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Assessment of Negative Gingival Recession: A Critical Component of Periodontal Diagnosis. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12147015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Accurate measurement of negative gingival recession (GR) is essential to accurately determine the clinical attachment loss, which leads to an accurate diagnosis and optimal therapy of periodontal disease. However, the accuracy of measuring the negative GR has been shown to be low and highly variable between examiners. The position of the gingiva margin in relation to the cemento-enamel junction (CEJ) varies among different stages of passive eruption. The amount of negative GR is about 2 mm on average at the mid-facial sites and ranges from 2 to 3.5 mm at interproximal sites in periodontally healthy patients. Some other clinical conditions may change the gingival dimension coronal to the CEJ, such as altered passive eruption and gingival enlargement. In addition to the traditional approach using a periodontal probe to assess the negative GR, nowadays dental ultrasound imaging may be able to assist in accurately measuring the amount of negative GR. This narrative review will discuss the existing evidence of the dimension of dentogingival tissue and the clinical assessment of negative GR using different clinical tools.
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Clark-Perry D, Van der Weijden G, Berkhout W, Wang T, Levin L, Slot D. ACCURACY OF CLINICAL AND RADIOGRAPHIC MEASUREMENTS OF PERIODONTAL INFRABONY DEFECTS OF DIAGNOSTIC TEST ACCURACY (DTA) STUDIES: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Evid Based Dent Pract 2021; 22:101665. [DOI: 10.1016/j.jebdp.2021.101665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 10/08/2021] [Accepted: 11/06/2021] [Indexed: 10/19/2022]
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Goergen J, Albandar JM, Oppermann RV, Rösing CK, Susin C, Haas AN. Periodontitis stage and grade are associated with poor oral-health-related quality of life: Findings from the Porto Alegre cohort study. J Clin Periodontol 2021; 48:1333-1343. [PMID: 34296465 DOI: 10.1111/jcpe.13527] [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: 03/08/2021] [Accepted: 07/07/2021] [Indexed: 12/13/2022]
Abstract
AIM To determine the association between periodontitis stage and grade with oral-health-related quality of life (OHRQoL). MATERIALS AND METHODS This cohort was derived from the Porto Alegre study. The original sample was representative of more than 3 million inhabitants of a Brazilian urban area. Full-mouth periodontal examinations at six sites per tooth were performed at baseline and 5 years later. Periodontitis grade was determined by direct evidence of progression of attachment loss over the follow-up. Stage of periodontitis and OHRQoL, determined by the oral health impact profile version 14 (OHIP-14), were recorded at the follow-up examination. Mean ratios (MRs) and 95% confidence intervals (95% CIs) were estimated adjusting for age, sex, smoking, systemic diseases, tooth loss, and baseline periodontitis diagnosis. RESULTS Five-hundred and ninety-nine individuals were analysed. Individuals with periodontitis grade C + stage II (MR = 1.49; 95% CI = 1.08-2.04) and stages III/IV (MR = 1.83; 95% CI = 1.25-2.66) had significantly higher OHIP scores than those without periodontitis or with periodontitis stage I/grade B. Individuals with periodontitis stages II and III/IV + grade B did not differ from those without periodontitis or with periodontitis stage I/grade B. CONCLUSION Severity and progression rate of periodontitis are associated with poor OHRQoL.
