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Adachi N, Sugimoto K, Shinada K. Association between tooth loss and adherence to oral maintenance in a dental clinic: A retrospective study of more than 20 years. Int J Dent Hyg 2024; 22:596-603. [PMID: 37635371 DOI: 10.1111/idh.12719] [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: 06/03/2021] [Revised: 02/06/2023] [Accepted: 07/30/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVES The relationship between adherence to professional oral maintenance visits and tooth loss is generally accepted in periodontal treatment; however, this relationship has not been clarified in general dental practices. We evaluated the effectiveness of adherence to professional maintenance by a retrospective survey in a private practice. METHODS We retrospectively extracted data of 395 patients in a general dental practice who had been followed for more than 20 years. For comparisons, two patient groups were created based on oral maintenance rates: a high- (≥75%) and a low- (<75%) adherence groups. Additionally, multiple logistic regression analysis for tooth loss was conducted with the same two adherence groups and three adherence groups (<50%, ≥50% and <75% and ≥75%), adjusting with risk factors including sex, age, decayed, missing, and filled teeth (DMFT), periodontal status, smoking status, and diabetes at the beginning of maintenance. RESULTS The number of teeth lost and increased DMFT over time were significantly lower in the high-adherence group than in the low-adherence group. Multiple logistic regression analysis for tooth loss in the two adherence groups yielded an odds ratio (95% confidence interval) of 6.50 (3.73-11.32) in the low-adherence group relative to the high-adherence group. Further analysis with the three adherence groups showed highest risk in the low-adherence group and a higher risk in the moderate-adherence group than the high-adherence group. CONCLUSIONS Patients with high adherence to maintenance schedules for more than 20 years demonstrated significantly less tooth loss. Dental practitioners should promote high adherence to professional maintenance in general dental practices.
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Affiliation(s)
- Naoko Adachi
- Department of Preventive Oral Health Care Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kumiko Sugimoto
- Department of Oral Health Care Education, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kayoko Shinada
- Department of Preventive Oral Health Care Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Ikhar AS, Kolte RA, Kolte AP, Rathi PR, Ghoderao DG, Dahake RN. Comparative evaluation of semaphorin-4D, peptidylarginine deiminase-2, and matrix metalloproteinase-8 levels of gingival crevicular fluid in periodontally healthy and Stage III periodontitis smoker and non-smoker patients before and after non-surgical periodontal therapy. J Periodontol 2024; 95:563-570. [PMID: 37846733 DOI: 10.1002/jper.23-0324] [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: 05/19/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND This study was designed to assess the influence of non-surgical periodontal therapy (NSPT) on gingival crevicular fluid (GCF) levels of semaphorin-4D (SEMA-4D), peptidylarginine deiminase-2 (PAD-2), and matrix metalloproteinase-8 (MMP-8) levels in periodontally healthy, Stage III periodontitis non-smoker and smoker patients. METHODS Sixty patients were equally divided into three groups, Group I: Periodontally healthy, Group II: Non-smokers with Stage III periodontitis, and Group III: Smokers with Stage III periodontitis. The patients underwent NSPT with clinical and biochemical parameters examined at baseline and 3 months post therapy. GCF was collected for levels of SEMA-4D, PAD-2, and MMP-8 through enzyme-linked immunosorbent assay (ELISA). RESULTS Greater values of PPD (8.06 ± 0.19 mm), CAL (8.94 ± 0.19 mm), PI (2.58 ± 0.19) while lower PBI (1.39 ± 0.19%) and GI (1.72 ± 0.19) scores were seen in Group III as compared to Group II, which reduced significantly from baseline to 3 months in both the groups after NSPT. Minimum values of SEMA-4D, PAD-2, and MMP-8 levels in GCF were seen for Group I, which increased incrementally to Group II and III. Also, among Group II and III the SEMA-4D, PAD-2, and MMP-8 levels in GCF reduced from baseline to 3 months indicating a favorable response within the tissues. CONCLUSION Greater levels in GCF of Levels of SEMA-4D, PAD-2, and MMP-8 in Group II and III, which reduced significantly post NSPT, implied that these biomarkers play a pivotal role in the inflammatory process and can be utilized for early diagnosis.
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Affiliation(s)
- Aishwarya S Ikhar
- Department of Periodontology and Implant Dentistry, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India
| | - Rajashri A Kolte
- Department of Periodontology and Implant Dentistry, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India
| | - Abhay P Kolte
- Department of Periodontology and Implant Dentistry, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India
| | - Prachi R Rathi
- Department of Periodontology and Implant Dentistry, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India
| | - Dhanashree G Ghoderao
- Department of Periodontology and Implant Dentistry, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India
| | - Rahul N Dahake
- Department of Oral and Maxillofacial Surgery, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India
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Hasan F, Magan-Fernandez A, Akcalı A, Sun C, Donos N, Nibali L. Tooth loss during supportive periodontal care: A prospective study. J Clin Periodontol 2024; 51:583-595. [PMID: 38409875 DOI: 10.1111/jcpe.13943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 12/07/2023] [Accepted: 12/23/2023] [Indexed: 02/28/2024]
Abstract
AIM To assess periodontal stability and the association between tooth- and patient-related factors and tooth loss during supportive periodontal care (SPC). MATERIALS AND METHODS A prospective observational study was carried out on previously treated periodontitis patients followed up for 5 years in SPC. The risk profile (low, moderate, high) of each patient based on periodontal risk assessment (PRA) scoring at baseline was evaluated, and tooth loss rates were analysed. RESULTS Two hundred patients were included in the study, and 143 had 5-year follow-up data available for analysis. The overall annual tooth loss per patient was 0.07 ± 0.14 teeth/patient/year. Older age, smoking, staging and grading were associated with increased tooth loss rates. Most patients whose teeth were extracted belonged to the PRA high-risk group. Both PRA and a tooth prognosis system used at baseline showed high negative predictive value but low positive predictive value for tooth loss during SPC. CONCLUSIONS Overall, the tooth loss rate of periodontitis patients in this prospective cohort study under SPC in private practice was low. Both tooth-based and patient-based prognostic systems can identify high-risk cases, but their positive predictive value should be improved.
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Affiliation(s)
- Fatemah Hasan
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Antonio Magan-Fernandez
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
- Periodontology Unit, Department of Stomatology, School of Dentistry, University of Granada, Granada, Spain
| | - Aliye Akcalı
- Department of Periodontology, Faculty of Dentistry, Dokuz Eylul University, İzmir, Turkey
- Centre for Oral Clinical Research, Institute of Dentistry, Barts and The London, School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Chuanming Sun
- Department of Periodontology, Faculty of Dentistry, Suzhou Health College, Suzhou, China
| | - Nikos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Barts and The London, School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Luigi Nibali
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
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Saleh MHA, Dias DR, Kumar P. The economic and societal impact of periodontal and peri-implant diseases. Periodontol 2000 2024. [PMID: 38693603 DOI: 10.1111/prd.12568] [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: 02/01/2024] [Accepted: 03/26/2024] [Indexed: 05/03/2024]
Abstract
Periodontal and peri-implant diseases result from a chronic inflammatory response to dysbiotic microbial communities and are characterized by inflammation in the soft tissue and the ensuing progressive destruction of supporting bone, resulting in tooth or implant loss. These diseases' high prevalence, multifactorial etiology, extensive treatment costs, and significant detriment to patients' quality-of-life underscore their status as a critical public health burden. This review delineates the economic and sociocultural ramifications of periodontal and peri-implant diseases on patient welfare and healthcare economics. We delve into the implications of diagnosis, treatment, supportive care, and managing destructive tissue consequences, contrasting these aspects with healthy patients.
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Affiliation(s)
- Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Debora R Dias
- Department of Dentistry, State University of Maringá, Maringá, Paraná, Brazil
| | - Purnima Kumar
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Chen X, Xu C, Wu Y, Zhao L. The survival of periodontally treated molars in long-term maintenance: A systematic review and meta-analysis. J Clin Periodontol 2024; 51:631-651. [PMID: 38317331 DOI: 10.1111/jcpe.13951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 12/30/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024]
Abstract
AIM This systematic review and meta-analysis aimed to determine the survival of periodontally treated molars during maintenance care and identify the risk factors associated with molar loss among patients with periodontitis who received professional periodontal therapy and maintenance. MATERIALS AND METHODS Longitudinal studies with a minimum follow-up duration of 5 years published until 28 August 2023 were retrieved from the following databases: the Cochrane Library, Embase, MEDLINE and Web of Science. All included studies reported data on molar retention. Meta-analysis was performed using Review Manager 5.4. A modified version of the Newcastle-Ottawa Scale was used to evaluate the study quality. Statistical results of analyses of the overall survival rate and molar loss are presented as estimated standardized mean differences, whereas the results of the analyses of risk factors are presented as risk ratios with 95% confidence intervals (95% CIs). RESULTS From among the 1323 potentially eligible reports, 41 studies (5584 patients, 29,908 molars retained at the beginning of maintenance therapy, mean follow-up duration of 14.7 years) were included. The pooled survival rate of the molars during maintenance therapy was 82% (95% CI: 80%-84%). The average loss of molars was 0.05 per patient per year (95% CI: 0.04-0.06) among the patients receiving long-term periodontal maintenance (PM) therapy. Fifteen factors were examined in this meta-analysis. Six patient-related factors (older age, lack of compliance, smoking, bruxism, diabetes and lack of private insurance) and five tooth-related factors (maxillary location, high probing pocket depth, furcation involvement, higher mobility and lack of pulpal vitality) were identified as risk factors for molar loss during maintenance therapy. CONCLUSIONS The findings of the present study suggest that the long-term retention of periodontally compromised molars can be achieved. The average number of molars lost per decade was <1 among the patients receiving long-term PM therapy. Older age, noncompliance, smoking, bruxism, diabetes, lack of private insurance coverage, maxillary location, furcation involvement, higher mobility, increase in the probing pocket depth and loss of pulpal vitality are strong risk factors for the long-term prognosis of molars.
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Affiliation(s)
- Xiao Chen
- State Key Laboratory of Oral Diseases and National Center for Stomatology and National Clinical Research Center for Oral Diseases and Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Chunmei Xu
- State Key Laboratory of Oral Diseases and National Center for Stomatology and National Clinical Research Center for Oral Diseases and Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yafei Wu
- State Key Laboratory of Oral Diseases and National Center for Stomatology and National Clinical Research Center for Oral Diseases and Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Lei Zhao
- State Key Laboratory of Oral Diseases and National Center for Stomatology and National Clinical Research Center for Oral Diseases and Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
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Lee CT, Zhang K, Li W, Tang K, Ling Y, Walji MF, Jiang X. Identifying predictors of the tooth loss phenotype in a large periodontitis patient cohort using a machine learning approach. J Dent 2024; 144:104921. [PMID: 38437976 DOI: 10.1016/j.jdent.2024.104921] [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: 10/14/2023] [Revised: 02/17/2024] [Accepted: 03/01/2024] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVES This study aimed to identify predictors associated with the tooth loss phenotype in a large periodontitis patient cohort in the university setting. METHODS Information on periodontitis patients and nineteen factors identified at the initial visit was extracted from electronic health records. The primary outcome is tooth loss phenotype (presence or absence of tooth loss). Prediction models were built on significant factors (single or combinatory) selected by the RuleFit algorithm, and these factors were further adopted by regression models. Model performance was evaluated by Area Under the Receiver Operating Characteristic Curve (AUROC) and Area Under the Precision-Recall Curve (AUPRC). Associations between predictors and the tooth loss phenotype were also evaluated by classical statistical approaches to validate the performance of machine learning models. RESULTS In total, 7840 patients were included. The machine learning model predicting the tooth loss phenotype achieved AUROC of 0.71 and AUPRC of 0.66. Age, periodontal diagnosis, number of missing teeth at baseline, furcation involvement, and tooth mobility were associated with the tooth loss phenotype in both machine learning and classical statistical models. CONCLUSIONS The rule-based machine learning approach improves model explainability compared to classical statistical methods. However, the model's generalizability needs to be further validated by external datasets. CLINICAL SIGNIFICANCE Predictors identified by the current machine learning approach using the RuleFit algorithm had clinically relevant thresholds in predicting the tooth loss phenotype in a large and diverse periodontitis patient cohort. The results of this study will assist clinicians in performing risk assessment for periodontitis at the initial visit.
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Affiliation(s)
- Chun-Teh Lee
- Department of Periodontics and Dental Hygiene, The University of Texas Health Science Center at Houston School of Dentistry, 7500 Cambridge Street, Houston, TX 77054, USA
| | - Kai Zhang
- The University of Texas Health Science Center at Houston School of Biomedical Informatics, 7000 Fannin St, Houston, Texas 77030, USA
| | - Wen Li
- Division of Clinical and Translational Sciences, Department of Internal Medicine, the University of Texas McGovern Medical School at Houston, 6431 Fannin St, Houston, Texas, USA; Biostatistics/Epidemiology/Research Design (BERD) Component, Center for Clinical and Translational Sciences (CCTS), University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, Houston, Texas 77030, USA
| | - Kaichen Tang
- The University of Texas Health Science Center at Houston School of Biomedical Informatics, 7000 Fannin St, Houston, Texas 77030, USA
| | - Yaobin Ling
- The University of Texas Health Science Center at Houston School of Biomedical Informatics, 7000 Fannin St, Houston, Texas 77030, USA
| | - Muhammad F Walji
- The University of Texas Health Science Center at Houston School of Biomedical Informatics, 7000 Fannin St, Houston, Texas 77030, USA; Department of Diagnostic and Biomedical Sciences, The University of Texas Health Science Center at Houston School of Dentistry, 7000 Fannin St., Houston, Texas 77030, USA
| | - Xiaoqian Jiang
- The University of Texas Health Science Center at Houston School of Biomedical Informatics, 7000 Fannin St, Houston, Texas 77030, USA.
