1
|
Citterio F, Kanmaz B, Baima G, Romano F, Buduneli N, Aimetti M. Pocket closure in stage III-IV grade C periodontitis: A multilevel analysis following non-surgical periodontal therapy. Int J Dent Hyg 2024; 22:547-553. [PMID: 37154234 DOI: 10.1111/idh.12688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/30/2023] [Accepted: 04/02/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Risk of disease progression and tooth loss is higher in cases where deep probing pocket depths (PPDs) and bleeding on probing (BOP) persist after active periodontal treatment. This study aimed to investigate the efficacy of non-surgical periodontal therapy on pocket closure (PC), defined as PPD ≤4 mm without BOP (PC1) or PPD ≤4 mm solely (PC2) 3 months after non-surgical periodontal treatment and to compare PC between smokers and non-smokers. METHODS This cohort study is a secondary analysis from a controlled clinical trial consisting of systemically healthy patients with stage III or IV grade C periodontitis. All the sites with baseline PPD ≥5 mm are included as diseased sites and PC at 3 months after completion of non-surgical periodontal treatment was calculated. PC was compared between smokers and non-smokers at site and patient levels. Multilevel analysis is used to investigate factors at patient, tooth and site levels affecting PPD changes and the probability of PC. RESULTS A total of 1998 diseased sites in 27 patients were included in the analysis. The rates of PC1 and PC2 were 58.4% and 70.2% and were significantly correlated to smoking habits at site level (r (1) = 7.03, p = 0.008; r (1) = 36.17, p < 0.001). Tooth type, mobility, clinical attachment level (CAL) and PPD at baseline significantly affected PC. CONCLUSIONS The present findings indicate that non-surgical periodontal treatment is effective in PC, but its performance is influenced by baseline PPD and CAL and residual pockets may remain.
Collapse
Affiliation(s)
- Filippo Citterio
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Burcu Kanmaz
- Department of Periodontology, School of Dentistry, İzmir Demokrasi University, İzmir, Turkey
| | - Giacomo Baima
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Federica Romano
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Nurcan Buduneli
- Department of Periodontology, School of Dentistry, Ege University, İzmir, Turkey
| | - Mario Aimetti
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| |
Collapse
|
2
|
Zhang H, Xu T, Wei Y, Wei N, Han Z, Hu W. Assessment of soft and hard tissue changes following micro crestal flap-Alveolar ridge preservation and augmentation at molar extraction sites in patients with stage III/IV periodontitis: A randomized controlled trial. J Clin Periodontol 2024. [PMID: 39043452 DOI: 10.1111/jcpe.14045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 06/25/2024] [Accepted: 07/02/2024] [Indexed: 07/25/2024]
Abstract
AIM This study aimed to assess hard and soft tissue contour changes following micro crestal flap-alveolar ridge preservation (MCF-ARP) and natural healing (NH) in periodontally compromised molar extraction sites and to analyse the feasibility and need for bone augmentation during implant therapy. MATERIALS AND METHODS Fifty-six patients with 70 sites were randomized into two groups at the site level (35 sites from 31 patients in the test group and 35 sites from 29 patients in the control group). Among whom, four patients contributed one tooth to the control group and one tooth to the test group. Hard tissue indicators were measured using cone beam computed tomography performed before tooth extraction and 6 months after surgery. Soft tissue contour changes were assessed using intraoral scanning performed before and immediately after surgery and also 2 weeks and 1, 3 and 6 months after surgery. RESULTS Six months after surgery, the MCF-ARP group showed less resorption in buccal bone height (p = .032) and greater augmentation in central bone height (p = .001) and ridge width (p = .009). The mean, vertical and horizontal collapse of buccal soft tissue contour in the MCF-ARP group were 0.95 mm (p = .010), 0.61 mm (p = .019) and 0.56 mm (p = .013) less than that in the NH group, respectively. There were significantly (p = .007) fewer sites in the MCF-ARP group than in the NH group (0% vs. 26.7%) for staged bone augmentation and more sites that could be treated with simple implant procedure in the MCF-ARP group than in the NH group (71.9% vs. 56.6%). CONCLUSIONS Compared with NH, MCF-ARP reduced bone resorption in periodontally compromised molar extraction sites and maintained the buccal soft tissue contour. MCF-ARP reduces the need for complex bone augmentation procedures in implant therapy. TRIAL REGISTRATION Chinese Clinical Trial Register (ChiCTR) ChiCTR2200056335. Registered on 4 February 2022, Version 1.0.
Collapse
Affiliation(s)
- Haoyun Zhang
- Department of Periodontology, Peking University School and Hospital of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, NHC Research Center of Engineering and Technology for Computerized Dentistry, Beijing, China
| | - Tao Xu
- Department of Emergency, Peking University School and Hospital of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, NHC Research Center of Engineering and Technology for Computerized Dentistry, Beijing, China
| | - Yiping Wei
- Department of Periodontology, Peking University School and Hospital of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, NHC Research Center of Engineering and Technology for Computerized Dentistry, Beijing, China
| | - Ning Wei
- Department of Periodontology, Peking University School and Hospital of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, NHC Research Center of Engineering and Technology for Computerized Dentistry, Beijing, China
| | - Ziyao Han
- Department of Periodontology, Peking University School and Hospital of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, NHC Research Center of Engineering and Technology for Computerized Dentistry, Beijing, China
| | - Wenjie Hu
- Department of Periodontology, Peking University School and Hospital of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, NHC Research Center of Engineering and Technology for Computerized Dentistry, Beijing, China
| |
Collapse
|
3
|
Shi S, Meng Y, Jiao J, Shi D, Feng X, Meng H. A nomogram-based predictive model for tooth survival in Chinese patients with periodontitis: An 11-year retrospective cohort study. J Clin Periodontol 2024. [PMID: 38986602 DOI: 10.1111/jcpe.14027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/02/2024] [Accepted: 05/27/2024] [Indexed: 07/12/2024]
Abstract
AIM To develop a nomogram-based predictive model of tooth survival by comprehensively analysing clinical and radiographic risk factors of tooth loss (TL). MATERIALS AND METHODS In this study, 3447 teeth of 131 subjects who underwent non-surgical periodontal treatment were examined retrospectively within a mean follow-up period of 11.6 years. The association of risk factors including clinical and radiographic parameters with TL was assessed using univariate and multivariate Cox regression analyses. A nomogram-based predictive model was developed, and its validation and discriminatory ability were analysed. RESULTS In all, 313 teeth were lost in 94 patients in this study (overall tooth loss [OTL] 9.08%; 0.21 teeth/patient/year). Male, heavy smoking, molar teeth, probing depth (PD), attachment loss (AL), tooth mobility and radiographic bone loss were significantly associated with TL (p < .05). A gradient effect of tooth mobility on TL increased from degree I to III versus none (p < .0001). The area under the curve (AUC) of the model was 0.865. Calibration curve and decision curve analysis demonstrated good performance and high net benefit, respectively. CONCLUSIONS Adopting a specific nomogram could facilitate the prediction of tooth survival and the development of tailored treatment plans in Chinese patients with advanced periodontitis.
Collapse
Affiliation(s)
- Shuwen Shi
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, People's Republic of China
- Department of Stomatology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yang Meng
- Department of Periodontology, Qingdao Stomatological Hospital Affiliated to Qingdao University, Qingdao, People's Republic of China
| | - Jian Jiao
- First Clinical Division & Department of Periodontology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, People's Republic of China
| | - Dong Shi
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, People's Republic of China
| | - Xianghui Feng
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, People's Republic of China
| | - Huanxin Meng
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, People's Republic of China
| |
Collapse
|
4
|
Chen X, Xu C, Wu Y, Zhao L. The survival of periodontally treated molars in long-term maintenance: A systematic review and meta-analysis. J Clin Periodontol 2024; 51:631-651. [PMID: 38317331 DOI: 10.1111/jcpe.13951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 12/30/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024]
Abstract
AIM This systematic review and meta-analysis aimed to determine the survival of periodontally treated molars during maintenance care and identify the risk factors associated with molar loss among patients with periodontitis who received professional periodontal therapy and maintenance. MATERIALS AND METHODS Longitudinal studies with a minimum follow-up duration of 5 years published until 28 August 2023 were retrieved from the following databases: the Cochrane Library, Embase, MEDLINE and Web of Science. All included studies reported data on molar retention. Meta-analysis was performed using Review Manager 5.4. A modified version of the Newcastle-Ottawa Scale was used to evaluate the study quality. Statistical results of analyses of the overall survival rate and molar loss are presented as estimated standardized mean differences, whereas the results of the analyses of risk factors are presented as risk ratios with 95% confidence intervals (95% CIs). RESULTS From among the 1323 potentially eligible reports, 41 studies (5584 patients, 29,908 molars retained at the beginning of maintenance therapy, mean follow-up duration of 14.7 years) were included. The pooled survival rate of the molars during maintenance therapy was 82% (95% CI: 80%-84%). The average loss of molars was 0.05 per patient per year (95% CI: 0.04-0.06) among the patients receiving long-term periodontal maintenance (PM) therapy. Fifteen factors were examined in this meta-analysis. Six patient-related factors (older age, lack of compliance, smoking, bruxism, diabetes and lack of private insurance) and five tooth-related factors (maxillary location, high probing pocket depth, furcation involvement, higher mobility and lack of pulpal vitality) were identified as risk factors for molar loss during maintenance therapy. CONCLUSIONS The findings of the present study suggest that the long-term retention of periodontally compromised molars can be achieved. The average number of molars lost per decade was <1 among the patients receiving long-term PM therapy. Older age, noncompliance, smoking, bruxism, diabetes, lack of private insurance coverage, maxillary location, furcation involvement, higher mobility, increase in the probing pocket depth and loss of pulpal vitality are strong risk factors for the long-term prognosis of molars.
Collapse
Affiliation(s)
- Xiao Chen
- State Key Laboratory of Oral Diseases and National Center for Stomatology and National Clinical Research Center for Oral Diseases and Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Chunmei Xu
- State Key Laboratory of Oral Diseases and National Center for Stomatology and National Clinical Research Center for Oral Diseases and Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yafei Wu
- State Key Laboratory of Oral Diseases and National Center for Stomatology and National Clinical Research Center for Oral Diseases and Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Lei Zhao
- State Key Laboratory of Oral Diseases and National Center for Stomatology and National Clinical Research Center for Oral Diseases and Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
5
|
Ciardo A, Rampf S, Kim TS. Vital root resection with radicular retrograde partial pulpotomy in furcation-involved maxillary molars in patients with periodontitis: Technique description and case series considering clinical and economic aspects. Int Endod J 2024; 57:617-628. [PMID: 38306111 DOI: 10.1111/iej.14031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/03/2024]
Abstract
AIM Conventional root resection in periodontally compromised furcation-involved maxillary molars requires preceding endodontic treatment and is therefore associated with loss of tooth vitality, higher invasiveness, treatment time and costs, and the risk of endodontic complications. Vital root resection (VRR) could overcome these disadvantages while establishing stable periodontal and endodontic conditions. This case series aimed to introduce the concept of one-stage VRR with radicular retrograde partial pulpotomy (VRRretro). SUMMARY Seven vital maxillary molars with residual probing pocket depths (PPD) ≥ 6 mm and furcation ≥ class 2 of five patients with stage III/IV periodontitis were treated with VRRretro using mineral trioxide aggregate. Teeth with residual through-and-through furcations were additionally tunnelled. Follow-up up to 2.5 years postoperatively during supportive periodontal care included full periodontal status, percussion and thermal sensitivity testing. Periapical radiographs were obtained to rule out possible periradicular radiolucencies. All seven treated molars were in-situ at an average of 26.84 ± 5.37 months postoperatively and were clinically and radiographically inconspicuous independent of tooth position, the resected root, the need for tunnelling and the restorative status. The mean PPD on the seven treated molars was 4.02 ± 0.85 mm (6-10 mm) preoperatively and 2.62 ± 0.42 mm (3-4 mm) at the last follow-up. Clinical attachment level and bleeding on probing could also be decreased. The teeth showed no mobility over time and furcations class 2 were reduced to class 1 while the tunnelled furcations were accessible with interdental brushes. All molars reacted negatively to percussion and positively to thermal sensitivity testing. KEY LEARNING POINTS In carefully selected cases considering patient- and tooth-related factors, VRRretro could be a promising treatment option to establish stable periodontal and endodontic conditions in furcation-involved maxillary molars while preserving tooth vitality.