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Affiliation(s)
- Joseane Goergen
- Department of Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Jasim M Albandar
- Periodontal Diagnostics Research Laboratory, Department of Periodontology and Oral Implantology, Temple University School of Dentistry, Philadelphia, Pennsylvania, USA
| | - Rui Vicente Oppermann
- Department of Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Cassiano Kuchenbecker Rösing
- Department of Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Cristiano Susin
- Division of Comprehensive Oral Health-Periodontology, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alex Nogueira Haas
- Department of Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Jasa EE, Gradoville JM, Christiansen MM, Samson KK, Reinhardt RA, Payne JB, Killeen AC. Effects of enamel matrix derivative on clinical and inflammatory outcomes in periodontal maintenance patients: Randomized controlled clinical trial. J Periodontol 2020; 91:1400-1408. [PMID: 32182380 DOI: 10.1002/jper.19-0623] [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: 11/05/2019] [Revised: 02/13/2020] [Accepted: 02/27/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Efficient methods to treat persistent pockets during periodontal maintenance therapy (PMT) require further investigation. The hypothesis of this randomized controlled clinical trial was that local application of enamel matrix derivative (EMD) added to papilla reflection/root preparation (PR/RP) could enhance clinical and inflammatory outcomes, primarily clinical attachment level (CAL). METHODS Fifty PMT patients with generalized stage III-IV, grade B periodontitis presenting with a 6- to 9-mm interproximal PD were randomly allocated to (PR/RP+EMD; n = 24) and control (PR/RP+saline; n = 26) therapies by sex and smoking status. Roots were treated with reflection of interproximal papillae, root planing assisted with endoscope evaluation, and acid etching, followed by EMD or saline application. Probing depth (PD), CAL, plaque index (PI), and interproximal bone height were evaluated at baseline and 12-months post-therapy. Gingival crevicular fluid, bleeding on probing (BOP), and interleukin-1β were tested (ELISA) at baseline, 2 weeks, and 6 and 12 months. Groups were compared over time and between groups with Wilcoxon Rank Sum and t-tests. RESULTS Both PR/RP+ EMD and PR/RP+S resulted in significant improvements in clinical outcomes (PD and CAL, BOP) from baseline to 12 months. No significant differences were found in clinical or inflammatory outcomes between the experimental and control groups. CONCLUSIONS The addition of EMD to PR/RP does not significantly improve clinical or inflammatory outcomes compared with PR/RP alone during periodontal maintenance therapy.
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Affiliation(s)
- Erica E Jasa
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE
| | - Jessica M Gradoville
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE
| | - Mary M Christiansen
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE
| | - Kaeli K Samson
- Department of Biostatistics, University of Nebraska Medical Center, College of Public Health, Omaha, NE
| | - Richard A Reinhardt
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE
| | - Jeffrey B Payne
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE
| | - Amy C Killeen
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE
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Nascimento GG, Dahlén G, López R, Baelum V. Periodontitis phenotypes and clinical response patterns to non-surgical periodontal therapy: reflections on the new periodontitis classification. Eur J Oral Sci 2020; 128:55-65. [PMID: 31995259 DOI: 10.1111/eos.12670] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2019] [Indexed: 11/30/2022]
Abstract
We aimed to identify response patterns to non-surgical periodontal therapy and to investigate whether the new classification system for periodontitis reflects response to treatment after 1 yr. At baseline, data on sociodemographic status, smoking, and diabetes were obtained from participants with periodontal disease. Clinical periodontal data and subgingival plaque were also collected. Participants underwent non-surgical periodontal therapy, and after 3 and 12 months, clinical data were reassessed. Factor analyses, group-based-trajectory modeling, and mixed-effects regression models were used for data analysis. Factor analysis of the baseline periodontal parameters revealed two different periodontitis dimensions: 'moderate' and 'severe'. Two response patterns for each of these periodontitis dimensions were identified. Periodontal therapy had a beneficial effect on both 'moderate' and 'severe' periodontitis; however, individuals with higher levels of disease at baseline experienced greater treatment effect. Regarding the new classification system, while the staging component distinguished different levels of 'moderate' and 'severe' periodontitis before and after treatment, the grading component did not. This study shows the beneficial effect of non-surgical periodontal therapy on both 'moderate' and 'severe' periodontitis. However, the benefit was limited among individuals with low levels of disease. The new classification system did not adequately reflect the periodontal response to therapy in this patient group.
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Affiliation(s)
- Gustavo G Nascimento
- Section of Periodontology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Gunnar Dahlén
- Department of Oral Microbiology and Immunology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rodrigo López
- Section of Periodontology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Vibeke Baelum
- Section of Oral Epidemiology and Dental Public Health, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
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Graetz C, Mann L, Krois J, Sälzer S, Kahl M, Springer C, Schwendicke F. Comparison of periodontitis patients' classification in the 2018 versus 1999 classification. J Clin Periodontol 2019; 46:908-917. [PMID: 31152600 DOI: 10.1111/jcpe.13157] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/17/2019] [Accepted: 05/20/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We aimed to assess how the 2018 and 1999 classifications of periodontal diseases reflect (a) patients' characteristics, (b) disease severity/extent/progression and (c) tooth loss (TL) during observation period. METHODS A total of 251 patients were followed over 21.8 ± 6.2 years. For the 1999 classification, using clinical attachment level (CAL), patients were classified as localized/generalized, mild/moderate/severe and aggressive/chronic periodontitis. For the 2018 classification, patients were staged according to their CAL or bone loss (BL) and the number of lost teeth (stages I-IV). Further factors like probing pocket depths (PPD) or furcation involvement modified the stage. The extent was sub-classified as generalized/localized. Patients were graded according to the BL/age index, smoking and/or diabetes. RESULTS According to the 1999 classification, most patients suffered from generalized severe chronic periodontitis (203/251) or generalized aggressive periodontitis (45/251). Patients with aggressive periodontitis were younger and less often female or smokers. They showed similar TL (0.25 ± 0.22 teeth/patient*year) as generalized severe chronic periodontitis patients (0.23 ± 0.25 teeth/patient*year). According to the 2018 classification, most patients were classified as generalized III-C (140/251), III-B (31/251) or IV-C (64/251). Patients' age, smoking status, CAL, PPD and BL were well reflected. TL differed between IV-C (0.36 ± 0.47), generalized III-C (0.21 ± 0.24) and localized forms (0.10-0.15). CONCLUSIONS Patients' characteristics, disease severity/extent/progression and TL were well reflected by the 2018 classification.