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Batı BÇ, Buduneli N, Meriç P. Examining awareness of tobacco's oral health effects: Dentists' role in smoking cessation among dental patients. Tob Induc Dis 2024; 22:TID-22-41. [PMID: 38370493 PMCID: PMC10870343 DOI: 10.18332/tid/176227] [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: 04/23/2023] [Revised: 11/26/2023] [Accepted: 12/01/2023] [Indexed: 02/20/2024] Open
Abstract
INTRODUCTION Tobacco products are well-known as a major risk factor for systemic and oral diseases. Dentists may play an important role in the prevention and progression of oral problems related to smoking. The aim of this study was to evaluate the level of awareness about the poor oral health effects of tobacco products and the role of dentists in smoking cessation among dental patients. METHODS A survey containing 40 questions was prepared, and patients seeking dental treatment between June and October 2019 at the School of Dentistry, Ege University, were asked to participate. The survey included demographic variables in the first part, habits of using tobacco products in the second part, relations between smoking and oral health, and the possible role of dentists in smoking cessation in the last part. Data were tested statistically by Mann Whitney U and chi-squared tests. RESULTS A total of 501 patients participated in the survey; more than half of the participants were non-smokers (63.7%). Cigarettes (95.06%), hookah (7.69%), e-cigarettes (2.75%), and cigars (1.65%) were the most frequently consumed tobacco products. The biggest obstacle to quitting smoking was 'having smoker friends'. The rate of non-smokers (41.4%) agreeing that smoking is related to periodontal diseases was more than that of smokers (32.4%) (p<0.05). The most known side effect of tobacco products was halitosis (81.6%). Half of the respondents (46.7%) did not know about dentists' role in helping them quit smoking. The rate of participants previously recommended by a dentist to quit smoking was only 36%. CONCLUSIONS The aesthetic and social consequences of using tobacco products are well known, but smokers are substantially less aware than non-smokers of the relationship between tobacco products and oral diseases. The present findings suggest that dentists should inform their patients about the detrimental effects of tobacco products and play an active role in advising them to quit.
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Affiliation(s)
- Betül Çalışkan Batı
- Department of Periodontology, Faculty of Dentistry, Ege University, İzmir, Türkiye
| | - Nurcan Buduneli
- Department of Periodontology, Faculty of Dentistry, Ege University, İzmir, Türkiye
| | - Pınar Meriç
- Department of Periodontology, Faculty of Dentistry, Ege University, İzmir, Türkiye
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Gobin E, Izidoro C, Lyra P, Morgado M, Alves RC, Mendes JJ, Botelho J, Machado V. Self-Management Ability Questionnaire Validation in Portuguese Adults With Periodontitis. Int Dent J 2023; 73:889-895. [PMID: 37442684 PMCID: PMC10658420 DOI: 10.1016/j.identj.2023.06.003] [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: 04/04/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 07/15/2023] Open
Abstract
OBJECTIVES We aimed to test the psychometric validity of the adapted and translated Self-Management Ability Questionnaire-Short Form (SMAQ-12) to Portuguese. METHODS The translation and adaptation of the SMAQ-12 followed international guidelines. We included 280 participants with chronic periodontitis from the Department of Periodontology of the Egas Moniz Dental Clinic. Participants completed the Portuguese version of the SMAQ-12 (SMAQ-12-PT), a 12-item scale with 3 conceptual domains (Role Management, Medical Management, and Emotional Management). The validity of the content, its construct and internal consistency, as well as test-retest reliability were used to estimate psychometric properties. RESULTS The SMAQ-12-PT showed an interclass correlation coefficient value of 0.90, with a 95% confidence interval (0.79-0.95; P < .001) and high reliability (Cronbach alpha coefficient ranging between 0.78 and 0.94). Confirmatory factor analysis revealed adequate model fit, with comparative fit index of 0.853, goodness-of-fit of 0.947, and a 0.052 value of root mean squared error of approximation. CONCLUSIONS The SMAQ-12-PT was found to be a valid and reliable instrument in the Portuguese population. Disease management representation for the specialty of periodontology and its impact on periodontal schedules and practices should be evaluated in future studies.
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Affiliation(s)
- Eloïse Gobin
- Clinical Research Unit (CRU), Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Almada, Portugal
| | - Catarina Izidoro
- Clinical Research Unit (CRU), Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Almada, Portugal
| | - Patrícia Lyra
- Clinical Research Unit (CRU), Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Almada, Portugal
| | - Mariana Morgado
- Clinical Research Unit (CRU), Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Almada, Portugal
| | - Ricardo Castro Alves
- Clinical Research Unit (CRU), Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Almada, Portugal
| | - José João Mendes
- Clinical Research Unit (CRU), Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Almada, Portugal; Evidence-Based Hub, Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Almada, Portugal
| | - João Botelho
- Clinical Research Unit (CRU), Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Almada, Portugal; Evidence-Based Hub, Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Almada, Portugal
| | - Vanessa Machado
- Clinical Research Unit (CRU), Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Almada, Portugal; Evidence-Based Hub, Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Almada, Portugal.
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Rattu V, Raindi D, Antonoglou G, Nibali L. Prevalence of stable and successfully treated periodontitis subjects and incidence of subsequent tooth loss within supportive periodontal care: A systematic review with meta-analyses. J Clin Periodontol 2023; 50:1371-1389. [PMID: 37402624 DOI: 10.1111/jcpe.13835] [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: 10/26/2022] [Revised: 04/24/2023] [Accepted: 05/16/2023] [Indexed: 07/06/2023]
Abstract
AIM To identify (i) the prevalence of meeting the endpoints of 'stable periodontitis' (probing pocket depth [PPD] ≤ 4 mm, bleeding on probing [BoP] < 10%, no BoP at 4 mm sites), 'endpoints of therapy' (no PPD > 4 mm with BoP, no PPD ≥ 6 mm), 'controlled periodontitis' (≤4 sites with PPD ≥ 5 mm), 'PPD < 5 mm' and 'PPD < 6 mm' at the start of supportive periodontal care [SPC]) and (ii) the incidence of tooth loss in relation to not meeting these endpoints within a minimum of 5 years of SPC. MATERIALS AND METHODS Systematic electronic and manual searches were conducted to identify studies where subjects, upon completion of active periodontal therapy, entered into SPC. Duplicate screening was performed to find relevant articles. Corresponding authors were contacted to confirm inclusion and retrieve required clinical data for further analyses to assess the prevalence of reaching endpoints and incidence of subsequent tooth loss, if available, within at least 5 years of SPC. Meta-analyses were carried out to evaluate risk ratios for tooth loss in relation to not reaching the various endpoints. RESULTS Fifteen studies including 12,884 patients and 323,111 teeth were retrieved. Achievement of endpoints at baseline SPC was rare (1.35%, 11.00% and 34.62%, respectively, for 'stable periodontitis', 'endpoints of therapy' and 'controlled periodontitis'). Less than a third of the 1190 subjects with 5 years of SPC data lost teeth-a total of 3.14% of all teeth were lost. Statistically significant associations with tooth loss, at the subject-level, were found for not achieving 'controlled periodontitis' (relative risk [RR] = 2.57), PPD < 5 mm (RR = 1.59) and PPD < 6 mm (RR = 1.98). CONCLUSIONS An overwhelming majority of subjects and teeth do not achieve the proposed endpoints for periodontal stability, yet most periodontal patients preserve most of their teeth during an average of 10-13 years in SPC.
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Affiliation(s)
- V Rattu
- Periodontology Unit, Centre for Host-Microbiome Interactions, Dental Institute, King's College London, London, UK
| | - D Raindi
- Periodontal Research Group, University of Birmingham, Birmingham, UK
| | - G Antonoglou
- Periodontology Unit, Centre for Host-Microbiome Interactions, Dental Institute, King's College London, London, UK
| | - L Nibali
- Periodontology Unit, Centre for Host-Microbiome Interactions, Dental Institute, King's College London, London, UK
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10
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Aykol-Sahin G, Arsan B. Furcation area and root proximity of molars as a risk indicator of periodontitis: a cone‑beam computed tomography-based study. Oral Radiol 2023; 39:802-810. [PMID: 37596499 DOI: 10.1007/s11282-023-00706-6] [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: 03/30/2023] [Accepted: 08/03/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVES This study assessed the root proximity in molars and the furcation area (FA) in the first root separation point (RSP) using cone‑beam computed tomography (CBCT) and evaluated the association between the furcation area of molars and periodontal status of the patients. METHODS A total of 264 molar teeth in 66 participants were included in the study. The control group consisted of 110 molar teeth of participants, and 154 molar teeth were included in periodontitis group, which consisted of only stage II and III periodontitis patients. FA, RSP, and root proximities were measured in axial slices, and bone resorption rates were measured in sagittal slices. RESULTS Both maxillary and mandibular molar groups had significantly less FA in periodontitis group than in controls (p < 0.005), and there were significant relationships between the degree of bone resorption in molars and FA and furcation grades (p < 0.001). According to regression analysis, the risk of periodontitis increased by 1.011 times as total FA decreased (p < 0.001), and periodontitis risk of maxillary molar was 1.693 times higher than mandibular molars but not found to be statistically significant (p = 0.152). When assessing the root proximity between molar teeth, maxillary molars showed significantly higher root proximity in CEJs than mandibular molars in both periodontitis and control groups (p < 0.05). CONCLUSIONS The results indicate that the association between FA and the degree of bone resorption and root proximity of maxillary molars might be considered as a risk indicator for bone resorption in molars and might play a role during disease progression.
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Affiliation(s)
- Gokce Aykol-Sahin
- Department of Periodontology, Faculty of Dentistry, Istanbul Okan University, Istanbul, Turkey.
| | - Belde Arsan
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Istanbul Medeniyet University, Istanbul, Turkey
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Lee CT, Zhang K, Li W, Tang K, Ling Y, Walji MF, Jiang X. Identifying predictors of tooth loss using a rule-based machine learning approach: A retrospective study at university-setting clinics. J Periodontol 2023; 94:1231-1242. [PMID: 37063053 DOI: 10.1002/jper.23-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/18/2023] [Accepted: 04/12/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND This study aimed to identify predictors associated with tooth loss in a large periodontitis patient cohort in the university setting using the machine learning approach. METHODS Information on periodontitis patients and 18 factors identified at the initial visit was extracted from electronic health records. A two-step machine learning pipeline was proposed to develop the tooth loss prediction model. The primary outcome is tooth loss count. The prediction model was built on significant factors (single or combination) selected by the RuleFit algorithm, and these factors were further adopted by the count regression model. Model performance was evaluated by root-mean-squared error (RMSE). Associations between predictors and tooth loss were also assessed by a classical statistical approach to validate the performance of the machine learning model. RESULTS In total, 7840 patients were included. The machine learning model predicting tooth loss count achieved RMSE of 2.71. Age, smoking, frequency of brushing, frequency of flossing, periodontal diagnosis, bleeding on probing percentage, number of missing teeth at baseline, and tooth mobility were associated with tooth loss in both machine learning and classical statistical models. CONCLUSION The two-step machine learning pipeline is feasible to predict tooth loss in periodontitis patients. Compared to classical statistical methods, this rule-based machine learning approach improves model explainability. However, the model's generalizability needs to be further validated by external datasets.
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Affiliation(s)
- Chun-Teh Lee
- Department of Periodontics and Dental Hygiene, The University of Texas Health Science Center at Houston School of Dentistry, Houston, Texas, USA
| | - Kai Zhang
- The University of Texas Health Science Center at Houston, McWilliams School of Biomedical Informatics, Houston, Texas, USA
| | - Wen Li
- Division of Clinical and Translational Sciences, Department of Internal Medicine, The University of Texas McGovern Medical School at Houston, Houston, Texas, USA
- Biostatistics/Epidemiology/Research Design (BERD) Component, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Kaichen Tang
- The University of Texas Health Science Center at Houston, McWilliams School of Biomedical Informatics, Houston, Texas, USA
| | - Yaobin Ling
- The University of Texas Health Science Center at Houston, McWilliams School of Biomedical Informatics, Houston, Texas, USA
| | - Muhammad F Walji
- Department of Diagnostic and Biomedical Sciences, The University of Texas Health Science Center at Houston School of Dentistry, Houston, Texas, USA
| | - Xiaoqian Jiang
- The University of Texas Health Science Center at Houston, McWilliams School of Biomedical Informatics, Houston, Texas, USA
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12
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Fardal Ø, Skau I, Grytten J. A 30-year retrospective cohort outcome study of periodontal treatment of stages III and IV patients in a private practice. J Clin Periodontol 2023. [PMID: 37726161 DOI: 10.1111/jcpe.13877] [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: 04/04/2023] [Revised: 07/28/2023] [Accepted: 08/28/2023] [Indexed: 09/21/2023]
Abstract
AIM Tooth loss studies show that periodontal treatment is effective. However, it is not known whether these results can be projected into a lifetime of treatment. The aim of the study was to study all patients with stages III/IV of periodontitis over 30 years in a private practice. MATERIALS AND METHODS All patients referred between 1986 and 1990 were monitored for 30 years for tooth loss and prognostic factors. All dropouts were accounted for. RESULTS In all, 386 patients were followed, of whom 283 patients dropped out, leaving 103 patients (67 females and 36 males, average age 40.1 years) monitored over 30 years. Tooth loss was stable until 16 years, when the population was divided into groups of low (n = 65), moderate (n = 18) and high (n = 20) tooth loss, losing 1.05 (SD 1.27), 4.83 (SD 0.96) and 11.90 (SD 4.25) teeth, respectively. The strongest prognostic factors were first-degree relatives with periodontitis, periodontal treatment before the age of 35 years, diabetes and patients with teeth with initial hopeless prognosis. CONCLUSION The majority of patients with stages III and IV periodontitis could be successfully treated with conventional periodontal treatment over a period of 30 years. The findings suggest that retrospective studies with shorter observation times cannot automatically be projected onto the outcome of a lifetime of periodontal treatment.