Collapse
Affiliation(s)
- Antonio Ciardo
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg Faculty of Medicine, Heidelberg University, Heidelberg, Germany
| | - Sarah Rampf
- Section of Endodontology and Dental Traumatology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg Faculty of Medicine, Heidelberg University, Heidelberg, Germany
| | - Ti-Sun Kim
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg Faculty of Medicine, Heidelberg University, Heidelberg, Germany
| |
Collapse
|
6
|
Anuwar AHK, Ng CW, Safii SH, Saub R, Ab-Murat N. Modelling the national economic burden of non-surgical periodontal management in specialist clinics in Malaysia using a markov model. BMC Oral Health 2024; 24:346. [PMID: 38500175 PMCID: PMC10949624 DOI: 10.1186/s12903-024-04094-z] [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: 07/06/2023] [Accepted: 03/04/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Non-surgical periodontal treatment is the mainstay of periodontal treatment. In Malaysia, the prevalence of periodontal disease is substantial among adults with almost half of them having periodontitis. Therefore, we estimated the economic burden of non-surgical periodontal treatment in specialist clinics in Malaysia. METHODS Relevant data from multiple data sources which include national oral health and health surveys, national census, extensive systematic literature reviews, as well as discussion with experts, were used to estimate the economic burden of non-surgical periodontal management in specialist clinics in Malaysia in 2020. This estimation was done from the oral healthcare provider's perspective in both public and private sectors using an irreducible Markov model of 3-month cycle length over a time horizon of one year. RESULTS In 2020, the national economic burden of non-surgical periodontal treatment during the first year of periodontal management in specialist clinics in Malaysia was MYR 696 million (USD 166 million), ranging from MYR 471 million (USD 112 million) to MYR 922 million (USD 220 million). Of these, a total of MYR 485 million (USD 115 million) and MYR 211 million (USD 50 million) were the direct oral healthcare cost in public and private dental clinics, respectively. CONCLUSION The findings of this study demonstrated substantial economic burden of non-surgical periodontal management in specialist clinics in Malaysia. Being a life-long disease, these findings highlight the importance of enforcing primary and secondary preventive measures. On the strength and reliability of this economic evidence, this study provides vital information to inform policy- and decision-making regarding the future direction of managing periodontitis in Malaysia.
Collapse
Affiliation(s)
- Ainol Haniza Kherul Anuwar
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| | - Chiu Wan Ng
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| | - Syarida Hasnur Safii
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, 50603, Malaysia.
| | - Roslan Saub
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| | - Norintan Ab-Murat
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| |
Collapse
|
7
|
Bertl K, Vlachou S, Pandis N, Zampelis A, Stavropoulos A. Repeated local delivery of hyaluronic acid gel as adjunctive treatment of residual pockets in periodontitis patients undergoing supportive periodontal care. A randomized controlled clinical trial. Clin Oral Investig 2024; 28:158. [PMID: 38376596 PMCID: PMC10879318 DOI: 10.1007/s00784-024-05505-9] [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: 11/19/2023] [Accepted: 01/09/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVES To assess the effect of hyaluronic acid (HyA) application as adjunct to re-instrumentation of residual pockets in patients undergoing regular supportive periodontal care (SPC). METHODS Chronic periodontitis patients (stage III and IV, grade B and C) with 4 interproximal residual pockets were randomly assigned to the test (HyA gel) or control (saline) group. After subgingival instrumentation, test or control substance was applied subgingivally, then daily supragingivally for 3 months, and if required a second time after subgingival re-instrumentation after 3 months. Clinical and patient reported outcome parameters were recorded every 3 months for 12 months. Pocket closure [probing pocket depth (PPD) ≤ 4mm with absence of bleeding on probing (BoP) at PPD = 4mm] was the main outcome parameter. RESULTS Fifty-six patients (221 experimental sites) were analysed. Pocket closure was achieved in 56.8 and 46.6% of the experimental sites in the test and control group, respectively (p > 0.05), while median PPD and PPD distribution (< 5mm/5mm/ > 5mm) differed significantly between groups in favour of the test group, at 12 months. Further, significantly fewer sites in the HyA group required re-instrumentation at 3 months, and sites in the HyA group showed a tendency for lower odds to remain diseased compared to the control group (OR 0.48, 95%CI 0.22-1.06). The odds for a site to remain diseased after 12 months increased significantly in the presence of plaque (OR 7.94, 95%CI 4.12-15.28), but in general, decreased significantly over time (OR 0.48, 95%CI 0.28-0.81). CONCLUSION Re-instrumentation of residual pockets in SPC patients, per se, leads to a significant increase in pocket closure over time; this was impeded by poor plaque control. Repeated local application of HyA results in fewer sites requiring re-instrumentation and might slightly improve the rate of pocket closure. (clinicaltrials.gov registration nr. NCT04792541). CLINICAL RELEVANCE HyA gel is easy to apply, well accepted by patients, and may have some positive effect in terms of fewer sites requiring re-instrumentation at 3 months and higher pocket closure rate at 12 months.
Collapse
Affiliation(s)
- Kristina Bertl
- Department of Periodontology, Dental Clinic, Faculty of Medicine, Sigmund Freud University Vienna, Freudplatz 3, 1020, Vienna, Austria
- Department of Periodontology, Blekinge Hospital, Hälsovägen, Byggnad 13, 371 41, Karlskrona, Sweden
| | - Stefania Vlachou
- Division of Regenerative Dental Medicine and Periodontology, CUMD, University of Geneva, Rue Michel-Servet 1, 1211, Genève 4, Switzerland
| | - Nikolaos Pandis
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Antonios Zampelis
- Private Practice, Drottninggatan 27, 652 25, Karlstad, Sweden
- Specialist Clinic for Endodontics and Periodontology, Public Dental Service, Värmland, Hagagatan 6, 652 20, Karlstad, Sweden
| | - Andreas Stavropoulos
- Department of Periodontology, Blekinge Hospital, Hälsovägen, Byggnad 13, 371 41, Karlskrona, Sweden.
- Periodontology, Faculty of Odontology, University of Malmö, Carl Gustafs väg 34, 205 06, Malmö, Sweden.
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090, Vienna, Austria.
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, Bern, 3010, Switzerland.
| |
Collapse
|
8
|
Werner N, Heck K, Walter E, Ern C, Bumm CV, Folwaczny M. Probing pocket depth reduction after non-surgical periodontal therapy: Tooth-related factors. J Periodontol 2024; 95:29-39. [PMID: 37436696 DOI: 10.1002/jper.23-0285] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND To investigate tooth-related factors that influence the reduction of probing pocket depths (PPD) after non-surgical periodontal therapy (NST). METHODS Seven hundred forty-six patients with a total of 16,825 teeth were included and retrospectively analyzed. PPD reduction after NST was correlated with the tooth-related factors; tooth type, number of roots, furcation involvement, vitality, mobility, and type of restoration; using logistic multilevel regression for statistical analysis. RESULTS NST was able to reduce probing depth overall stratified probing depths (1.20 ± 1.51 mm, p ≤ 0.001). The reduction was significantly higher at teeth with higher probing depths at baseline. At pockets with PPD ≥ 6 mm, PPD remains high after NST. Tooth type, number of roots, furcation involvement, vitality, mobility, and type of restoration are significantly and independently associated with the rate of pocket closure. CONCLUSIONS The tooth-related factors: tooth type, number of roots, furcation involvement, vitality, mobility, and type of restoration had a significant and clinically relevant influence on phase I and II therapy. Considering these factors in advance may enhance the prediction of sites not responding adequately and the potential need for additional treatment, such as re-instrumentation or periodontal surgery, to ultimately achieve the therapy end points.
Collapse
Affiliation(s)
- Nils Werner
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU, Munich, Germany
| | - Katrin Heck
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU, Munich, Germany
| | - Elias Walter
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU, Munich, Germany
| | | | - Caspar Victor Bumm
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU, Munich, Germany
- Private practice, Munich, Germany
| | - Matthias Folwaczny
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU, Munich, Germany
| |
Collapse
|
9
|
Gobin E, Izidoro C, Lyra P, Morgado M, Alves RC, Mendes JJ, Botelho J, Machado V. Self-Management Ability Questionnaire Validation in Portuguese Adults With Periodontitis. Int Dent J 2023; 73:889-895. [PMID: 37442684 PMCID: PMC10658420 DOI: 10.1016/j.identj.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 07/15/2023] Open
Abstract
OBJECTIVES We aimed to test the psychometric validity of the adapted and translated Self-Management Ability Questionnaire-Short Form (SMAQ-12) to Portuguese. METHODS The translation and adaptation of the SMAQ-12 followed international guidelines. We included 280 participants with chronic periodontitis from the Department of Periodontology of the Egas Moniz Dental Clinic. Participants completed the Portuguese version of the SMAQ-12 (SMAQ-12-PT), a 12-item scale with 3 conceptual domains (Role Management, Medical Management, and Emotional Management). The validity of the content, its construct and internal consistency, as well as test-retest reliability were used to estimate psychometric properties. RESULTS The SMAQ-12-PT showed an interclass correlation coefficient value of 0.90, with a 95% confidence interval (0.79-0.95; P < .001) and high reliability (Cronbach alpha coefficient ranging between 0.78 and 0.94). Confirmatory factor analysis revealed adequate model fit, with comparative fit index of 0.853, goodness-of-fit of 0.947, and a 0.052 value of root mean squared error of approximation. CONCLUSIONS The SMAQ-12-PT was found to be a valid and reliable instrument in the Portuguese population. Disease management representation for the specialty of periodontology and its impact on periodontal schedules and practices should be evaluated in future studies.
Collapse
Affiliation(s)
- Eloïse Gobin
- Clinical Research Unit (CRU), Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Almada, Portugal
| | - Catarina Izidoro
- Clinical Research Unit (CRU), Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Almada, Portugal
| | - Patrícia Lyra
- Clinical Research Unit (CRU), Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Almada, Portugal
| | - Mariana Morgado
- Clinical Research Unit (CRU), Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Almada, Portugal
| | - Ricardo Castro Alves
- Clinical Research Unit (CRU), Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Almada, Portugal
| | - José João Mendes
- Clinical Research Unit (CRU), Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Almada, Portugal; Evidence-Based Hub, Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Almada, Portugal
| | - João Botelho
- Clinical Research Unit (CRU), Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Almada, Portugal; Evidence-Based Hub, Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Almada, Portugal
| | - Vanessa Machado
- Clinical Research Unit (CRU), Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Almada, Portugal; Evidence-Based Hub, Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Almada, Portugal.
| |
Collapse
|
10
|
Rug J, Holtfreter B, Völzke H, Kocher T. Have extraction patterns in German adults with severe periodontitis changed between 2000 and 2010? Results from two cohort studies. J Clin Periodontol 2023; 50:463-475. [PMID: 36574775 DOI: 10.1111/jcpe.13765] [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: 08/16/2022] [Revised: 11/30/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Abstract
AIM The aim of this study was to evaluate whether extraction thresholds in persons with severe periodontitis have changed between 2000 and 2010 and whether potential shifts have contributed to the reported decrease in tooth extractions in German adults over the last decades. MATERIALS AND METHODS Data from two German population-based cohort studies in Northeast Germany (Studies of Health in Pomerania; SHIP-START [baseline 1997-2001; 11-year follow-up] and SHIP-TREND [baseline 2008-2012; 7-year follow-up]) were used. In SHIP-START (SHIP-TREND), 522 (478) participants with severe periodontitis according to the CDC/AAP case definition were included. Patterns of maximum probing depth (PD) and maximum clinical attachment level (CAL) for retained and extracted teeth were compared between SHIP-START and SHIP-TREND participants. RESULTS No major differences in patterns of baseline maximum CAL of retained or extracted teeth were detected between SHIP-START and SHIP-TREND. Extraction thresholds were identified at the baseline at maximum CAL ≥6 and ≥9 mm. Tooth-level incidence rates for extraction for baseline maximum CAL of 6 mm were comparable between SHIP-START and SHIP-TREND (17.1 vs. 15.9 events per 1000 person-years). CONCLUSIONS After a decade, teeth in persons with severe periodontitis were still undergoing extraction with minor or moderate attachment loss. A change in extraction pattern did not contribute to the higher tooth retention rate.
