disorders, drugs) which can alter the severity of the plaque-induced inflammation and; e) stable (i.e., non-changing) attachment levels on a periodontium which may or may not have experienced a loss of attachment or alveolar bone. The simplified taxonomy of gingival conditions includes: 1) introduction of the term "incipient gingivitis;" 2) a description of the extent and severity of gingival inflammation; 3) a description of the extent and severity of gingival enlargement and; 4) a reduction of categories in the dental plaque-induced gingival disease taxonomy. CONCLUSIONS Dental plaque-induced gingival inflammation is modified by various systemic and oral factors. The appropriate intervention is crucial for the prevention of periodontitis.
Collapse
Affiliation(s)
- Shinya Murakami
- Osaka University, Graduate School of Dentistry-Department of Periodontology, Osaka, Japan
| | - Brian L Mealey
- Department of Periodontics, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Angelo Mariotti
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - Iain L C Chapple
- Department of Periodontology, University of Birmingham School of Dentistry, Birmingham, UK
| |
Collapse
|
11
|
Angst PDM, Finger Stadler A, Mendez M, Oppermann RV, van der Velden U, Gomes SC. Supportive periodontal therapy in moderate‐to‐severe periodontitis patients: A two‐year randomized clinical trial. J Clin Periodontol 2019; 46:1083-1093. [DOI: 10.1111/jcpe.13178] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/26/2019] [Accepted: 07/30/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Amanda Finger Stadler
- Division of Comprehensive Oral Health ‐ Periodontology Adams School of Dentistry The University of North Carolina at Chapel Hill Chapel Hill NC USA
| | | | - Rui Vicente Oppermann
- Conservative Dentistry Department School of Dentistry Federal University of Rio Grande do Sul Porto Alegre Brazil
| | - Ubele van der Velden
- Department of Periodontology Academic Centre for Dentistry Amsterdam (ACTA) University of Amsterdam VU University Amsterdam Amsterdam The Netherlands
| | - Sabrina Carvalho Gomes
- Conservative Dentistry Department School of Dentistry Federal University of Rio Grande do Sul Porto Alegre Brazil
| |
Collapse
|
12
|
Megally A, Zekeridou A, Cancela J, Giannopoulou C, Mombelli A. Short ultrasonic debridement with adjunctive low-concentrated hypochlorite/amino acid gel during periodontal maintenance: randomized clinical trial of 12 months. Clin Oral Investig 2019; 24:201-209. [PMID: 31079243 DOI: 10.1007/s00784-019-02949-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/03/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The objective of this study was to evaluate the benefit of repeated subgingival cleaning with a low-concentrated hypochlorite/amino acid gel in subjects in maintenance care with residual pockets ≥ 5 mm. MATERIAL AND METHODS Examiner masked, randomized two-arm parallel design. Thirty-two adult periodontal patients in maintenance phase, > 3 months after periodontal therapy, with at least one residual periodontal pocket ≥ 5 mm, were randomly assigned to treatment by subgingival ultrasonic debridement with the gel or ultrasonic debridement only. At months 0, 4, and 8, all sites presenting with a probing depth (PD) ≥ 5 mm were treated. Six sites were monitored on each tooth. The primary end point was the presence or absence of PD ≥ 5 mm after 12 months. Secondary clinical outcomes were oral tissue safety; patient acceptance; changes in PD; bleeding on probing; recession after 4, 8, and 12 months; and the presence or absence of six target microorganisms in treated pockets at baseline, after 7 days and 4 months. RESULTS A total of 365 sites in 32 patients with PD ≥ 5 mm were treated at baseline. At the final evaluation at month 12, 47% of these sites in the test and 49% in the control group were still in this PD category. The difference between baseline and month 12 was significant in both groups (p < 0.01), whereas the difference between groups was not. Repeated short ultrasonic instrumentation with adjunctive administration of the test product resulted in a clinical attachment level (CAL) gain of 1.02 mm (p < 0.01) and led to - 0.97 mm of pocket reduction (p < 0.01) without inducing further recession. However, repeated short ultrasonic debridement without the gel led to a similar clinical outcome (p < 0.01). No adverse events were recorded. CONCLUSIONS Short ultrasonic instrumentation of residual pockets with PD ≥ 5 mm during maintenance visits resulted in a clinically relevant CAL gain and PD reduction in the order of 1 mm in 1 year, without inducing further recession. CLINICAL RELEVANCE This study corroborates the benefit of regular maintenance care after periodontal therapy, including short debridement of the residual pockets.
Collapse
Affiliation(s)
- Andrew Megally
- University Clinic of Dental Medicine, Division of Periodontology, University of Geneva, 1 rue Michel-Servet, 1211, Geneva 4, Switzerland
| | - Alkisti Zekeridou
- University Clinic of Dental Medicine, Division of Periodontology, University of Geneva, 1 rue Michel-Servet, 1211, Geneva 4, Switzerland
| | - José Cancela
- University Clinic of Dental Medicine, Division of Periodontology, University of Geneva, 1 rue Michel-Servet, 1211, Geneva 4, Switzerland
| | - Catherine Giannopoulou
- University Clinic of Dental Medicine, Division of Periodontology, University of Geneva, 1 rue Michel-Servet, 1211, Geneva 4, Switzerland
| | - Andrea Mombelli
- University Clinic of Dental Medicine, Division of Periodontology, University of Geneva, 1 rue Michel-Servet, 1211, Geneva 4, Switzerland.
