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Motmaen I, Xie K, Schönbrunn L, Berens J, Grunert K, Plum AM, Raufeisen J, Ferreira A, Hermans A, Egger J, Hölzle F, Truhn D, Puladi B. Insights into Predicting Tooth Extraction from Panoramic Dental Images: Artificial Intelligence vs. Dentists. Clin Oral Investig 2024; 28:381. [PMID: 38886242 PMCID: PMC11182848 DOI: 10.1007/s00784-024-05781-5] [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: 04/22/2024] [Accepted: 06/11/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVES Tooth extraction is one of the most frequently performed medical procedures. The indication is based on the combination of clinical and radiological examination and individual patient parameters and should be made with great care. However, determining whether a tooth should be extracted is not always a straightforward decision. Moreover, visual and cognitive pitfalls in the analysis of radiographs may lead to incorrect decisions. Artificial intelligence (AI) could be used as a decision support tool to provide a score of tooth extractability. MATERIAL AND METHODS Using 26,956 single teeth images from 1,184 panoramic radiographs (PANs), we trained a ResNet50 network to classify teeth as either extraction-worthy or preservable. For this purpose, teeth were cropped with different margins from PANs and annotated. The usefulness of the AI-based classification as well that of dentists was evaluated on a test dataset. In addition, the explainability of the best AI model was visualized via a class activation mapping using CAMERAS. RESULTS The ROC-AUC for the best AI model to discriminate teeth worthy of preservation was 0.901 with 2% margin on dental images. In contrast, the average ROC-AUC for dentists was only 0.797. With a 19.1% tooth extractions prevalence, the AI model's PR-AUC was 0.749, while the dentist evaluation only reached 0.589. CONCLUSION AI models outperform dentists/specialists in predicting tooth extraction based solely on X-ray images, while the AI performance improves with increasing contextual information. CLINICAL RELEVANCE AI could help monitor at-risk teeth and reduce errors in indications for extractions.
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Affiliation(s)
- Ila Motmaen
- Department of Oral and Maxillofacial Surgery, University Hospital Knappschaftskrankenhaus Bochum, 44892, Bochum, Germany
| | - Kunpeng Xie
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Institute of Medical Informatics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Leon Schönbrunn
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Institute of Medical Informatics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Jeff Berens
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Institute of Medical Informatics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Kim Grunert
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Institute of Medical Informatics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Anna Maria Plum
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Institute of Medical Informatics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Johannes Raufeisen
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Institute of Medical Informatics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - André Ferreira
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Institute of Medical Informatics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Centre Algoritmi / LASI, University of Minho, 4710-057, Braga, Portugal
- Institute for Artificial Intelligence in Medicine, Essen University Hospital, 45147, Essen, Germany
| | - Alexander Hermans
- Visual Computing Institute, Computer Science and Natural Sciences, RWTH Aachen University, 52074, Aachen, Germany
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University, 52074, Aachen, Germany
| | - Jan Egger
- Institute for Artificial Intelligence in Medicine, Essen University Hospital, 45147, Essen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Daniel Truhn
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University, 52074, Aachen, Germany
| | - Behrus Puladi
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
- Institute of Medical Informatics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
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Roccuzzo A, Imber J, Marruganti C, Salvi GE, Ramieri G, Roccuzzo M. Clinical outcomes of dental implants in patients with and without history of periodontitis: A 20-year prospective study. J Clin Periodontol 2022; 49:1346-1356. [PMID: 36054302 PMCID: PMC9804375 DOI: 10.1111/jcpe.13716] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/26/2022] [Accepted: 08/07/2022] [Indexed: 01/05/2023]
Abstract
AIM To present the 20-year clinical outcomes of tissue-level implants in partially edentulous patients previously treated for periodontitis and in periodontally healthy patients (PHP). MATERIAL AND METHODS The original population consisted of 149 partially edentulous patients consecutively enrolled in a private specialist practice and divided into three groups: PHP, moderately periodontally compromised patients (mPCP) and severely PCP (sPCP). After successful completion of periodontal/implant therapy, patients were enrolled in an individualized supportive periodontal care (SPC) programme. RESULTS Eighty-four patients rehabilitated with 172 implants reached the 20-year examination. During the observation time, 12 implants were removed (i.e., 11 due to biological complications and 1 due to implant fracture), leading to an overall implant survival rate of 93% (i.e., 94.9% for PHP, 91.8% for mPCP and 93.1% for sPCP [p = .29]). At 20 years, PCP compliant with SPC did not present with significantly higher odds of implant loss compared with PHP compliant with SPC (p > .05). Conversely, PCP not compliant with SPC experienced implant loss with odds ratio of 14.59 (1.30-164.29, p = .03). CONCLUSIONS Tissue-level implants, placed after comprehensive periodontal therapy and SPC, yield favourable long-term results. However, patients with a history of periodontitis and non-compliant with SPC are at higher risk of biological complications and implant loss.
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Affiliation(s)
- Andrea Roccuzzo
- Department of PeriodontologySchool of Dental Medicine, University of BernBernSwitzerland,Department of Oral and Maxillofacial SurgeryCopenhagen University Hospital (Rigshospitalet)CopenhagenDenmark,Department of Restorative, Pediatric and Preventive DentistrySchool of Dental Medicine, University of BernBernSwitzerland
| | - Jean‐Claude Imber
- Department of PeriodontologySchool of Dental Medicine, University of BernBernSwitzerland
| | - Crystal Marruganti
- Department of Surgical, Medical and Molecular Pathology and Critical Care MedicineUniversity of PisaPisaItaly,Sub‐Unit of Periodontology, Halitosis and Periodontal MedicineUniversity Hospital of PisaPisaItaly,Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | - Giovanni E. Salvi
- Department of PeriodontologySchool of Dental Medicine, University of BernBernSwitzerland
| | | | - Mario Roccuzzo
- Division of Maxillofacial SurgeryUniversity of TorinoTorinoItaly,Department of Periodontics and Oral MedicineUniversity of MichiganAnn ArborMichiganUSA,Private PracticeTorinoItaly
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Clinical, Histological, and Radiological Outcomes of Sinus Floor Elevation Using a New Approach before Extraction of Periodontally Hopeless Maxillary Molars: A Case Report with 3-year Follow-Up. Case Rep Dent 2022; 2022:8143765. [DOI: 10.1155/2022/8143765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/16/2022] [Accepted: 10/22/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction. This report is the first to present a case with 3-year follow-up, in which sinus floor elevation was performed before extraction of periodontally hopeless teeth, in order to shorten the edentulous interval between extraction and loading of implants and improve the patient’s quality of life. Case Presentation. After a series of initial and supportive periodontal therapies, the lateral window was created at the apices of the hopeless teeth, followed by grafting of bone substitute and membrane material at the sinus floor. The tooth was preserved for 13 months prior to extraction followed by immediate implant placement. The patient is satisfied with the oral function partially retained during the treatment period. Predominance of new bone was detected by histologic analysis. The available bone height was augmented from 1–2 to 12–14 mm with little resorption (less than 2 mm of height) after 3 years of follow-up. The dental implant is in good condition without obvious signs of peri-implantitis or mobility after 3 years of loading. Discussion. The feasibility of modified sinus floor elevation (MSFE) could be seen in the current case. The potential benefit of MSFE may include shortening the edentulous interval, facilitating bone regeneration, and providing a chance for immediate implant placement. However, further clinical case evaluations and controlled studies are required to determine indications, effectiveness, and safety of such augmentation procedures.