Collapse
Affiliation(s)
- Joey Rug
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Birte Holtfreter
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- German Center for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| |
Collapse
|
11
|
Agudio G, Buti J, Bonaccini D, Pini Prato G, Cortellini P. Longevity of teeth in patients susceptible to periodontitis: Clinical outcomes and risk factors associated with tooth loss after active therapy and 30 years of supportive periodontal care. J Clin Periodontol 2023; 50:520-532. [PMID: 36631984 DOI: 10.1111/jcpe.13770] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/23/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
AIM (i) To evaluate the efficacy of active periodontal therapy supplemented by supportive periodontal care (SPC) in retaining dentition during a 30-year follow-up period in patients susceptible to periodontitis, and (ii) to assess the prognostic factors associated with tooth loss. MATERIALS AND METHODS One-hundred and fifty-four patients with periodontitis, retrospectively classified as stage I-IV and grade B-C periodontitis, treated between 1984 and 1986 in a private practice, were enrolled in this study. After periodontal assessment, patients received non-surgical treatment followed by surgical periodontal therapy, orthodontic treatment, and tooth-splinting, where appropriate. SPC consisted of a strict recall programme every 3-6 months over a 30-year period. Recurrences were treated either with subgingival root planing or flap surgery. Dental and periodontal variables were measured at baseline (T0), end of active therapy (T1), and after 25 (T2) and 30 (T3) years. Generalized mixed models were analysed to assess the prognostic factors associated with and survival analyses for tooth loss. RESULTS Data on 154 patients (4083 teeth) were available at baseline (T0). Teeth considered unworthy of treatment were extracted during active therapy (160, 3.9%) and at re-assessment (13, 0.3%; T1). After 25 years of SPC, 140 teeth out of 3910 in 154 patients (3.6%) were lost (24 in 18 patients for periodontal reasons). Between 25 and 30 years, 20 patients (482 teeth) dropped out, and 61 teeth (2%) were lost (15 in 14 patients for periodontal reasons). Overall, 201 teeth (5.1%) were lost (39 for periodontal reasons) in 30 years of SPC. Generalized mixed models showed that stage III or stage IV periodontitis was associated with greater tooth loss during SPC compared to stage I or stage II (OR = 2.10; p = .048). Generalized periodontitis showed a statistically significant OR = 3.24 (p = .016) compared to the localized one. In SPC (T1-T3), age (p = .011), gender (male; p = .038), molar teeth (p = < .001), T0 and T1 pocket depth (p = < .001), tooth mobility grades 2 (p = .018) and 3 (p = .050), T0 and T1 bone loss (p = < .001), and presence of a root canal treatment (p = < .001) and a crown (p = .009) were statistically significantly associated with tooth loss. CONCLUSION (i) Periodontal therapy and a stringent SPC are effective in maintaining most of the teeth in patients with moderate/advanced periodontitis for 30 years, and (ii) age, gender, molar teeth, pocket depth, bone loss, and the presence of a root canal treatment and a crown are prognostic factors associated with tooth loss.
Collapse
Affiliation(s)
| | - Jacopo Buti
- Unit of Periodontology, UCL Eastman Dental Institute, London, UK
| | | | - Giovanpaolo Pini Prato
- Private Practice, Florence, Italy
- Accademia Toscana di Ricerca Odontostomatologica (ATRO), Florence, Italy
| | - Pierpaolo Cortellini
- Private Practice, Florence, Italy
- Accademia Toscana di Ricerca Odontostomatologica (ATRO), Florence, Italy
- European Research Group on Periodontology (ERGOPERIO), Bern, Switzerland
- Department of Oral Health Sciences, KU Leuven and Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
12
|
Leite FRM, López R, Pajaniaye JB, Nascimento GG. Effect of Smoking Exposure on Nonsurgical Periodontal Therapy: 1-Year Follow-up. J Dent Res 2023; 102:280-286. [PMID: 36333874 DOI: 10.1177/00220345221135100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This study investigated the influence of different levels of exposure to smoking on periodontal healing for 12 mo after nonsurgical periodontal therapy and supportive periodontal care every third month. Eighty smokers willing to quit smoking and with periodontitis were included. Participants were offered an individualized voluntary smoking cessation program. Data collection included questionnaires and a full-mouth periodontal examination. Group-based trajectory modeling was used to model smoking trajectories over the follow-up. The effect of smoking trajectory on periodontal parameters over time was estimated with mixed effects modeling. Three smoking patterns were identified: light smokers/quitters (n = 46), moderate smokers (n = 17), and heavy smokers (n = 17). For the periodontal data, the first factor, moderate periodontitis, included the number of sites with clinical attachment levels (CALs) of 4, 5, 6, and 7 mm; periodontal pocket depths (PPDs) of 4, 5, and 6 mm; and bleeding on probing. The second factor, severe periodontitis, consisted of the number of sites with a CAL ≥8 mm and PPD ≥7 mm. Heavy smokers commenced with a higher average CAL of 1.1 mm and 10 more sites with severe periodontitis than light smokers/quitters. While light smokers/quitters and moderate smokers obtained an average improvement of 0.6-mm PPD and 0.7-mm CAL, respectively, heavy smokers experienced 0.5-mm attachment loss. Heavy smokers had only a 50% reduction in the number of sites with moderate periodontitis when compared with light smokers/quitters and moderate smokers. While most participants benefited from nonsurgical periodontal therapy with results affected in a dose-response manner, the therapy had no effect on severe periodontitis among heavy smokers. Smoking cessation should be part of periodontal therapy; otherwise, limited benefits would be observed among heavy smokers, hindering the effect of treatment.
Collapse
Affiliation(s)
- F R M Leite
- Section for Periodontology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore
- ORH ACP, Duke-NUS Medical School, Singapore
| | - R López
- Section for Periodontology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - J B Pajaniaye
- Section for Periodontology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - G G Nascimento
- Section for Periodontology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore
- ORH ACP, Duke-NUS Medical School, Singapore
| |
Collapse
|
13
|
Trullenque-Eriksson A, Tomasi C, Petzold M, Berglundh T, Derks J. Furcation involvement and tooth loss: A registry-based retrospective cohort study. J Clin Periodontol 2023; 50:339-347. [PMID: 36415171 DOI: 10.1111/jcpe.13754] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 11/14/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022]
Abstract
AIM This registry-based retrospective cohort study aimed to evaluate the impact of furcation status on the risk for molar loss. MATERIALS AND METHODS Subjects with and without furcation involvement (FI) in 2010/2011 were identified in a nationwide registry in Sweden (age- and gender-matched sample: 381,450 subjects; 2,374,883 molars). Data on dental and periodontal status were extracted for the subsequent 10-year period. Impact of FI (at baseline or detected during follow-up) on molar loss (i.e., tooth extraction) was evaluated through multilevel logistic regression and survival analyses. RESULTS FI had a significant impact on molar loss. FI degrees 2 and 3 resulted in adjusted risk ratios of 1.67 (95% confidence interval [CI] 1.63-1.71) and 3.30 (95% CI 3.18-3.43), respectively. Following the first detection of deep FI (degrees 2-3), estimated survival decreased by 4% at 5 years and 8% at 10 years. In addition to FI, endodontic status and probing depth were relevant risk factors for molar loss. CONCLUSIONS Furcation status had a clinically relevant impact on the risk for molar loss. Following first detection of deep FI, however, the decline in molar survival was minor.
Collapse
Affiliation(s)
- Anna Trullenque-Eriksson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Cristiano Tomasi
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Tord Berglundh
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
14
|
Comparison between Conventional Modality Versus Cone-Beam Computer Tomography on the Assessment of Vertical Furcation in Molars. Diagnostics (Basel) 2022; 13:diagnostics13010106. [PMID: 36611398 PMCID: PMC9818298 DOI: 10.3390/diagnostics13010106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/20/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
This study aimed to assess the accuracy of diagnosis of vertical furcation subclass in molars using periapical radiographs (PAs) and clinical chartings compared against cone-beam computer tomography (CBCT) as the gold standard. The protocol involved examiners with different levels of experience. This retrospective radiographic study retrieved 40 molar teeth with full periodontal chartings, PAs, and CBCT records. Fifteen examiners with different levels of experience evaluated the PAs and periodontal chartings to assess the vertical depth of furcation and, thus, the vertical subclassification. CBCT was used as the gold standard for comparison. The accuracy of vertical furcal depth measured was assessed together with the accuracy of vertical subclassification assignment. The reliability of the conventional diagnostic modality among the examiners was also evaluated. A linear mixed model adjusted for the CBCT vertical furcal depth measurement was constructed to determine if tooth position, horizontal furcation distribution, and examiner experience level affect the bias in the vertical depth of furcation measurement. The reliability of the conventional periodontal diagnostic method in measuring vertical furcal depth was found to be fair, while vertical subclass assignment was moderate. Significantly better reliability during subclass assignment was found with mandibular molars (p < 0.001) and in maxillary molars with isolated buccal class II furcation. Within the study’s limitations, conventional periodontal diagnostics based on periapical radiographs and clinical periodontal chartings appear to be in poor to fair agreement with CBCT (gold standard) when measuring the vertical depth of furcation. Examiners with the least experience were more prone to bias when estimating the vertical furcal depth.
Collapse
|
15
|
Furcation-involved molar teeth - part 2: management and prognosis. Br Dent J 2022; 233:923-928. [PMID: 36494531 DOI: 10.1038/s41415-022-5254-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 05/23/2022] [Indexed: 12/13/2022]
Abstract
Furcation-involved molars are a common presentation in general dental practice. Teeth with increasing degrees of furcation involvement are at a higher risk of requiring extraction. This second article reviews management and prognosis of furcation-involved molar teeth. An improved understanding of how to appropriately manage these teeth can result in improved outcomes for patients.
Collapse
|
16
|
Jolivet G, Huck O, Petit C. Evaluation of furcation involvement with diagnostic imaging methods: a systematic review. Dentomaxillofac Radiol 2022; 51:20210529. [PMID: 35787071 PMCID: PMC9717400 DOI: 10.1259/dmfr.20210529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 06/09/2022] [Accepted: 07/01/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Multirooted teeth respond less favorably to non-surgical periodontal treatment and long-term tooth prognosis is influenced by the degree of furcation involvement (FI). Therapeutic strategy for multirooted teeth is essentially based on accurate diagnosis of the FI. The aim of this systematic review is to evaluate the accuracy of the different furcation assessment methods and to determine if radiographic help is needed to determine early stage of FI. METHODS Electronic databases were searched up to March 2021. Comparative studies describing the reliability of different clinical and/or radiological furcation assessment methods were identified. RESULTS A total of 22 studies comparing at least 2 furcation assessment methods, among which 15 retrospective studies, 5 prospective studies, 1 randomized controlled trial and 1 case series, were included in this review. The reliability of cone beam CT (CBCT), intraoral radiographs (IOs), orthopantomograms (OPGs) and MRI to identify FI was evaluated. Using OFS as a reference for FI detection and diagnosis, agreement ranged from 43.3 to 63% for OPG, 38.7 to 83.1% for IO and 82.4 to 84% for CBCT. The validity of the measurements was mainly influenced by the location of the furcation entrance. For radiological diagnosis, CBCT displayed the closest agreement with OFS while the accuracy of IO and OPG showed modest agreement and were influenced by the examiner's experience. CONCLUSION Altogether, it appears that the use of IO, OPG or CBCT allows detection of FI but could not be considered as gold-standard techniques.
Collapse
|
17
|
Zhang H, Wei Y, Xu T, Zhen M, Wang C, Han Z, Hu W, Chung KH. Assessment of soft and hard tissue characteristics of ridge preservation at molar extraction sites with severe periodontitis: a randomized controlled trial. BMC Oral Health 2022; 22:511. [DOI: 10.1186/s12903-022-02544-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/27/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
Background
Changes in alveolar bone dimension after tooth extraction may affect placement of the subsequent implant, resulting in ridge deficiency that can adversely impact long-term implant stability or aesthetics. Alveolar ridge preservation (ARP) was effective in reducing the amount of ridge resorption following tooth extraction. There is sparse evidence regarding the benefit of ARP at periodontally compromised molar extraction sockets. This study will be a randomized trial to assess the soft tissue contour, radiographical, and histological changes of ARP at molar extraction sites in order to compare severe periodontitis cases with natural healing results and determine the most beneficial and least traumatic clinical treatment for such patients.
Methods
This research is designed as a two-group parallel randomized controlled trial. The total number of tooth extraction sites will be 70 after calculation with power analysis. Teeth will be randomly assigned to two groups with the test group conducting ridge preservation and the control group healing naturally. Periodontal examination, cone beam-computed tomography (CBCT) data, and stereolithographic (STL) files obtained by intraoral scanning will be collected through the follow-up period, and bone biopsy samples would be obtained during implant surgery. The primary outcomes are the vertical and horizontal change of alveolar ridge measured on CBCT images, soft tissue contour changes evaluated by superimposing the digital impressions, alterations of mucosa thickness (as measured by superimposing the CBCT data and STL files), histological features of implant sites and periodontal parameter changes. The secondary outcomes are patient-reported post-operative reaction and conditions of simultaneous bone graft or sinus lifting procedures during implantation.
Discussion
This study will provide information about hard and soft tissue dimension changes and histomorphology evaluation following ARP and natural healing in periodontally compromised molar sites, which may contribute to complement the missing information of ARP at periodontally compromised molar extraction sockets.