| |
Collapse
|
13
|
Murakami S, Mealey BL, Mariotti A, Chapple IL. Dental plaque-induced gingival conditions. J Clin Periodontol 2018; 45 Suppl 20:S17-S27. [DOI: 10.1111/jcpe.12937] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 08/08/2017] [Accepted: 08/19/2017] [Indexed: 01/07/2023]
Affiliation(s)
- Shinya Murakami
- Osaka University; Graduate School of Dentistry-Department of Periodontology; Osaka Japan
| | - Brian L. Mealey
- Department of Periodontics; The University of Texas Health Science Center at San Antonio; San Antonio TX USA
| | - Angelo Mariotti
- Division of Periodontology, College of Dentistry; The Ohio State University; Columbus OH USA
| | - Iain L.C. Chapple
- Department of Periodontology; University of Birmingham School of Dentistry; Birmingham UK
| |
Collapse
|
14
|
Graziani F, Karapetsa D, Alonso B, Herrera D. Nonsurgical and surgical treatment of periodontitis: how many options for one disease? Periodontol 2000 2018; 75:152-188. [PMID: 28758300 DOI: 10.1111/prd.12201] [Citation(s) in RCA: 217] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Treatment of periodontitis aims at preventing further disease progression with the intentions to reduce the risk of tooth loss, minimize symptoms and perception of the disease, possibly restore lost periodontal tissue and provide information on maintaining a healthy periodontium. Therapeutic intervention includes introduction of techniques to change behavior, such as: individually tailored oral-hygiene instructions; a smoking-cessation program; dietary adjustment; subgingival instrumentation to remove plaque and calculus; local and systemic pharmacotherapy; and various types of surgery. No single treatment option has shown superiority, and virtually all types of mechanical periodontal treatment benefit from adjunctive antimicrobial chemotherapy. Periodontal treatment, because of the chronic nature of periodontitis, is a lifelong commitment to intricate oral-hygiene techniques, which, when properly implemented, will minimize the risk of disease initiation and progression.
Collapse
|
15
|
Manresa C, Sanz‐Miralles EC, Twigg J, Bravo M. Supportive periodontal therapy (SPT) for maintaining the dentition in adults treated for periodontitis. Cochrane Database Syst Rev 2018; 1:CD009376. [PMID: 29291254 PMCID: PMC6491071 DOI: 10.1002/14651858.cd009376.pub2] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Periodontitis is a bacterially-induced, chronic inflammatory disease that destroys the connective tissues and bone that support teeth. Active periodontal treatment aims to reduce the inflammatory response, primarily through eradication of bacterial deposits. Following completion of treatment and arrest of inflammation, supportive periodontal therapy (SPT) is employed to reduce the probability of re-infection and progression of the disease; to maintain teeth without pain, excessive mobility or persistent infection in the long term, and to prevent related oral diseases.According to the American Academy of Periodontology, SPT should include all components of a typical dental recall examination, and importantly should also include periodontal re-evaluation and risk assessment, supragingival and subgingival removal of bacterial plaque and calculus, and re-treatment of any sites showing recurrent or persistent disease. While the first four points might be expected to form part of the routine examination appointment for periodontally healthy patients, the inclusion of thorough periodontal evaluation, risk assessment and subsequent treatment - normally including mechanical debridement of any plaque or calculus deposits - differentiates SPT from routine care.Success of SPT has been reported in a number of long-term, retrospective studies. This review aimed to assess the evidence available from randomised controlled trials (RCTs). OBJECTIVES To determine the effects of supportive periodontal therapy (SPT) in the maintenance of the dentition of adults treated for periodontitis. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 8 May 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 5), MEDLINE Ovid (1946 to 8 May 2017), and Embase Ovid (1980 to 8 May 2017). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA Randomised controlled trials (RCTs) evaluating SPT versus monitoring only or alternative approaches to mechanical debridement; SPT alone versus SPT with adjunctive interventions; different approaches to or providers of SPT; and different time intervals for SPT delivery.We excluded split-mouth studies where we considered there could be a risk of contamination.Participants must have completed active periodontal therapy at least six months prior to randomisation and be enrolled in an SPT programme. Trials must have had a minimum follow-up period of 12 months. DATA COLLECTION AND ANALYSIS Two review authors independently screened search results to identify studies for inclusion, assessed the risk of bias in included studies and extracted study data. When possible, we calculated mean differences (MDs) and 95% confidence intervals (CIs) for continuous variables. Two review authors assessed the quality of evidence for each comparison and outcome using GRADE criteria. MAIN RESULTS We included four trials involving 307 participants aged 31 to 85 years, who had been previously treated for moderate to severe chronic periodontitis. Three studies compared adjuncts to mechanical debridement in SPT versus debridement only. The adjuncts were local antibiotics in two studies (one at high risk of bias and one at low risk) and photodynamic therapy in one study (at unclear risk of bias). One study at high risk of bias compared provision of SPT by a specialist versus general practitioner. We did not identify any RCTs evaluating the effects of SPT versus monitoring only, or of providing SPT at different time intervals, or that compared the effects of mechanical debridement using different approaches or technologies.No included trials measured our primary outcome 'tooth loss'; however, studies evaluated signs of inflammation and potential periodontal disease progression, including bleeding on probing (BoP), clinical attachment level (CAL) and probing pocket depth (PPD).There was no evidence of a difference between SPT delivered by a specialist versus a general practitioner for BoP or PPD at 12 months (very low-quality evidence). This study did not measure CAL or adverse events.Due to heterogeneous outcome reporting, it was not possible to combine data from the two studies comparing mechanical debridement with or without the use of adjunctive local antibiotics. Both studies found no evidence of a difference between groups at 12 months (low to very low-quality evidence). There were no adverse events in either study.The use of adjunctive photodynamic therapy did not demonstrate evidence of benefit compared to mechanical debridement only (very low-quality evidence). Adverse events were not measured.The quality of the evidence is low to very low for these comparisons. Future research is likely to change the findings, therefore the results should be interpreted with caution. AUTHORS' CONCLUSIONS Overall, there is insufficient evidence to determine the superiority of different protocols or adjunctive strategies to improve tooth maintenance during SPT. No trials evaluated SPT versus monitoring only. The evidence available for the comparisons evaluated is of low to very low quality, and hampered by dissimilarities in outcome reporting. More trials using uniform definitions and outcomes are required to address the objectives of this review.