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Sarafidou K, Lazaridi I, Gotsis S, Kirmanidou Y, Vasilaki D, Hirayama H, Michalakis K. Tooth preservation vs. extraction and implant placement in periodontally compromised patients: A systematic review and analysis of studies. J Prosthodont 2022; 31:e87-e99. [PMID: 35794083 DOI: 10.1111/jopr.13560] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/11/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The aim of this systematic review was to identify studies with a minimum of 5-years follow-up, reporting on the management of periodontally compromised teeth with either extraction and subsequent implant placement or teeth preservation with conventional periodontal treatment and application of regenerative procedures. The outcomes of these two approaches, based on clinical and radiographic data and the incidence of tooth- and implant-loss, were also investigated. MATERIAL AND METHODS A systematic search for studies reporting on clinical and radiographic outcomes of periodontal treatment or replacement of periodontally compromised teeth with implants was conducted in 3 electronic databases, followed by a hand-search in 8 journals. Only randomized controlled trials (RCTs), cohort studies, and case series with prospective design were included. RESULTS The initial search resulted in 1080 papers. After the first two screenings, 24 publications were selected for inclusion in this systematic review. The treatment protocols for the teeth preservation group contained nonsurgical and/or surgical periodontal treatment with or without regeneration procedures. The implant studies included extraction of periodontally involved teeth and implant placement with or without bone and soft tissue augmentation, followed by restoration with fixed dental prostheses (FDPs). Survival rates ranged between 81.8% and 100% in the tooth retention group, and between 94.8% and 100% in the implant group. In the extraction group, no complications were reported for 76.09% of the implants. Similarly, no complications were reported for 86.83% of the tooth retention group. The lack of standardized comparable studies prohibited conduction of a metaanalysis. CONCLUSION Both treatment approaches, treatment of periodontally compromised teeth, or tooth extraction followed by implant placement, present high survival rates. The application of bone regeneration techniques improves the long-term prognosis of periodontally involved teeth. Hence, treatment of periodontally involved teeth with subsequent application of a rigorous maintenance protocol can be a viable alternative for a number of years, before proceeding to extraction and replacement with dental implants. More well-designed randomized controlled trials are needed in order to draw definite conclusions on the subject.
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Affiliation(s)
- Katia Sarafidou
- Department of Prosthodontics, Aristotle University of Thessaloniki, Faculty of Health Sciences, School of Dentistry, Thessaloniki, Greece
| | - Ioanna Lazaridi
- Division of Regenerative Dentistry and Periodontology, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Sotirios Gotsis
- Graduate and Postgraduate Prosthodontics, Tufts University School of Dental Medicine, Boston, MA, USA
| | - Yvoni Kirmanidou
- Private Practice limited to Prosthodontics, Thessaloniki, Greece
| | - Dimitra Vasilaki
- Private Practice limited to Prosthodontics, Thessaloniki, Greece
| | - Hiroshi Hirayama
- Department of Restorative Sciences and Biomaterials, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA
| | - Konstantinos Michalakis
- Department of Restorative Sciences and Biomaterials, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
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Cárcamo-España V, Cuesta Reyes N, Flores Saldivar P, Chimenos-Küstner E, Estrugo Devesa A, López-López J. Compromised Teeth Preserve or Extract: A Review of the Literature. J Clin Med 2022; 11:jcm11185301. [PMID: 36142946 PMCID: PMC9504015 DOI: 10.3390/jcm11185301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 12/03/2022] Open
Abstract
Multiple systems and associated factors have been described in the literature to assess the prognosis of teeth with periodontal disease. Nowadays there is a tendency among clinicians to consider implants as the best solution after tooth extraction, in cases of teeth with a questionable prognosis. However, the value of the natural tooth must be considered, as the proprioception of the periodontal ligament is preserved, and it adapts to stress during functional loads. We first review the literature focusing on analyzing the factors that should guide decision-making to maintain or extract a tooth with a compromised periodontium. Then, we propose a schematic diagram of prognostic indicators to reflect the main factors to consider and the survival rate that each one represents when preserving or extracting a tooth.
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Affiliation(s)
- Valentina Cárcamo-España
- Department of Oral Medicine, Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona Dental Hospital, University of Barcelona, 08907 Barcelona, Spain
- Correspondence: (V.C.-E.); or (J.L.-L.); Tel.: +34-606-45-73-62 (J.L.-L.)
| | - Nataly Cuesta Reyes
- Department of Oral Medicine, Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona Dental Hospital, University of Barcelona, 08907 Barcelona, Spain
| | - Paul Flores Saldivar
- Department of Oral Medicine, Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona Dental Hospital, University of Barcelona, 08907 Barcelona, Spain
| | - Eduardo Chimenos-Küstner
- Department of Odontostomatology and Oral Medicine, Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona Dental Hospital, University of Barcelona, 08907 Barcelona, Spain
| | - Alberto Estrugo Devesa
- Department of Odontostomatology and Oral Medicine, Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona Dental Hospital, University of Barcelona, 08907 Barcelona, Spain
| | - José López-López
- Department of Odontostomatology and Oral Medicine, Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona Dental Hospital, University of Barcelona, 08907 Barcelona, Spain
- Correspondence: (V.C.-E.); or (J.L.-L.); Tel.: +34-606-45-73-62 (J.L.-L.)