Trial registration
Chinese Clinical Trial Register (ChiCTR) ChiCTR2200056335. Registered on February 4, 2022, Version 1.0.
Collapse
|
18
|
Georgiou GO, Tarallo F, Marchetti E, Bizzarro S. Overview of the Effect of Different Regenerative Materials in Class II Furcation Defects in Periodontal Patients. MATERIALS (BASEL, SWITZERLAND) 2022; 15:3194. [PMID: 35591533 PMCID: PMC9103580 DOI: 10.3390/ma15093194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/14/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022]
Abstract
The aim of this review was to give an overview of the outcomes of the use of different regenerative materials to treat molars with class II furcation defects in patients with periodontitis in comparison with open flap debridement (OFD). A search of five databases (PubMed-Medline, Embase, Cochrane, Scopus and Web of Science) was conducted up to and including January 2022. According to the PICOS guidelines, only randomized control trials (S) considering periodontal patients with at least one molar with a class II furcation involvement (P) treated with regenerative materials (I) in comparison to OFD as control treatment (C) and a minimum follow-up period of 6 months were included. Vertical clinical attachment level (VCAL) was considered as the primary outcome (O), while horizontal clinical attachment level (HCAL), horizontal probing depth (HPD) and vertical probing depth (VPD) were considered as secondary outcomes. The search through the databases initially identified 1315 articles. Only 25 of them met the eligibility criteria and were included. The studies were grouped in four macro-categories according to the material used: absorbable and non-absorbable membranes, blood derivatives and a combination of different materials. The greater part of the included studies reported a statistically significant difference in using regenerative materials when compared to OFD. The blood derivatives groups reported a range of mean changes in VCAL of 0.86-4.6 mm, absorbable membrane groups reported -0.6-3.75 mm, non-absorbable membranes groups reported -2.47-4.1 mm, multiple materials groups reported -1.5-4.87 mm and enamel matrix derivatives reported a mean change in VCAL of 1.45 mm. OFD showed a range of mean VCAL changes of -1.86-2.81 mm. Although no statistical analysis was performed, the use of regenerative materials may be considered moderately beneficial in the treatment of molars with grade II furcation involvement. However, the substantial heterogeneity in the protocols' design does not allow us to draw definitive conclusions. In addition, low levels of evidence for morbidity and patient-centered outcomes were reported.
Collapse
Affiliation(s)
- Gerasimos Odysseas Georgiou
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, 1081 LA Amsterdam, The Netherlands; (G.O.G.); (S.B.)
| | - Francesco Tarallo
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Coppito, 67100 L’Aquila, Italy;
| | - Enrico Marchetti
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Coppito, 67100 L’Aquila, Italy;
| | - Sergio Bizzarro
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, 1081 LA Amsterdam, The Netherlands; (G.O.G.); (S.B.)
| |
Collapse
|
19
|
Sant’Anna HR, Casati MZ, Mussi MC, Cirano FR, Pimentel SP, Ribeiro FV, Corrêa MG. Peri-Implant Repair Using a Modified Implant Macrogeometry in Diabetic Rats: Biomechanical and Molecular Analyses of Bone-Related Markers. MATERIALS 2022; 15:ma15062317. [PMID: 35329768 PMCID: PMC8953263 DOI: 10.3390/ma15062317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 02/01/2023]
Abstract
DM has a high prevalence worldwide and exerts a negative influence on bone repair around dental implants. Modifications of the microgeometry of implants have been related to positive results in bone repair. This study assessed, for the first time, the influence of an implant with modified macrodesign based on the presence of a healing chamber in the pattern of peri-implant repair under diabetic conditions. Thirty Wistar rats were assigned to receive one titanium implant in each tibia (Control Implant (conventional macrogeometry) or Test Implant (modified macrogeometry)) according to the following groups: Non-DM + Control Implant; Non-DM + Test Implant; DM + Control Implant; DM + Test Implant. One month from the surgeries, the implants were removed for counter-torque, and the bone tissue surrounding the implants was stored for the mRNA quantification of bone-related markers. Implants located on DM animals presented lower counter-torque values in comparison with Non-DM ones, independently of macrodesign (p < 0.05). Besides, higher biomechanical retention levels were observed in implants with modified macrogeometry than in the controls in both Non-DM and DM groups (p < 0.05). Moreover, the modified macrogeometry upregulated OPN mRNA in comparison with the control group in Non-DM and DM rats (p < 0.05). Peri-implant bone repair may profit from the use of implants with modified macrogeometry in the presence of diabetes mellitus, as they offer higher biomechanical retention and positive modulation of important bone markers in peri-implant bone tissue.
Collapse
|
20
|
Costa FO, Cortelli JR, Cortelli SC, Costa AA, Esteves Lima RP, Costa AM, Pereira GHM, Cota LOM. The loss of molars in supportive periodontal care: a 10-year follow-up for tooth- and patient-related factors. J Clin Periodontol 2021; 49:292-300. [PMID: 34905803 DOI: 10.1111/jcpe.13585] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/20/2021] [Accepted: 11/24/2021] [Indexed: 11/28/2022]
Abstract
AIM Determining the impact of the degree of furcation involvement (FI) on the longevity of molar teeth and assessing risk variables (tooth- and patients-related factors) associated with loss of molars (LM) in individuals treated for periodontitis and monitored in a private program of supportive periodontal care (SPC). MATERIALS AND METHODS The present retrospective cohort study included 222 individuals with 1,329 molars under a 10-year monitoring period in SPC. Periodontal clinical parameters, FI, type of molar, pulp vitality and other variables of interest were colleted at approximately 50 days after active periodontal therapy and after 10 years. The association of tooth- and patients-related factors with LM was assessed using a multilevel Cox regression analysis. RESULTS 235 molars were extracted during the SPC period of 12.4(±1.9) years. Age >50 years old, male gender, diabetes, smoking and no compliance were identified as relevant patient-related factors for LM during SPC (p<0.05). Significant tooth-related factors for LM were bleeding on probing (BOP) and probing depth (PD) ≥5mm, tooth non-vitality and class II and III FI (p<0.05). CONCLUSIONS Class III FI, tooth non-vitality, higher mean PD and BOP, age, male gender, diabetes and smoking all strongly influenced the prognosis of molars during SPC. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Fernando Oliveira Costa
- School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - José Roberto Cortelli
- Departament of Dentistry, Periodontics Research Division, University of Taubaté, São Paulo, Brazil
| | - Sheila Cavalca Cortelli
- Departament of Dentistry, Periodontics Research Division, University of Taubaté, São Paulo, Brazil
| | - Amanda Almeida Costa
- School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | | | | |
Collapse
|
21
|
Bertl K, Pandis N, Stopfer N, Haririan H, Bruckmann C, Stavropoulos A. The impact of a "successfully treated stable periodontitis patient status" on patient-related outcome parameters during long-term supportive periodontal care. J Clin Periodontol 2021; 49:101-110. [PMID: 34866227 DOI: 10.1111/jcpe.13582] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/14/2021] [Accepted: 11/20/2021] [Indexed: 01/22/2023]
Abstract
AIM To assess the importance of achieving a successfully treated stable periodontitis patient status (PPS) during long-term supportive periodontal care (SPC). MATERIALS AND METHODS This retrospective cohort study included 100 periodontitis patients, who continued for ≥7.5 years after active periodontal treatment with SPC and were judged as overall adherent. The effect of various predictors on three patient-related outcome parameters was assessed: (1) number of diseased teeth at last SPC, (2) number of teeth lost due to periodontitis, and (3) number of teeth lost due to any reason. RESULTS One-fifth of the patients were classified as stable after active periodontal treatment. After a mean follow-up of 10.77 years, 24 patients lost 38 teeth due to periodontitis. An unstable PPS and a higher number of diseased teeth per patient at first SPC, and inadequate oral hygiene levels over time, significantly increased the risk for a higher number of diseased teeth per patient at last SPC and for more lost teeth due to periodontitis. However, high adherence to SPC appeared to mitigate the negative effect of an unstable PPS, especially regarding tooth loss due to periodontitis. Further, tooth loss due to any reason was about 3 times higher than tooth loss due to periodontitis and was affected by a larger number of predictors. CONCLUSIONS Successfully treated patients with a stable PPS maintained a small number of diseased teeth and barely lost any teeth during long-term SPC compared to patients who did not achieve a stable PPS after active periodontal therapy.
Collapse
Affiliation(s)
- Kristina Bertl
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden.,Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Nikolaos Pandis
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Nikolaus Stopfer
- Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Hady Haririan
- Department of Periodontology, Medical Faculty, Sigmund Freud University Vienna, Vienna, Austria
| | - Corinna Bruckmann
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Andreas Stavropoulos
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden.,Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria.,Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine (CUMD), University of Geneva, Geneva, Switzerland
| |
Collapse
|
22
|
Al-Harthi S, Barbagallo G, Psaila A, d'Urso U, Nibali L. Tooth loss and radiographic bone loss in patients without regular supportive care: A retrospective study. J Periodontol 2021; 93:354-363. [PMID: 34564843 DOI: 10.1002/jper.21-0415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Very few studies have investigated the effect of patient and site factors on periodontal progression and long-term tooth loss in populations with minimal dental care. The aim of this retrospective study was to assess tooth loss and radiographic bone loss over at least 5 years in patients attending a national-health service primary care practice in Sicily and undergoing no regular care. METHODS Records of two hundred consecutive patients with at least 5 years follow-up were screened and demographic, clinical and radiographic data were retrieved. Analyses of associations between patient and site factors and tooth loss were performed. RESULTS After excluding not suitable patients, a total of 159 patient records with clinical and radiographic data with average 8.6 years follow-up were included. One hundred of these patients had no professional mechanical plaque removal (PMPR) carried out throughout the study follow-up. Nearly 65% of patients lost at least 1 tooth during the follow-up period, with a total of 400 extracted teeth (for periodontal and non-periodontal reasons). The annual tooth loss rate was slightly higher for "no PMPR" (untreated) patients (0.30 teeth/patient/year) compared with patients who had PMPR (0.27 teeth/patient/year). On a patient-level, only reduced frequency of daily tooth brushing was associated with tooth loss at logistic regression, whereas staging, grading and diagnosis of caries were associated with rates of tooth loss/year. At multilevel analysis including patient- and tooth-factors, age, diagnosis of caries and endodontic disease and percentage of bone loss at baseline were associated with tooth loss. CONCLUSION This study confirms the importance of tooth brushing, initial bone loss, caries and endodontic disease in predicting tooth survival in a primary care setting.
Collapse
Affiliation(s)
- Shaima Al-Harthi
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Giovanni Barbagallo
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Catania, Italy
| | - Alessandro Psaila
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Catania, Italy
| | - Umberto d'Urso
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Catania, Italy
| | - Luigi Nibali
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| |
Collapse
|
23
|
Eickholz P, Runschke M, Dannewitz B, Nickles K, Petsos H, Kronsteiner D, Pretzl B. Long-term prognosis of teeth with class III furcation involvement. J Clin Periodontol 2021; 48:1528-1536. [PMID: 34545596 DOI: 10.1111/jcpe.13551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/16/2021] [Accepted: 09/08/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Evaluation of survival of teeth with class III furcation involvement (FI) ≥5 years after active periodontal treatment (APT) and identification of prognostic factors. METHODS All charts of patients who completed APT at the Department of Periodontology of Goethe-University Frankfurt, Germany, beginning October 2004 were screened for teeth with class III FI. APT had to be accomplished for ≥5 years. Charts were analysed for data of class III FI teeth at baseline (T0), at accomplishment of APT (T1), and at the last supportive periodontal care (T2). Baseline radiographic bone loss (RBL) and treatment were assessed. RESULTS One-hundred and sixty patients (age: 54.4 ± 9.8 years; 82 females; 39 active smokers; 9 diabetics, 85 stage III, 75 stage IV, 59 grade B, 101 grade C) presented 265 teeth with class III FI. Ninety-eight teeth (37%) were lost during 110, 78/137 (median, lower/upper quartile) months. Logistic mixed-model regression and mixed Cox proportional hazard model associated adjunctive systemic antibiotics with fewer tooth loss (26% vs. 42%; p = .019/.004) and RBL (p = .014/.024) and mean probing pocket depth (PPD) at T1 (p < .001) with more tooth loss. CONCLUSIONS Subgingival instrumentation with adjunctive systemic antibiotics favours retention of class III furcation-involved teeth. Baseline RBL and PPD at T1 deteriorate long-term prognosis.