Collapse
Affiliation(s)
- Carolina Manresa
- Dental School, University of BarcelonaAdult Comprehensive DentistryFeixa LLarga s/nHospitalet de LlobregatBarcelonaSpain08907
| | - Elena C Sanz‐Miralles
- Dental School, University of BarcelonaAdult Comprehensive DentistryFeixa LLarga s/nHospitalet de LlobregatBarcelonaSpain08907
- Columbia UniversityDivision of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental MedicineNew YorkNYUSA
| | - Joshua Twigg
- Cardiff UniversitySchool of DentistryDepartment of Oral and Biomedical SciencesHeath ParkCardiffUKCF14 4XY
| | - Manuel Bravo
- Dental School, University of GranadaPreventive DentistryCampus de la Cartuja s/nGranadaSpain08071
| | | |
Collapse
|
16
|
Laleman I, Cortellini S, De Winter S, Rodriguez Herrero E, Dekeyser C, Quirynen M, Teughels W. Subgingival debridement: end point, methods and how often? Periodontol 2000 2017; 75:189-204. [DOI: 10.1111/prd.12204] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
17
|
Angst PDM, Stadler AF, Oppermann RV, Gomes SC. Microbiological outcomes from different periodontal maintenance interventions: a systematic review. Braz Oral Res 2017; 31:e33. [PMID: 28513785 DOI: 10.1590/1807-3107bor-2017vol310033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 03/27/2017] [Indexed: 11/21/2022] Open
Abstract
This study aimed to investigate the differences in the subgingival microbiological outcomes between periodontal patients submitted to a supragingival control (SPG) regimen as compared to subgingival scaling and root planing performed combined with supragingival debridement (SPG + SBG) intervention during the periodontal maintenance period (PMP). A systematic literature search using electronic databases (MEDLINE and EMBASE) was conducted looking for articles published up to August 2016 and independent of language. Two independent reviewers performed the study selection, quality assessment and data collection. Only human randomized or non-randomized clinical trials with at least 6-months-follow-up after periodontal treatment and presenting subgingival microbiological outcomes related to SPG and/or SPG+SBG therapies were included. Search strategy found 2,250 titles. Among these, 148 (after title analysis) and 39 (after abstract analysis) papers were considered to be relevant. Finally, 19 studies were selected after full-text analysis. No article had a direct comparison between the therapies. Five SPG and 14 SPG+SBG studies presented experimental groups with these respective regimens and were descriptively analyzed while most of the results were only presented graphically. The results showed that both SPG and SPG+SBG protocols of PMP determined stability in the microbiological results along time. Nevertheless, new studies comparing these interventions in PMP are needed, especially if the limitations herein discussed could be better controlled.
Collapse
Affiliation(s)
| | - Amanda Finger Stadler
- Augusta University, The Dental College of Georgia, Department of Periodontics, Augusta, GA, United States of America
| | - Rui Vicente Oppermann
- Universidade Federal do Rio Grande do Sul - UFRGS, Dental School, Department of Conservative Dentistry, Porto Alegre, RS, Brazil
| | - Sabrina Carvalho Gomes
- Universidade Federal do Rio Grande do Sul - UFRGS, Dental School, Department of Conservative Dentistry, Porto Alegre, RS, Brazil
| |
Collapse
|
18
|
Armitage GC, Xenoudi P. Post-treatment supportive care for the natural dentition and dental implants. Periodontol 2000 2016; 71:164-84. [DOI: 10.1111/prd.12122] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2015] [Indexed: 12/11/2022]
|
19
|
Trombelli L, Franceschetti G, Farina R. Effect of professional mechanical plaque removal performed on a long-term, routine basis in the secondary prevention of periodontitis: a systematic review. J Clin Periodontol 2015; 42 Suppl 16:S221-36. [DOI: 10.1111/jcpe.12339] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Leonardo Trombelli
- Research Centre for the Study of Periodontal and Peri-Implant Diseases; University of Ferrara; Ferrara Italy
- Operative Unit of Dentistry; University-Hospital of Ferrara; Ferrara Italy
| | - Giovanni Franceschetti
- Research Centre for the Study of Periodontal and Peri-Implant Diseases; University of Ferrara; Ferrara Italy
| | - Roberto Farina
- Research Centre for the Study of Periodontal and Peri-Implant Diseases; University of Ferrara; Ferrara Italy
- Operative Unit of Dentistry; University-Hospital of Ferrara; Ferrara Italy
| |
Collapse
|
20
|
Müller N, Moëne R, Cancela JA, Mombelli A. Subgingival air-polishing with erythritol during periodontal maintenance: randomized clinical trial of twelve months. J Clin Periodontol 2014; 41:883-9. [PMID: 25041441 PMCID: PMC4287198 DOI: 10.1111/jcpe.12289] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2014] [Indexed: 11/30/2022]
Abstract
Objectives To evaluate repeated subgingival air-polishing in residual pockets with a new erythritol powder
containing 0.3% chlorhexidine. Material and Methods Single-centre, examiner masked, randomized clinical trial of 12 months with a two-arm,