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Affiliation(s)
- Øystein Fardal
- Private practice, Egersund, Norway
- Institute of Community Dentistry, University of Oslo, Oslo, Norway
- Institute of Education for Medical and Dental Sciences, University of Aberdeen, Aberdeen, UK
| | - Irene Skau
- Institute of Community Dentistry, University of Oslo, Oslo, Norway
| | - Jostein Grytten
- Institute of Community Dentistry, University of Oslo, Oslo, Norway
- Division of Obstetrics and Gynaecology, Akershus University Hospital, Lørenskog, Norway
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13
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Chambrone L, Garcia-Valenzuela FS, Avila-Ortiz G. Errors and complications in clinical periodontal practice due to methodologic bias and bad interpretation of the evidence. Periodontol 2000 2023; 92:373-381. [PMID: 36604793 DOI: 10.1111/prd.12475] [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: 04/01/2022] [Revised: 08/01/2022] [Accepted: 08/21/2022] [Indexed: 01/07/2023]
Abstract
Different types of errors and complications may arise during and after the execution of periodontal or implant-related procedures. Some of the most relevant, although also controversial, and less commented, causative agents of errors and complications are methodological biases and bad interpretation of the evidence. Proper assessment of the literature requires of solid clinical knowledge combined with a systematic approach built on the recognition of common methodological biases and the avoidance of interpretive errors to critically retrieve, dissect, and judiciously apply available information for the promotion of periodontal and peri-implant health. This review addresses common types of methodological bias and interpretive errors that can alter the reader's perceptions on the real effect and potential ramifications of the reported outcomes of a given therapeutic approach due to bad interpretation of the available evidence: (1) types of methodological biases; (2) spin and interpretive bias; (3) interpretation pitfalls when assessing the evidence (4) choice of relevant endpoints to answer the question(s) of interest; and (5) balance between statistical significance and clinical relevance.
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Affiliation(s)
- Leandro Chambrone
- Evidence-Based Hub, Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz, CRL, Monte de Caparica, Portugal
- Unit of Basic Oral Investigation (UIBO), School of Dentistry, Universidad El Bosque, Bogota, Colombia
- Department of Periodontics, School of Dental Medicine, The University of Pennsylvania, Pennsylvania, Philadelphia, USA
| | | | - Gustavo Avila-Ortiz
- Private Practice, Atelier Dental, Madrid, Spain
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Massachusetts, Boston, USA
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14
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Han JH, Jeong SN, Lee JH. A retrospective epidemiological investigation of periodontitis risk and current smoking status based on the number of cigarettes per day and the Fagerström Test for Nicotine Dependence: a preliminary pilot study. J Periodontal Implant Sci 2023; 53:135-144. [PMID: 36468481 PMCID: PMC10133818 DOI: 10.5051/jpis.2202560128] [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: 05/23/2022] [Revised: 07/22/2022] [Accepted: 08/30/2022] [Indexed: 04/26/2023] Open
Abstract
PURPOSE The aim of this study was to investigate the risk of periodontitis according to current smoking status based on the number of cigarettes smoked per day (CPD) and the Fagerström Test for Nicotine Dependence (FTND). METHODS All enrolled patients were diagnosed and classified according to the new periodontal classification scheme, and current smoking status was investigated via a self-reported questionnaire. The correlation between smoking status (CPD and FTND) and periodontitis risk (severity of periodontitis and tooth loss due to periodontal reasons) was statistically assessed using Spearman correlation coefficients. Moreover, partial correlation analyses between smoking and periodontal status were performed after adjusting for age, sex, and diabetes mellitus. RESULTS Overall, data from 74 men and 16 women (mean age: 48.1±10.8 years) were evaluated. The mean number of missing teeth, CPD, and FTND score were 3.5±5.2, 24.6±15.5, and 3.5±2, respectively. CPD and the FTND were significantly positively correlated with each other (r=0.741, P<0.001). CPD and the FTND were also significantly correlated with the severity of periodontitis (CPD: r=0.457, P<0.05 and FTND: r=0.326, P<0.05) and the number of missing teeth due to periodontal reasons (CPD: r=0.525, P<0.05 and FTND: r=0.480, P<0.05), respectively. CONCLUSIONS Within the limitations of this study, both CPD and the FTND were significantly correlated with the severity of periodontitis and the number of periodontally compromised extracted teeth.
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Affiliation(s)
- Ji-Hoo Han
- Department of Periodontology, Daejeon Dental Hospital, Institute of Wonkwang Dental Research, Wonkwang University College of Dentistry, Daejeon, Korea
| | - Seong-Nyum Jeong
- Department of Periodontology, Daejeon Dental Hospital, Institute of Wonkwang Dental Research, Wonkwang University College of Dentistry, Daejeon, Korea
| | - Jae-Hong Lee
- Department of Periodontology, College of Dentistry and Institute of Oral Bioscience, Jeonbuk National University, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea.
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15
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Agudio G, Buti J, Bonaccini D, Pini Prato G, Cortellini P. Longevity of teeth in patients susceptible to periodontitis: Clinical outcomes and risk factors associated with tooth loss after active therapy and 30 years of supportive periodontal care. J Clin Periodontol 2023; 50:520-532. [PMID: 36631984 DOI: 10.1111/jcpe.13770] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/23/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
AIM (i) To evaluate the efficacy of active periodontal therapy supplemented by supportive periodontal care (SPC) in retaining dentition during a 30-year follow-up period in patients susceptible to periodontitis, and (ii) to assess the prognostic factors associated with tooth loss. MATERIALS AND METHODS One-hundred and fifty-four patients with periodontitis, retrospectively classified as stage I-IV and grade B-C periodontitis, treated between 1984 and 1986 in a private practice, were enrolled in this study. After periodontal assessment, patients received non-surgical treatment followed by surgical periodontal therapy, orthodontic treatment, and tooth-splinting, where appropriate. SPC consisted of a strict recall programme every 3-6 months over a 30-year period. Recurrences were treated either with subgingival root planing or flap surgery. Dental and periodontal variables were measured at baseline (T0), end of active therapy (T1), and after 25 (T2) and 30 (T3) years. Generalized mixed models were analysed to assess the prognostic factors associated with and survival analyses for tooth loss. RESULTS Data on 154 patients (4083 teeth) were available at baseline (T0). Teeth considered unworthy of treatment were extracted during active therapy (160, 3.9%) and at re-assessment (13, 0.3%; T1). After 25 years of SPC, 140 teeth out of 3910 in 154 patients (3.6%) were lost (24 in 18 patients for periodontal reasons). Between 25 and 30 years, 20 patients (482 teeth) dropped out, and 61 teeth (2%) were lost (15 in 14 patients for periodontal reasons). Overall, 201 teeth (5.1%) were lost (39 for periodontal reasons) in 30 years of SPC. Generalized mixed models showed that stage III or stage IV periodontitis was associated with greater tooth loss during SPC compared to stage I or stage II (OR = 2.10; p = .048). Generalized periodontitis showed a statistically significant OR = 3.24 (p = .016) compared to the localized one. In SPC (T1-T3), age (p = .011), gender (male; p = .038), molar teeth (p = < .001), T0 and T1 pocket depth (p = < .001), tooth mobility grades 2 (p = .018) and 3 (p = .050), T0 and T1 bone loss (p = < .001), and presence of a root canal treatment (p = < .001) and a crown (p = .009) were statistically significantly associated with tooth loss. CONCLUSION (i) Periodontal therapy and a stringent SPC are effective in maintaining most of the teeth in patients with moderate/advanced periodontitis for 30 years, and (ii) age, gender, molar teeth, pocket depth, bone loss, and the presence of a root canal treatment and a crown are prognostic factors associated with tooth loss.
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Affiliation(s)
| | - Jacopo Buti
- Unit of Periodontology, UCL Eastman Dental Institute, London, UK
| | | | - Giovanpaolo Pini Prato
- Private Practice, Florence, Italy
- Accademia Toscana di Ricerca Odontostomatologica (ATRO), Florence, Italy
| | - Pierpaolo Cortellini
- Private Practice, Florence, Italy
- Accademia Toscana di Ricerca Odontostomatologica (ATRO), Florence, Italy
- European Research Group on Periodontology (ERGOPERIO), Bern, Switzerland
- Department of Oral Health Sciences, KU Leuven and Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium
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16
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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.
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17
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Shah C, Holtfreter B, Hughes FJ, Nibali L. Retrospective exploratory study of smoking status and e-cigarette use with response to non-surgical periodontal therapy. J Periodontol 2023; 94:41-54. [PMID: 35781714 PMCID: PMC10087441 DOI: 10.1002/jper.21-0702] [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: 12/17/2021] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND To compare periodontal treatment responses in electronic cigarette (e-cigarette) users, non-smokers, former and current smokers. METHODS In this retrospective clinical study, 220 patients with periodontitis were seen for baseline periodontal charting, professional-mechanical-plaque-removal (PMPR) and re-evaluation by postgraduate students. Sixty of these patients were former smokers, twenty were former smokers now using e-cigarettes, twenty current smokers, while all others (n = 120) were non-smokers. Effects of smoking status and treatment duration on clinical outcomes were analyzed by linear models using generalized least squares adjusted for known confounders. The primary outcome was "need for surgery" defined as number of sextants with ≥2 non-adjacent sites of probing depths (PD) ≥5 mm. RESULTS Compared with non-smokers, e-cigarette users had a less favorable treatment response after PMPR. This included statistically significant increased "need for surgery", as well as increased number of sextants with PD ≥5 mm, number of sites with PD >5 mm and mean PD. There were no statistically significant differences between e-cigarette users and current smokers. Former smokers responded statistically significantly better than e-cigarette users for the primary outcome as well as for the number of sextants and sites with PD ≥5 mm and mean PD. CONCLUSIONS Overall, e-cigarette users had a statistically significantly less favorable response to PMPR than non-smokers; their response was not statistically significantly different to those of current smokers. This, however, needs to be validated with further research in prospective clinical and observational studies in different populations.
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Affiliation(s)
- Chandni Shah
- Periodontology UnitCentre for Host Microbiome Interactions, Faculty of DentistryOral & Craniofacial SciencesKing's College LondonLondonUK
| | - Birte Holtfreter
- Department of Restorative DentistryPeriodontologyEndodontologyand Preventive and Pediatric DentistryUniversity Medicine GreifswaldGreifswaldGermany
| | - Francis J. Hughes
- Periodontology UnitCentre for Host Microbiome Interactions, Faculty of DentistryOral & Craniofacial SciencesKing's College LondonLondonUK
| | - Luigi Nibali
- Periodontology UnitCentre for Host Microbiome Interactions, Faculty of DentistryOral & Craniofacial SciencesKing's College LondonLondonUK
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18
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Siow DSF, Goh EXJ, Ong MMA, Preshaw PM. Risk factors for tooth loss and progression of periodontitis in patients undergoing periodontal maintenance therapy. J Clin Periodontol 2023; 50:61-70. [PMID: 36065561 DOI: 10.1111/jcpe.13721] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/27/2022] [Accepted: 08/27/2022] [Indexed: 12/25/2022]
Abstract
AIM The aim of this study was to investigate patient- and tooth-level factors that may predict tooth loss and periodontitis progression in patients who have undergone at least 5 years of periodontal maintenance. MATERIALS AND METHODS In this retrospective cohort study, 135 patients were examined after active periodontal therapy (APT) and periodontal maintenance for 5.09-8.65 years (mean 6.16 ± 0.74 years). Regression models were applied to identify risk factors associated with tooth loss and disease progression. RESULTS Stage IV periodontitis (incidence rate ratio [IRR] = 4.61; 95% confidence interval, CI [2.97-7.18], p < .001), the presence of ≥5 sites with probing pocket depth (PPD) ≥5 mm at the end of APT (IRR = 2.04; 95% CI [1.32-3.20], p < .01), and residual PPD ≥7 mm at the end of APT (odds ratio [OR] = 3.01; 95% CI [1.14-7.94], p < .05) were risk factors for tooth loss. Residual PPDs of 5 mm (OR = 2.02; 95% CI [1.20-3.40], p < .01) and 6 mm (OR = 2.41; 95% CI [1.22-4.76], p < .05) at the end of APT were risk factors for disease progression. Above 3 mm, each 1 mm increase in maximum PPD/clinical attachment loss was associated with an increased risk of tooth loss and disease progression. CONCLUSIONS Stage IV periodontitis is associated with an increased risk of tooth loss. Teeth with PPD ≥5 mm at the end of APT are at risk of periodontitis progression or tooth loss.