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Tomasi C, Albouy JP, Schaller D, Navarro RC, Derks J. Efficacy of rehabilitation of stage IV periodontitis patients with full-arch fixed prostheses: Tooth-supported versus Implant-supported-A systematic review. J Clin Periodontol 2021; 49 Suppl 24:248-271. [PMID: 34761430 DOI: 10.1111/jcpe.13511] [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: 01/04/2021] [Revised: 04/29/2021] [Accepted: 05/25/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To evaluate the efficacy of implant-supported in comparison to tooth-supported full-arch prostheses in patients with stage IV periodontitis. MATERIALS AND METHODS Systematic electronic search (CENTRAL/MEDLINE/SCOPUS) up to March 2020 was conducted to identify randomized controlled trials and cohort-like studies comparing/evaluating fixed full-arch rehabilitation on teeth or implants in patients with stage IV periodontitis. The primary outcome measure was loss of teeth/implants and restorations. Data extraction was performed to create evidence tables, and meta-analyses were carried out as appropriate. RESULTS A total of 26 studies (31 publications) were identified but none addressed the scientific question in a controlled and randomized design. The risk of bias throughout the included studies was judged to be high, and meta-analyses demonstrated a high degree of heterogeneity. Mean-weighted observation periods in studies on tooth-supported restorations were significantly longer than in studies on implant-supported restorations. The predicted loss of teeth and tooth-supported full-arch restorations over 10 years was 1% and 5%, respectively. The 15-year estimates were 10% and 13%. Corresponding predictions for implants and implant-supported restorations for 10 years amounted to 4% and 6%, respectively. Technical complications were the most commonly reported and affected 8% of tooth-supported restorations (during 7.2 years) and 42% of implant-supported structures (during 2.6 years). Peri-implantitis- or peri-implantitis-like symptoms were observed at an estimated 9% of implants (after 3.1 years). CONCLUSIONS Based on observational studies on full-arch rehabilitation of stage IV periodontitis patients, 10-year estimates of tooth loss were lower than the corresponding estimates for implants. Estimated loss of tooth- and implant-supported restorations at 10 years was similar. Technical complications were more prevalent at implant-supported when compared to tooth-supported restorations.
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Affiliation(s)
- Cristiano Tomasi
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jean-Pierre Albouy
- Division of Comprehensive Oral Health, Department of Prosthodontics, Adams School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Dennis Schaller
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Renata Camino Navarro
- Division of Comprehensive Oral Health, Department of Prosthodontics, Adams School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Pontons-Melo JC, Garcia IM, Melo MA, Collares FM. Single-Tooth Rehabilitation Combining Root Displacement and Crown Lengthening Two-Year Follow-Up: A Case Report. Oper Dent 2021; 46:246-254. [PMID: 34242393 DOI: 10.2341/20-110-s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2020] [Indexed: 11/23/2022]
Abstract
CLINICAL RELEVANCE Combined techniques to expose circumferential tooth structure associated with subsequent restoration may represent a valid option in many situations. This case provides an example of the successful management of the anterior tooth rehabilitation combining root displacement and crown lengthening. SUMMARY Rehabilitation of an extensively compromised single anterior tooth represents an intriguing challenge for dentists, particularly when the rehabilitation involves esthetic, psychosocial, and functional requirements. The success in rehabilitating a patient with a conservative approach depends on a critical evaluation of the remaining structures, precise treatment plan, systematic treatment strategies, and patient compliance. In this case, the patient's chief complaint was the undesirable appearance of the maxillary right lateral, caused by the displacement of the post and crown. Clinical examination revealed a remaining tooth with coronal fracture, severe loss of tissue due to caries, and absence of ferrule effect. Radiographic examination revealed that the fracture margin was located subgingival. This case report describes a single-tooth rehabilitation involving a combination of root displacement via orthodontic extrusion and crown lengthening. The rehabilitation was followed by post-and-core restoration using a prefabricated glass fiber post associated with a disilicate lithium crown. The clinical decision making and combined effect of both treatment strategies are explained in this report. The treatment required three months, including recovery times after surgery and the placement of the provisional crown. The patient was esthetically and functionally satisfied with the restoration. Patient follow-up examination was performed 24 months after the treatment. This clinical report contributes to the clinical practice and exemplifies the possibility of rehabilitating the natural tooth using combined techniques, which may offer particular advantages regarding prognosis and invested efforts.
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Yue Z, Liu Q, Zhang H, Yang J, Hou J. Histological, radiological, and clinical outcomes of sinus floor elevation using a lateral approach for pre-/post-extraction of the severely compromised maxillary molars: a study protocol for a randomized controlled trial. Trials 2021; 22:101. [PMID: 33509257 PMCID: PMC7844904 DOI: 10.1186/s13063-021-05047-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 01/16/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The volume of residual alveolar bone is critical to the survival of dental implants. When the volume of alveolar bone in the posterior maxillary region is less than 4 mm, maxillary sinus floor elevation (MSFE) with the lateral approach is an effective option. Traditionally, this standard approach is usually conducted at 4-6 months after tooth extraction (standard MSFE). However, defective dentition due to extraction can impair mastication during the period of bone remodeling, especially if the molars on both sides are severely compromised and must be extracted. MSFE before extraction (modified MSFE) can take full advantage of residual tooth strength. However, the effectiveness and practicability of the modified MSFE procedure remain unknown. Therefore, the aim of this study was to compare the clinical outcomes of modified vs. standard MSFE, in order to provide references to periodontists. METHODS/DESIGN The study cohort included 25 adult patients (50 surgery sites) recruited from Peking University Hospital and School of Stomatology who met the inclusion criteria. The two sides of each patient will be randomly divided into two groups: a test group-modified MSFE or a control group-standard MSFE. The surgical duration and patient-reported outcomes (visual analog scale for discomfort) will be documented. Clinical indicators, including implant survival rates, mucosal conditions, and complications, will be recorded every 6 months during the 5-year follow-up period. The volume of the alveolar bone and marginal bone level will be assessed radiographically (cone-beam CT and periapical films) every 6 months. Histological analysis of biopsy samples retrieved from both sides will be performed to evaluate the biological features of the bone. DISCUSSION The current study will explore the implant survival rates, safety, reliability, effectiveness, and practicability of the modified MSFE procedure. Moreover, the extent of osteogenesis on the sinus floor will also be assessed. The results of this trial will provide strategies for the modified MSFE procedure to achieve ideal clinical outcomes. TRIAL REGISTRATION International Clinical Trials Registry Platform ChiCTR1900020648 . Registered on 1 January 2019.
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Affiliation(s)
- Zhaoguo Yue
- Department of Periodontology, Peking University Hospital and School of Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, China
- National Clinical Research Center for Oral Diseases, Peking University Hospital and School of Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University Hospital and School of Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, China
- Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, China
| | - Qi Liu
- BYBO Dental Hospital, Qinian Street, Dongcheng District, Beijing, 100062, China
| | - Haidong Zhang
- Department of Periodontology, Peking University Hospital and School of Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, China
- National Clinical Research Center for Oral Diseases, Peking University Hospital and School of Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University Hospital and School of Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, China
- Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, China
| | - Jingwen Yang
- National Clinical Research Center for Oral Diseases, Peking University Hospital and School of Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University Hospital and School of Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, China
- Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, China
- Department of Prosthetics, Peking University Hospital and School of Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, China
| | - Jianxia Hou
- Department of Periodontology, Peking University Hospital and School of Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, China.