within-subject parallel design. Fifty patients in periodontal maintenance were monitored in 3-month
intervals. At months 0, 3, 6 and 9, all sites presenting with a probing depth (PD)
>4 mm were subject to subgingival air-polishing (test side) or ultrasonic debridement
(control side). The primary endpoint was presence/absence of PD >4 mm after
12 months. Results Totally 6918 sites were monitored at baseline, 457 of them had a PD >4 mm
(range 5–9 mm). The number of pockets >4 mm per subject, PD and bleeding
on probing were significantly lower at month 12. Differences between test and control were not
significant. There was a significant difference in favour of air-polishing for the perception of
pain/discomfort. Differences of frequencies at >1000 and >100,000 cells/ml of
six microorganisms between baseline and month 12 were not significant. At month 12, test sites were
less frequently positive for Aggregatibacter actinomycetemcomitans at
>1000 cells/ml than controls, and counts never exceeded 100,000 cells/ml. Conclusions Repeated subgingival air-polishing reduced the number of pockets >4 mm similar to
ultrasonic debridement. It was safe and induced less pain.
Collapse
Affiliation(s)
- Nada Müller
- Division of Periodontology and Oral Pathophysiology, School of Dental Medicine, University of Geneva, Geneva, Switzerland
| | | | | | | |
Collapse
|
21
|
Gomes SC, Romagna R, Rossi V, Corvello PC, Angst PDM. Supragingival treatment as an aid to reduce subgingival needs: a 450-day investigation. Braz Oral Res 2014; 28. [PMID: 25000595 DOI: 10.1590/s1806-83242014.50000004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study investigated the clinical effects of using a supragingival biofilm control regimen (SUPRA) as a step prior to scaling and root planing (SRP). A split-mouth clinical trial was performed in which 25 subjects with periodontitis (47.2 ± 6.5 years) underwent treatment (days 0–60) and monitoring (days 90–450) phases. At Day 0 (baseline) treatments were randomly assigned per quadrant: SUPRA, SRP and S30SRP (SUPRA 30 days before SRP). The full-mouth visible plaque index (VPI), gingival bleeding index (GBI), periodontal probing depth (PPD), bleeding on probing (BOP), and clinical attachment loss (CAL) were examined on days 0, 30, 60, 90, 120, 270, and 450. Baseline data were similar among all groups. From days 0 to 60, the groups showed similar significant decreases in VPI and GBI. Reductions in PPD for the SRP (3.39 ± 0.17 to2.42 ± 0.16 mm) and S30SRP (3.31 ± 0.11 to 2.40 ± 0.07 mm) groups were greater (p < 0.05) than those for the SUPRA group. This pattern was also observed for BOP. Attachment gain was similar and greater for the SRP (3.34 ± 0.28 to 2.58 ± 0.26 mm) and S30SRP (3.25 ± 0.21 to 2.54 ± 0.19 mm) groups compared to the SUPRA group. Results were maintained from day 90 forward. Overall, the S30SRP treatment reduced the subgingival treatment needs in 48.16%. Performance of a SUPRA step before SRP decreased subgingival treatment needs and maintained the periodontal stability over time.
Collapse
|
22
|
Chen L, Luo G, Xuan D, Wei B, Liu F, Li J, Zhang J. Effects of non-surgical periodontal treatment on clinical response, serum inflammatory parameters, and metabolic control in patients with type 2 diabetes: a randomized study. J Periodontol 2011; 83:435-43. [PMID: 21859323 DOI: 10.1902/jop.2011.110327] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Scientific evidence on the effects of chronic periodontitis on diabetes mellitus remains inadequate and inconclusive. This intervention study is designed to evaluate the effects of periodontal treatment on clinical response, systemic inflammatory parameters, and metabolic control in patients with Type 2 diabetes. METHODS A total of 134 patients were randomly allocated into two treatment groups and one control group. Treatment group 1 underwent non-surgical periodontal treatment at baseline and additional subgingival debridement at the 3-month follow-up. Patients in treatment group 2 received non-surgical periodontal treatment and supragingival prophylaxis at the 3-month follow-up, and those in the control group received no intervention throughout the study. All participants were reexamined at 1.5, 3, and 6 months after initial treatment. At each visit, clinical periodontal examinations were conducted and blood samples were taken to evaluate high-sensitivity C-reactive protein (hsCRP), tumor necrosis factor-α (TNF-α), glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), and lipid profiles. RESULTS Both treatment groups had a significantly lower hsCRP level after periodontal therapy (P <0.05). Although HbA1c declined significantly in treatment group 2 (P <0.05), the intergroup difference for HbA1c, FPG, TNF-α, and lipid profiles was not statistically significant after therapy (P >0.05). CONCLUSIONS Non-surgical periodontal treatment can effectively improve periodontal and circulating inflammatory status. Despite a lack of strong evidence, trends in some results support improved glycemic control after periodontal treatment in patients with diabetes.