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Affiliation(s)
- Christian Graetz
- Clinic of Conservative Dentistry and Periodontology, University of Kiel, Kiel, Germany
| | - Lucas Mann
- Clinic of Conservative Dentistry and Periodontology, University of Kiel, Kiel, Germany
| | - Joachim Krois
- Department of Operative and Preventive Dentistry, Charité University of Berlin, Berlin, Germany
| | - Sonja Sälzer
- Clinic of Conservative Dentistry and Periodontology, University of Kiel, Kiel, Germany
| | - Maren Kahl
- Clinic of Conservative Dentistry and Periodontology, University of Kiel, Kiel, Germany
| | - Claudia Springer
- Clinic of Conservative Dentistry and Periodontology, University of Kiel, Kiel, Germany
| | - Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité University of Berlin, Berlin, Germany
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Effect of Smoking on Periodontitis: A Systematic Review and Meta-regression. Am J Prev Med 2018; 54:831-841. [PMID: 29656920 DOI: 10.1016/j.amepre.2018.02.014] [Citation(s) in RCA: 253] [Impact Index Per Article: 42.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 02/02/2018] [Accepted: 02/19/2018] [Indexed: 11/23/2022]
Abstract
CONTEXT The study systematically reviewed articles on the association between tobacco smoking and periodontitis, as it has been hypothesized that smoking affects the course of periodontitis through impairment of immunological and vascular mechanisms. EVIDENCE ACQUISITION Searches of articles indexed in PubMed, Scopus, and Embase were performed up to and including May 2017. Search strategy included MeSH and free terms: periodontitis, periodontal diseases, smoking, tobacco use, tobacco, tobacco products, cigarette, pipe, and cigar. Only original prospective longitudinal studies that investigated the association between smoking and periodontitis incidence or progression were included. Results were shown as combined risk ratio. Meta-regression and subgroup analyses were used to explore potential sources of heterogeneity. Analyses were conducted in August 2017. EVIDENCE SYNTHESIS Twenty-eight studies were included in the review; of these, only 14 presented data that could be included in the meta-analysis. Pooled adjusted risk ratios estimate that smoking increases the risk of periodontitis by 85% (risk ratio=1.85, 95% CI=1.5, 2.2). Meta-regression demonstrated that age explained 54.2% of the variability between studies, time of follow-up explained 13.5%, loss to follow-up 10.7%, criteria used to assess the periodontal status explained 2.1%, and severity of periodontitis explained 16.9%. CONCLUSIONS Smoking has a detrimental effect on the incidence and progression of periodontitis. Tobacco smoking, therefore, is important information that should be assessed along with other risk factors for periodontitis.