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Affiliation(s)
- Dawn S F Siow
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore
| | - Edwin X J Goh
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore
| | - Marianne M A Ong
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore.,Oral Health Academic Clinical Programme, Duke-NUS Medical School, Singapore
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19
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Park SH, Paek SH, Kim B, Lee JT. Assessment of Bone Height Changes Based on the Cone-Beam Computed Tomography Following Intentional Replantation for Periodontally Compromised Teeth. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010040. [PMID: 36676664 PMCID: PMC9864039 DOI: 10.3390/medicina59010040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022]
Abstract
Background and Objectives; This study aimed to evaluate the clinical outcomes and bone changes before and after intentional replantation (IR) for periodontally compromised teeth by using cone-beam computed tomography (CBCT). Materials and Methods; Fourteen periodontally involved teeth were selected for IR. A preoperative orthodontic procedure was performed to apply luxation, and the tooth was then gently extracted. Retrograde filling of the root-end canal was performed. Once the tooth was repositioned in the socket, it was splinted with the adjacent tooth. After three months, prosthetic restoration was performed. Results; Clinical parameters and CBCT images were obtained before and after the IR procedure. The height of the alveolar bone was measured on the CBCT images by using software. Most preoperative symptoms, including pain, mobility, probing depth (PD) and bleeding on probing (BOP), significantly decreased after IR (pain: 4.71 to 1.00; mobility: 1.36 to 0.29; PD: 5.60 to 2.85; BOP: 3.50 to 0.79). CBCT analysis indicated an increase in bone height after IR (the amount of change: maxilla, 4.00; mandible, 1.95). Conclusions; A previous study reported that IR for periodontally involved teeth is quite limited. However, in this study, IR of periodontally compromised teeth showed favorable results in clinical and radiographic evaluations, suggesting that IR may be an alternative to extraction of teeth with periodontal disease.
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Affiliation(s)
- So-hyun Park
- Department of Advanced General Dentistry, Dankook University Jukjeon Dental Hospital, Yongin-si 16890, Republic of Korea
| | - Seung-Heon Paek
- Department of Advanced General Dentistry, Dankook University Jukjeon Dental Hospital, Yongin-si 16890, Republic of Korea
| | - Bongju Kim
- Dental Life Science Research Institute, Seoul National University Dental Hospital, Seoul 03722, Republic of Korea
- Correspondence: (B.K.); (J.-T.L.)
| | - Jung-Tae Lee
- Department of Periodontics, One-Stop Specialty Center, Seoul National University, Dental Hospital, Seoul 05698, Republic of Korea
- Correspondence: (B.K.); (J.-T.L.)
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20
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Chatzopoulos GS, Doufexi AE, Zarenti S, Anastasopoulos M, Kouvatsi A. Periodontal disease progression and gene polymorphisms: results after 3 years of active periodontal treatment. Minerva Dent Oral Sci 2022; 71:329-338. [PMID: 35686958 DOI: 10.23736/s2724-6329.22.04709-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although non-surgical periodontal treatment is considered the gold standard, a subgroup of patients displays recurrence/progression of periodontitis after treatment. The aim of the present prospective study was to assess the effect of IL-6 -572 G/C and IL-10 -592 C/A gene polymorphisms on the risk of disease recurrence/progression at 3 years following non-surgical periodontal treatment. METHODS Thirty-seven patients diagnosed with chronic periodontitis received oral hygiene instructions and non-surgical periodontal treatment and were monitored for 3 years. All individuals were clinically evaluated for PPD, CAL and BOP at baseline and 3 years. Based on the clinical findings at 3 years, all subjects were considered either "at risk" or "not at risk" of periodontal disease progression based on specific criteria. Blood samples were collected at baseline and genotyping of the polymorphisms in IL-6 (rs1800796) and IL-10 (rs1800872) genes were performed by PCR. RESULTS Following DNA separation and genotyping, 70.3% of the patients were homozygous carriers of the IL-6 -572G and 45.9% were carriers of the IL-10 -592A allele. Individuals at risk of disease progression ranged from 16.2% to 56.8% based on the criteria used. IL-6 -572 G/C and IL-10 -592 C/A polymorphisms were not associated with an increased risk of further disease progression (P>0.05) when the three criteria were examined. All examined periodontal clinical measures were significantly improved (P<0.05) after treatment. Males showed a significantly higher risk of disease progression than females when full-mouth BOP ≥30% was considered (P=0.008). CONCLUSIONS Within the limitations of this 3-year prospective study, individuals susceptible to periodontal disease as determined by the presence of the IL-6 -572GG genotype or the IL-10 -592A allele were not associated with an increased risk of further disease progression and the potential need for further treatment following non-surgical periodontal treatment. Males were more prone to be at risk of disease progression than females.
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Affiliation(s)
- Georgios S Chatzopoulos
- Division of Periodontology, Department of Developmental and Surgical Sciences, University of Minnesota, Minneapolis, MN, USA - .,Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece -
| | - Aikaterini-Elisavet Doufexi
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Private practitioner, Thessaloniki, Greece
| | - Sofia Zarenti
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Menelaos Anastasopoulos
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Kouvatsi
- Department of Genetics, Development and Molecular Biology, School of Biology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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21
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Caggiano M, Gasparro R, D’Ambrosio F, Pisano M, Di Palo MP, Contaldo M. Smoking Cessation on Periodontal and Peri-Implant Health Status: A Systematic Review. Dent J (Basel) 2022; 10:162. [PMID: 36135157 PMCID: PMC9497918 DOI: 10.3390/dj10090162] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 08/16/2022] [Accepted: 08/27/2022] [Indexed: 12/22/2022] Open
Abstract
Since smoking is considered among the main risk factors for the onset and progression of periodontitis and peri-implantitis, the present systematic review aimed to evaluate the effect of smoking cessation on clinical, radiographic, and gingival crevicular periodontal parameters around natural teeth and dental implants in ex-smokers compared to current and non-smokers. The study protocol was developed based on the PRISMA guidelines, the research question was formulated according to the PICO model, and the literature search was conducted through PubMed/MEDLINE, Cochrane library, and BioMed Central databases. From the 916 title/abstracts initially identified, seven articles were included in the present systematic review and assessed for quality through the ROBINS-I tool. Reported findings on clinical and crevicular periodontal parameters around natural teeth were contrasting when comparing ex-smokers to current and non-smokers; thus, individualized recommendations for previous smoker periodontal patients are currently lacking. No data on radiographic parameters were retrieved. Similarly, data on periodontal parameters around dental implants were not available, highlighting the need for focused investigations assessing the role of both smoking habit and cessation on peri-implant health status and responsiveness to treatment.
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Affiliation(s)
- Mario Caggiano
- Department of Medicine, Surgery and Dentistry “Schola Medica Salernitana”, University of Salerno, Via S. Allende, 84081 Baronissi, Italy
| | - Roberta Gasparro
- Department of Neuroscience, Reproductive Science and Dentistry, University of Naples Federico II, 80131 Naples, Italy
| | - Francesco D’Ambrosio
- Department of Medicine, Surgery and Dentistry “Schola Medica Salernitana”, University of Salerno, Via S. Allende, 84081 Baronissi, Italy
| | - Massimo Pisano
- Department of Medicine, Surgery and Dentistry “Schola Medica Salernitana”, University of Salerno, Via S. Allende, 84081 Baronissi, Italy
| | - Maria Pia Di Palo
- Department of Medicine, Surgery and Dentistry “Schola Medica Salernitana”, University of Salerno, Via S. Allende, 84081 Baronissi, Italy
| | - Maria Contaldo
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialities, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
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22
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Evaluation of periodontitis-related tooth loss according to the new 2018 classification of periodontitis. Sci Rep 2022; 12:11893. [PMID: 35831375 PMCID: PMC9279363 DOI: 10.1038/s41598-022-15462-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 06/23/2022] [Indexed: 11/21/2022] Open
Abstract
The new 2018 classification of periodontal diseases is reported to be related to tooth loss due to periodontal disease (TLPD) during supportive periodontal therapy (SPT). However, few reports have evaluated this relationship for Asians or have analyzed the association of the new classification and TLPD by distinguishing between active periodontal therapy (APT) and SPT. In this study, we retrospectively applied the new classification to 607 Japanese periodontitis patients and examined the relationship between the new classification and annual TLPD rates per patient during the respective periods. TLPD rates were higher in patients in stage IV and/or grade C during both APT and SPT. TLPD during SPT was not associated with the presence or absence of TLPD during APT. Multivariate analysis revealed that stage IV and grade C as independent variables were significantly associated with the number of instances of TLPD not only during the total treatment period, but also during APT or SPT. Our results suggest that the new classification has a significantly strong association with TLPD during both APT and SPT, and that patients diagnosed with stage IV and/or grade C periodontitis had a higher risk of TLPD during both periods.
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Fardal Ø, Skau I, Nevland K, Grytten J. Proposing a model for auditing data quality of long-term periodontal outcome studies. Acta Odontol Scand 2022; 80:374-381. [PMID: 34962852 DOI: 10.1080/00016357.2021.2020895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The assessment of the success of conventional periodontal therapy is based on retrospective studies from private practice and university clinics. Due to their marked heterogeneity, it is difficult to assess the data quality and rate these studies. The aim is to test a model for auditing and rating the data quality of periodontal outcome studies. METHODS The method was adapted from the NIH Health Care Systems Collaboratory model, which uses three data quality dimensions: completeness (including all the relevant variables), consistency (ensuring that the same variables are compared) and accuracy (proportion of data in error with a gold standard). The model was applied to studies from a Norwegian specialist practice and data from the Norwegian Health database to test if the auditing process was workable using real world data. RESULTS Forty-seven risk and prognostic factors were included for completeness. Seven variables were specified for consistency: tooth loss, smoking, systemic conditions, oral hygiene, individual tooth prognosis, maintenance profiles and timing of extractions. The factors tested showed a 95.7% completeness and an average accuracy deviation from the gold standard of -2.3% for each of the risk/prognostic factors and an overall study score of 93.3%. CONCLUSIONS It was possible to develop a method for auditing and rating the quality of periodontal outcome studies. The model was tested using both real world data including risk and prognostic factors from individual outcome studies and national big data. The application of the model to these sets of data showed a high accuracy of the risk/prognostic factors and a close relationship with national big data.
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Affiliation(s)
- Øystein Fardal
- Private Practice, Egersund, Norway
- Institute of Education for Medical and Dental Sciences, University of Aberdeen, Aberdeen, UK
- Institute of Community Dentistry, University of Oslo, Oslo, Norway
| | - Irene Skau
- Institute of Community Dentistry, University of Oslo, Oslo, Norway
| | | | - Jostein Grytten
- Institute of Community Dentistry, University of Oslo, Oslo, Norway
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Akershus University Hospital, Lørenskog, Norway
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Saydzai S, Buontempo Z, Patel P, Hasan F, Sun C, Akcalı A, Lin GH, Donos N, Nibali L. Comparison of the efficacy of periodontal prognostic systems in predicting tooth loss. J Clin Periodontol 2022; 49:740-748. [PMID: 35702014 PMCID: PMC9543611 DOI: 10.1111/jcpe.13672] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/11/2022] [Accepted: 05/18/2022] [Indexed: 12/14/2022]
Abstract
Aim The aim of this analysis was to assess how different tooth‐prognosis systems could predict tooth loss in a cohort of periodontitis patients followed up prospectively during supportive periodontal care (SPC). Materials and Methods Clinical and radiographic data of 97 patients undergoing regular SPC for 5 years were used to assign tooth prognosis using four different systems (McGuire & Nunn, 1996; Kwok & Caton, 2007; Graetz et al., 2011; Nibali et al., 2017). Three independent examiners assigned tooth prognosis using all four systems, following a calibration exercise. The association between prognostic categories and tooth loss was tested for each prognostic system separately and across prognostic systems. Results All four systems showed good reproducibility and could identify teeth at higher risk of being lost during 5 years of SPC; the risk of tooth loss increased with the worsening of tooth‐prognosis category (p < .0001). Although specificity and negative predictive values were good, low sensitivity and positive predictive values were detected for all systems. Conclusions Previously published periodontal prognostic systems exhibited good reproducibility and predictive ability for tooth retention. However, low sensitivity was detected, with several teeth in the worst prognosis category being retained at 5 years. Some modifications in the number of categories and their definitions are suggested.