Collapse
Affiliation(s)
- Lei Chen
- Department of Periodontology, Guangdong Provincial Stomatological Hospital, Southern Medical University, Guangzhou, China
| | | | | | | | | | | | | |
Collapse
|
23
|
König J, Schwahn C, Fanghänel J, Plötz J, Hoffmann T, Kocher T. Repeated scaling versus surgery in young adults with generalized advanced periodontitis. J Periodontol 2008; 79:1006-13. [PMID: 18533777 DOI: 10.1902/jop.2008.070380] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Residual probing depth (PD) after subgingival scaling can be treated with repeated scaling or periodontal surgery. Ambiguous results about the additional clinical benefit of a second scaling procedure exist. Therefore, we performed a prospective study comparing the clinical results of repeated subgingival scaling versus periodontal surgery in 30- to 40-year-old subjects with generalized advanced periodontitis. METHODS Twenty-six subjects (mean age, 37 +/- 3 years) were treated after an initial examination (t(1)), initial subgingival scaling, and baseline examination (t(2)) with a randomly assigned second subgingival scaling (test) and periodontal surgery (control) in a split-mouth design. The final examination (t(3)) took place 6 months postoperatively. Intraindividual comparisons of mean PD and clinical attachment level (CAL) were analyzed. RESULTS PD was reduced from 4.1 +/- 0.2 mm initially (t(1)) to 3.1 +/- 0.1 mm at baseline (t(2)), and to 2.9 +/- 0.1 mm at the end of the study (t(3)) for the test sites; and from 4.5 +/- 0.2 mm (t(1)) to 3.5 +/- 0.1 mm (t(2)), and 3.1 +/- 0.1 mm (t(3)) for the control sites. The total PD decrease from t(1) to t(3) was significant (P <0.001) for both therapies. PD reduction from t(2) to t(3) was only significant (P <0.001) for control sites, resulting in a significant (P = 0.010) difference between test and control at the final examination. CAL increased 0.2 +/- 0.1 mm (t(2)) plus 0.3 +/- 0.1 mm (t(3)) for the test sites and 0.2 +/- 0.1 mm (t(2)) plus 0.2 +/- 0.1 mm (t(3)) for the control sites. Total CAL gain was statistically significant for the test and control sites. CAL gain from t(2) to t(3) was only significant (P = 0.022) for the test sites. CONCLUSIONS Both treatments reduced PD and increased CAL. A second subgingival scaling resulted in significant additional CAL gain and reduced the need for surgery.
Collapse
Affiliation(s)
- Jörgen König
- Unit of Periodontology, School of Dentistry, University of Greifswald, Greifswald, Germany.
| | | | | | | | | | | |
Collapse
|
24
|
Cosyn J, De Bruyn H. Interclinician disparity in periodontal decision making: need for consensus statements on surgical treatment. J Periodontal Res 2007; 42:311-7. [PMID: 17559627 DOI: 10.1111/j.1600-0765.2006.00950.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVE The clinical factors involved in the decision-making process for surgical treatment have been described. However, there is still little standardization of the criteria upon which such a decision should be based. The impact of this lack of practice guidelines on the recommendation of surgery in clinical practice is unclear. The objective of the present study was to investigate the recommendation of surgical therapy during the corrective/reparative treatment phase by trained clinicians with various backgrounds on the basis of clinical data. MATERIAL AND METHODS Fifteen clinicians (10 periodontal students and/or recent graduates from two dental schools and five experienced practitioners) were asked to make a treatment decision (surgery or no surgery) at a tooth level. Therefore, they were given 23 initially treated patients with details on demographics and smoking habits. Radiographs and clinical information on 573 teeth at baseline (prior to root debridement) and at 9 mo of follow-up were provided. RESULTS Clinicians interpret clinical data quite differently in their advice of surgery when practice guidelines are not provided, as the results showed high variation in surgical recommendation. Experienced practitioners showed most variation, with a range from 13 to 50% in surgical recommendation. Clinicians linked to a training center shared a common treatment philosophy as to when periodontal surgery should be performed. This philosophy differed markedly among the two dental schools. Most disagreement among the 15 clinicians was found for deep pockets and for multirooted teeth. Disease status, tooth type, age, and full-mouth plaque levels had a significant impact on decision making. CONCLUSION The substantial variation in recommending surgery calls for consensus statements on surgical treatment.
Collapse
Affiliation(s)
- J Cosyn
- Free University of Brussels (VUB), School of Dental Medicine, Department of Periodontology, Brussels, Belgium.