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Teles R, Moss K, Preisser JS, Genco R, Giannobile WV, Corby P, Garcia N, Jared H, Torresyap G, Salazar E, Moya J, Howard C, Schifferle R, Falkner KL, Gillespie J, Dixon D, Cugini M. Patterns of periodontal disease progression based on linear mixed models of clinical attachment loss. J Clin Periodontol 2017; 45:15-25. [PMID: 28985450 DOI: 10.1111/jcpe.12827] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2017] [Indexed: 11/30/2022]
Abstract
AIM The goal of the present longitudinal cohort study was to examine patterns of periodontal disease progression at progressing sites and subjects defined based on linear mixed models (LMM) of clinical attachment loss (CAL). MATERIALS AND METHODS A total of 113 periodontally healthy and 302 periodontitis subjects had their CAL calculated bimonthly for 12 months. LMMs were fitted for each site and the predicted CAL levels used to categorize their progression state. Participants were grouped based on the number of progressing sites into unchanged, transitional and active subjects. Patterns of periodontal disease progression were explored using descriptive statistics. RESULTS Progression occurred primarily at molars (50% of progressing sites) and inter-proximal sites (72%), affected a higher proportion of deep than shallow sites (2.7% versus 0.7%), and pocketing was the main mode of progression (49%). We found a low level of agreement (47%) between the LMM and traditional approaches to determine progression such as change in CAL ≥3 mm. Fourteen per cent of subjects were classified as active and among those 93% had periodontitis. The annual mean rate of progression for the active subjects was 0.35 mm/year. CONCLUSION Progressing sites and subjects defined based on LMMs presented patterns of disease progression similar to those previously reported in the literature.
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Affiliation(s)
- Ricardo Teles
- Department of Periodontics, Penn Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Applied Oral Sciences, Forsyth Institute, Cambridge, MA, USA
| | - Kevin Moss
- Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - John S Preisser
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Robert Genco
- Department of Oral Biology, School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY, USA
| | - William V Giannobile
- Department of Periodontics and Oral Medicine, Michigan Center for Oral Health Research, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Patricia Corby
- New York University College of Dentistry, Bluestone Center for Clinical Research, New York, NY, USA
| | - Nathalia Garcia
- Section of Periodontics, Department of Applied Dental Medicine, Southern Illinois University School of Dental Medicine, Alton, IL, USA
| | - Heather Jared
- Rho Inc., Contract Research Organization, Chapel Hill, NC, USA
| | - Gay Torresyap
- Department of Applied Oral Sciences, Forsyth Institute, Cambridge, MA, USA
| | - Elida Salazar
- Department of Applied Oral Sciences, Forsyth Institute, Cambridge, MA, USA
| | - Julie Moya
- New York University College of Dentistry, Bluestone Center for Clinical Research, New York, NY, USA
| | - Cynthia Howard
- New York University College of Dentistry, Bluestone Center for Clinical Research, New York, NY, USA
| | - Robert Schifferle
- Department of Oral Biology, School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY, USA
| | - Karen L Falkner
- Department of Oral Biology, School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY, USA
| | - Jane Gillespie
- Section of Periodontics, Department of Applied Dental Medicine, Southern Illinois University School of Dental Medicine, Alton, IL, USA
| | - Debra Dixon
- Section of Periodontics, Department of Applied Dental Medicine, Southern Illinois University School of Dental Medicine, Alton, IL, USA
| | - MaryAnn Cugini
- Department of Applied Oral Sciences, Forsyth Institute, Cambridge, MA, USA
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Zhang W, Rajani S, Wang BY. Comparison of periodontal evaluation by cone-beam computed tomography, and clinical and intraoral radiographic examinations. Oral Radiol 2017; 34:208-218. [PMID: 30484028 DOI: 10.1007/s11282-017-0298-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 07/12/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Cone-beam computed tomography (CBCT) has been widely used in many fields of dentistry. However, little is known about the accuracy of CBCT for evaluation of periodontal status. The objective of this study was to compare and correlate periodontal assessments among CBCT, clinical attachment loss (CAL) measurement, and periapical (PA)/bitewing (BW) radiography. METHODS Eighty patients (28 males, 52 females; age range, 19-84 years) from the University of Texas School of Dentistry at Houston were evaluated retrospectively. Measurements were taken on the central incisors, canines, and first molars of the right maxilla and left mandible. CAL was extracted from periodontal charts. The radiographic distance from the cementum-enamel junction (CEJ) to the alveolar crest was measured for tooth mesial and distal sites on PA/BW and CBCT images using MiPacs software and Anatomage Invivo software, respectively. One-way ANOVA and Pearson analysis were performed for statistical analyses. RESULTS The CEJ-crest distances for CBCT, PA/BW, and CAL were 2.56 ± 0.12, 2.04 ± 0.12, and 2.08 ± 0.17 mm (mean ± SD), respectively. CBCT exhibited larger values than the other two methods (p < 0.05). There were highly significant positive correlations among CBCT, PA/BW, and CAL measurements at all examined sites (p < 0.001). The Pearson correlation coefficient was higher for CBCT with CAL relative to PA/BW with CAL, but the difference was not significant (r = 0.64 and r = 0.55, respectively, p > 0.05). CONCLUSIONS This study validates the suitability of CBCT for periodontal assessment. Further studies are necessary to optimize the measurement methodology with CBCT.