- National Clinical Research Center for Oral Diseases, Peking University Hospital and School of Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, China.
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University Hospital and School of Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, China.
- Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, China.
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Maria GP, Vitelli C, Dian A, Radaelli K, Basso M. Single Tooth Prosthetic Restoration Through Surgical Crown Lengthening, Conservative Therapies and CAD-CAM Milled Restoration in Lithium-Disilicate. A Case Report. Acta Stomatol Croat 2020; 53:371-378. [PMID: 32099263 PMCID: PMC6993475 DOI: 10.15644/asc53/4/8] [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] [Indexed: 11/21/2022] Open
Abstract
Objective The restorative treatment of a decayed, non-vital upper premolar often requires an interdisciplinary approach. Esthetics and the entity of the masticatory loads are usually affecting the choice of procedures and materials. A conservative treatment in a case with esthetic needs and functional requirements is investigated in this case report. Materials and methods A case of a 45- year- old woman with a severely decayed upper premolar is presented. The tooth has been previously treated in an emergency department with a provisional endodontic medication, but a further treatment has been then performed. The tooth was painful at the moment of the visit and the carious lesion appeared to invade the subgingival level. A surgical-conservative approach has been selected involving crown lengthening, endodontic treatment and a prosthetic crown with a monolithic Lithium-Silicate. Results The rehabilitative process required 3 months, including maturation times after surgery and the placement of the provisional crown. The patient claimed to be both esthetically and functionally satisfied with the restoration. Conclusion A conservative treatment of a severely involved tooth requires a critical evaluation of the remaining structures and a precise selection of the restorative materials. A monolithic crown could represent an ideal solution for restoring an upper premolar requiring esthetics and solid function, but the choice of a high translucent, easily polishable and possibly even chair-side prosthetic material might be an appreciable added value for clinicians.
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Affiliation(s)
- Giulia Pulcini Maria
- Centre of Minimally Invasive, Aesthetic and Digital Oral Rehabilitation (CROMED), IRCCS Galeazzi Orthopedic Institute, Dental Clinic, University of Milan, Italy
| | - Carlo Vitelli
- Dental student, Centre of Minimally Invasive, Aesthetic and Digital Oral Rehabilitation (CROMED), IRCCS Galeazzi Orthopedic Institute, Dental Clinic, University of Milan, Italy
| | - Arturo Dian
- Centre of Minimally Invasive, Aesthetic and Digital Oral Rehabilitation (CROMED), IRCCS Galeazzi Orthopedic Institute, Dental Clinic, University of Milan, Italy
| | - Katherine Radaelli
- MSc student, Centre of Minimally Invasive, Aesthetic and Digital Oral Rehabilitation (CROMED), IRCCS Galeazzi Orthopedic Institute, Dental Clinic, University of Milan, Italy
| | - Matteo Basso
- Centre of Minimally Invasive, Aesthetic and Digital Oral Rehabilitation (CROMED), IRCCS Galeazzi Orthopedic Institute, Dental Clinic, University of Milan, Italy
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Long-Term Outcomes of Tooth-Implant-Supported Rehabilitation of Periodontally Compromised and Treated Patients Refusing Bone Grafting Surgical Therapies. IMPLANT DENT 2019; 28:528-536. [PMID: 31219945 DOI: 10.1097/id.0000000000000847] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the long-term incidence of complications in abutment teeth and dental implants in periodontally treated and maintained patients, refusing bone grafting surgical therapies, rehabilitated with full-arch telescopic-retained retrievable prostheses (TRPs) and full-arch fixed prosthesis (FPs), both supported by teeth-implants combination. MATERIALS AND METHODS After active periodontal therapy, 18 patients were rehabilitated with full-arch TRPs, whereas 17 patients were rehabilitated with full-arch FPs. Patients were annually evaluated for technical and/or biological failures/complications. RESULTS During the 15-year observation period, 6 of 164 (3.6%) implants failed and 19 of 233 teeth were extracted (9.2%) in the TRPs group, whereas 6 of 152 (3.9%) implants failed and 23 of 221 (10.4%) abutment teeth were extracted in the FPs group. Differences in implant failures and abutment teeth loss between the 2 groups were not statistically significant. In both the groups, Cox regressions identified significant difference (P < 0.05) for mean initial bone loss, aggressive periodontitis, and smoking, as factors contributing to tooth loss and implant failures in general. CONCLUSION In periodontally treated patients, refusing bone grafting surgical therapies, rehabilitated with full-arch TRPs and full-arch fixed prostheses, both supported by teeth-implants connection, high survival rates can be expected if regular supportive periodontal therapy had been performed.
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Ashnagar S, Barootchi S, Ravidá A, Tattan M, Wang HL, Wang CW. Long-term survival of structurally compromised tooth preserved with crown lengthening procedure and restorative treatment: A pilot retrospective analysis. J Clin Periodontol 2019; 46:751-757. [PMID: 31050812 DOI: 10.1111/jcpe.13124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/11/2019] [Accepted: 04/29/2019] [Indexed: 12/27/2022]
Abstract
AIM Since there is limited study to assist in an evidenced-based decision whether to extract or preserve a structurally compromised tooth, the aim of this retrospective study was to investigate the long-term survival rate of tooth preservation after crown lengthening procedure (CLP) and restorative treatments. METHODS Electronic and paper chart of patients received CLP in our graduate clinic from 1990 to 2015 were reviewed. Statistical analysis was done using Cox regression analysis and Kaplan-Meier estimator. RESULTS A total of 766 coded charts were initially collected. Four hundred and fourteen cases were included in the final analysis. The Kaplan-Meier estimate shows a cumulative survival rate of 88.3% in 5 years, 78.4% in 10 years and 68.1% in 15 years. In terms of reasons for failure, restorative problem such as recurrent decays was the main issue (35.2%), followed by fracture (29.6%), endodontic complications (23.9%) and periodontal breakdown (11.3%). CONCLUSIONS Within the limitation of this study, structurally compromised teeth have a reasonable long-term survival rate close to 80% after 10 years in a teaching institute. Patients with high fracture or caries risk may pose a higher chance of failure. Objective information should be presented to the patient to arrive at an evidence-based decision.