| | | |
Collapse
|
25
|
Gomes SC, Piccinin FB, Susin C, Oppermann RV, Marcantonio RAC. Effect of Supragingival Plaque Control in Smokers and Never-Smokers: 6-Month Evaluation of Patients With Periodontitis. J Periodontol 2007; 78:1515-21. [PMID: 17668970 DOI: 10.1902/jop.2007.060462] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The effect of supragingival plaque control on clinical signs of periodontitis is controversial, particularly when smoking habits are considered. This study evaluated the clinical effects of supragingival plaque control on clinical signs of periodontitis in smokers and never-smokers. METHODS The following data were collected for 25 never-smokers and 25 smokers at baseline and 30, 90, and 180 days: visible plaque index (VPI), gingival bleeding index (GBI), bleeding on probing (BOP), periodontal probing depth (PD), and clinical attachment loss (CAL). After baseline examinations, supragingival scaling was performed. Oral hygiene practices were reinforced and reevaluated weekly during the experimental period. Linear models adjusted for clustering of observations within individuals were used for statistical analysis. RESULTS Reductions in VPI were significant for both groups, with no intergroup differences. GBI at baseline was similar between groups, and at 30, 90, and 180 days, smokers had a lower GBI than never-smokers. Significant reductions were observed in PD for shallow (1 to 3 mm), moderate (4 to 5 mm), and deep sites (> or = 6 mm) in both groups. CAL was significantly greater in smokers throughout the study, but gains in attachment were similar for both groups (0.71 to 1.00 mm). BOP reductions were similar in both groups. CONCLUSIONS Supragingival plaque control resulted in significant changes in clinical parameters associated with gingivitis and periodontitis. Smoking did not affect results, regardless of initial PD.
Collapse
|
26
|
Leung WK, Ng DKC, Jin L, Corbet EF. Tooth loss in treated periodontitis patients responsible for their supportive care arrangements. J Clin Periodontol 2006; 33:265-75. [PMID: 16553635 DOI: 10.1111/j.1600-051x.2006.00903.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To identify risk indicators associated with tooth loss and periodontitis in treated patients responsible for arranging supportive periodontal care (SPC). MATERIALS AND METHODS Ninety-seven Chinese subjects (34-77 years) who showed favourable responses to periodontal therapy provided in a teaching hospital 5-12 years previously were recalled. They were advised to seek regular SPC on discharge. Background information, general health status, smoking, oral hygiene habits, follow-up dental care, tooth loss, and periodontal parameters were investigated. Multiple regression analysis was performed. RESULTS Two hundred and fifty-six teeth had been lost, 195 because of self-reported periodontal reasons. Up to 26.8% sites were with pockets > or =6 mm. Positive correlations were found between total/periodontal tooth loss and (i) smoking pack-years, (ii) time spent on oral hygiene, (iii) years since therapy's conclusion, (iv) age, and negative correlations with (v) inter-dental brush use, and (vi) education levels. Tooth loss by arch was correlated with wearing of removable partial denture in that arch. Percentage sites with pockets > or =6 mm were significantly negatively correlated with percentage sites without bleeding on probing. CONCLUSIONS Smokers, more elderly patients, removable partial denture wearers, and patients with lower education levels or not using inter-dental brushes ought to be targeted for clinic-based SPC.
Collapse
Affiliation(s)
- W K Leung
- Faculty of Dentistry, The University of Hong Kong, China
| | | | | | | |
Collapse
|
27
|
Pastagia J, Nicoara P, Robertson PB. The Effect of Patient-Centered Plaque Control and Periodontal Maintenance Therapy on Adverse Outcomes of Periodontitis. J Evid Based Dent Pract 2006; 6:25-32. [PMID: 17138393 DOI: 10.1016/j.jebdp.2005.12.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to evaluate systematic reviews that addressed the effectiveness of periodontal maintenance therapy for the management of patients with periodontitis. Recent surveys of dental care patterns suggest a marked increase in preventive and maintenance periodontal care in populations that retain the dentition for an increasingly longer lifetime. A considerable body of clinical investigation concludes that a multitherapy periodontal maintenance approach is effective in improving periodontal outcomes in patients treated for periodontitis. Individual components of such maintenance therapy were assessed, including the effects of an oral examination, personal oral hygiene instructions, supragingival scaling and polishing, subgingival scaling and root planing, adjunctive procedures, and maintenance frequency. There is much controversy about improvement in oral health that may accrue from the placebo effect of an examination and the maintenance ritual. Improved plaque control by the patient in anticipation of a forthcoming examination alone might be reflected in decreased measurements for plaque accumulation and gingival inflammation but the role of placebo effects on periodontitis remains unclear. There are insufficient randomized controlled trials to reach conclusions regarding the individual beneficial effects of repeated oral hygiene instructions or routine scaling/polishing on the recurrence of periodontitis. While subgingival root planing seems an effective component of periodontal maintenance, neither clinical investigations nor randomly controlled trial evidence have established an ideal maintenance frequency based on individual patient risk for periodontitis. The adjunctive beneficial effects of both locally and systemically administered antimicrobial agents were statistically significant for some formulations, and may be particularly useful clinically in patients who are resistant to mechanical therapy. We conclude that few clinical or randomized controlled studies have evaluated the individual benefit or required frequency of the periodontal maintenance ritual for patients who are relatively resistant or susceptible to periodontitis.
Collapse
Affiliation(s)
- Julie Pastagia
- Department of Periodontics, School of Dentistry, University of Washington, Seattle, WA, USA
| | | | | |
Collapse
|
28
|
McColl E, Patel K, Dahlen G, Tonetti M, Graziani F, Suvan J, Laurell L. Supportive periodontal therapy using mechanical instrumentation or 2% minocycline gel: a 12 month randomized, controlled, single masked pilot study. J Clin Periodontol 2006; 33:141-50. [PMID: 16441740 DOI: 10.1111/j.1600-051x.2005.00879.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the short-term performance of subgingival local delivery of 2% minocycline gel and conventional subgingival debridement in supportive periodontal therapy (SPT) patients. METHODS Forty adult patients having completed active treatment for moderate to advanced chronic periodontitis were included in a randomized, controlled, single masked maintenance care pilot study. Sites with residual pocket probing depths > or =5 mm and bleeding on probing were treated with either minocycline gel (minocycline-group) or scaling and root planing only (debridement-group) at baseline, 3, 6, and 9 months. Clinical and microbiological examinations were performed at baseline, 3, 6, 9, and 12 months. RESULTS Full-mouth plaque and bleeding scores remained <10% and <20%, respectively, for both groups throughout the study. In both groups there was a persistent reduction in number of teeth and sites with probing pocket depths > or =5 mm (p<0.05) with no significant differences between the groups. The prevalence of Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Actinobacillus actinomycetemcomitans, Prevotella intermedia, and Prevotella nigrescens, remained at levels < or =10(5) in the majority of patients and sites in both groups. CONCLUSION This pilot study failed to show a difference between local delivery of 2% minocycline gel as mono-therapy and traditional subgingival debridement in patients on SPT.