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Affiliation(s)
- Wenjian Zhang
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, University of Texas Health Science Center at Houston, 7500 Cambridge Street, Suite 5366, Houston, TX, 77054, USA.
| | - Shazia Rajani
- Dental Hygiene Program, School of Dentistry, University of Texas Health Science Center at Houston, 7500 Cambridge Street, Suite 5366, Houston, TX, 77054, USA
| | - Bing-Yan Wang
- Department of Periodontics and Dental Hygiene, School of Dentistry, University of Texas Health Science Center at Houston, 7500 Cambridge Street, Suite 5366, Houston, TX, 77054, USA
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Fernandes LO, Mota CCBO, de Melo LSA, da Costa Soares MUS, da Silva Feitosa D, Gomes ASL. In vivo assessment of periodontal structures and measurement of gingival sulcus with Optical Coherence Tomography: a pilot study. JOURNAL OF BIOPHOTONICS 2017; 10:862-869. [PMID: 27503608 DOI: 10.1002/jbio.201600082] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/21/2016] [Accepted: 07/20/2016] [Indexed: 05/20/2023]
Abstract
There has been increasing interest on the development of clinically acceptable, more sensitive and specific methods for non-invasive diagnosis in Periodontics. In this pilot study, the performance of an Optical Coherence Tomography (OCT) system in imaging periodontal structures in humans was evaluated. Gingival sulcus depth measurements were obtained and compared with traditional probes. In total, 445 sites of 23 periodontally healthy individuals were measured by 3 instruments: North Carolina manual probe, Florida automated probe and OCT at 1325 nm. To obtain quantitative measurements from OCT images, the gingival refractive index was also determined. Discomfort/pain perception and the duration of examinations were compared among the instruments. The analysis of OCT images allowed the identification of relevant anatomic dental and periodontal regions. The average sulcus depth measured by OCT, 0.85 ± 0.27 mm and 0.87 ± 0.28 mm, was lower than the values obtained by manual and automated probing. Discomfort/pain were prevalent for traditional probes, which are invasive methods, than for the non-invasive OCT technique. OCT has the potential to be a reliable tool for in vivo periodontal tissues evaluation and for reproducible sulcus depth measurements in healthy sites. Further technological advances are required to reduce the procedure time and promote evaluation of posterior oral regions. Photonic assessment of periodontal tissue with OCT (top) in a clinical environment, showing tooth/gingiva features (bottom).
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Affiliation(s)
- Luana Osório Fernandes
- Graduate Program in Dentistry, Federal University of Pernambuco, Recife, PE, Brazil, 50670-901
| | - Cláudia Cristina Brainer Oliveira Mota
- Faculty of Dentistry, Caruaruense Association of Technical and Higher Education, Caruaru, PE, Brazil, 55016-400
- Department of Physics, Federal University of Pernambuco, Recife, PE, Brazil, 50670-901
| | | | | | - Daniela da Silva Feitosa
- Department of Clinical and Preventive Dentistry, School of Dentistry, Federal University of Pernambuco, Recife, PE, Brazil, 50670-901
| | - Anderson Stevens Leônidas Gomes
- Graduate Program in Dentistry, Federal University of Pernambuco, Recife, PE, Brazil, 50670-901
- Department of Physics, Federal University of Pernambuco, Recife, PE, Brazil, 50670-901
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11
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Sälzer S, Graetz C, Plaumann A, Heinevetter N, Grender J, Klukowska M, Schneider CA, Springer C, Van der Weijden FA, Dörfer CE. Effect of a Multidirectional Power Toothbrush and a Manual Toothbrush in Individuals Susceptible to Gingival Recession: A 12-Month Randomized Controlled Clinical Study. J Periodontol 2016; 87:548-56. [DOI: 10.1902/jop.2016.150472] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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12
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Teles R, Benecha HK, Preisser JS, Moss K, Starr JR, Corby P, Genco R, Garcia N, Giannobile WV, Jared H, Torresyap G, Salazar E, Moya J, Howard C, Schifferle R, Falkner KL, Gillespie J, Dixon D, Cugini M. Modelling changes in clinical attachment loss to classify periodontal disease progression. J Clin Periodontol 2016; 43:426-34. [PMID: 26935472 PMCID: PMC5021116 DOI: 10.1111/jcpe.12539] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2016] [Indexed: 11/30/2022]
Abstract
