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De Ry SP, Roccuzzo A, Lang NP, Sculean A, Salvi GE. Long-term clinical outcomes of periodontal regeneration with Enamel Matrix Derivative (EMD): a retrospective cohort study with a mean follow-up of 10 years. J Periodontol 2021; 93:548-559. [PMID: 34258767 PMCID: PMC9373923 DOI: 10.1002/jper.21-0347] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/10/2021] [Accepted: 07/10/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Despite the large body of evidence on the efficacy of Enamel Matrix Derivative (EMD) in the treatment of periodontal intrabony defects, few studies reported long-term data (≥ 10-year). METHODS Periodontal patients treated with regenerative surgery with EMD between 1999 and 2012 were invited to participate in a clinical examination. The following clinical parameters were recorded and compared at baseline (T0), 6 months after surgery (T1) and after at least 8 years of follow-up (T2): probing depth (PD), gingival recession (GR), clinical attachment level (CAL), plaque and bleeding scores. The primary outcome variable was CAL change. RESULTS Forty-one patients with 75 treated teeth were available for analysis. Out of these, 68 (tooth survival rate: 90.7%) reached the latest follow-up with a mean observation period of 10.3 years (range: 8.0-21.3). The most frequent reason for tooth loss was recurrence of periodontal disease. Tooth survival curves showed a statistically significant difference between smokers and non-smokers (p = 0.028). Mean CAL changed from 8.43 ± 1.86 (T0) to 6.47 ± 1.70 (T1) (p<0.001) and to 5.91 ± 1.83 (T2) (p<0.001). At T1, a CAL gain of ≥3 mm was measured in 35% of the defects while at T2 it was detected in 51% of cases. CONCLUSIONS Within their limitations, the present results have shown that in intrabony defects, the clinical improvements obtained following regenerative surgery with EMD can be maintained on a mean period of 10 years. Smoking status and maxillary molars were correlated with an increased risk for tooth and CAL loss, respectively. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Siro P De Ry
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Niklaus P Lang
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Treatment Outcome of the Teeth with Cemental Tears. J Endod 2014; 40:1315-20. [DOI: 10.1016/j.joen.2014.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/27/2014] [Accepted: 05/29/2014] [Indexed: 11/18/2022]
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Salvi GE, Mischler DC, Schmidlin K, Matuliene G, Pjetursson BE, Brägger U, Lang NP. Risk factors associated with the longevity of multi-rooted teeth. Long-term outcomes after active and supportive periodontal therapy. J Clin Periodontol 2014; 41:701-7. [PMID: 24766602 DOI: 10.1111/jcpe.12266] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2014] [Indexed: 11/27/2022]
Abstract
AIM To investigate risk factors for the loss of multi-rooted teeth (MRT) in subjects treated for periodontitis and enrolled in supportive periodontal therapy (SPT). MATERIAL AND METHODS A total of 172 subjects were examined before (T0) and after active periodontal therapy (APT)(T1) and following a mean of 11.5 ± 5.2 (SD) years of SPT (T2). The association of risk factors with loss of MRT was analysed with multilevel logistic regression. The tooth was the unit of analysis. RESULTS Furcation involvement (FI) = 1 before APT was not a risk factor for tooth loss compared with FI = 0 (p = 0.37). Between T0 and T2, MRT with FI = 2 (OR: 2.92, 95% CI: 1.68, 5.06, p = 0.0001) and FI = 3 (OR: 6.85, 95% CI: 3.40, 13.83, p < 0.0001) were at a significantly higher risk to be lost compared with those with FI = 0. During SPT, smokers lost significantly more MRT compared with non-smokers (OR: 2.37, 95% CI: 1.05, 5.35, p = 0.04). Non-smoking and compliant subjects with FI = 0/1 at T1 lost significantly less MRT during SPT compared with non-compliant smokers with FI = 2 (OR: 10.11, 95% CI: 2.91, 35.11, p < 0.0001) and FI = 3 (OR: 17.18, 95% CI: 4.98, 59.28, p < 0.0001) respectively. CONCLUSIONS FI = 1 was not a risk factor for tooth loss compared with FI = 0. FI = 2/3, smoking and lack of compliance with regular SPT represented risk factors for the loss of MRT in subjects treated for periodontitis.