Collapse
Affiliation(s)
- E McColl
- Department of Periodontology, Eastman Dental Institute, University College London, London, UK
| | | | | | | | | | | | | |
Collapse
|
29
|
Gilbert GH, Shelton BJ, Fisher MA. Forty-Eight–Month Periodontal Attachment Loss Incidence in a Population-Based Cohort Study: Role of Baseline Status, Incident Tooth Loss, and Specific Behavioral Factors. J Periodontol 2005; 76:1161-70. [PMID: 16018760 DOI: 10.1902/jop.2005.76.7.1161] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The objectives of this study were to: 1) test hypotheses that behavioral factors, baseline clinical status, and incident tooth loss are significantly associated with attachment loss incidence (ALI) and 2) quantify the effect of incident tooth loss on conclusions made about ALI. METHODS The Florida Dental Care Study was a prospective study of persons > or =45 years old. In-person interviews and examinations were conducted at baseline and 48 months, with telephone interviews in between. RESULTS Of 560 persons with baseline and 48-month examinations, 22% of persons and 1.8% of teeth had ALI. This was highest among persons with no dental visit during follow-up (person-level incidence of 46%; 5.0% tooth-level incidence). Statistically significant covariates in a multivariable regression of ALI were: losing a tooth due to periodontal reasons after baseline, but before the 48-month examination; not receiving a dental cleaning; and baseline factors (worst attachment level of > or =7 mm, not flossing, a molar tooth, current smoker). CONCLUSIONS A substantial percentage of persons experienced ALI. Baseline attachment level and behavioral factors were significantly associated with ALI. Persons with incident tooth loss were also at increased risk for ALI, and teeth lost during follow-up had worse baseline attachment level. Had these teeth not been lost before the final examination, the ALI estimate could only have been higher. These findings demonstrate that those at greatest risk for ALI are least likely to enter the dental care system, and among those who do, one health outcome (tooth loss) can affect conclusions made about the incidence of another (ALI).
Collapse
Affiliation(s)
- Gregg H Gilbert
- Department of Diagnostic Sciences, School of Dentistry, University of Alabama at Birmingham, 1530 3rd Avenue South, Birmingham, AL 35294, USA.
| | | | | |
Collapse
|
30
|
Ehmke B, Moter A, Beikler T, Milian E, Flemmig TF. Adjunctive Antimicrobial Therapy of Periodontitis: Long-Term Effects on Disease Progression and Oral Colonization. J Periodontol 2005; 76:749-59. [PMID: 15898936 DOI: 10.1902/jop.2005.76.5.749] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND This study assessed the long-term effects of adjunctive antimicrobial therapy on periodontal disease progression and oral colonization. METHODS Patients with previously untreated chronic periodontitis and subgingival Actinobacillus actinomycetemcomitans and/or Porphyromonas gingivalis were randomly assigned to subgingival scaling without (control group) or with systemic amoxicillin plus metronidazole and CHX irrigation (test group). Relative attachment levels were determined and subgingival and mucosal plaque samples were taken at baseline, at 10 days (plaque only) and at 3, 6, 9, 12, 18, and 24 months following initial therapy. During maintenance therapy, patients received supragingival debridement only. RESULTS After 24 months, the 18 test group patients showed at sites with initial probing depths (PD) > or =7 mm a significantly (P <0.05) higher frequency of 2 mm or more attachment gain (37.3% +/- 4.6%) and lower frequency of attachment loss (7.2% +/- 3.1%) compared to the 17 controls (8.2% +/- 3.9% and 19.1% +/- 13.1%, respectively). Compared to controls, the intraoral prevalence of A. actinomycetemcomitans (up to 18 months) and P. gingivalis (up to 3 months) decreased and that of Eikenella corrodens (at 10 days) increased in test patients (P <0.05). In both treatment groups, the detection frequency of Tannerella forsythensis decreased transiently, while an overall increase was recorded for Treponema ssp. CONCLUSIONS Over the 24-month period, a single course of the administered adjunctive antimicrobial therapy led to a relative risk reduction of 62% for attachment loss at deep sites. However, with the exception of A. actinomycetemcomitans, it failed to induce long-term changes in the prevalence profiles of oral colonization.