Collapse
Affiliation(s)
- Peter Eickholz
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Maren Runschke
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Bettina Dannewitz
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Katrin Nickles
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Hari Petsos
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Dorothea Kronsteiner
- Institute of Medical Biometry and Informatics (IMBI), University Hospital Heidelberg, Heidelberg, Germany
| | - Bernadette Pretzl
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
24
|
Nibali L, Shemie M, Li G, Ting R, Asimakopoulou K, Barbagallo G, Lee R, Eickholz P, Kocher T, Walter C, Aimetti M, Rüdiger S. Periodontal furcation lesions: A survey of diagnosis and management by general dental practitioners. J Clin Periodontol 2021; 48:1441-1448. [PMID: 34472119 DOI: 10.1111/jcpe.13543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/19/2021] [Indexed: 12/27/2022]
Abstract
AIM The aim of this study was to explore general dental practitioners' (GDPs) attitude to periodontal furcation involvement (FI). MATERIALS AND METHODS An online survey focused on diagnosis and management of periodontal FI was circulated to GDPs in seven different countries. RESULTS A total of 400 responses were collected. Nearly a fifth of participants reported rarely or never taking 6-point pocket charts; 65.8% of participants had access to a Nabers probe in their practice. When shown clinical pictures and radiographs of FI-involved molars, the majority of participants correctly diagnosed it. Although 47.1% of participants were very/extremely confident in detecting FI, only 8.9% felt very/extremely confident at treating it. Differences in responses were detected according to country and year of qualification, with a trend towards less interest in periodontal diagnosis and treatment in younger generations. Lack of knowledge of management/referral pathways (reported by 22.8%) and lack of correct equipment were considered the biggest barriers to FI management. Most participants (80.9%) were interested in learning more about FI, ideally face to face followed by online tutorials. CONCLUSIONS Plans should be put in place to improve general dentists' knowledge and ability to manage FI, as this can have a significant impact on public health.
Collapse
Affiliation(s)
- Luigi Nibali
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Melissa Shemie
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Guanhong Li
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Rachel Ting
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Koula Asimakopoulou
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Giovanni Barbagallo
- Department of General Surgery and Surgical-Medical Specialties, University of Catania, Catania, Italy
| | - Ryan Lee
- School of Dentistry, University of Queensland, Brisbane, Australia
| | - Peter Eickholz
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt am Main, Frankfurt, Germany
| | - Thomas Kocher
- Department of Periodontology, University of Greifswald, Greifswald, Germany
| | - Clemens Walter
- Department of Periodontology, Endodontology and Cariology, University of Basel, Basel, Switzerland
| | - Mario Aimetti
- Department of Periodontology, University of Torino, Turin, Italy
| | | |
Collapse
|
25
|
Majzoub J, Salami A, Barootchi S, Tavelli L, Wang HL, Chan HL. Multivariate outcome evaluation of furcation-involved molars treated with non-surgical mechanical therapy alone or combined with open flap debridement: A retrospective study. J Periodontol 2021; 93:673-686. [PMID: 34449893 DOI: 10.1002/jper.21-0113] [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: 02/22/2021] [Revised: 08/04/2021] [Accepted: 08/09/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND This retrospective study assessed the effect of non-surgical and surgical mechanical therapy for furcation-involved molars. METHODS Furcation defects treated and followed for at least 1 year were selected. Data relative to the clinical outcomes were recorded. The immediate (3- to 6-month) clinical outcomes and the long-term survival of the treated molars were assessed. The potential variables influencing the treatment outcomes through multi-level regression analysis, and Cox Proportional-Hazards Models were also analyzed. RESULTS One hundred and eighty-four molars were included with an average follow-up of 7.52 years. At the 3- to 6-month re-evaluation 1.39 ± 0.99 mm pocket depth reduction, 0.88 ± 1.29 mm clinical attachment gain, and a 0.51 ± 1.13 mm increase in recession was observed. The 5- and 10-year survival rates were 88.3% and 61.3%, respectively. The horizontal and vertical extent of furcation involvement, baseline probing depth, mucoperiosteal flap elevation, and the frequency of supportive periodontal therapy influenced the clinical outcomes and tooth survival. CONCLUSION Non-surgical and surgical mechanical root debridement is a viable treatment for the management of furcation involved molars with shallow horizontal and vertical components.
Collapse
Affiliation(s)
- Jad Majzoub
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
| | - Ali Salami
- Department of Mathematics, Faculty of Sciences, Lebanese University, Nabatieh, Lebanon
| | - Shayan Barootchi
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
| | - Lorenzo Tavelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI.,Department of Oral Medicine, Infection and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, MA
| | - Hom-Lay Wang
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
| | - Hsun-Liang Chan
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
| |
Collapse
|
26
|
Rahim-Wöstefeld S, Kronsteiner D, ElSayed S, ElSayed N, Eickholz P, Pretzl B. Development of a prognostic tool: based on risk factors for tooth loss after active periodontal therapy. Clin Oral Investig 2021; 26:813-822. [PMID: 34435251 PMCID: PMC8791882 DOI: 10.1007/s00784-021-04060-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/27/2021] [Indexed: 11/30/2022]
Abstract
Objectives The aim of this study was to develop a prognostic tool to estimate long-term tooth retention in periodontitis patients at the beginning of active periodontal therapy (APT). Material and methods Tooth-related factors (type, location, bone loss (BL), infrabony defects, furcation involvement (FI), abutment status), and patient-related factors (age, gender, smoking, diabetes, plaque control record) were investigated in patients who had completed APT 10 years before. Descriptive analysis was performed, and a generalized linear-mixed model-tree was used to identify predictors for the main outcome variable tooth loss. To evaluate goodness-of-fit, the area under the curve (AUC) was calculated using cross-validation. A bootstrap approach was used to robustly identify risk factors while avoiding overfitting. Results Only a small percentage of teeth was lost during 10 years of supportive periodontal therapy (SPT; 0.15/year/patient). The risk factors abutment function, diabetes, and the risk indicator BL, FI, and age (≤ 61 vs. > 61) were identified to predict tooth loss. The prediction model reached an AUC of 0.77. Conclusion This quantitative prognostic model supports data-driven decision-making while establishing a treatment plan in periodontitis patients. In light of this, the presented prognostic tool may be of supporting value. Clinical relevance In daily clinical practice, a quantitative prognostic tool may support dentists with data-based decision-making. However, it should be stressed that treatment planning is strongly associated with the patient’s wishes and adherence. The tool described here may support establishment of an individual treatment plan for periodontally compromised patients.
Collapse
Affiliation(s)
- Sonja Rahim-Wöstefeld
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, 69120, Heidelberg, Germany.
- Private Practice, 68159, Mannheim, Germany.
| | - Dorothea Kronsteiner
- Institute of Medical Biometry and Informatics (IMBI), University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Shirin ElSayed
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Nihad ElSayed
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Peter Eickholz
- Department of Periodontology, Center of Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, 60596, Frankfurt, Germany
| | - Bernadette Pretzl
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, 69120, Heidelberg, Germany
| |
Collapse
|
27
|
Carvalho R, Botelho J, Machado V, Mascarenhas P, Alcoforado G, Mendes JJ, Chambrone L. Predictors of tooth loss during long-term periodontal maintenance: An updated systematic review. J Clin Periodontol 2021; 48:1019-1036. [PMID: 33998031 DOI: 10.1111/jcpe.13488] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 12/24/2022]
Abstract
AIM To evaluate the risk factors / predictors of tooth loss in patients with periodontitis who underwent periodontal therapy and long-term periodontal maintenance (PM). MATERIAL AND METHODS PubMed, CENTRAL, EMBASE, Web of Science, LILACS and Scholar were searched up to and including September 2020. Studies limited to periodontitis patients who underwent active periodontal therapy (APT) and followed a regular PM programme with 5 years follow-up minimum were eligible for inclusion in this review. Studies were included if they reported data on tooth loss during PM. Random effects meta-analyses of number of tooth loss per patient per year were conducted. RESULTS Thirty-six papers regarding thirty-three studies were included in this review, with three prospective 30 retrospective trials. Subgroup meta-analysis showed no differences between prospective and retrospective studies, with an average of 0.1 tooth loss per year per patient (p < 0.001). Maxillary and molar teeth were more susceptible to be extracted during long-term PM. Baseline characteristics (smoking, diabetes mellitus, cardiovascular disease, being male and teeth with furcation lesions) showed no significance as predictor of tooth loss through meta-regression. The percentage of tooth loss due to periodontal reasons ranged from 0.45% to 14.4%. The individual outcomes in each study evidenced different patient-related factors (age and smoking) and tooth-related factors (i.e. tooth type and location) were associated with tooth loss during PM. CONCLUSION The majority of patients undergoing long-term PM have not lost teeth. On average, long-term PM effectively causes the loss of 1 tooth per patient every 10 years. Additional prospective trials may confirm these results.
Collapse
Affiliation(s)
- Rui Carvalho
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal
| | - João Botelho
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal.,Periodontology Department, Egas Moniz Dental Clinic (EMDC), Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal
| | - Vanessa Machado
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal.,Periodontology Department, Egas Moniz Dental Clinic (EMDC), Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal
| | - Paulo Mascarenhas
- Evidence-Based Hub, CiiEM, Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal
| | - Gil Alcoforado
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal.,Periodontology Department, Egas Moniz Dental Clinic (EMDC), Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal
| | - José João Mendes
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal.,Evidence-Based Hub, CiiEM, Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal
| | - Leandro Chambrone
- Evidence-Based Hub, CiiEM, Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal.,Graduate Dentistry Program, School of Dentistry, Ibirapuera University, São Paulo, Brazil.,Unit of Basic Oral Investigation (UIBO), Universidad El Bosque, Bogota, Colombia
| |
Collapse
|
28
|
Corrêa MG, Ribeiro FV, Pimentel SP, Benatti BB, Felix Silva PH, Casati MZ, Cirano FR. Impact of resveratrol in the reduction of the harmful effect of diabetes on peri-implant bone repair: bone-related gene expression, counter-torque and micro-CT analysis in rats. Acta Odontol Scand 2021; 79:174-181. [PMID: 32697922 DOI: 10.1080/00016357.2020.1797159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Investigate the impact of resveratrol (RESV) on peri-implant repair and its effect on bone-related markers in rats with induced diabetes mellitus (DM). MATERIAL AND METHODS Ninety rats were divided into: DM + RESV (n = 18); DM + placebo (PLAC) (n = 18); DM + insulin (INS) (n = 18); DM + RESV + INS (n = 18); Non-DM (n = 18). Diabetes was induced by streptozotocin. One screw-shaped titanium implant was inserted in each tibiae of animals. Treatments were administered during 30 days. After, one of the implants was removed for counter-torque and the peri-implant tissue was collected for mRNA quantification of BMP-2, OPN, Runx2, Lrp-5, Osx, β-catenin, Dkk1, OPG, and RANKL by Real-time PCR. The other tibia was submitted to MicroCT analysis to measure: bone volume (BV/TV), trabecular thickness (Tb.Th) and bone-implant contact (BIC). RESULTS Higher counter-torque values were observed for implant removal in DM + RESV, DM + RESV + INS and Non-DM groups when compared to DM + PLAC (p < .05). Augmented Tb.Th was observed in DM + RESV and Non-DM when compared to DM + PLAC group (p < .05), whereas higher BIC was detected in DM + RESV, DM + RESV + INS and Non-DM animals when compared to DM + PLAC (p < .05). Levels of RANKL were downregulated by the RESV and/or INS therapy, whereas only the association of RESV and INS upregulated the levels of Runx2 (p < .05). CONCLUSIONS The therapy with RESV may favour peri-implant bone repair improving bone formation around implants.
Collapse
Affiliation(s)
| | | | - Suzana Peres Pimentel
- Dental Research Division, School of Dentistry, Paulista University, São Paulo, Brazil
| | | | - Pedro Henrique Felix Silva
- Department of Surgery and Bucco-Maxillofacial Traumatology and Periodontology, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, Brazil
| | | | | |
Collapse
|
29
|
Tooth loss in complying and non-complying periodontitis patients with different periodontal risk levels during supportive periodontal care. Clin Oral Investig 2021; 25:5897-5906. [PMID: 33760975 PMCID: PMC8443470 DOI: 10.1007/s00784-021-03895-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/16/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To evaluate yearly tooth loss rate (TLR) in periodontitis patients with different periodontal risk levels who had complied or not complied with supportive periodontal care (SPC). MATERIALS AND METHODS Data from 168 periodontitis patients enrolled in a SPC program based on a 3-month suggested recall interval for at least 3.5 years were analyzed. For patients with a mean recall interval within 2-4 months ("compliers") or > 4 months ("non-compliers") with different PerioRisk levels (Trombelli et al. 2009), TLR (irrespective of the cause for tooth loss) was calculated. TLR values were considered in relation to meaningful TLR benchmarks from the literature for periodontitis patients either under SPC (0.15 teeth/year; positive benchmark) or irregularly complying with SPC (0.36 teeth/year; negative benchmark). RESULTS In both compliers and non-compliers, TLR was significantly below or similar to the positive benchmark in PerioRisk level 3 (0.08 and 0.03 teeth/year, respectively) and PerioRisk level 4 (0.12 and 0.18 teeth/year, respectively). Although marked and clinically relevant in non-compliers, the difference between TLR of compliers (0.32 teeth/year) and non-compliers (0.52 teeth/year) with PerioRisk level 5 and the negative benchmark was not significant. CONCLUSION A SPC protocol based on a 3- to 6-month recall interval may effectively limit long-term tooth loss in periodontitis patients with PerioRisk levels 3 and 4. A fully complied 3-month SPC protocol seems ineffective when applied to PerioRisk level 5 patients. CLINICAL RELEVANCE PerioRisk seems to represent a valid tool to inform the SPC recall interval as well as the intensity of active treatment prior to SPC enrollment.