AIM The goal of this study was to identify progressing periodontal sites by applying linear mixed models (LMM) to longitudinal measurements of clinical attachment loss (CAL). METHODS Ninety-three periodontally healthy and 236 periodontitis subjects had their CAL measured bi-monthly for 12 months. The proportions of sites demonstrating increases in CAL from baseline above specified thresholds were calculated for each visit. The proportions of sites reversing from the progressing state were also computed. LMM were fitted for each tooth site and the predicted CAL levels used to categorize sites regarding progression or regression. The threshold for progression was established based on the model-estimated error in predictions. RESULTS Over 12 months, 21.2%, 2.8% and 0.3% of sites progressed, according to thresholds of 1, 2 and 3 mm of CAL increase. However, on average, 42.0%, 64.4% and 77.7% of progressing sites for the different thresholds reversed in subsequent visits. Conversely, 97.1%, 76.9% and 23.1% of sites classified as progressing using LMM had observed CAL increases above 1, 2 and 3 mm after 12 months, whereas mean rates of reversal were 10.6%, 30.2% and 53.0% respectively. CONCLUSION LMM accounted for several sources of error in longitudinal CAL measurement, providing an improved method for classifying progressing sites.
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Affiliation(s)
- Ricardo Teles
- Department of Periodontology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Applied Oral Sciences, Forsyth Institute, Cambridge, MA, USA
| | - Habtamu K Benecha
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - John S Preisser
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kevin Moss
- Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jacqueline R Starr
- Department of Applied Oral Sciences, Forsyth Institute, Cambridge, MA, USA.,Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | - Patricia Corby
- New York University College of Dentistry, Bluestone Center for Clinical Research, New York, NY, USA
| | - Robert Genco
- Department of Oral Biology, School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY, USA
| | - Nathalia Garcia
- Section of Periodontics, Department of Applied Dental Medicine, Southern Illinois University School of Dental Medicine, Alton, IL, USA
| | - William V Giannobile
- Department of Periodontics and Oral Medicine & Michigan Center for Oral Health Research, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Heather Jared
- Rho Inc., Contract Research Organization, Chapel Hill, NC, USA
| | - Gay Torresyap
- Department of Applied Oral Sciences, Forsyth Institute, Cambridge, MA, USA
| | - Elida Salazar
- Department of Applied Oral Sciences, Forsyth Institute, Cambridge, MA, USA
| | - Julie Moya
- New York University College of Dentistry, Bluestone Center for Clinical Research, New York, NY, USA
| | - Cynthia Howard
- New York University College of Dentistry, Bluestone Center for Clinical Research, New York, NY, USA
| | - Robert Schifferle
- Department of Oral Biology, School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY, USA
| | - Karen L Falkner
- Department of Oral Biology, School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY, USA
| | - Jane Gillespie
- Section of Periodontics, Department of Applied Dental Medicine, Southern Illinois University School of Dental Medicine, Alton, IL, USA
| | - Debra Dixon
- Section of Periodontics, Department of Applied Dental Medicine, Southern Illinois University School of Dental Medicine, Alton, IL, USA
| | - MaryAnn Cugini
- Department of Applied Oral Sciences, Forsyth Institute, Cambridge, MA, USA
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13
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Barbosa VL, Angst PDM, Finger Stadler A, Oppermann RV, Gomes SC. Clinical attachment loss: estimation by direct and indirect methods. Int Dent J 2016; 66:144-9. [PMID: 26846817 DOI: 10.1111/idj.12218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE This observational study aimed to compare the estimation of clinical attachment loss (CAL) as measured by direct (CALD ) and indirect (CALI ) methods. METHODS Periodontitis patients (n = 75; mean age: 50.9 ± 8.02 years; 72.2% women; 50.6% smokers) received a periodontal examination (six sites/tooth) to determine the presence of visible plaque and calculus, the gingival bleeding index (GBI), periodontal probing depth (PPD), bleeding on probing (BOP), CALD and gingival recession (GR). CALI values resulted from the sum of PPD and GR values. Statistical analysis considered only data from sites with visible GR (e.g. the gingival margin apical to the cemento-enamel junction; n = 4,757 sites) and determined the mean difference between CALI and CALD measurements. Based on the mean difference, univariate and multivariate analyses were also performed. RESULTS Mean CALD and CALI values were 3.96 ± 2.07 mm and 4.47 ± 2.03 mm, respectively. The indirect method overestimated CAL compared with the direct method (mean difference: 0.51 ± 1.23 mm; P < 0.001). On uni- and multivariate analyses, absence of GBI and BOP, PPD and proximal site location had significant influences on the overestimation of CAL by the indirect method (all P ≤ 0.01). The indirect method increased the CAL value by 0.38 mm for each additional 1 mm in PPD. CONCLUSIONS To decrease the number of probing errors in daily practice it is suggested that direct examination is more appropriate than the indirect method for estimating CAL.