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Affiliation(s)
- Selai Saydzai
- Periodontology Unit, Centre for Host-Microbiome Interactions, Dental Institute, King's College London, London, UK
| | - Zoe Buontempo
- Periodontology Unit, Centre for Host-Microbiome Interactions, Dental Institute, King's College London, London, UK
| | - Pankti Patel
- Periodontology Unit, Centre for Host-Microbiome Interactions, Dental Institute, King's College London, London, UK
| | - Fatemah Hasan
- Periodontology Unit, Centre for Host-Microbiome Interactions, Dental Institute, King's College London, London, UK
| | - Chuanming Sun
- Department of Periodontology, Faculty of Dentistry, Suzhou Health College, Suzhou, China
| | - Aliye Akcalı
- Department of Periodontology, Faculty of Dentistry, Dokuz Eylul University, Izmir, Turkey.,Centre for Oral Clinical Research, Barts and The London School of Medicine & Dentistry, Institute of Dentistry, Queen Mary University of London (QMUL), London, UK
| | - Guo-Hao Lin
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, California, USA
| | - Nikos Donos
- Centre for Oral Clinical Research, Barts and The London School of Medicine & Dentistry, Institute of Dentistry, Queen Mary University of London (QMUL), London, UK
| | - Luigi Nibali
- Periodontology Unit, Centre for Host-Microbiome Interactions, Dental Institute, King's College London, London, UK
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Cortellini P, Cortellini S, Bonaccini D, Tonetti MS. Modified minimally invasive surgical technique in human intrabony defects with or without regenerative materials-10-year follow-up of a randomized clinical trial: Tooth retention, periodontitis recurrence, and costs. J Clin Periodontol 2022; 49:528-536. [PMID: 35415940 DOI: 10.1111/jcpe.13627] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/03/2022] [Accepted: 04/05/2022] [Indexed: 01/09/2023]
Abstract
AIM The modified minimally invasive surgical technique (M-MIST) optimizes wound stability in the treatment of intrabony defects. Short-term observations show similar results as with flap alone or adjunctive regenerative materials. This study aims to compare the stability of the long-term outcomes, complication-free survival, and costs of the three treatment options. MATERIALS AND METHODS Forty-five intrabony defects in 45 patients were randomized to M-MIST alone (N = 15), combined with enamel matrix derivative (M-MIST + EMD, N = 15), or EMD plus bone-mineral-derived xenograph (M-MIST + EMD + BMDX, N = 15). Supportive periodontal care (SPC) and necessary re-treatment were provided for 10 years. RESULTS Three subjects were lost to follow-up. Clinical attachment level differences between 1 and 10 years were -0.1 ± 0.7 mm for M-MIST, -0.1 ± 0.8 mm for M-MIST + EMD, and -0.3 ± 0.6 mm for M-MIST + EMD + BMDX (p > .05 for within- and between-group differences). Four episodes of recurrence occurred in the M-MIST group, four in the M-MIST + EMD group, and five in the M-MIST + EMD + BMDX group. No significant differences in complication-free survival were observed between the three groups (p = .47). Complication-free survival was 7.46 years (95% confidence interval: 7.05-7.87) for the whole population. The M-MIST + EMD + BMDX group lost one treated tooth. Data indicated no significant inter-group difference of the total cost of recurrence over 10 years. When the baseline cost of treatment was considered, the total cost was lower for M-MIST alone. CONCLUSIONS Teeth with deep pockets associated with intrabony defects can be successfully maintained over the long term with either M-MIST alone or by adding a regenerative material in the context of a careful SPC programme. M-MIST alone provided similar short- and long-term benefits as regeneration, at a lower cost. These findings need to be confirmed in larger, independent studies.
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Affiliation(s)
- Pierpaolo Cortellini
- Accademia Toscana di Ricerca Odontostomatologica (ATRO), Florence, Italy.,European Research Group on Periodontology (ERGOPERIO), Genova, Italy.,Private Practice, Florence, Italy.,Department of Oral Health Sciences, KU Leuven and Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium
| | - Simone Cortellini
- Department of Oral Health Sciences, KU Leuven and Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium.,Private Practice, The Hague, The Netherlands
| | | | - Maurizio S Tonetti
- Accademia Toscana di Ricerca Odontostomatologica (ATRO), Florence, Italy.,European Research Group on Periodontology (ERGOPERIO), Genova, Italy.,Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, Shanghai Ninth People Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center of Oral Diseases, National Center of Stomatology, College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
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26
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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.
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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.)
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Yamada R, Nogawa T, Takayama Y, Iwata K, Saito M, Yokoyama A. Comparison of the prognosis of the remaining teeth between implant-supported fixed prostheses and removable partial dentures in partially edentulous patients: A retrospective study. Clin Implant Dent Relat Res 2022; 24:83-93. [PMID: 35019228 DOI: 10.1111/cid.13064] [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: 09/14/2021] [Revised: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND There have been several reports about the prognosis of teeth adjacent to edentulous spaces for implant-supported fixed prostheses (ISFPs) and removable partial dentures (RPDs). However, there are few reports about the prognosis of the other remaining teeth comparing ISFPs with RPDs. PURPOSE The aim of this study was to evaluate and compare the prognosis of the remaining teeth for ISFPs and RPDs in terms of survival and complication-free rates. METHODS Subjects were partially edentulous patients with ISFPs or RPDs inserted in 2003-2016. Teeth adjacent to edentulous spaces (A-teeth), teeth not adjacent to edentulous spaces (R-teeth), and teeth opposing edentulous spaces (O-teeth) were investigated. The endpoints were tooth extraction and complications. A multivariate cox regression model was used to estimate the risk factors for survival of the investigated teeth. RESULTS A total of 233 (ISFP: 89, RPD: 144) patients were included in the statistical analyses. An IFSP prosthesis, when compared to an RPD prosthesis did not significantly decrease the tooth loss rate for A-teeth (hazard ratio [HR]: 0.76; 95% confidence interval [CI]: 0.30-1.92), for R-teeth (HR: 0.54; 95% CI: 0.28-1.05), or for O-teeth (HR: 0.45; 95% CI: 0.10-2.09). CONCLUSIONS In partially edentulous spaces, the difference between ISFPs and RPDs does not affect the prognosis of teeth adjacent to edentulous spaces, teeth not adjacent to edentulous spaces, and teeth opposing edentulous spaces. Namely, our findings suggest that it depends largely on the tooth type, jaw, endodontic therapy performed, not on the type of prostheses.
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Affiliation(s)
- Ryo Yamada
- Department of Oral Functional Prosthodontics, Division of Oral Functional Science, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Toshifumi Nogawa
- Department of Preventive Dentistry, Hokkaido University Hospital Sapporo, Sapporo, Hokkaido, Japan
| | - Yoshiyuki Takayama
- Department of Oral Rehabilitation, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Kai Iwata
- Department of Oral Functional Prosthodontics, Division of Oral Functional Science, Faculty of Dental Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Masayasu Saito
- Department of Oral Functional Prosthodontics, Division of Oral Functional Science, Faculty of Dental Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Atsuro Yokoyama
- Department of Oral Functional Prosthodontics, Division of Oral Functional Science, Faculty of Dental Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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Jayawardena DS, Yates R, West NX, Pollard AJ. Implementing the 2017 Classification of Periodontal and Peri-Implant Diseases - how are we doing in the South West region of the UK? Br Dent J 2021:10.1038/s41415-021-3716-2. [PMID: 34887553 DOI: 10.1038/s41415-021-3716-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/04/2021] [Indexed: 11/09/2022]
Abstract
Background A new world classification of periodontal diseases and conditions was developed in 2017 and implemented throughout the United Kingdom by the British Society of Periodontology and Implant Dentistry.Method A retrospective audit was undertaken at Bristol Dental Hospital (BDH) (December 2019 to March 2020) to assess uptake of the new classification in referral letters and its implementation by staff. In total, 75 consecutive new patient referrals seen at BDH were manually searched for diagnosis/classification. Additionally, the 75 most recent referrals where both the referring practitioner and BDH staff used the 2017 classification were analysed for agreeability.Results Within South West England, there was a positive uptake of the new classification in general practice, with 85% of referrals using the 2017 periodontal classification. Further, 98% of patients attending BDH for periodontology consultations were diagnosed using the 2017 classification. Results indicate 50.7% and 57.3% agreement for staging and grading, respectively, when comparing consultants to referring clinicians.Discussion The new classification has been widely conveyed to the profession and is being adopted quickly by specialists, general practitioners and dental health professionals. There is an underestimation of both stage and grade by referring practitioners, with 40% of referrals underestimating the stage and 38.7% underestimating the grade.
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Affiliation(s)
- Don S Jayawardena
- Dental Core Trainee 2, Bristol Dental Hospital, Lower Maudlin St, Bristol, BS1 2LY, UK.
| | - Roger Yates
- Consultant in Restorative Dentistry/Periodontology, MCN South West Lead for Periodontology, Bristol Dental Hospital, Lower Maudlin St, Bristol, BS1 2LY, UK
| | - Nicola X West
- Professor and Honorary Consultant in Periodontology, Bristol Dental Hospital, Lower Maudlin St, Bristol, BS1 2LY, UK
| | - Alexander J Pollard
- Specialty Registrar in Periodontology, Bristol Dental Hospital, Lower Maudlin St, Bristol, BS1 2LY, UK
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Popa GV, Costache A, Badea O, Cojocaru MO, Mitroi G, Lazăr AC, Olimid DA, Mogoantă L. Histopathological and immunohistochemical study of periodontal changes in chronic smokers. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 62:209-217. [PMID: 34609423 PMCID: PMC8597366 DOI: 10.47162/rjme.62.1.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Periodontal disease is a chronic inflammatory, multifactorial condition, that, in the absence of an early and adequate treatment, may lead to a progressive damaging of the alveolar tissues that support the teeth (periodontal ligament, cement and alveolar bone) followed by teeth mobility and, subsequently, their loss. Periodontal disease is one of the most common inflammatory disease affecting adult individuals all over the world, being considered a real worldwide pandemic. This disease may influence the progression of certain systemic diseases: diabetes mellitus, cardiovascular diseases, ischemic cardiomyopathy, myocardial infarction, stroke, neurodegenerative diseases, chronic kidney diseases, cancer, etc. The association between smoking and periodontal disease was described in numerous clinical and epidemiological studies, suggesting that products derived from tobacco burning may change the clinical aspects and the disease progression. The present study analyzed microscopically and immunohistochemically 58 periodontal fragments, from 50 patients, chronic smokers, clinically diagnosed with severe periodontitis. There were highlighted major changes in the gingival epithelium (epithelium thickening, acanthosis, intraepithelial edema, infiltrates of neutrophils or lymphocytes, epithelial necrosis), in the periodontal conjunctive tissue (more or less intense inflammatory infiltrates, microhemorrhages, vascular congestion, intense immunohistochemical expression for some matrix metalloproteinases). The periodontal changes may be the expression of both toxic factors present in tobacco smoke and due to the changes caused by tobacco in the microbial flora of the oral cavity.
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Affiliation(s)
- Gabriel Valeriu Popa
- Department of Histology, University of Medicine and Pharmacy of Craiova, Romania;
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Cimões R, Pinho RCM, Gurgel BCDV, Borges SB, Marcantonio Júnior E, Marcantonio CC, Melo MARDC, Piattelli A, Shibli JA. Impact of tooth loss due to periodontal disease on the prognosis of rehabilitation. Braz Oral Res 2021; 35:e101. [PMID: 34586215 DOI: 10.1590/1807-3107bor-2021.vol35.0101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 03/31/2021] [Indexed: 01/21/2023] Open
Abstract
When periodontal disease is diagnosed, it is difficult to predict the clinical response of treatment of a tooth over time because the result of treatment is affected by several factors and will depend on the maintenance and support of periodontal treatment. Rehabilitation with removable dental prostheses, fixed prostheses, and dental implants makes it possible to restore the function and esthetics of patients with tooth loss due to periodontal disease. The predictive factors of tooth loss in periodontitis patients should be assessed by dentists to inform their clinical decision-making during dental treatment planning. This will provide detailed individualized information and level of risk of patients considered suitable for dental rehabilitation. Therefore, the aim of this article was to review the subject of "Impact of tooth loss due to periodontal disease on the prognosis of rehabilitation" and the effect of fixed, removable, and implant-supported prostheses in periodontal patients.