Collapse
|
30
|
Petsos H, Ramich T, Nickles K, Dannewitz B, Pfeifer L, Zuhr O, Eickholz P. Tooth loss in periodontally compromised patients: Retrospective long-term results 10 years after active periodontal therapy. Tooth-related outcomes. J Periodontol 2021; 92:1761-1775. [PMID: 33748997 DOI: 10.1002/jper.21-0056] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/16/2021] [Accepted: 03/16/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Estimating prognosis of periodontally affected teeth at the beginning of supportive periodontal care (SPC) is an important component for further treatment planning. This study aimed to evaluate tooth loss (TL) during 10 years of SPC in periodontally compromised patients and to identify tooth-related factors affecting TL. METHODS Patients were re-examined 120 ± 12 months after accomplishment of active periodontal therapy. TL was defined as primary outcome variable and tooth-related factors (abutment status, furcation involvement [FI], tooth mobility, mean periodontal probing depth [PD], and clinical attachment level [CAL] at beginning of SPC, and initial bone loss [BL]) were estimated based on an adjusted regression analyses model. RESULTS Ninety-seven patients (51 females and 46 males; mean age, 65.3 ± 11 years) lost 119 of 2,323 teeth (overall TL [OTL]: 0.12 teeth/patient/y) during 10 years of SPC. Forty of these teeth (33.6%) were lost for periodontal reasons (TLP; 0.04 teeth/patient/y). Significantly more teeth were lost due to other reasons (P <0.0001). TLP (OTL) only occurred in 5.9% (14.7%) of all teeth, when BL was at least 80%. Use as abutment tooth, FI degree III, tooth mobility degrees I and II, mean PD, and CAL positively correlated with OTL (P <0.05). For TLP, FI and tooth mobility degree III as well as mean CAL were identified as tooth-related prognostic factors (P <0.05). CONCLUSIONS During 10 years of SPC, most of the teeth (93.4%) of periodontally compromised patients were retained, showing the positive effect of a well-established treatment concept. Well-known tooth-related prognostic factors were confirmed.
Collapse
Affiliation(s)
- Hari Petsos
- Private practice, Soest, Germany.,Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt am Main, Germany
| | - Tatjana Ramich
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt am Main, Germany
| | - Katrin Nickles
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt am Main, Germany.,Private practice, Mannheim, Germany
| | - Bettina Dannewitz
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt am Main, Germany.,Private practice, Weilburg, Germany
| | - Leon Pfeifer
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt am Main, Germany
| | - Otto Zuhr
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt am Main, Germany.,Private practice, Münich, Germany
| | - Peter Eickholz
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt am Main, Germany
| |
Collapse
|
31
|
Conte A, Ghiraldini B, Denófrio PHF, Ribeiro FV, Pimentel SP, Casati MZ, Corrêa MG, Cirano FR. Could implant position influence the peri-implant parameters in edentulous mandibles of diabetics rehabilitated with overdentures? A split-mouth randomized study. Int J Oral Maxillofac Surg 2021:S0901-5027(21)00088-6. [PMID: 33715937 DOI: 10.1016/j.ijom.2021.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 12/15/2020] [Accepted: 02/07/2021] [Indexed: 10/21/2022]
Abstract
This randomized controlled trial assessed the impact of crestal level position of implants installed in type 2 diabetes mellitus (T2DM) patients rehabilitated with overdentures. Twenty-two mandibular edentulous T2DM patients were submitted to implant placement for retention of an overdenture. By means of a split-mouth design, two implants were installed: one at supracrestal level (SL) and one at crestal level (CL). Clinical, immunoenzymatic and tomographic analyses were performed at prosthesis placement (baseline) and after 6, 12 and 24 months following implant loading. Increased peri-implant probing depths were detected in CL implants when compared with SL implants at all time-points (baseline P=0.047; 6 months P=0.014; 12 months P=0.027; 24 months P=0.036). Indeed, augmented clinical attachment levels were also detected in CL implants when compared with SL implants at all time-points (baseline P=003; 6 months P=0.045; 12 months P=0.029; 24 months P=0.026). CL implants demonstrated increased amounts of interleukin-6 (IL-6) at 6 months (P=0.043) and higher IL-17 (P=0.021), IL-21 (P=0.034) and tumour necrosis factor alpha (TNF-α) concentrations (P=0.030) at 24 months in comparison with SL implants. CL group revealed enhanced bone loss from baseline to 6 (P=0.032), 12 (P=0.043) and 24 months (P=0.028) when compared with SL. In conclusion, this study showed that implants placed supracrestally in T2DM patients rehabilitated with overdentures demonstrated lower bone loss and better clinical parameters with beneficial modulation of peri-implant immunoinflammatory biomarkers when compared with implants positioned at crestal level.
Collapse
Affiliation(s)
- A Conte
- Dental Research Division, School of Dentistry, Paulista University, São Paulo, Brazil
| | - B Ghiraldini
- Dental Research Division, School of Dentistry, Paulista University, São Paulo, Brazil
| | - P H F Denófrio
- Dental Research Division, School of Dentistry, Paulista University, São Paulo, Brazil
| | - F V Ribeiro
- Dental Research Division, School of Dentistry, Paulista University, São Paulo, Brazil
| | - S P Pimentel
- Dental Research Division, School of Dentistry, Paulista University, São Paulo, Brazil
| | - M Z Casati
- Dental Research Division, School of Dentistry, Paulista University, São Paulo, Brazil
| | - M G Corrêa
- Dental Research Division, School of Dentistry, Paulista University, São Paulo, Brazil
| | - F R Cirano
- Dental Research Division, School of Dentistry, Paulista University, São Paulo, Brazil.
| |
Collapse
|
32
|
Dommisch H, Walter C, Dannewitz B, Eickholz P. Resective surgery for the treatment of furcation involvement: A systematic review. J Clin Periodontol 2021; 47 Suppl 22:375-391. [PMID: 31912534 DOI: 10.1111/jcpe.13241] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/09/2019] [Accepted: 12/16/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the benefit of resective surgical periodontal therapy (root amputation or resection, root separation, tunnelling) in periodontitis patients exhibiting class II and III furcation involvement (FI) compared with non-surgical treatment (SRP) or open flap debridement (OFD). MATERIAL Outcomes were tooth survival (primary), vertical probing attachment gain, and reduction in probing pocket depth (secondary) evidenced by randomized clinical trials, prospective and retrospective cohort studies and case series with ≥ 12 months of follow-up. Search was performed on 3 electronic databases from January 1998 to December 2018. RESULTS From a total of 683 articles, 66 studies were identified for full-text analysis and 7 studies finally included. Six hundred sixty-seven patients contributed 2,021 teeth with class II or III FI. Data were very heterogeneous regarding follow-up and distribution of FI. A total of 1,515 teeth survived 4 to 30.8 years after therapy. Survival ranged from 38%-94.4% (root amputation or resection, root separation), 62%-67% (tunnelling), 63%-85% (OFD) and 68%-80% (SRP). Overall, treatment provided better results for class II FI than class III. CONCLUSION Within their limits, the data indicate that in class II and III FI, SRP and OFD may result in similar survival rates as root amputation/resection, root separation or tunnelling.
Collapse
Affiliation(s)
- Henrik Dommisch
- Department of Periodontology and Synoptic Dentistry, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Clemens Walter
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine (UZB), University of Basel, Basel, Switzerland
| | - Bettina Dannewitz
- Department of Periodontology, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany
| | - Peter Eickholz
- Department of Periodontology, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany
| |
Collapse
|
33
|
Jepsen S, Gennai S, Hirschfeld J, Kalemaj Z, Buti J, Graziani F. Regenerative surgical treatment of furcation defects: A systematic review and Bayesian network meta-analysis of randomized clinical trials. J Clin Periodontol 2021; 47 Suppl 22:352-374. [PMID: 31860125 DOI: 10.1111/jcpe.13238] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/11/2019] [Accepted: 12/16/2019] [Indexed: 01/10/2023]
Abstract
AIMS To investigate the clinical performance of regenerative periodontal surgery in the treatment of furcation defects versus open flap debridement (OFD) and to compare different regenerative modalities. MATERIAL AND METHODS A systematic search was conducted to identify RCTs evaluating regenerative surgical treatment of furcations with a minimum of 12-month follow-up. Three authors independently reviewed, selected and extracted data from the search conducted and assessed risk of bias. Primary outcomes were tooth loss, furcation improvement (closure/conversion) (FImp), gain of horizontal bone level (HBL) and attachment level (HCAL). Secondary outcomes were gain in vertical attachment level (VCAL), probing pocket depth (PPD) reduction, PROMs and adverse events. Data were summarized into Bayesian standard and network meta-analysis in order to estimate direct and indirect treatment effects and to establish a ranking of treatments. RESULTS The search identified 19 articles, reporting on 20 RCTs (19 on class II, 1 on class III furcations) with a total of 575 patients/787 defects. Tooth loss was not reported. Furcation closure ranged between 0% and 60% (10 trials), and class I conversion from 29% to 100% (six trials). Regenerative techniques were superior to OFD for FImp (OR = 20.9; 90% CrI = 5.81, 69.41), HCAL gain (1.6 mm), VCAL gain (1.3 mm) and PPD reduction (1.3 mm). Bone replacement grafts (BRG) resulted in the highest probability (Pr = 61%) of being the best treatment for HBL gain. Non-resorbable membranes + BRG ranked as the best treatment for VCAL gain (Pr = 75%) and PPD reduction (Pr = 56%). CONCLUSIONS Regenerative surgery of class II furcations is superior to OFD. FImp (furcation closure or class I conversion) can be expected for the majority of defects. Treatment modalities involving BRG are associated with higher performance.