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Affiliation(s)
- Sajjad Ashnagar
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan
| | - Shayan Barootchi
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan
| | - Andrea Ravidá
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan
| | - Mustafa Tattan
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan
| | - Chin-Wei Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan
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Quaranta A. The law of dental implant. MINERVA STOMATOLOGICA 2018; 68:1-2. [PMID: 30547510 DOI: 10.23736/s0026-4970.18.04218-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Alessandro Quaranta
- School of Dentistry and Oral Health, Griffith University, Southport, Australia -
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Schwendicke F, Schmietendorf E, Plaumann A, Sälzer S, Dörfer CE, Graetz C. Validation of multivariable models for predicting tooth loss in periodontitis patients. J Clin Periodontol 2018; 45:701-710. [DOI: 10.1111/jcpe.12900] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Falk Schwendicke
- Department of Operative and Preventive Dentistry; Charité University of Berlin; Berlin Germany
| | - Elisa Schmietendorf
- Clinic of Conservative Dentistry and Periodontology; University of Kiel; Kiel Germany
| | - Anna Plaumann
- Clinic of Conservative Dentistry and Periodontology; University of Kiel; Kiel Germany
| | - Sonja Sälzer
- Clinic of Conservative Dentistry and Periodontology; University of Kiel; Kiel Germany
| | - Christof E. Dörfer
- Clinic of Conservative Dentistry and Periodontology; University of Kiel; Kiel Germany
| | - Christian Graetz
- Clinic of Conservative Dentistry and Periodontology; University of Kiel; Kiel Germany
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Implant and root canal treatment: Survival rates and factors associated with treatment outcome. J Dent 2018; 71:61-66. [PMID: 29499242 DOI: 10.1016/j.jdent.2018.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 02/16/2018] [Accepted: 02/26/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To assess and compare the survival rates of implant and root canal treatment as well as to investigate the effect of patient and tooth related variables on the treatment outcome in a large-scale population-based study. METHODS Dental records of patients who received root canal treatment and implant therapy were retrieved from the electronic records of the University of Minnesota School of Dentistry. Demographic characteristics, dental insurance status, socioeconomic status as well as medical history and tobacco use were recorded. The treatment outcome was included as a binary variable (survival/failure). RESULTS A total of 13,434 records of patients who had implant (33.6%) or root canal therapy (66.4%) were included. The survival rate analysis and Kaplan-Meier table revealed the majority of the implants were removed within the first year (58.8%), while only 35.2% of the root canal treatments failed in the same time period. The overall survival rate was significantly (p < 0.001) higher for implant therapy (98.3%) compared to root canal treatment (72.7%). A statistically significant association was found between treatment (p <n0.001), age (p < 0.001) and anxiety (p = 0.004) with treatment outcome CONCLUSIONS: Implant therapy exhibited significantly lower failures when compared to root canal treatment, but the selection of either treatment should be based on multiple factors. Higher age and anxiety were also significantly associated with root canal and implant treatment failure. CLINICAL SIGNIFICANCE Clinicians are in an increased dilemma that affects the decision-making process due to the inadequate evidence in regards to the question of retention or extraction of a tooth in the natural dentition. This study demonstrated that both root canal and implant treatments are sound options with high survival rates; however, root canal therapy exhibited a significantly higher failure rate.
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Hertel M, Roh YC, Neumann K, Strietzel FP. Premature exposure of dental implant cover screws. A retrospective evaluation of risk factors and influence on marginal peri-implant bone level changes. Clin Oral Investig 2016; 21:2109-2122. [PMID: 27838845 DOI: 10.1007/s00784-016-2001-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 11/01/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objectives of this study were to identify risk factors associated with the premature cover screw exposure (pCSE) at dental implants and to evaluate the influence of a pCSE on peri-implant marginal bone level (MBL) change compared to non-exposed implants. MATERIALS AND METHODS Retrospective data assessment from 165 patients (mean age = 54.0 ± 14.4 years) who received 395 submerged implants included demographic, health-related, and therapeutic variables which were analyzed for their respective impact. MBL change was detected at digital radiographs obtained from first- and second-stage surgeries. RESULTS pCSE were detected in 43 patients (26.1%) and 53 implants (13.4%). An increased frequency of exposure was significantly associated with (I) male gender (p = 0.012) at patient level and (II) the posterior region of the jaws (p = 0.005), implant systems with platform-matching cover screws, and a vertical distance of ≥0.5 mm between bone crest and the implant platform (both p < 0.001) at implant level. The decrease in mesial, distal, and total MBL differed significantly (mean total = 0.8 ± 0.7 vs. 0.3 ± 0.5; mean mesial = 0.8 ± 0.8 vs. 0.3 ± 0.6; mean distal = 0.8 ± 0.8 vs. 0.3 ± 0.6 mm; p < 0.001) between non-exposed and pCSE implants. CONCLUSIONS Male patients, implants with platform-matched cover screws, or when placed supracrestally or in posterior sites revealed significantly more pCSE, resulting in significantly decreased peri-implant MBL compared with non-exposed implants. CLINICAL RELEVANCE Patients with an enhanced risk of pCSE should follow frequent regular recalls during the healing period to enable for early diagnosis and intervention.
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Affiliation(s)
- Moritz Hertel
- Department of Oral Medicine, Dental Radiology, and Oral Surgery, Charité-Universitätsmedizin Berlin, Assmanshauser Str. 4-6, 14197, Berlin, Germany.
| | - Yun-Chie Roh
- Department of Oral Medicine, Dental Radiology, and Oral Surgery, Charité-Universitätsmedizin Berlin, Assmanshauser Str. 4-6, 14197, Berlin, Germany
| | - Konrad Neumann
- Institute of Medical Biometrics and Clinical Epidemiology, Charite-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Frank Peter Strietzel
- Department of Oral Medicine, Dental Radiology, and Oral Surgery, Charité-Universitätsmedizin Berlin, Assmanshauser Str. 4-6, 14197, Berlin, Germany
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Diamantatou T, Kotina E, Roussou I, Kourtis S. Treatment Options for Anterior Teeth with Questionable Prognosis: Critical Factors in Determining Whether to Maintain or Extract. J ESTHET RESTOR DENT 2016; 28:157-70. [PMID: 27142845 DOI: 10.1111/jerd.12214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
UNLABELLED Implants nowadays have conquered the majority of prosthetic restorations in the everyday clinical practice. As a result there has been a tendency among many clinicians to believe that implant therapy is the best solution in every clinical case, even if extraction of natural tooth with questionable prognosis is necessary. The value of natural teeth has been recently reconsidered. An implant not placed under ideal circumstances, may lead to a compromised result especially in the anterior maxillary region. Conversely natural teeth, even in a compromised clinical condition, maintain proprioception and can be adapted to the stresses of functional loading. The most demanding task in daily clinical practice is the treatment plan. The role of the clinician is more complicated for the anterior teeth where the patient's expectations and the esthetic criteria complicate the objective way of thinking. Therefore, a frequent dilemma in dental practice is whether to maintain an anterior tooth with a questionable prognosis or to extract it and replace it with an implant. The aim of this article is to approach the dilemma of extraction or maintenance of anterior teeth with a questionable prognosis through a series of clinical cases focusing on the factors that should be taken under consideration. CLINICAL SIGNIFICANCE Dental implants offer increased possibilities in the restoration of the anterior maxillary teeth. In specific clinical cases however a satisfying clinical result can be achieved by maintaining the existing natural teeth even if they have a questionable prognosis and a more complicated treatment plan may be needed. (J Esthet Restor Dent, 2016).