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Affiliation(s)
- Renata Cimões
- Universidade Federal de Pernambuco - UFPE, Health Sciences Centre, Department of Prosthesis and Oral and Maxillofacial Surgery, Recife, PE, Brazil
| | | | | | - Samuel Batista Borges
- Universidade Federal do Rio Grande do Norte - UFRN, Health Sciences Centre, Department of Dentistry, Natal, RN Brazil
| | - Elcio Marcantonio Júnior
- Universidade Estadual Paulista Júlio de Mesquita Filho - Unesp, Faculdade de Odontologia de Araraquara, Department of Diagnosis and Surgery, Araraquara, SP, Brazil
| | - Camila Chierici Marcantonio
- Universidade Estadual Paulista Júlio de Mesquita Filho - Unesp, Faculdade de Odontologia de Araraquara, Department of Diagnosis and Surgery, Araraquara, SP, Brazil
| | | | - Adriano Piattelli
- University of Chieti, Dental School, Department of Medical, Oral and Biotechnological Sciences, Chieti, Italy
| | - Jamil Awad Shibli
- Universidade de Guarulhos - UnG, Dental Research Division, Department of Periodontology and Oral Implantology, Guarulhos, SP, Brazil
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Al-Harthi S, Barbagallo G, Psaila A, d'Urso U, Nibali L. Tooth loss and radiographic bone loss in patients without regular supportive care: A retrospective study. J Periodontol 2021; 93:354-363. [PMID: 34564843 DOI: 10.1002/jper.21-0415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Very few studies have investigated the effect of patient and site factors on periodontal progression and long-term tooth loss in populations with minimal dental care. The aim of this retrospective study was to assess tooth loss and radiographic bone loss over at least 5 years in patients attending a national-health service primary care practice in Sicily and undergoing no regular care. METHODS Records of two hundred consecutive patients with at least 5 years follow-up were screened and demographic, clinical and radiographic data were retrieved. Analyses of associations between patient and site factors and tooth loss were performed. RESULTS After excluding not suitable patients, a total of 159 patient records with clinical and radiographic data with average 8.6 years follow-up were included. One hundred of these patients had no professional mechanical plaque removal (PMPR) carried out throughout the study follow-up. Nearly 65% of patients lost at least 1 tooth during the follow-up period, with a total of 400 extracted teeth (for periodontal and non-periodontal reasons). The annual tooth loss rate was slightly higher for "no PMPR" (untreated) patients (0.30 teeth/patient/year) compared with patients who had PMPR (0.27 teeth/patient/year). On a patient-level, only reduced frequency of daily tooth brushing was associated with tooth loss at logistic regression, whereas staging, grading and diagnosis of caries were associated with rates of tooth loss/year. At multilevel analysis including patient- and tooth-factors, age, diagnosis of caries and endodontic disease and percentage of bone loss at baseline were associated with tooth loss. CONCLUSION This study confirms the importance of tooth brushing, initial bone loss, caries and endodontic disease in predicting tooth survival in a primary care setting.
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Affiliation(s)
- Shaima Al-Harthi
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Giovanni Barbagallo
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Catania, Italy
| | - Alessandro Psaila
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Catania, Italy
| | - Umberto d'Urso
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Catania, Italy
| | - Luigi Nibali
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
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Saleh MHA, Dukka H, Troiano G, Ravidà A, Galli M, Qazi M, Greenwell H, Wang HL. External validation and comparison of the predictive performance of 10 different tooth-level prognostic systems. J Clin Periodontol 2021; 48:1421-1429. [PMID: 34472120 DOI: 10.1111/jcpe.13542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/15/2021] [Indexed: 12/21/2022]
Abstract
AIM Tooth-level prognostic systems can be used for treatment planning and risk assessment. This retrospective longitudinal study aimed to evaluate the prognostic performance of 10 different tooth-level risk assessment systems in terms of their ability to predict periodontal-related tooth loss (TLP). MATERIALS AND METHODS Data were retrieved retrospectively from patients who received surgical and non-surgical periodontal treatment. Data on medical history and smoking status at baseline and the last maintenance visit were collected. Ten tooth-level prognostic systems were compared using both univariate and multivariate Cox proportional hazard regression models to analyse the prognostic capability of each system for predicting TLP risk. RESULTS One-hundred and forty-eight patients with 3787 teeth, followed-up for a mean period of 26.5 ± 7.4 years, were evaluated according to 10 different tooth-level prognostic systems, making up a total of 37,870 individual measurements. All compared prognostic systems were able to stratify the risk of TLP at baseline when different classes of association were compared. After controlling for maintenance, age, and gender, all systems exhibited excellent predictive capacity for TLP with no system scoring a Harrell's C-index less than 0.925. CONCLUSIONS All tooth-level prognostic systems displayed excellent predictive capability for TLP. Overall, the Miller and McEntire system may have shown the best discrimination and model fit, followed by the Nunn et al. system.
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Affiliation(s)
- Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA.,Department of Periodontics, University of Louisville School of Dentistry, Louisville, Kentucky, USA
| | - Himabindu Dukka
- Department of Periodontics, University of Louisville School of Dentistry, Louisville, Kentucky, USA
| | - Giuseppe Troiano
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Andrea Ravidà
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Matthew Galli
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Musa Qazi
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Henry Greenwell
- Department of Periodontics, University of Louisville School of Dentistry, Louisville, Kentucky, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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El Sayed N, Rahim-Wöstefeld S, Stocker F, Behnisch R, Eickholz P, Pretzl B. The 2018 classification of periodontal diseases. Its predictive value for tooth loss. J Periodontol 2021; 93:560-569. [PMID: 34272728 DOI: 10.1002/jper.21-0211] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Predictive models and assessment tools for disease susceptibility and progression are necessary to enhance personalized medicine. The aim of this study is to assess the predictive accuracy of using the 2018 classification to predict likelihood of tooth loss. MATERIAL AND METHODS 134 patients were screened 10 years after periodontal therapy. Data were extracted from 82 patients' records and periodontal diagnoses were assigned according to the 1999 and 2018 classifications at baseline, whereas patient- and tooth-related parameters were documented at baseline and at reexamination. Statistical analysis included descriptive statistics, hurdle regression with a zero and count model as well as logistic regression. RESULTS Significantly more teeth were lost during SPT in patients with Stage IV or Grade C (p<0.05). Patients' adherence seems to have an impact on the predictability of the 2018 classification (p<0.001). In comparison, neither classification system alone (1999 vs. 2018) showed a high predictive value for tooth loss (Area under the curve (AUC) = 59.2% vs. 58.2%). CONCLUSION Class III and IV/grade C of the 2018 classification of periodontal diseases show similar predictive accuracy for tooth loss as severe cases in the former classification. Patients adherence seems to influence the prognostic value of the classification. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Nihad El Sayed
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, Heidelberg, 69120, Germany
| | | | - Florian Stocker
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, Heidelberg, 69120, Germany
| | - Rouven Behnisch
- Institute of Medical Biometry and Informatics (IMBI), University Hospital Heidelberg, Heidelberg, 69120, Germany
| | - Peter Eickholz
- Department of Periodontology, Center of Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt, 60596, Germany
| | - Bernadette Pretzl
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, Heidelberg, 69120, Germany
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Tiwari T, Tranby E, Thakkar-Samtani M, Frantsve-Hawley J. Determinants of Tooth Loss in a Medicaid Adult Population. JDR Clin Trans Res 2021; 7:289-297. [PMID: 34269110 DOI: 10.1177/23800844211022277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The objective of this retrospective cohort study is to examine the determinants of tooth loss in a Medicaid-enrolled population using claims data from 2016 to 2018. METHODS Deidentified administrative claims data for Medicaid-enrolled adults between the ages of 50 and 90 y in 2016 to 2018 were examined using the IBM Watson MarketScan Medicaid Database. The sample size was 91,468. The entire sample was divided into 2 cohorts: no tooth loss cohort (n = 54,786) and tooth loss cohort (n = 36,682). The tooth loss cohort was further divided into 2 groups: 1 to 5 teeth lost (n = 29,141) and 6 or more teeth lost (n = 7,541). Tooth loss was described by age, gender, race, number of commodities, and if periodontal treatment was performed. Logistic regression models were conducted to examine factors associated with tooth loss. RESULTS Within the tooth loss cohort, the patients who had periodontal treatment had higher odds of losing at least 1 tooth (odds ratio [OR], 1.15; confidence interval [CI], 1.10-1.20) and lower odds of losing 6 or more teeth (OR, 0.25; CI, 0.22-0.29). In the regression analysis, the predictive margins of tooth loss for 1 tooth and 6 or more teeth follow a linear path. Compared to no comorbidities, the odds of losing 6 or more teeth increased with 1, 2, or 3+ comorbidities. KNOWLEDGE TRANSFER STATEMENT This study provides significant information about the quantification of comorbidities and its direct correlation with the increased odds of tooth loss. This study also highlighted the protective effect of periodontal treatment on tooth loss. This knowledge can be useful to dental care providers to understand the risk of tooth loss in their patient population.
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Affiliation(s)
- T Tiwari
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - E Tranby
- DentaQuest Partnership for Oral Health Advancement, MA, USA
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Junge T, Topoll H, Eickholz P, Petsos H. Retrospective long-term analysis of tooth loss over 20 years in a specialist practice setting: Periodontally healthy/gingivitis and compromised patients. J Clin Periodontol 2021; 48:1356-1366. [PMID: 34251030 DOI: 10.1111/jcpe.13520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 05/26/2021] [Accepted: 07/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess tooth loss (TL) in initially periodontally healthy/gingivitis (PHG) and periodontally compromised (PC) individuals during a 15- to 25-year follow-up in a specialist practice and to identify the factors influencing TL. MATERIALS AND METHODS Patients were re-examined 240 ± 60 months after active periodontal therapy (PC) or initial examination (PHG). PHG patients were periodontally healthy or had gingivitis, and PC patients exhibited at least stage II periodontitis. TL, patient-related outcomes, and risk factors for TL were assessed at the patient level (group-relation, gender, age, smoking, bleeding on probing, educational status, mean number of visits/year). RESULTS Fifty-six PC patients receiving regular supportive periodontal care (12 female, mean age 49.1 ± 10.9 years, stage II: 10, stage III/IV: 46) lost 38 teeth (0.03 ± 0.05 teeth/year). Fifty-one PHG patients (23 female, mean age 34.5 ± 12.4 years) following regular oral prevention lost 39 teeth (0.04 ± 0.05 teeth/year) (p = .631). Both PC and PHG groups did not show any significant differences regarding visual analogue scale measurements [aesthetics (p = .309), chewing function (p = .362), hygiene (p = .989)] and overall Oral Health Impact Profile (p = .484). Age at the start of follow-up was identified as a risk factor for TL (p < .0001). CONCLUSION PC and PHG patients exhibited similarly small TL rates over 240 ± 60 months, which should, however, be interpreted with caution in view of the group heterogeneity. Clinical trial number: DRKS00018840 (URL: https://drks.de).
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Affiliation(s)
| | - Heinz Topoll
- Private Practice, Münster, Germany.,Department of Periodontology, University Hospital Münster, Münster, Germany
| | - Peter Eickholz
- Department of Periodontology, Center of Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt/Main, Germany
| | - Hari Petsos
- Department of Periodontology, Center of Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt/Main, Germany.,Private Practice, Soest, Germany
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36
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Lock EF, Bandyopadhyay D. Bayesian nonparametric multiway regression for clustered binomial data. Stat (Int Stat Inst) 2021; 10. [DOI: 10.1002/sta4.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Eric F. Lock
- Division of Biostatistics University of Minnesota Minneapolis Minnesota USA
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Ravidà A, Galli M, Saleh MHA, Rodriguez MV, Qazi M, Troiano G, Chan HL, Wang HL. Maintenance visit regularity has a different impact on periodontitis-related tooth loss depending on patient staging and grading. J Clin Periodontol 2021; 48:1008-1018. [PMID: 33998024 DOI: 10.1111/jcpe.13489] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/24/2021] [Accepted: 04/30/2021] [Indexed: 12/11/2022]
Abstract
AIM To assess whether maintenance variables have a differential effect on tooth loss due to periodontitis (TLP) based on staging and grading. MATERIALS AND METHODS Patients treated for periodontitis for a minimum of ≥10 years follow-up were included and categorized according to their stage and grade at baseline. Impact of number, regularity, and pattern of supportive periodontal therapy visits (SPT) on TLP was explored by dividing teeth into test (5 year time periods prior to TLP events) and control groups (random 5 year periods without tooth loss). RESULTS The regularity of maintenance visits, but not the overall quantity, had a significant impact on risk of TLP and showed higher importance as staging and grading increased (larger impact for stages III/IV and grade C). The minimum threshold of visits below which the risk of TLP was equivalent to that of the control group was one visit every 7.4 months for stages I-II, 6.7 months for stage III-IV, 7.2 months for grade B and 6.7 months for grade C. This frequency should be increased for former and current smokers, diabetics and elderly patients. Stage III and IV patients who skip more than 1 year of maintenance in a 5 year period have an increased risk of TLP (OR = 2.55) compared to those only miss 1 year. A similar trend was noted for grade C patients, but not for stages I/II or grades A/B. CONCLUSIONS Lack of SPT regularity and missing multiple years of maintenance had a larger influence on risk of TLP for higher-level staging and grading.
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Affiliation(s)
- Andrea Ravidà
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Matthew Galli
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Department of Periodontics, University of Louisville School of Dentistry, Louisville, KY, USA
| | - Maria Vera Rodriguez
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Musa Qazi
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Giuseppe Troiano
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Hsun-Liang Chan
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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Carvalho R, Botelho J, Machado V, Mascarenhas P, Alcoforado G, Mendes JJ, Chambrone L. Predictors of tooth loss during long-term periodontal maintenance: An updated systematic review. J Clin Periodontol 2021; 48:1019-1036. [PMID: 33998031 DOI: 10.1111/jcpe.13488] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 12/24/2022]
Abstract
AIM To evaluate the risk factors / predictors of tooth loss in patients with periodontitis who underwent periodontal therapy and long-term periodontal maintenance (PM). MATERIAL AND METHODS PubMed, CENTRAL, EMBASE, Web of Science, LILACS and Scholar were searched up to and including September 2020. Studies limited to periodontitis patients who underwent active periodontal therapy (APT) and followed a regular PM programme with 5 years follow-up minimum were eligible for inclusion in this review. Studies were included if they reported data on tooth loss during PM. Random effects meta-analyses of number of tooth loss per patient per year were conducted. RESULTS Thirty-six papers regarding thirty-three studies were included in this review, with three prospective 30 retrospective trials. Subgroup meta-analysis showed no differences between prospective and retrospective studies, with an average of 0.1 tooth loss per year per patient (p < 0.001). Maxillary and molar teeth were more susceptible to be extracted during long-term PM. Baseline characteristics (smoking, diabetes mellitus, cardiovascular disease, being male and teeth with furcation lesions) showed no significance as predictor of tooth loss through meta-regression. The percentage of tooth loss due to periodontal reasons ranged from 0.45% to 14.4%. The individual outcomes in each study evidenced different patient-related factors (age and smoking) and tooth-related factors (i.e. tooth type and location) were associated with tooth loss during PM. CONCLUSION The majority of patients undergoing long-term PM have not lost teeth. On average, long-term PM effectively causes the loss of 1 tooth per patient every 10 years. Additional prospective trials may confirm these results.