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Affiliation(s)
- Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Evidence-based outcomes of periodontal therapy: a legacy of Sigurd P. Ramfjord. 1987. J Am Dent Assoc 2013; 144:1230-3. [PMID: 24177400 DOI: 10.14219/jada.archive.2013.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Evidence-based outcomes of periodontal therapy. J Am Dent Assoc 2013; 144 Spec No:57S-60S. [DOI: 10.14219/jada.archive.2013.0251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kumar S, Panwar J, Vyas A, Sharma J, Goutham B, Duraiswamy P, Kulkarni S. Tooth cleaning frequency in relation to socio-demographic variables and personal hygiene measures among school children of Udaipur district, India. Int J Dent Hyg 2011; 9:3-8. [PMID: 21226844 DOI: 10.1111/j.1601-5037.2009.00404.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to determine if frequency of tooth cleaning varies with social group, family size, bedtime and other personal hygiene habits among school children. METHODS Target population comprised schoolchildren aged 8-16 years of Udaipur district attending public schools. A two stage cluster random sampling procedure was executed to collect the representative sample, consequently final sample size accounted to 852 children. Data were collected by means of structured questionnaires which consisted of questions related to oral hygiene habits including a few general hygiene habits, bed time, family size, family income and dental visiting habits. RESULTS The results show that 30.5% of the total sample cleaned their teeth twice or more daily and there was no significant difference between the genders for tooth cleaning frequency. Logistic regression analysis revealed that older children and those having less than two siblings were more likely to clean their teeth twice a day than the younger ones and children with more than two siblings. Furthermore, frequency of tooth cleaning was significantly lower among children of parents with low level of education and less annual income as compared with those of high education and more annual income. In addition, tooth cleaning habits were more regular in children using tooth paste and regularly visiting to the dentist. CONCLUSIONS This study observed that tooth cleaning is not an isolated behaviour, but is a part of multifarious pattern of various social and behavioural factors.
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Affiliation(s)
- S Kumar
- Department of Preventive and Community Dentistry, Darshan Dental College and Hospital, Rajasthan, India.
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Brägger U, Hirt-Steiner S, Schnell N, Schmidlin K, Salvi GE, Pjetursson B, Matuliene G, Zwahlen M, Lang NP. Complication and failure rates of fixed dental prostheses in patients treated for periodontal disease. Clin Oral Implants Res 2010; 22:70-7. [DOI: 10.1111/j.1600-0501.2010.02095.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schmidlin K, Schnell N, Steiner S, Salvi GE, Pjetursson B, Matuliene G, Zwahlen M, Brägger U, Lang NP. Complication and failure rates in patients treated for chronic periodontitis and restored with single crowns on teeth and/or implants. Clin Oral Implants Res 2010; 21:550-7. [DOI: 10.1111/j.1600-0501.2009.01907.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Matuliene G, Studer R, Lang NP, Schmidlin K, Pjetursson BE, Salvi GE, Brägger U, Zwahlen M. Significance of Periodontal Risk Assessment in the recurrence of periodontitis and tooth loss. J Clin Periodontol 2010; 37:191-9. [DOI: 10.1111/j.1600-051x.2009.01508.x] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Krieger O, Matuliene G, Hüsler J, Salvi GE, Pjetursson B, Brägger U. Failures and complications in patients with birth defects restored with fixed dental prostheses and single crowns on teeth and/or implants. Clin Oral Implants Res 2009; 20:809-16. [DOI: 10.1111/j.1600-0501.2009.01720.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Incici E, Matuliene G, Hüsler J, Salvi GE, Pjetursson B, Brägger U. Cumulative costs for the prosthetic reconstructions and maintenance in young adult patients with birth defects affecting the formation of teeth. Clin Oral Implants Res 2009; 20:715-21. [DOI: 10.1111/j.1600-0501.2009.01711.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Matuliene G, Pjetursson BE, Salvi GE, Schmidlin K, Brägger U, Zwahlen M, Lang NP. Influence of residual pockets on progression of periodontitis and tooth loss: results after 11 years of maintenance. J Clin Periodontol 2008; 35:685-95. [PMID: 18549447 DOI: 10.1111/j.1600-051x.2008.01245.x] [Citation(s) in RCA: 420] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Limited evidence exists on the significance of residual probing pocket depth (PPD) as a predictive parameter for periodontal disease progression and tooth loss. AIM The aim of this study was to investigate the influence of residual PPD >or=5 mm and bleeding on probing (BOP) after active periodontal therapy (APT) on the progression of periodontitis and tooth loss. MATERIAL AND METHODS In this retrospective cohort, 172 patients were examined after APT and supportive periodontal therapy (SPT) for 3-27 years (mean 11.3 years). Analyses were conducted using information at site, tooth and patient levels. The association of risk factors with tooth loss and progression of periodontitis was investigated using multilevel logistic regression analysis. RESULTS The number of residual PPD increased during SPT. Compared with PPD<or=3 mm, PPD=5 mm represented a risk factor for tooth loss with odds ratios of 5.8 and 7.7, respectively, at site and tooth levels. The corresponding odds ratios for PPD=6 mm were 9.3 and 11.0 and for PPD>or=7 mm 37.9 and 64.2, respectively. At patient level, heavy smoking, initial diagnosis, duration of SPT and PPD>or=6 mm were risk factors for disease progression, while PPD>or=6 mm and BOP>or=30% represented a risk for tooth loss. CONCLUSION Residual PPD>or=6 mm represent an incomplete periodontal treatment outcome and require further therapy.