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Affiliation(s)
- Theodora Diamantatou
- Post-Graduate Student, Department of Prosthodontics, Dental School, National and Kapodestrian University of Athens, Greece
| | - Elli Kotina
- Post-Graduate Student, Department of Prosthodontics, Dental School, National and Kapodestrian University of Athens, Greece
| | - Ilia Roussou
- Lecturer in Department of Prosthodontics, National and Kapodestrian University of Athens, Greece
| | - Stefanos Kourtis
- Associate Professor, Department of Prosthodontics, National and Kapodestrian University of Athens, Greece
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17
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Nonsurgical periodontal therapy to treat a case of severe periodontitis. J Am Dent Assoc 2015; 146:631-637. [DOI: 10.1016/j.adaj.2015.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 02/10/2015] [Accepted: 02/18/2015] [Indexed: 11/23/2022]
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Teughels W, Dhondt R, Dekeyser C, Quirynen M. Treatment of aggressive periodontitis. Periodontol 2000 2014; 65:107-33. [PMID: 24738589 DOI: 10.1111/prd.12020] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2012] [Indexed: 12/12/2022]
Abstract
Despite etiological differences between aggressive and chronic periodontitis, the treatment concept for aggressive periodontitis is largely similar to that for chronic periodontitis. The goal of treatment is to create a clinical condition that is conducive to retaining as many teeth as possible for as long as possible. When a diagnosis has been made and risk factors have been identified, active treatment is commenced. The initial phase of active treatment consists of mechanical debridement, either alone or supplemented with antimicrobial drugs. Scaling and root planing has been shown to be effective in improving clinical indices, but does not always guarantee long-term stability. Antimicrobials can play a significant role in controlling aggressive periodontitis. Few studies have been published on this subject for localized aggressive periodontitis, but generalized aggressive periodontitis has been subject to more scrutiny. Studies have demonstrated that systemic antibiotics as an adjuvant to scaling and root planing are more effective in controlling disease compared with scaling and root planing alone or with supplemental application of local antibiotics or antiseptics. It has also become apparent that antibiotics ought to be administered with, or just after, mechanical debridement. Several studies have shown that regimens of amoxicillin combined with metronidazole or regimens of clindamycin are the most effective and are preferable to regimens containing doxycycline. Azithromycin has been shown to be a valid alternative to the regimen of amoxicillin plus metronidazole. A limited number of studies have been published on surgical treatment in patients with aggressive periodontitis, but the studies available show that the effect can be comparable with the effect on patients with chronic periodontitis, provided that proper oral hygiene is maintained, a strict maintenance program is followed and modifiable risk factors are controlled. Both access surgery and regenerative techniques have shown good results in patients with aggressive periodontitis. Once good periodontal health has been obtained, patients must be enrolled in a strict maintenance program that is directed toward controlling risk factors for disease recurrence and tooth loss. The most significant risk factors are noncompliance with regular maintenance care, smoking, high gingival bleeding index and poor plaque control. There is no evidence to suggest that daily use of antiseptic agents should be part of the supportive periodontal therapy for aggressive periodontitis.
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Pegoraro LF, do Valle AL, Pegoraro TA, Corotti KMV, Vidotti HA. Resolution of complex esthetic problems in abnormal anterior teeth: a clinical report. J Prosthet Dent 2014; 112:94-8. [PMID: 24445025 DOI: 10.1016/j.prosdent.2013.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 10/06/2013] [Accepted: 10/14/2013] [Indexed: 10/25/2022]
Abstract
A conservative treatment is presented for a patient with complex severe esthetic problems related to the presence of anomalous teeth. The patient showed a rare occurrence of macrodontia of the maxillary right lateral incisor and microdontia of the maxillary left lateral incisor. The treatment plan was conservative to avoid tooth extraction, periodontal tissue trauma, and the risk of an unpredictable esthetic outcome. A multidisciplinary treatment involving orthodontic extrusion, endodontic therapy, periodontal therapy, and minimally invasive restorations was performed. A successful outcome was observed after a 2-year follow-up.
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Affiliation(s)
- Luiz F Pegoraro
- Professor, Department of Prosthodontics, University of São Paulo Bauru School of Dentistry, São Paulo, Brazil
| | - Accácio L do Valle
- Professor, Department of Prosthodontics, University of São Paulo Bauru School of Dentistry, São Paulo, Brazil
| | - Thiago A Pegoraro
- Assistant Professor, Department of Prosthodontics, School of Dentistry, University of Sagrado Coração, Bauru, Brazil
| | - Karyna M V Corotti
- Associate Professor, Postgraduate Program, City University of São Paulo, São Paulo, Brazil
| | - Hugo A Vidotti
- Doctoral student, Department of Prosthodontics, University of São Paulo Bauru School of Dentistry, São Paulo, Brazil.
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20
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Setzer FC, Kim S. Comparison of long-term survival of implants and endodontically treated teeth. J Dent Res 2013; 93:19-26. [PMID: 24065635 DOI: 10.1177/0022034513504782] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The outcomes of both dental implants and endodontically treated teeth have been extensively studied. However, there is still a great controversy over when to keep a natural tooth and when to extract it for a dental implant. This article reviews the benefits and disadvantages of both treatment options and discusses success vs. survival outcomes, as well as the impact of technical advances for modern endodontics and endodontic microsurgery on the long-term prognosis of tooth retention.