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Affiliation(s)
- Rui Carvalho
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal
| | - João Botelho
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal.,Periodontology Department, Egas Moniz Dental Clinic (EMDC), Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal
| | - Vanessa Machado
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal.,Periodontology Department, Egas Moniz Dental Clinic (EMDC), Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal
| | - Paulo Mascarenhas
- Evidence-Based Hub, CiiEM, Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal
| | - Gil Alcoforado
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal.,Periodontology Department, Egas Moniz Dental Clinic (EMDC), Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal
| | - José João Mendes
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal.,Evidence-Based Hub, CiiEM, Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal
| | - Leandro Chambrone
- Evidence-Based Hub, CiiEM, Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal.,Graduate Dentistry Program, School of Dentistry, Ibirapuera University, São Paulo, Brazil.,Unit of Basic Oral Investigation (UIBO), Universidad El Bosque, Bogota, Colombia
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Schoenmakers MGP, Willems EJS, Slot DE, Van der Weijden GAF. Success of supportive periodontal therapy in periodontitis patients - A retrospective analysis. Int J Dent Hyg 2021; 20:318-327. [PMID: 34013646 PMCID: PMC9292265 DOI: 10.1111/idh.12521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 04/09/2021] [Accepted: 05/14/2021] [Indexed: 11/28/2022]
Abstract
Objective The aim of this retrospective analysis was to evaluate, in adult patients treated for periodontitis, the periodontal stability during supportive periodontal therapy (SPT). Methods Data were collected and analyzed retrospectively for periodontitis patients aged ≥36 years who underwent active periodontal therapy (APT) and were following an SPT programme. The stability of the APT success, defined as a probing pocket depth (PPD) of ≤5 mm, was the main outcome parameter. Analyses were performed in which PPD, tooth loss (TL), bleeding on probing (BOP), periodontal epithelium surface area (PESA), and the effects of age, gender, smoking status, and the number of years in SPT were evaluated. The annual TL and BOP of <10% in addition to a PPD of ≤5 mm were considered to be secondary outcome variables. Results In total, 993 patients were included, in 36% of whom a PPD ≤5 mm was found at the evaluation of APT. If the outcome was defined as a BOP of <10% in addition to a PPD of ≤5 mm, this was present in only 16% of the patients. During SPT, a small overall increase in clinical parameters for the total population and an annual average TL of 0.15 per patient was observed. Patients of male gender and smokers negatively affected the success of SPT. Conclusion The periodontal clinical status remained ‘fairly’ stable during SPT in chronic periodontitis patients aged ≥36 years. Smoking negatively affects the outcome of APT and periodontal stability during SPT.
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Affiliation(s)
- Max G P Schoenmakers
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), A Joint Venture between the Faculty of Dentistry of the University of Amsterdam and the Faculty of Dentistry of the Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eveline J S Willems
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), A Joint Venture between the Faculty of Dentistry of the University of Amsterdam and the Faculty of Dentistry of the Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Dagmar Else Slot
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), A Joint Venture between the Faculty of Dentistry of the University of Amsterdam and the Faculty of Dentistry of the Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - G A Fridus Van der Weijden
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), A Joint Venture between the Faculty of Dentistry of the University of Amsterdam and the Faculty of Dentistry of the Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Clinic for Periodontology, Utrecht, The Netherlands
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Miziara LNB, Sendyk WR, Ortega KL, Gallottini M, Sendyk DI, Martins F. Risk of Bleeding during Implant Surgery in Patients Taking Antithrombotics: A Systematic Review. Semin Thromb Hemost 2021; 47:702-708. [PMID: 33971681 DOI: 10.1055/s-0041-1722845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The objective of this systematic review is to assess the risk of postoperative bleeding in oral surgery for implant placement in individuals taking antithrombotics (i.e., anticoagulants and/or antiplatelet agents). A literature search was performed in PubMed (MEDLINE), Web of Science, Scopus, and EMBASE databases for articles published until August 2020, with no date restriction, and manually completed. We included prospective clinical studies that provided information regarding the presence of an experimental group (i.e., implant placement), a control group (patients not under treatment with antithrombotics), and a well-established protocol for evaluating bleeding. Meta-analysis determined the risk of bleeding during the placement of implants in antithrombotic-treated patients. Of the 756 potentially eligible articles, 5 were included in the analysis with 4 ranked as high and 1 as medium quality. Antithrombotic treatment comprised the following drug classes: (1) anticoagulants: vitamin K antagonists, (2) nonvitamin K antagonist oral anticoagulants, (3) low-molecular-weight heparin, and (4) antiplatelet agents (not specified). The results suggest that the risk of bleeding is not substantially higher in antithrombotic-treated patients (odds ratio = 2.19; 95% confidence interval: 0.88-5.44, p = 0.09) compared with nontreated patients. This systematic review suggests that the absolute risk is low and there is no need to discontinue or alter the dose of the antithrombotic treatment for implant placement surgery.
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Affiliation(s)
| | - Wilson Roberto Sendyk
- Department of Oral Implantology, Dental School, University of Santo Amaro, São Paulo, Brazil
| | - Karem López Ortega
- Division of Oral Pathology, Department of Stomatology, Dental School, University of São Paulo, São Paulo, Brazil
| | - Marina Gallottini
- Division of Oral Pathology, Department of Stomatology, Dental School, University of São Paulo, São Paulo, Brazil
| | - Daniel Isaac Sendyk
- Division of Periodontics, Department of Stomatology, Dental School, University of São Paulo, São Paulo, Brazil
| | - Fabiana Martins
- Department of Oral Implantology, Dental School, University of Santo Amaro, São Paulo, Brazil
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Probst M, Burian E, Robl T, Weidlich D, Karampinos D, Brunner T, Zimmer C, Probst FA, Folwaczny M. Magnetic resonance imaging as a diagnostic tool for periodontal disease: A prospective study with correlation to standard clinical findings-Is there added value? J Clin Periodontol 2021; 48:929-948. [PMID: 33745132 DOI: 10.1111/jcpe.13458] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/25/2021] [Accepted: 02/28/2021] [Indexed: 12/11/2022]
Abstract
AIM To evaluate the correlation between standard clinical findings, radiographic (OPT) and magnetic resonance imaging (MRI) as well as to assess whether MRI is capable of providing additional information related to the severity and extent of periodontal disease. METHODS 42 patients with generalized periodontitis received pre-interventional MRI scans. These were compared to MR images of a periodontal healthy control group (n = 34). The extent of the osseous oedema, detected by MRI, was set in correlation with clinical periodontitis-associated findings. RESULTS A highly significant correlation between bone oedema and clinical testings such as probing depth (p < 0.0001) and bleeding on probing (p < 0.0001) was revealed. The oedema exceeded the extent of demineralized bone. Patients with a positive BOP test showed a 2.51-fold increase in risk of already having a bone oedema around the respective tooth even if probing depth was ≤3 mm (logistic binary regression analysis, OR 2.51; 95% CI: 1.54-4.11; p < 0.0001). CONCLUSION MRI findings correlated with standard clinical findings, and MRI was able to depict intraosseous changes before any osseous defect had occurred.
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Affiliation(s)
- Monika Probst
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - Egon Burian
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - Teresa Robl
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - Dominik Weidlich
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - Dimitrios Karampinos
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - Teresa Brunner
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - Florian Andreas Probst
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Matthias Folwaczny
- Department of Restorative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University, Munich, Germany
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Saleh MHA, Dukka H, Troiano G, Ravidà A, Qazi M, Wang HL, Greenwell H. Long term comparison of the prognostic performance of PerioRisk, periodontal risk assessment, periodontal risk calculator, and staging and grading systems. J Periodontol 2021; 93:57-68. [PMID: 33914347 DOI: 10.1002/jper.20-0662] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Clinicians predominantly use personal judgment for risk assessment. Periodontal risk assessment tools (PRATs) provide an effective and logical system to stratify patients based on their individual treatment needs. This retrospective longitudinal study aimed to validate the association of different risk categories of four PRATs (Staging and grading; Periodontal Risk Assessment (PRA); Periodontal Risk Calculator; and PerioRisk) with periodontal related tooth loss (TLP), and to compare their prognostic performance. METHODS Data on medical history, smoking status, and clinical periodontal parameters were retrieved from patients who received surgical and non-surgical periodontal treatment. A comparison of the rate of TLP and non-periodontal related tooth loss (TLO) within the risk tool classes were performed by means of Kruskal-Wallis test followed by post-hoc comparison with the Bonferroni test. Both univariate and multivariate Cox Proportional hazard regression models were built to analyze the prognostic significance for each single risk assessment tool class on TLP. RESULTS A total of 167 patients with 4321 teeth followed up for a mean period of 26 years were assigned to four PRATs. PerioRisk class 5 had a hazard ratio of 18.43, Stage 4 had a hazard ratio of 7.99, and PRA class 3 had a hazard ratio of 6.13 compared with class/stage I. With respect to prognostic performance, PerioRisk tool demonstrated the best discrimination and model fit followed by PRA. CONCLUSION All PRATs displayed very good predictive capability of TLP. PerioRisk showed the best discrimination and model fit, followed by PRA.
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Affiliation(s)
- Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA.,Department of Periodontics, University of Louisville School of Dentistry, Louisville, Kentucky, USA
| | - Himabindu Dukka
- Department of Periodontics, University of Louisville School of Dentistry, Louisville, Kentucky, USA
| | - Giuseppe Troiano
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Andrea Ravidà
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Musa Qazi
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Henry Greenwell
- Department of Periodontics, University of Louisville School of Dentistry, Louisville, Kentucky, USA
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Tooth loss in complying and non-complying periodontitis patients with different periodontal risk levels during supportive periodontal care. Clin Oral Investig 2021; 25:5897-5906. [PMID: 33760975 PMCID: PMC8443470 DOI: 10.1007/s00784-021-03895-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/16/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To evaluate yearly tooth loss rate (TLR) in periodontitis patients with different periodontal risk levels who had complied or not complied with supportive periodontal care (SPC). MATERIALS AND METHODS Data from 168 periodontitis patients enrolled in a SPC program based on a 3-month suggested recall interval for at least 3.5 years were analyzed. For patients with a mean recall interval within 2-4 months ("compliers") or > 4 months ("non-compliers") with different PerioRisk levels (Trombelli et al. 2009), TLR (irrespective of the cause for tooth loss) was calculated. TLR values were considered in relation to meaningful TLR benchmarks from the literature for periodontitis patients either under SPC (0.15 teeth/year; positive benchmark) or irregularly complying with SPC (0.36 teeth/year; negative benchmark). RESULTS In both compliers and non-compliers, TLR was significantly below or similar to the positive benchmark in PerioRisk level 3 (0.08 and 0.03 teeth/year, respectively) and PerioRisk level 4 (0.12 and 0.18 teeth/year, respectively). Although marked and clinically relevant in non-compliers, the difference between TLR of compliers (0.32 teeth/year) and non-compliers (0.52 teeth/year) with PerioRisk level 5 and the negative benchmark was not significant. CONCLUSION A SPC protocol based on a 3- to 6-month recall interval may effectively limit long-term tooth loss in periodontitis patients with PerioRisk levels 3 and 4. A fully complied 3-month SPC protocol seems ineffective when applied to PerioRisk level 5 patients. CLINICAL RELEVANCE PerioRisk seems to represent a valid tool to inform the SPC recall interval as well as the intensity of active treatment prior to SPC enrollment.
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Petsos H, Ramich T, Nickles K, Dannewitz B, Pfeifer L, Zuhr O, Eickholz P. Tooth loss in periodontally compromised patients: Retrospective long-term results 10 years after active periodontal therapy. Tooth-related outcomes. J Periodontol 2021; 92:1761-1775. [PMID: 33748997 DOI: 10.1002/jper.21-0056] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/16/2021] [Accepted: 03/16/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Estimating prognosis of periodontally affected teeth at the beginning of supportive periodontal care (SPC) is an important component for further treatment planning. This study aimed to evaluate tooth loss (TL) during 10 years of SPC in periodontally compromised patients and to identify tooth-related factors affecting TL. METHODS Patients were re-examined 120 ± 12 months after accomplishment of active periodontal therapy. TL was defined as primary outcome variable and tooth-related factors (abutment status, furcation involvement [FI], tooth mobility, mean periodontal probing depth [PD], and clinical attachment level [CAL] at beginning of SPC, and initial bone loss [BL]) were estimated based on an adjusted regression analyses model. RESULTS Ninety-seven patients (51 females and 46 males; mean age, 65.3 ± 11 years) lost 119 of 2,323 teeth (overall TL [OTL]: 0.12 teeth/patient/y) during 10 years of SPC. Forty of these teeth (33.6%) were lost for periodontal reasons (TLP; 0.04 teeth/patient/y). Significantly more teeth were lost due to other reasons (P <0.0001). TLP (OTL) only occurred in 5.9% (14.7%) of all teeth, when BL was at least 80%. Use as abutment tooth, FI degree III, tooth mobility degrees I and II, mean PD, and CAL positively correlated with OTL (P <0.05). For TLP, FI and tooth mobility degree III as well as mean CAL were identified as tooth-related prognostic factors (P <0.05). CONCLUSIONS During 10 years of SPC, most of the teeth (93.4%) of periodontally compromised patients were retained, showing the positive effect of a well-established treatment concept. Well-known tooth-related prognostic factors were confirmed.