Collapse
Affiliation(s)
- Benjamin Ehmke
- Department of Periodontology, University of Münster, Münster, Germany.
| | | | | | | | | |
Collapse
|
31
|
Preshaw PM, Heasman PA. Periodontal maintenance in a specialist periodontal clinic and in general dental practice. J Clin Periodontol 2005; 32:280-6. [PMID: 15766371 DOI: 10.1111/j.1600-051x.2005.00659.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To monitor the efficacy of periodontal maintenance whether conducted in a specialist periodontology clinic or in the practice of the referring general dentist. MATERIALS AND METHODS Thirty-five subjects with a diagnosis of moderate-severe chronic periodontitis who were referred to the specialist clinic received periodontal non-surgical therapy. Following a 6-month healing phase, subjects were randomly allocated to one of two groups: A (n=18, periodontal maintenance provided within the specialist clinic) or B (n=17, periodontal maintenance provided by the referring general dentist in accordance with written instructions provided by the specialist). All subjects were examined at months 0 (corresponding to 6 months post-completion of non-surgical therapy), 6 and 12. Full-mouth plaque index (PI), % bleeding on probing (%BOP) and probing depth (PD) measurements were recorded. PDs were also recorded at eight test sites which, prior to non-surgical therapy, exhibited PD 5-8 mm, BOP and radiographic alveolar bone loss. Standardized radiographs were exposed at test sites at months 0 and 12, and bone changes assessed using digital subtraction radiography (DSR). RESULTS As a result of the non-surgical therapy, statistically significant improvements in all clinical parameters were recorded. In the maintenance period, mean PI increased significantly from months 0 to 12 (p<0.05), but this increase did not differ significantly between groups A and B (p>0.05). No other clinical parameters changed significantly in the maintenance phase of the study. Reductions in %BOP, mouth mean PD and mean test sites PD achieved by the non-surgical therapy were maintained and did not differ significantly whether subjects were allocated to group A or group B (p>0.05). Current smokers had significantly deeper PD than non-smokers and former smokers at all time points (p<0.05), although otherwise, smoking status did not affect the outcomes of the study. DSR analysis identified statistically non-significant, slight, alveolar bone loss in both groups between months 0 and 12. CONCLUSION In the short term, periodontal maintenance can be provided in general dental practice with the same expected outcomes compared with maintenance that is provided in a specialist clinic, providing that general dentists are given specific instructions regarding the maintenance regimen. A strong emphasis on effective plaque control is necessary.
Collapse
Affiliation(s)
- Philip M Preshaw
- School of Dental Sciences, University of Newcastle upon Tyne, Framlington Place, Newcastle upon Tyne, UK.
| | | |
Collapse
|
32
|
Affiliation(s)
- Jean E Suvan
- Department of Periodontology, Eastman Dental Institute for Oral Health Care Sciences, University College London, UK
| |
Collapse
|
33
|
Affiliation(s)
- Stefan Renvert
- Department of Periodontology and Fixed Prosthodontics, University of Bern, Switzerland
| | | |
Collapse
|
34
|
Abstract
An important part of the design process for any study is deciding how to assess and measure the phenomena you are aiming to research. In this article we will use the term outcome measure to indicate the tool or index that can be used to quantify, in an accurate and predictable way, the phenomenon under investigation. This might, for example, be a patient's opinion, the effect of a treatment, the outcome of an intervention, or the prevalence of an oral disease. The paper presents an overview of outcome measures which can be used in research. We will discuss the properties to look for in a measure, suggest suitable evidence-based measures and briefly introduce how to go about developing new measures, in particular, questionnaires.
Collapse
Affiliation(s)
- A C Williams
- Department of Child Dental Health, University of Bristol Dental School, Lower Maudlin St, Bristol BS 2LY
| | | | | |
Collapse
|
35
|
Ehmke B, Beikler T, Riep B, Flemmig T, Göbel U, Moter A. Intraoral dissemination of treponemes after periodontal therapy. Clin Oral Investig 2004; 8:219-25. [PMID: 15221659 DOI: 10.1007/s00784-004-0272-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2004] [Accepted: 05/11/2004] [Indexed: 10/26/2022]
Abstract
Oral treponemes are related to chronic periodontitis, but the effect of periodontal therapy on the majority of treponemal species is unknown. The aim of this prospective study was to evaluate the dynamics in prevalence profiles of treponemes in different habitats of the oral cavity. Thirty-five patients with chronic periodontitis were randomly assigned to mechanical debridement alone (control group) or systemic amoxicillin/metronidazole plus chlorhexidine (test group). Subgingival and mucous membrane plaque samples were taken at baseline, after 10 days, and during supportive periodontal therapy at 3, 6, 9, 12, 18, and 24 months. T. denticola, T. lecithinolyticum, T. maltophilum, T. socranskii, T. vincentii, and treponemal phylotypes I-VII were detected using polymerase chain reaction (PCR) and dot blot analysis. For the majority of the assessed treponemes, a significant intragroup increase in prevalence in the different habitats ( P<0.05) occurred over the study course but, compared to debridement alone, adjunctive antimicrobial therapy resulted in a nonsignificant trend toward lower prevalence in the subgingival habitat. In no case were treponemes eradicated from the oral cavity. After both therapies, possibly new infection with and/or dissemination of Treponema ssp. occurred, which led to treponemes recovering in different habitats and to increased intraoral prevalence. The prescribed adjunctive antimicrobial therapy may limit this increase in the subgingival region.
Collapse
Affiliation(s)
- Benjamin Ehmke
- Department of Periodontology, Westfalian Wilhelm University, Waldeyerstrasse 30, 48149 Münster, Germany.
| | | | | | | | | | | |
Collapse
|
36
|
Evidence-based Periodontology. J Evid Based Dent Pract 2004. [DOI: 10.1016/j.jebdp.2004.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|