Collapse
Affiliation(s)
- Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University Hospital Bonn, Bonn, Germany
| | - Stefano Gennai
- Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | | | | | - Jacopo Buti
- Unit of Periodontology, UCL Eastman Dental Institute, London, UK
| | - Filippo Graziani
- Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| |
Collapse
|
34
|
Rahim‐Wöstefeld S, El Sayed N, Weber D, Kaltschmitt J, Bäumer A, El‐Sayed S, Eickholz P, Pretzl B. Tooth‐related factors for tooth loss 20 years after active periodontal therapy–A partially prospective study. J Clin Periodontol 2020; 47:1227-1236. [DOI: 10.1111/jcpe.13348] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/28/2020] [Accepted: 06/28/2020] [Indexed: 02/01/2023]
Affiliation(s)
- Sonja Rahim‐Wöstefeld
- Section of Periodontology Department of Conservative Dentistry Clinic for Oral, Dental and Maxillofacial Diseases University Hospital Heidelberg Heidelberg Germany
| | - Nihad El Sayed
- Section of Periodontology Department of Conservative Dentistry Clinic for Oral, Dental and Maxillofacial Diseases University Hospital Heidelberg Heidelberg Germany
| | - Dorothea Weber
- Institute of Medical Biometry and Informatics (IMBI) University Hospital Heidelberg Heidelberg Germany
| | | | - Amelie Bäumer
- Section of Periodontology Department of Conservative Dentistry Clinic for Oral, Dental and Maxillofacial Diseases University Hospital Heidelberg Heidelberg Germany
- Private Practice Bielefeld Germany
| | - Shirin El‐Sayed
- Section of Periodontology Department of Conservative Dentistry Clinic for Oral, Dental and Maxillofacial Diseases University Hospital Heidelberg Heidelberg Germany
| | - Peter Eickholz
- Department of Periodontology Center of Dentistry and Oral Medicine (Carolinum) Johann Wolfgang Goethe‐University Frankfurt/Main, Frankfurt Germany
| | - Bernadette Pretzl
- Section of Periodontology Department of Conservative Dentistry Clinic for Oral, Dental and Maxillofacial Diseases University Hospital Heidelberg Heidelberg Germany
| |
Collapse
|
35
|
Cosgarea R, Jepsen S, Fimmers R, Bodea A, Eick S, Sculean A. Clinical outcomes following periodontal surgery and root surface decontamination by erythritol-based air polishing. A randomized, controlled, clinical pilot study. Clin Oral Investig 2020; 25:627-635. [PMID: 32839833 PMCID: PMC7820077 DOI: 10.1007/s00784-020-03533-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/14/2020] [Indexed: 12/11/2022]
Abstract
Aim To evaluate the outcomes following surgical periodontal treatment and root surface decontamination by means of air polishing using an erythritol powder or conventional mechanical root debridement. Material and methods Thirty systemically healthy patients (44.38 ± 8.2 years old, 11 smokers, 19 women) diagnosed with periodontitis stages III–IV were included. Each patient, with one single-rooted tooth, with one probing pocket depth (PD) ≥ 6 mm associated with horizontal bone loss, was treated by means of simplified papilla preservation flap (SPPF) and randomized to either test treatment (careful removal of the calculus with the tip of a blade, air polishing of the root surfaces with erythritol) or to the control group (scaling and root planing with hand curettes, ultrasonic instruments). PD, clinical attachment (CAL), bone sounding (BS), and radiographic bone level (BL) were evaluated at baseline and 12 months postsurgically. Results Twenty-seven patients completed the 12-month follow-up (test: n = 14, control: n = 13). In both groups, statistically significant improvements were obtained (p < 0.05, mean CAL gain/PD reduction: test, 2.50 ± 1.60 mm/3.00 ± 0.96 mm; control, 2.85 ± 1.21 mm/3.38 ± 1.12 mm). No statistically significant differences were observed between the groups for any of the investigated parameters (p < 0.05). Conclusion Within their limits, the present results indicate that the use of air polishing with an erythritol powder during periodontal surgery may represent a valuable minimally invasive adjunct following calculus removal by means of hand and ultrasonic instruments or a valuable alternative to these, for root surfaces without calculus. Clinical relevance The use of air polishing with an erythritol powder during periodontal surgery appears to represent a valuable minimally invasive adjunct following calculus removal by means of hand and ultrasonic instruments or a valuable alternative to these, for root surfaces without calculus.
Collapse
Affiliation(s)
- Raluca Cosgarea
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Welschnonnenstr. 17, 53111, Bonn, Germany. .,Department of Prosthetic Dentistry, University Iuliu-Hatieganu, Str. Clinicilor nr 32, 400006, Cluj-Napoca, Romania. .,Department of Periodontology and Peri-implant Diseases, Philipps University of Marburg, Georg-Voigt Str. 3, 35033, Marburg, Germany.
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Welschnonnenstr. 17, 53111, Bonn, Germany
| | - Rolf Fimmers
- Institute for Medical Biometry, Informatics and Epidemiology, University Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Aura Bodea
- Periodontal Private Practice for Periodontology, Gheorghe Doja Str. 9, 400068, Cluj-Napoca, Romania
| | - Sigrun Eick
- Department of Periodontology, University Bern, Bern, Switzerland, Freiburgstrasse 7, CH-3010, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, University Bern, Bern, Switzerland, Freiburgstrasse 7, CH-3010, Bern, Switzerland
| |
Collapse
|
36
|
Raedel M, Noack B, Priess HW, Bohm S, Walter MH. Massive data analyses show negative impact of type 1 and 2 diabetes on the outcome of periodontal treatment. Clin Oral Investig 2020; 25:2037-2043. [PMID: 32820433 PMCID: PMC7966218 DOI: 10.1007/s00784-020-03512-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/06/2020] [Indexed: 11/25/2022]
Abstract
Objectives The aim was to evaluate the impact of diabetes on the outcome of periodontal treatment based on massive data analyses. Materials and methods Data originated from the database of a major German National Health Insurance. Patients who underwent periodontal treatment were allocated to four groups according to their medical condition: type 1 diabetes (D1), type 2 diabetes with the intake of oral anti-diabetics (D2M), type 2 diabetes without the intake of oral anti-diabetics (D2), and a control group without diabetes (ND). Four-year Kaplan-Meier survival analyses on the patient level and multivariate regression analyses were conducted for tooth extraction. Results Of 415,718 patients, 4139 matched the criteria for D1, 22,430 for D2M, and 23,576 for D2. At 4 years, the cumulative survival rate (no extraction) was 51.7% in the D1 group, 54.0% in the D2M group, and 57.7% in the D2 group. The ND control group had a significantly higher survival rate of 65.9% (P < 0.0001). In the multivariate analyses, both diabetes types were significantly associated with further tooth loss after periodontal treatment. Conclusions The diagnosis of diabetes type 1 or 2 seems to be associated with a higher risk of tooth loss after periodontal treatment. Clinical relevance The long-term prognosis of teeth in diabetes patients should be judged carefully.
Collapse
Affiliation(s)
- Michael Raedel
- Prosthodontics, Carl Gustav Carus Faculty of Medicine, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Barbara Noack
- Periodontics, Carl Gustav Carus Faculty of Medicine, TU Dresden, Dresden, Germany
| | | | | | - Michael H Walter
- Prosthodontics, Carl Gustav Carus Faculty of Medicine, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| |
Collapse
|
37
|
Shi S, Meng Y, Li W, Jiao J, Meng H, Feng X. A nomogram prediction for mandibular molar survival in Chinese patients with periodontitis: A 10-year retrospective cohort study. J Clin Periodontol 2020; 47:1121-1131. [PMID: 32645225 DOI: 10.1111/jcpe.13343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 11/27/2022]
Abstract
AIMS To develop a nomogram prediction model of mandibular molar survival by comprehensively analysing clinical and radiographic risk factors of mandibular molar loss. MATERIALS AND METHODS Four hundred and seventy-eight mandibular molars of 139 subjects who underwent non-surgical periodontal treatment were examined retrospectively within a mean follow-up period of 11.1 years. The association of risk factors including clinical and radiographic parameters with mandibular molar loss was assessed using univariate and multivariate Cox regression analyses. A nomogram prediction model was developed, and the validation and discriminatory ability of it were analysed. RESULTS Hundred and four molars were lost in this study. Probing depth (PD), attachment loss (AL), furcation involvement (FI), bleeding on probing (BOP), tooth mobility and radiographic bone loss were significantly associated with tooth loss (p < .01). A gradient effect of degree of FI on mandibular molar loss existed increasing from degree Ⅱ (HR = 2.37, 95% CI: 1.48, 3.79) to Ⅲ (HR = 5.61, 95% CI: 3.01, 10.45) versus none & degree Ⅰ. The area under the curve (AUC) of the model was 0.891. The calibration curve and decision curve analysis demonstrated good performance and high net benefit of nomogram, respectively. CONCLUSIONS A specific nomogram could be adopted to predict the mandibular molar survival and formulate tailored treatment plans in Chinese.
Collapse
Affiliation(s)
- Shuwen Shi
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yang Meng
- Department of Periodontology, Qingdao Municipal Hospital of Stomatology, Qingdao, China
| | - Wenjing Li
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Jian Jiao
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Huanxin Meng
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xianghui Feng
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| |
Collapse
|
38
|
Tarallo F, Mancini L, Pitzurra L, Bizzarro S, Tepedino M, Marchetti E. Use of Platelet-Rich Fibrin in the Treatment of Grade 2 Furcation Defects: Systematic Review and Meta-Analysis. J Clin Med 2020; 9:jcm9072104. [PMID: 32635413 PMCID: PMC7408882 DOI: 10.3390/jcm9072104] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 02/07/2023] Open
Abstract
In periodontitis patients, furcation defects are crucial sites to regenerate due to their complex anatomy. Various modern surgical techniques and use of biomaterials have been suggested in the literature. Among all, platelet-rich fibrin (PRF) has potential in tissue regeneration thanks to its role in the release of growth factors. Therefore, the purpose of this study was to evaluate the beneficial effect of the addition of PRF to open flap debridement (OFD) or as an adjuvant to other biomaterials such as bone grafts in the treatment of grade 2 mandibular furcation defects. Systematic research was carried out on the databases Medline, Scopus, Embase, and Cochrane Library and registered on PROSPERO (CRD42020167662). According to the PICO guidelines by Cochrane, randomized trials and prospective non-randomized trials were evaluated, with a minimum follow-up period of 6 months. The inclusion criteria were the absence of systemic diseases, non-smoking patients, and a population aged from 18 to 65 years. Vertical pocket probing depth (PPD), vertical clinical attachment level (VCAL), and gingival recession (REC) were the primary outcomes. Vertical furcation depth (VFD), and the percentage of bone defect fill (%v-BDF) were considered as secondary outcomes. A meta-analysis of the primary and secondary outcomes was performed. Publication bias was assessed through a funnel plot. Eighty-four articles were initially extracted. Eight randomized clinical trials were analyzed according to the exclusion and inclusion criteria. The Quality assessment instrument (QAI) revealed four articles at low risk of bias, one at moderate, and three at high risk of bias. The metanalysis showed significant data regarding PPD, VCAL, VFD and %v-BDF in the comparison between PRF + OFD vs. OFD alone. The adjunct of PRF to a bone graft showed a significant difference for VCAL and a not statistically significant result for the other involved parameters. In conclusion, the adjunctive use of PRF to OFD seems to enhance the periodontal regeneration in the treatment of grade 2 furcation defects. The combination of PRF and bone graft did not show better clinical results, except for VCAL, although the amount of literature with low risk of bias is scarce. Further well-designed studies to evaluate the combination of these two materials are therefore needed.
Collapse
Affiliation(s)
- Francesco Tarallo
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Piazzale Salvatore Tommasi 1, 67100 L’Aquila, Coppito, Italy; (L.M.); (E.M.)
- Correspondence:
| | - Leonardo Mancini
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Piazzale Salvatore Tommasi 1, 67100 L’Aquila, Coppito, Italy; (L.M.); (E.M.)
| | - Luciano Pitzurra
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands; (L.P.); (S.B.)
| | - Sergio Bizzarro
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands; (L.P.); (S.B.)
| | - Michele Tepedino
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Piazzale Salvatore Tommasi 1, 67100 L’Aquila, Coppito, Italy;
| | - Enrico Marchetti
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Piazzale Salvatore Tommasi 1, 67100 L’Aquila, Coppito, Italy; (L.M.); (E.M.)
| |
Collapse
|
39
|
Petsos H, Arendt S, Eickholz P, Nickles K, Dannewitz B. Comparison of two different periodontal risk assessment methods with regard to their agreement: Periodontal risk assessment versus periodontal risk calculator. J Clin Periodontol 2020; 47:921-932. [DOI: 10.1111/jcpe.13327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 04/07/2020] [Accepted: 06/01/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Hari Petsos
- Department of Periodontology Center for Dentistry and Oral Medicine (Carolinum) Johann Wolfgang Goethe‐University Frankfurt/Main Frankfurt am Main Germany
- Private Practice Soest Germany
| | - Susanne Arendt
- Department of Periodontology Center for Dentistry and Oral Medicine (Carolinum) Johann Wolfgang Goethe‐University Frankfurt/Main Frankfurt am Main Germany
- Private Practice Weilburg Germany
| | - Peter Eickholz
- Department of Periodontology Center for Dentistry and Oral Medicine (Carolinum) Johann Wolfgang Goethe‐University Frankfurt/Main Frankfurt am Main Germany
| | - Katrin Nickles
- Department of Periodontology Center for Dentistry and Oral Medicine (Carolinum) Johann Wolfgang Goethe‐University Frankfurt/Main Frankfurt am Main Germany
- Private Practice Mannheim Germany
| | - Bettina Dannewitz
- Department of Periodontology Center for Dentistry and Oral Medicine (Carolinum) Johann Wolfgang Goethe‐University Frankfurt/Main Frankfurt am Main Germany
- Private Practice Weilburg Germany
| |
Collapse
|
40
|
Impact of Molar Furcations on Photodynamic Therapy Outcomes: A 6-Month Split-Mouth Randomized Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114162. [PMID: 32545223 PMCID: PMC7312923 DOI: 10.3390/ijerph17114162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/07/2020] [Accepted: 06/09/2020] [Indexed: 12/29/2022]
Abstract
The effectiveness of adjunctive photodynamic treatment (PDT) to non-surgical periodontal therapy has been shown to depend on initial periodontal status. As molar furcation involvement impairs healing response to non-surgical periodontal therapy, the aim of this study was to evaluate the impact of furcation involvement on PDT outcomes. Thirty-six patients suffering from severe chronic periodontitis were included in a 6-month split-mouth randomized clinical trial. PDT applications used the toluidine blue O and a light-emitting diode (LED) with a red spectrum. Repeated PDT applications were performed in addition to non-surgical periodontal treatment at baseline and at 3-months. Pocket probing depth (PPD), plaque index, bleeding on probing, and clinical attachment level were recorded at baseline, and again at 3- and 6-months. Furcation sites of molars were compared to other sites of molars and non-molars. Multilevel analysis showed no PDT effect in molar furcation sites while an additional significant reduction (odds ratio = 0.67) of pockets with PPD > 5 mm in other sites at 3-months was measured. PPD reduction appeared delayed in molar furcation sites treated with PDT. There is no additional apparent benefit to use PDT in molar furcation sites for the reduction of pockets with PPD > 5 mm contrary to other sites.