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Affiliation(s)
- Hari Petsos
- Private practice, Soest, Germany.,Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt am Main, Germany
| | - Tatjana Ramich
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt am Main, Germany
| | - Katrin Nickles
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt am Main, Germany.,Private practice, Mannheim, Germany
| | - Bettina Dannewitz
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt am Main, Germany.,Private practice, Weilburg, Germany
| | - Leon Pfeifer
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt am Main, Germany
| | - Otto Zuhr
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt am Main, Germany.,Private practice, Münich, Germany
| | - Peter Eickholz
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt am Main, Germany
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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.
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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
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46
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Loos BG, Needleman I. Endpoints of active periodontal therapy. J Clin Periodontol 2021; 47 Suppl 22:61-71. [PMID: 31912527 PMCID: PMC7670400 DOI: 10.1111/jcpe.13253] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/21/2019] [Accepted: 01/04/2020] [Indexed: 01/01/2023]
Abstract
Aim Position paper on endpoints of active periodontal therapy for designing treatment guidelines. The question was as follows: How are, for an individual patient, commonly applied periodontal probing measures—recorded after active periodontal therapy—related to (a) stability of clinical attachment level, (b) tooth survival, (c) need for re‐treatment or (d) oral health‐related quality of life. Methods A literature search was conducted in Ovid MEDLINE(R) and Epub Ahead of Print, In‐Process & Other Non‐Indexed Citations and Daily <1946 to 07 June 2019>. Results A total of 94 papers were retrieved. From the literature search, it was found that periodontitis patients with a low proportion of deep residual pockets after active periodontal therapy are more likely to have stability of clinical attachment level over a follow‐up time of ≥1 year. Other supporting literature confirms this finding and additionally reports, at the patient level, that probing pocket depths ≥6 mm and bleeding on probing scores ≥30% are risks for tooth loss. There is lack of evidence that periodontal probing measures after completion of active periodontal treatment are tangible to the patient. Conclusions Based on literature and biological plausibility, it is reasonable to state that periodontitis patients with a low proportion of residual periodontal pockets and little inflammation are more likely to have stability of clinical attachment levels and less tooth loss over time. Guidelines for periodontal therapy should take into consideration (a) long‐term tangible patient outcomes, (b) that shallow pockets (≤4 mm) without bleeding on probing in patients with <30% bleeding sites are the best guarantee for the patient for stability of his/her periodontal attachment, (c) patient heterogeneity and patient changes in immune response over time, and (d) that treatment strategies include lifestyle changes of the patient. Long‐term large population‐based and practice‐based studies on the efficacy of periodontal therapies including both clinical and patient‐reported outcomes (PROs) need to be initiated, which include the understanding that periodontitis is a complex disease with variation of inflammatory responses due to environment, (epi)genetics, lifestyle and ageing. Involving people living with periodontitis as co‐researchers in the design of these studies would also help to improve their relevance.
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Affiliation(s)
- Bruno G Loos
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - Ian Needleman
- Unit of Periodontology, University College London Eastman Dental Institute, London, UK
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Korsch M, Marten SM, Stoll D, Prechtl C, Dötsch A. Microbiological findings in early and late implant loss: an observational clinical case-controlled study. BMC Oral Health 2021; 21:112. [PMID: 33706748 PMCID: PMC7948356 DOI: 10.1186/s12903-021-01439-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/14/2021] [Indexed: 12/30/2022] Open
Abstract
Background Implants are a predictable and well-established treatment method in dentistry. Nevertheless, looking at possible failures of dental implants, early and late loss have to be distinguished. The intent of the study was to report microbiological findings on the surface of implants with severe peri-implantitis, which had to be explanted. Methods 53 specimens of implants from 48 patients without severe general illnesses have been examined. The groups investigated were implants that had to be removed in the period of osseointegration (early loss, 13 patients with 14 implants) or after the healing period (late loss, 14 patients with 17 implants). The implant losses were compared with two control groups (implants with no bone loss directly after completed osseointegration, two to four months after implant placement (17 patients with 17 implants) and implants with no bone loss and prosthetic restoration for more than three years (5 patients with 5 implants)). Data about the bacteria located in the peri-implant sulcus was collected using amplification and high throughput sequencing of the 16S rRNA gene. Results The biofilm composition differed substantially between individuals. Both in early and late implant loss, Fusobacterium nucleatum and Porphyromonas gingivalis were found to be abundant. Late lost implants showed higher bacterial diversity and in addition higher abundances of Treponema, Fretibacterium, Pseudoramibacter and Desulfobulbus, while microbial communities of early loss implants were very heterogeneous and showed no significantly more abundant bacterial taxa. Conclusions Specific peri-implant pathogens were found around implants that were lost after a primarily uneventful osseointegration. P. gingivalis and F. nucleatum frequently colonized the implant in early and late losses and could therefore be characteristic for implant loss in general. In general, early lost implants showed also lower microbial diversity than late losses. However, the microbial results were not indicative of the causes of early and late losses.
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Affiliation(s)
- Michael Korsch
- Dental Academy for Continuing Professional Development, Karlsruhe, Lorenzstrasse 7, 76135, Karlsruhe, Germany. .,Center for Implantology and Oral Surgery, Berliner Straße 41, 69120, Heidelberg, Germany. .,Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital, Saarland University, Building 73, 66421, Homburg, Germany.
| | - Silke-Mareike Marten
- Institute of Functional Interfaces, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Dominic Stoll
- Department of Safety and Quality of Fruit and Vegetables, Max Rubner-Institut, Karlsruhe, Germany
| | - Christopher Prechtl
- Dental Academy for Continuing Professional Development, Karlsruhe, Lorenzstrasse 7, 76135, Karlsruhe, Germany.,Center for Implantology and Oral Surgery, Berliner Straße 41, 69120, Heidelberg, Germany
| | - Andreas Dötsch
- Institute of Functional Interfaces, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany.,Department of Physiology and Biochemistry of Nutrition, Max Rubner-Institut, Karlsruhe, Germany
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Ekuni D, Kato S, Kawakami S, Maruyama T, Kataoka K, Uchida-Fukuhara Y, Fukuhara D, Toyama N, Yokoi A, Islam MM, Khair SB, Kodama N, Morita M. Parafunctional masseter muscle activity during waking is related to periodontitis progression: A pilot prospective cohort study. J Clin Periodontol 2021; 48:785-794. [PMID: 33484572 DOI: 10.1111/jcpe.13432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 01/03/2021] [Accepted: 01/15/2021] [Indexed: 12/16/2022]
Abstract
AIM The purpose of this pilot prospective cohort study was to investigate the effects of parafunctional masseter muscle activity on periodontitis progression among patients receiving supporting periodontal therapy (SPT). MATERIALS AND METHODS We collected data of patients treated at Okayama University Hospital from August 2014 to September 2018. The progression group was defined as patients with ≥2 teeth demonstrating a longitudinal loss of proximal attachment of ≥3 mm during the 3-year study period and/or at least one tooth extraction due to periodontitis progression. Surface electromyography of masseter muscles at baseline was continuously recorded while patients were awake and asleep. RESULTS We analysed 48 patients (36 females) aged 66.8 ± 9.1 years (mean ± SD). The rate of parafunctional masseter muscle activity during waking hours and sleeping hours at baseline was 60.4% and 52.1%, respectively. Cox's proportional hazards regression model showed that the incidence of periodontitis progression was significantly associated with number of teeth present (p = 0.001) and parafunctional masseter muscle activity during waking hours (p = 0.041). CONCLUSION Our results suggest that parafunctional masseter muscle activity during waking hours is a risk factor for periodontitis progression among patients receiving SPT.
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Affiliation(s)
- Daisuke Ekuni
- Department of Preventive Dentistry, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Seiya Kato
- Department of Occlusal and Oral Functional Rehabilitation, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Shigehisa Kawakami
- Department of Occlusal and Oral Functional Rehabilitation, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takayuki Maruyama
- Department of Preventive Dentistry, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.,Advanced Research Center for Oral and Craniofacial Sciences, Okayama University, Okayama, Japan
| | - Kota Kataoka
- Department of Preventive Dentistry, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Yoko Uchida-Fukuhara
- Department of Oral Morphology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Daiki Fukuhara
- Department of Preventive Dentistry, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Naoki Toyama
- Department of Preventive Dentistry, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Aya Yokoi
- Department of Preventive Dentistry, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Md Monirul Islam
- Department of Preventive Dentistry, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Subrina Binta Khair
- Department of Preventive Dentistry, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Naoki Kodama
- Department of Occlusal and Oral Functional Rehabilitation, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Manabu Morita
- Department of Preventive Dentistry, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Wang X, Wang Y. LncRNA DCST1-AS1 inhibits PDLCs' proliferation in periodontitis and may bind with miR-21 precursor to upregulate PLAP-1. J Periodontal Res 2021; 56:256-264. [PMID: 33533513 DOI: 10.1111/jre.12809] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 08/26/2020] [Accepted: 09/30/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study aimed to investigate the potential interactions among long noncoding RNA domain containing 1-antisense (lncRNA DCST1-AS1), miR-21, and periodontal ligament-associated protein-1 (PLAP-1) in periodontitis. BACKGROUND DATA DISCUSSING THE PRESENT STATE OF THE FIELD It has been verified that miR-21 can target PLAP-1 to regulate the osteogenic differentiation of periodontal ligament cells (PDLCs). METHODS Differential expression of DCST1-AS1 and miR-21 in PDLCs derived from periodontitis patients and healthy controls was determined by qPCR and unpaired t test. QPCR and Western blots were conducted to evaluate the effects of overexpression of DCST1-AS1 and miR-21 on the expression of PLAP-1. CCK-8 assay was applied to evaluate the effect of DCST1-ASI, miR-21, or PLAP-1 on PDLCs' proliferation. Western blotting was conducted to detect the expression levels of CKD family (CDK4, CDK6, and CCND1). RESULTS DCST1-AS1 was downregulated in PDLCs derived from periodontitis patients, and its expression was inversely correlated with the expression of miR-2 but positively correlated with PLAP-1. Bioinformatics analysis showed that DCST1-AS1 might bind with miR-21 precursor but not mature miR-21. Transfection experiments showed that overexpression of DCST1-AS1 led to decreased expression levels of miR-21 and significantly increased the expression levels of PLAP-1 at both mRNA and protein levels, while overexpression of miR-21 resulted in a dramatic lower level of PLAP-1. CCK-8 assay indicated that overexpression of DCST1-AS1 or PLAP-1 prohibited PDLCs' proliferation. However, elevation of miR-21 had a contrary effect on the proliferation of PDLCs. And increased expression levels of DCST1-AS1 could significantly inhibit the expression of CDK4, CDK6, and CCND-1, while overexpression of miR-21 inversed the effects of DCST1-AS1. CONCLUSION Therefore, the expression levels of DCST1-AS1 are much lower in periodontitis patients compared to that in healthy controls, and overexpression of DCST1-AS1 can significantly elevate the expression of PLAP-1 by inhibiting miR-21 in PDLCs.
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Affiliation(s)
- Xiaoying Wang
- Department of Stomatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yanhua Wang
- Department of Stomatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Early Tooth Loss after Periodontal Diagnosis: Development and Validation of a Clinical Decision Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031363. [PMID: 33540933 PMCID: PMC7908103 DOI: 10.3390/ijerph18031363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/23/2021] [Accepted: 01/30/2021] [Indexed: 11/22/2022]
Abstract
The aim of this study was to develop and validate a predictive early tooth loss multivariable model for periodontitis patients before periodontal treatment. A total of 544 patients seeking periodontal care at the university dental hospital were enrolled in the study. Teeth extracted after periodontal diagnosis and due to periodontal reasons were recorded. Clinical and sociodemographic variables were analyzed, considering the risk of short-term tooth loss. This study followed the transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD) guidelines for development and validation, with two cohorts considered as follows: 455 patients in the development phase and 99 in the validation phase. As a result, it was possible to compute a predictive model based on tooth type and clinical attachment loss. The model explained 25.3% of the total variability and correctly ranked 98.9% of the cases. The final reduced model area under the curve (AUC) was 0.809 (95% confidence interval (95% CI): 0.629–0.989) for the validation sample and 0.920 (95% CI: 0.891–0.950) for the development cohort. The established model presented adequate prediction potential of early tooth loss due to periodontitis. This model may have clinical and epidemiologic relevance towards the prediction of tooth loss burden.
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