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Affiliation(s)
- F C Setzer
- University of Pennsylvania, Philadelphia, PA, USA
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21
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Bravo F, Castro Y, Grados S. Factores de riesgo y periimplantitis en la terapia implantológica. Revisión narrativa. JOURNAL OF ORAL RESEARCH 2013. [DOI: 10.17126/joralres.2013.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Roccuzzo M, Bonino L, Dalmasso P, Aglietta M. Long-term results of a three arms prospective cohort study on implants in periodontally compromised patients: 10-year data around sandblasted and acid-etched (SLA) surface. Clin Oral Implants Res 2013; 25:1105-12. [PMID: 23865554 DOI: 10.1111/clr.12227] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to compare the long-term outcomes of sandblasted and acid-etched (SLA) implants in patients previously treated for periodontitis and in periodontally healthy patients (PHP). MATERIAL AND METHODS One hundred and forty-nine partially edentulous patients were consecutively enrolled in private specialist practice and divided into three groups according to their periodontal condition: PHP, moderately periodontally compromised patients (PCP) and severely PCP. Implants were placed to support fixed prostheses, after successful completion of initial periodontal therapy. At the end of active periodontal treatment (APT), patients were asked to follow an individualized supportive periodontal therapy (SPT) program. Diagnosis and treatment of peri-implant biological complications were performed according to cumulative interceptive supportive therapy (CIST). At 10 years, clinical and radiographic measures were recorded by two calibrated operators, blind to the initial patient classification, on 123 patients, as 26 were lost to follow up. The number of sites treated according to therapy modalities C and D (antibiotics and/or surgery) during the 10 years was registered. RESULTS Six implants were removed for biological complications. The implant survival rate was 100% for PHP, 96.9% for moderate PCP and 97.1% for severe PCP. Antibiotic and/or surgical therapy was performed in 18.8% of cases in PHP, in 52.2% of cases in moderate PCP and in 66.7% cases in severe PCP, with a statistically significant differences between PHP and both PCP groups. At 10 years, the percentage of implants, with at least one site that presented a PD ≥ 6 mm, was, respectively, 0% for PHP, 9.4% for moderate PCP and 10.8% for severe PCP, with a statistically significant difference between PHP and both PCP groups. CONCLUSIONS This study shows that SLA implants, placed under a strict periodontal control, offer predictable long-term results. Nevertheless, patients with a history of periodontitis, who did not fully adhere to the SPT, presented a statistically significant higher number of sites that required additional surgical and/or antibiotic treatment. Therefore, patients should be informed, from the beginning, of the value of the SPT in enhancing long-term outcomes of implant therapy, particularly those affected by periodontitis.
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Affiliation(s)
- Mario Roccuzzo
- Department of Maxillofacial Surgery, University of Torino, Torino, Italy; Private Practice, Torino, Italy
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Graetz C, Schwendicke F, Kahl M, Dörfer CE, Sälzer S, Springer C, Schützhold S, Kocher T, König J, Rühling A. Prosthetic rehabilitation of patients with history of moderate to severe periodontitis: a long-term evaluation. J Clin Periodontol 2013; 40:799-806. [DOI: 10.1111/jcpe.12124] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2013] [Indexed: 12/22/2022]
Affiliation(s)
- Christian Graetz
- Clinic of Conservative Dentistry and Periodontology; University of Kiel; Kiel Germany
| | - Falk Schwendicke
- Clinic of Conservative Dentistry and Periodontology; University of Kiel; Kiel Germany
| | - Maren Kahl
- Clinic of Conservative Dentistry and Periodontology; University of Kiel; Kiel Germany
| | - Christof E. Dörfer
- Clinic of Conservative Dentistry and Periodontology; University of Kiel; Kiel Germany
| | - Sonja Sälzer
- Clinic of Conservative Dentistry and Periodontology; University of Kiel; Kiel Germany
| | - Claudia Springer
- Clinic of Conservative Dentistry and Periodontology; University of Kiel; Kiel Germany
| | - Svenja Schützhold
- Unit of Periodontology, School of Dentistry; University of Greifswald; Greifswald Germany
| | - Thomas Kocher
- Unit of Periodontology, School of Dentistry; University of Greifswald; Greifswald Germany
| | - Jörgen König
- Folktandvården Kalmar län; Parodontologi Kalmar; Kalmar Sweden
| | - Andreas Rühling
- Clinic of Conservative Dentistry and Periodontology; University of Kiel; Kiel Germany
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Abstract
Periodontitis is a complex infectious disease that affects low-income individuals disproportionately. Periodontitis is associated with specific bacterial species and herpesviruses, and successful prevention and treatment of the disease is contingent upon effective control of these pathogens. This article presents an efficacious, highly safe, minimally invasive, practical and low-cost periodontal therapy that involves professional and patient-administered mechanical therapy and antimicrobial agents. The major components are scaling for calculus removal, periodontal pocket irrigation with potent antiseptics, and treatment with systemic antibiotics for advanced disease. Povidone-iodine and sodium hypochlorite have all the characteristics for becoming the first-choice antiseptics in the management of periodontal diseases. Both agents show excellent antibacterial and antiviral properties, are readily available throughout the world, have been safely used in periodontal therapy for decades, offer significant benefits for individuals with very limited financial resources, and are well accepted by most dental professionals and patients. Four per cent chlorhexidine applied with a toothbrush to the most posterior part to the tongue dorsum can markedly reduce or eliminate halitosis in most individuals. Systemic antibiotics are used to treat periodontopathic bacteria that are not readily reached by topical therapy, such as pathogens within gingival tissue, within furcation defects, at the base of periodontal pockets, and on the tongue, tonsils and buccal mucosae. Valuable antibiotic therapies are amoxicillin-metronidazole (250 mg of amoxicillin and 250 mg of metronidazole, three times daily for 8 days) for young and middle-aged patients, and ciprofloxacin-metronidazole (500 mg of each, twice daily for 8 days) for elderly patients and for patients in developing countries who frequently harbor enteric rods subgingivally. Scaling to remove dental calculus and the prudent use of inexpensive antimicrobial agents can significantly retard or arrest progressive periodontitis in the great majority of patients.
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25
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Lang-Hua BH, McGrath CPJ, Lo ECM, Lang NP. Factors influencing treatment decision-making for maintaining or extracting compromised teeth. Clin Oral Implants Res 2013; 25:59-66. [PMID: 23517053 DOI: 10.1111/clr.12142] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2013] [Indexed: 12/31/2022]
Affiliation(s)
- Bich Hue Lang-Hua
- Prince Philip Dental Hospital; The University of Hong Kong; Hong Kong SAR China
| | | | - Edward C. M. Lo
- Prince Philip Dental Hospital; The University of Hong Kong; Hong Kong SAR China
| | - Niklaus P. Lang
- Prince Philip Dental Hospital; The University of Hong Kong; Hong Kong SAR China
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Donos N, Laurell L, Mardas N. Hierarchical decisions on teeth vs. implants in the periodontitis-susceptible patient: the modern dilemma. Periodontol 2000 2012; 59:89-110. [PMID: 22507062 DOI: 10.1111/j.1600-0757.2011.00433.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
It is estimated that advanced periodontitis typically affects about 10% of most adult populations studied. These individuals can be considered highly susceptible to periodontitis and often present difficulties for clinicians in therapeutic decision making, especially when dental implants are involved. Poor plaque control and smoking are well established risk factors for periodontitis, as well as for peri-implant disease. Long-term follow-up studies have clearly demonstrated that treatment of periodontal disease, even if advanced, can be successful in arresting disease progression and preventing (or at least significantly delaying) tooth loss. With the increasing development of implant dentistry, traditional well documented and evidence-based therapies to treat periodontal diseases may sometimes not be used to their full potential. Instead, there appears to be an increasing tendency to extract periodontally compromised teeth and replace them with implants, as if implants can solve the problem. However, peri-implant diseases are prevalent, affecting between 28% and 56% of people with implants, and (at the implant level) 12-43% of implants. A history of periodontal disease, smoking and poor oral hygiene are all risk factors for developing peri-implantitis. Unlike periodontitis, there are currently no predictable means for treating peri-implantitis, although resective surgery seems to be the most effective technique. Consequently, if implant treatment is considered in patients who are susceptible to periodontitis, it should be preceded by appropriate and adequate periodontal treatment or re-treatment to control the condition, and should be followed by a stringent supportive maintenance program to prevent the development of peri-implant disease. The decision whether implant treatment should be performed should be based on an assessment of the patient's risk profile at the subject level, as well as at the site level.