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Affiliation(s)
- Viviane Leal Barbosa
- Department of Conservative Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Amanda Finger Stadler
- Department of Conservative Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Rui V Oppermann
- Department of Conservative Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Sabrina Carvalho Gomes
- Department of Conservative Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Baelum V, López R. Defining and predicting outcomes of non-surgical periodontal treatment: a 1-yr follow-up study. Eur J Oral Sci 2015; 124:33-44. [PMID: 26714428 DOI: 10.1111/eos.12240] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2015] [Indexed: 12/28/2022]
Abstract
This study reports on 1-yr outcomes of non-surgical periodontal therapy and compares predictive models resulting from different definitions of treatment success. A total of 149 participants, 30-70 yr of age, provided clinical periodontal data and data on sociodemographic status, health status, symptoms, and oral health-care behaviors at baseline. One week later, clinical attachment level and probing pocket depth were recorded again in 148 patients. Participants underwent non-surgical periodontal therapy, including scaling and root planing, during three to four clinical sessions. Three and 12 months later, clinical attachment level, probing pocket depth, and bleeding on probing (BOP) were recorded in 141 and 137 participants, respectively. Using test-retest data, patients were classified as having 'downhill', 'stable', or 'improved' results on three clinical attachment level and three probing pocket depth outcomes, and their classification was found to vary considerably according to outcome. Although the predictors of treatment outcome varied depending on the variable chosen to represent the treatment outcome, some predictors were more commonly noted as predicting improvement, namely a high baseline percentage of sites with subgingival calculus and the presence of suppuration at baseline. The latter was, however, also predictive for tooth loss during the study. Our findings underline the need for uniformity in defining the outcomes in trials of periodontal therapy.
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Affiliation(s)
- Vibeke Baelum
- Department of Dentistry, Section for Oral Epidemiology & Public Health, Aarhus University, Aarhus C, Denmark
| | - Rodrigo López
- Department of Dentistry, Section for Periodontology, Health, Aarhus University, Aarhus C, Denmark
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15
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López R, Baelum V. Periodontal disease classifications revisited. Eur J Oral Sci 2015; 123:385-9. [PMID: 26505468 DOI: 10.1111/eos.12227] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2015] [Indexed: 11/28/2022]
Abstract
An American Academy of Periodontology Task Force has recently published a report on the Update to the 1999 Classification of Periodontal Diseases and Conditions, which is a focused update outlining changes to be included in a comprehensive update planned for 2017. We discuss the proposed changes, and their rationales, and conclude that the periodontal classification carousel will continue to spin until it is realized that the only way forward is a profound reconsideration of what we hope to achieve with classifications.