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Affiliation(s)
- Giedre Matuliene
- School of Dental Medicine, University of Berne, Berne, Switzerland
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Pastagia J, Nicoara P, Robertson PB. The Effect of Patient-Centered Plaque Control and Periodontal Maintenance Therapy on Adverse Outcomes of Periodontitis. J Evid Based Dent Pract 2006; 6:25-32. [PMID: 17138393 DOI: 10.1016/j.jebdp.2005.12.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to evaluate systematic reviews that addressed the effectiveness of periodontal maintenance therapy for the management of patients with periodontitis. Recent surveys of dental care patterns suggest a marked increase in preventive and maintenance periodontal care in populations that retain the dentition for an increasingly longer lifetime. A considerable body of clinical investigation concludes that a multitherapy periodontal maintenance approach is effective in improving periodontal outcomes in patients treated for periodontitis. Individual components of such maintenance therapy were assessed, including the effects of an oral examination, personal oral hygiene instructions, supragingival scaling and polishing, subgingival scaling and root planing, adjunctive procedures, and maintenance frequency. There is much controversy about improvement in oral health that may accrue from the placebo effect of an examination and the maintenance ritual. Improved plaque control by the patient in anticipation of a forthcoming examination alone might be reflected in decreased measurements for plaque accumulation and gingival inflammation but the role of placebo effects on periodontitis remains unclear. There are insufficient randomized controlled trials to reach conclusions regarding the individual beneficial effects of repeated oral hygiene instructions or routine scaling/polishing on the recurrence of periodontitis. While subgingival root planing seems an effective component of periodontal maintenance, neither clinical investigations nor randomly controlled trial evidence have established an ideal maintenance frequency based on individual patient risk for periodontitis. The adjunctive beneficial effects of both locally and systemically administered antimicrobial agents were statistically significant for some formulations, and may be particularly useful clinically in patients who are resistant to mechanical therapy. We conclude that few clinical or randomized controlled studies have evaluated the individual benefit or required frequency of the periodontal maintenance ritual for patients who are relatively resistant or susceptible to periodontitis.
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Affiliation(s)
- Julie Pastagia
- Department of Periodontics, School of Dentistry, University of Washington, Seattle, WA, USA
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Vyas SP, Sihorkar V, Mishra V. Controlled and targeted drug delivery strategies towards intraperiodontal pocket diseases. J Clin Pharm Ther 2000; 25:21-42. [PMID: 10771461 DOI: 10.1046/j.1365-2710.2000.00261.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Advances in the understanding of the aetiology, epidemiology, pathogenesis and microbiology of periodontal pocket flora have revolutionized the strategies for the management of intraperiodontal pocket diseases. Intra-pocket, sustained release, drug delivery devices have been shown to be clinically effective in the treatment of periodontal infections. Several degradable and non-degradable devices are under investigation for the delivery of antimicrobial agents into the periodontal pocket including non-biodegradable fibres, films (biodegradable and non-biodegradable), bio-absorbable dental materials, biodegradable gels/ointments, injectables and microcapsules. With the realization that pocket bacteria accumulate as biofilms, studies are now being directed towards eliminating/killing biofilm concentrations rather than their planktonic (fluid phase) counterparts. Intraperiodontal pocket drug delivery has emerged as a novel paradigm for the future research. Similarly, bioadhesive delivery systems are explored that could significantly improve oral therapeutics for periodontal disease and mucosal lesions. A strategy is to target a wide range of molecular mediators of tissue destruction and hence arrest periodontal disease progression. Research into regenerating periodontal structures lost as a result of disease has also shown substantial progress in the last 25 years.
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Affiliation(s)
- S P Vyas
- Drug Delivery Research Laboratory, Department of Pharmaceutical Sciences, Dr H. S. Gour University, Sagar, M.P., India.
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