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Abstract
Since time immemorial, man has constantly contrived to replace natural body parts that are either congenitally absent or lost subsequent to disease or injury, so as to maintain a perfect amalgam of form and function. Dental implants have recently become established as a standard treatment protocol for replacing missing teeth. Ostensibly, a dilemma has arisen whether the implant should obviate the necessity to preserve teeth with debatable restorative prognosis. This article attempts to review the work done hitherto and to formulate a combined perspective in such cases.
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Affiliation(s)
- Rita Chandki
- Department of Conservative Dentistry and Endodontics, Government Dental College and Research Institute, Bangalore, India
| | - Munniswamy Kala
- Department of Conservative Dentistry and Endodontics, Government Dental College and Research Institute, Bangalore, India
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Field C, Li Q, Li W, Thompson M, Swain M. A comparative mechanical and bone remodelling study of all-ceramic posterior inlay and onlay fixed partial dentures. J Dent 2012; 40:48-56. [DOI: 10.1016/j.jdent.2011.10.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 10/05/2011] [Accepted: 10/07/2011] [Indexed: 12/15/2022] Open
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Meyer G, Fanghänel J, Proff P. Morphofunctional aspects of dental implants. Ann Anat 2011; 194:190-4. [PMID: 22137145 DOI: 10.1016/j.aanat.2011.09.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 09/12/2011] [Accepted: 09/27/2011] [Indexed: 10/16/2022]
Abstract
Although oral implantology is among the most beneficial developments of modern dentistry, the widely spread opinion that the long-term outcome of implants is superior to that of natural teeth has been refuted. To evade uncritical extractions, the morphofunctional properties of natural teeth and implant-supported restorations are compared from a proprioceptive and occlusal trauma perspective. The periodontal ligament of natural teeth provides the central nerve system with feedback for sensory perception and motor control. Conversely, the lack of such proprioception causes lower tactile sensitivity and less coordinated masticatory muscle activity in implant-borne restorations and makes them more prone to occlusal overload and possible subsequent failure. Moreover, occlusal anomalies may be conducive to parafunctional activity, craniomandibular disorder, tinnitus, and headache. Oral implantology, therefore, has to take appropriate account of occlusal conditions and the biomechanical and neuromuscular aspects of masticatory function.
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Affiliation(s)
- Georg Meyer
- Department of Restorative Dentistry and Periodontology and Endodontology, Ernst Moritz Arndt University of Greifswald, Germany
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Roccuzzo M, Bonino F, Aglietta M, Dalmasso P. Ten-year results of a three arms prospective cohort study on implants in periodontally compromised patients. Part 2: clinical results. Clin Oral Implants Res 2011; 23:389-95. [DOI: 10.1111/j.1600-0501.2011.02309.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2011] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Marco Aglietta
- Department of Periodontology; University of Bern; Bern; Switzerland
| | - Paola Dalmasso
- Department of Public Health and Microbiology; University of Torino; Torino; Italy
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Graetz C, Dörfer CE, Kahl M, Kocher T, Fawzy El-Sayed K, Wiebe JF, Gomer K, Rühling A. Retention of questionable and hopeless teeth in compliant patients treated for aggressive periodontitis. J Clin Periodontol 2011; 38:707-14. [PMID: 21627675 DOI: 10.1111/j.1600-051x.2011.01743.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
AIM The aim of this study was to determine the survival rates of questionable and hopeless teeth in patients with aggressive periodontitis (AgP) and chronic periodontitis (CP) during 15 years of supportive periodontal therapy (SPT). MATERIALS AND METHODS Thirty-four AgP and 34 CP patients (SPT≥10 years) with bone loss of ≥50% at ≥2 teeth were consecutively recruited. Bone loss was measured on digitized radiographs and teeth were categorized as "questionable" (≥50 to <70% bone loss) or as "hopeless" (≥70%). Progression in pocket probing depths (PPD) during SPT, tooth loss and reasons for extraction were analysed. RESULTS In AgP patients, 262 teeth were considered as questionable and 63 as hopeless (CP: 149/51). During active periodontal therapy, 25 questionable and 26 hopeless teeth were extracted (CP: 12/16). During 15.3 ± 4.1 years of SPT of AgP 28 questionable and 15 hopeless teeth were removed (CP: 28/12). The mean tooth loss per patient during SPT in total was 0.14 (AgP) and 0.16 (CP) teeth/year. There were no significant differences in tooth loss or longitudinal progression of PPD between AgP and CP patients. CONCLUSIONS In patients with AgP, 88.2% (209 of 237) of questionable and 59.5% (22 of 37) of hopeless teeth survived 15 years during regular SPT in a dental school department.
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Affiliation(s)
- Christian Graetz
- Clinic of Conservative Dentistry and Periodontology, University of Kiel, Kiel, Germany.
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Roccuzzo M, De Angelis N, Bonino L, Aglietta M. Ten-year results of a three-arm prospective cohort study on implants in periodontally compromised patients. Part 1: implant loss and radiographic bone loss. Clin Oral Implants Res 2010; 21:490-6. [DOI: 10.1111/j.1600-0501.2009.01886.x] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Popelut A, Rousval B, Fromentin O, Feghali M, Mora F, Bouchard P. Tooth extraction decision model in periodontitis patients. Clin Oral Implants Res 2010; 21:80-9. [DOI: 10.1111/j.1600-0501.2009.01850.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Avila G, Galindo-Moreno P, Soehren S, Misch CE, Morelli T, Wang HL. A Novel Decision-Making Process for Tooth Retention or Extraction. J Periodontol 2009; 80:476-91. [DOI: 10.1902/jop.2009.080454] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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