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Affiliation(s)
- Rodrigo López
- Section for Periodontology, Department of Dentistry, HEALTH, Aarhus University, Aarhus, Denmark
| | - Vibeke Baelum
- Section for Oral Epidemiology & Public Health, Department of Dentistry, HEALTH, Aarhus University, Aarhus, Denmark
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16
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Corraini P, Lopez R, Vaeth M. Implications of less-than-perfect reliability of clinical parameters for the misclassification of periodontitis. Community Dent Oral Epidemiol 2015; 43:183-92. [DOI: 10.1111/cdoe.12142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/14/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Priscila Corraini
- Department of Dentistry; Section of Periodontology; Health; Aarhus University; Aarhus Denmark
- Department of Clinical Epidemiology; Aarhus University; Aarhus Denmark
| | - Rodrigo Lopez
- Department of Dentistry; Section of Periodontology; Health; Aarhus University; Aarhus Denmark
| | - Michael Vaeth
- Department of Public Health; Section of Biostatistics; Health; Aarhus University; Aarhus Denmark
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17
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Rosa EF, Corraini P, Inoue G, Gomes EF, Guglielmetti MR, Sanda SR, Lotufo JPB, Romito GA, Pannuti CM. Effect of smoking cessation on non-surgical periodontal therapy: results after 24 months. J Clin Periodontol 2014; 41:1145-53. [DOI: 10.1111/jcpe.12313] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2014] [Indexed: 12/26/2022]
Affiliation(s)
- Ecinele Francisca Rosa
- Division of Periodontics; Department of Stomatology; School of Dentistry; University of São Paulo; São Paulo Brazil
| | - Priscila Corraini
- Division of Periodontics; Department of Stomatology; School of Dentistry; University of São Paulo; São Paulo Brazil
- Department of Clinical Epidemiology; Aarhus University; Aarhus Denmark
| | - Gislene Inoue
- Division of Periodontics; Department of Stomatology; School of Dentistry; University of São Paulo; São Paulo Brazil
| | - Elaine Fueta Gomes
- Division of Periodontics; Department of Stomatology; School of Dentistry; University of São Paulo; São Paulo Brazil
| | - Mariana Rocha Guglielmetti
- Division of Periodontics; Department of Stomatology; School of Dentistry; University of São Paulo; São Paulo Brazil
| | - Sheila Regina Sanda
- Division of Periodontics; Department of Stomatology; School of Dentistry; University of São Paulo; São Paulo Brazil
| | | | - Giuseppe Alexandre Romito
- Division of Periodontics; Department of Stomatology; School of Dentistry; University of São Paulo; São Paulo Brazil
| | - Cláudio Mendes Pannuti
- Division of Periodontics; Department of Stomatology; School of Dentistry; University of São Paulo; São Paulo Brazil
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Reliability of recordings of subgingival calculus detected using an ultrasonic device. Clin Oral Investig 2014; 19:709-16. [PMID: 25055747 DOI: 10.1007/s00784-014-1287-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 07/10/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To assess the intra-examiner reliability of recordings of subgingival calculus detected using an ultrasonic device, and to investigate the influence of subject-, tooth- and site-level factors on the reliability of these subgingival calculus recordings. MATERIALS AND METHODS On two occasions, within a 1-week interval, 147 adult periodontitis patients received a full-mouth clinical periodontal examination by a single trained examiner. Duplicate subgingival calculus recordings, in six sites per tooth, were obtained using an ultrasonic device for calculus detection and removal. RESULTS Agreement was observed in 65 % of the 22,584 duplicate subgingival calculus recordings, ranging 45 % to 83 % according to subject. Using hierarchical modeling, disagreements in the subgingival calculus duplicate recordings were more likely in all other sites than the mid-buccal, and in sites harboring supragingival calculus. Disagreements were less likely in sites with PD ≥ 4 mm and with furcation involvement ≥ degree 2. Bleeding on probing or suppuration did not influence the reliability of subgingival calculus. At the subject-level, disagreements were less likely in patients presenting with the highest and lowest extent categories of the covariate subgingival calculus. CONCLUSIONS AND CLINICAL RELEVANCE The reliability of subgingival calculus recordings using the ultrasound technology is reasonable. The results of the present study suggest that the reliability of subgingival calculus recordings is not influenced by the presence of inflammation. Moreover, subgingival calculus can be more reliably detected using the ultrasound device at sites with higher need for periodontal therapy, i.e., sites presenting with deep pockets and premolars and molars with furcation involvement.
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Haas AN, Wagner MC, Oppermann RV, Rösing CK, Albandar JM, Susin C. Risk factors for the progression of periodontal attachment loss: a 5-year population-based study in South Brazil. J Clin Periodontol 2014; 41:215-23. [DOI: 10.1111/jcpe.12213] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Alex Nogueira Haas
- Department of Periodontology; Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Brazil
| | - Marcius Comparsi Wagner
- Department of Periodontology; Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Brazil
| | - Rui Vicente Oppermann
- Department of Periodontology; Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Brazil
| | - Cassiano Kuchenbecker Rösing
- Department of Periodontology; Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Brazil
| | - Jasim M. Albandar
- Periodontal Diagnostics Research Laboratory; Department of Periodontology and Oral Implantology; Temple University School of Dentistry; Philadelphia PA USA
| | - Cristiano Susin
- Department of Periodontics and Oral Biology; College of Dental Medicine; Georgia Regents University; Augusta GA USA
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