Collapse
|
41
|
Jepsen K, Dommisch E, Jepsen S, Dommisch H. Vital root resection in severely furcation-involved maxillary molars: Outcomes after up to 7 years. J Clin Periodontol 2020; 47:970-979. [PMID: 32412133 DOI: 10.1111/jcpe.13306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 04/27/2020] [Accepted: 05/04/2020] [Indexed: 12/20/2022]
Abstract
AIMS To introduce a novel therapeutic approach for the treatment of furcation-involved maxillary molars by vital root resection and report longer-term outcomes of a case series. METHODS Eleven patients with 15 maxillary molars affected by double/triple class II (n = 10) or single/double class III (n = 5) furcation defects and advanced vertical bone loss around one root participated. Teeth were treated with deep pulpotomy using a calcium silicate-based cement. After 4 weeks, the affected roots were removed by periodontal microsurgery and processed for histological evaluation of the pulp. All patients were enrolled into a supportive periodontal care programme. During the follow-up period, assessments of tooth sensitivity, response to percussion, mobility, pocket probing depth (PPD) and bleeding on probing (BOP) were made, periapical radiographs obtained and patient-reported outcomes collected. RESULTS All teeth remained sensitive to pulp testing. After 1 year and 3-7 years of follow-up, PD was ≤5 mm at all resected teeth. Furcation status was much improved. Neither increasing mobility nor clinical or radiographic signs of periapical pathology were observed throughout the individual observation period. All patients were pleased with the result of therapy. Histologic sections revealed a functional dentin-pulp complex. CONCLUSIONS This case series demonstrates the possibility of maintaining severely furcation-involved molars by vital root resection for up to 7 years. Root canal therapy and its associated costs and complications can thus be avoided.
Collapse
Affiliation(s)
- Karin Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | | | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Henrik Dommisch
- Department of Periodontology and Synoptic Dentistry, Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
42
|
Patient history as a predictor of future treatment need? Considerations from a dataset containing over nine million courses of treatment. Br Dent J 2020; 228:345-350. [PMID: 32170254 DOI: 10.1038/s41415-020-1305-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Aim It is the aim of this paper to consider whether overall patient treatment history per se and what length of patient history, matters in predicting future treatment need.Methods This study used a data set (SN7024, available from UKDataService), consisting of treatment records for General Dental Services' (GDS) patients, this being obtained from all items of service payment records for patients treated in the GDS of England and Wales between 1990 and 2006. For the purpose of this study, the GDS dataset for patients attending in 2003 was restricted to adult patients (aged 18 or over on 31 December 1990; that is, year of birth earlier than 1973) who attended in both two-year periods 1991/2 and 2004/5. Each course of treatment was classified as 'active' (eg restoration, extraction, prosthesis) or 'not active' (eg prevention, diagnosis). Treatment costs for 2001-2005 (outcome), 2000 (one-year history), 1999-2000 (two-year history) and so on until 1991-2000 (ten-year history) were determined, and history and outcome correlated.Results A total of 455,844 patients met the inclusion criteria, namely adults with a full history. They received 9,341,583 courses of treatment, of which 49% were classified as 'active' and 51% as 'not active'. The analysis indicated that both total costs and active treatment costs are positively correlated with their historical values, with the correlation coefficients increasing from 0.24 and 0.25 with one year of history to 0.42 and 0.44 with ten years of history. Overall, therefore, future treatment cost is correlated with past treatment costs.Conclusions Treatment history may provide an important correlate of future dental treatment needs and the more history the better, at least up to five years. However, active treatment is the important component and should be distinguished from preventive and diagnostic treatments.
Collapse
|
43
|
Müller Campanile V, Megally A, Campanile G, Gayet-Ageron A, Giannopoulou C, Mombelli A. Risk factors for recurrence of periodontal disease in patients in maintenance care in a private practice. J Clin Periodontol 2019; 46:918-926. [PMID: 31271667 DOI: 10.1111/jcpe.13165] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/03/2019] [Accepted: 06/30/2019] [Indexed: 11/28/2022]
Abstract
AIM To assess periodontal and dental conditions in individuals in maintenance care after periodontal therapy in private practice, and to identify risk factors for recurrence of disease and tooth loss. MATERIALS AND METHODS One hundred patients attending a routine recall visit were included. All had been treated for periodontal disease and were in maintenance since ≥ 2 years. RESULTS Examinations took place 18.0 (±8.71) years after the start of periodontal therapy. A total of 40.1 ± 22.5 recall visits were registered during this time. 91% of the participants had an initial diagnosis of chronic, 9% of aggressive periodontitis. The average participant was 46 years old and had 26 teeth. 283 of 2,549 initially present teeth were lost, half of them being molars. Periodontal and endo-periodontal complications accounted for only 16 lost teeth. The prevalence of all probing depth (PD) categories decreased significantly. The longer the time, the more frequent the recall visits, and the more was spent during the maintenance phase, the greater was the reduction. Multivariate analysis rendered BMI and smoking as factors influencing number of sites with PD ≥ 4 mm and bleeding on probing. CONCLUSION Tooth loss and periodontal tissue damage can be contained over prolonged periods if periodontal disease is treated and patients attend regular maintenance care.
Collapse
Affiliation(s)
| | - Andrew Megally
- Division of Periodontology, University Clinic of Dental Medicine, University of Geneva, Geneva, Switzerland
| | | | - Angèle Gayet-Ageron
- CRC & Division of Clinical Epidemiology, Department of Health and Community Medicine, University Hospitals Geneva, Geneva, Switzerland
| | - Catherine Giannopoulou
- Division of Periodontology, University Clinic of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Andrea Mombelli
- Division of Periodontology, University Clinic of Dental Medicine, University of Geneva, Geneva, Switzerland
| |
Collapse
|
44
|
Gomes Filho VV, Gondinho BVC, Silva-Junior MF, Cavalcante DDFB, Bulgareli JV, Sousa MDLRD, Frias AC, Batista MJ, Pereira AC. Tooth loss in adults: factors associated with the position and number of lost teeth. Rev Saude Publica 2019; 53:105. [PMID: 31826174 PMCID: PMC6904121 DOI: 10.11606/s1518-8787.2019053001318] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 05/10/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To evaluate the factors associated with tooth loss in adults from the position and number of teeth lost in the dental arches. METHODS This is a cross-sectional, population-based study with adults participating in the epidemiological survey of oral health of São Paulo in 2015. The outcome of the study was tooth loss, assessed by the proposed classification, namely: I) lost up to 12 back teeth; II) lost up to 12 teeth (including front teeth); and III) lost more than 12 teeth. A four-block analysis was conducted, supported by a conceptual theoretical model adapted for tooth loss. For the multinomial logistic regression, "individuals who did not lose teeth due to caries or periodontal disease" was used as reference (p < 0.05). RESULTS Of 6,051 adults evaluated, 25.3% (n = 1,530) were classified in category I, 32.7% (n = 1,977) in II, 9.4% (n = 568) in III, and 1.9% (n = 117) were edentulous. Lower income and schooling, the perception of need for treatment and the last appointment motivated by routine, pain or extraction were associated with tooth loss, regardless of the classification. The negative evaluation of the dental service was associated with individuals who lost up to 12 teeth, both front and back. The presence of women and periodontal pocket were associated with tooth loss of up to 12 teeth, including front, and more than 12 teeth. Caries were associated with adults who lost up to 12 teeth, including front teeth. CONCLUSION The proposed classification allowed the identification of differences between the associated factors. Thus, the need to consider such classification in future studies is evident.
Collapse
Affiliation(s)
- Valmir Vanderlei Gomes Filho
- Universidade Estadual de Campinas. Programa de Pós-Graduação em Odontologia da Faculdade de Odontologia de Piracicaba. Piracicaba, SP, Brasil
| | - Brunna Verna Castro Gondinho
- Universidade Estadual de Campinas. Programa de Pós-Graduação em Odontologia da Faculdade de Odontologia de Piracicaba. Piracicaba, SP, Brasil
| | - Manoelito Ferreira Silva-Junior
- Universidade Estadual de Campinas. Programa de Pós-Graduação em Odontologia da Faculdade de Odontologia de Piracicaba. Piracicaba, SP, Brasil
| | - Denise de Fátima Barros Cavalcante
- Universidade Estadual de Campinas. Programa de Pós-Graduação em Odontologia da Faculdade de Odontologia de Piracicaba. Piracicaba, SP, Brasil
| | - Jaqueline Vilela Bulgareli
- Universidade Estadual de Campinas. Programa de Pós-Graduação em Odontologia da Faculdade de Odontologia de Piracicaba. Piracicaba, SP, Brasil
| | - Maria da Luz Rosario de Sousa
- Universidade Estadual de Campinas. Departamento de Odontologia Social, área de Odontologia Preventiva e Saúde Pública da Faculdade de Odontologia de Piracicaba. Piracicaba, SP, Brasil
| | - Antonio Carlos Frias
- Universidade de São Paulo. Faculdade de Odontologia. Departamento de Odontologia Social. São Paulo, SP, Brasil
| | - Marília Jesus Batista
- Faculdade de Medicina de Jundiaí. Departamento de Saúde Coletiva. Jundiaí, SP, Brasil
| | - Antonio Carlos Pereira
- Universidade Estadual de Campinas. Departamento de Odontologia Social, área de Odontologia Preventiva e Saúde Pública da Faculdade de Odontologia de Piracicaba. Piracicaba, SP, Brasil
| |
Collapse
|
45
|
El Sayed N, Cosgarea R, Rahim S, Giess N, Krisam J, Kim TS. Patient-, tooth-, and dentist-related factors influencing long-term tooth retention after resective therapy in an academic setting-a retrospective study. Clin Oral Investig 2019; 24:2341-2349. [PMID: 31720850 DOI: 10.1007/s00784-019-03091-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 09/22/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate long-term (≥5 years) tooth survival after resective therapy of multi-rooted, periodontally treated teeth and investigate the influence of patient-, tooth-, and dentist-related risk factors on tooth loss. MATERIALS AND METHODS A total of 128 patients with root-resected molars were reexamined. Patient-, tooth-, and dentist-related factors were assessed. Tooth survival times were estimated using the Kaplan-Meier method in addition to a Cox proportional hazard frailty model with survival as the dependent outcome to assess an association with predictor variables. RESULTS Overall, 100 patients with 130 molars were included. The average postoperative reevaluation period was a 9.62 ± 3.08 year showing an overall survival rate of 56.9% after resective therapy. A cumulative survival rate of 69% (95% CI (61%; 77%)) after 5 years decreasing to 48% (95% CI (35%; 61%)) after 15 years was detected. The median survival time of resected molars was 13.83 years (95% CI (8.75; ∞)). Adherence, smoking, and insurance status were detected to significantly influence the risk for loss of molars after resective therapy. CONCLUSIONS Resective periodontal procedures can still be considered an option to retain periodontally compromised molars. In contrast to dentist- and tooth-related factors, patient-related factors impacted significantly upon tooth survival. CLINICAL RELEVANCE Periodontally compromised molars could be retained in more than 50% of the cases thus prolonging their life span significantly. This information shall be valuable for clinicians in decision-making, treatment planning, and postoperative management. The weighting of resective therapy to implants especially with regards to the risk of peri-implantitis should be considered.
Collapse
Affiliation(s)
- Nihad El Sayed
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, Im Neuenheimer Feld, 400 69120, Heidelberg, Germany.
| | - Raluca Cosgarea
- Department of Periodontology, Philipps University Marburg, Marburg, Germany
- Department of Prosthetic Dentistry, University Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Sonja Rahim
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, Im Neuenheimer Feld, 400 69120, Heidelberg, Germany
| | - Natalia Giess
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, Im Neuenheimer Feld, 400 69120, Heidelberg, Germany
| | - Johannes Krisam
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, Heidelberg, Germany
| | - Ti-Sun Kim
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, Im Neuenheimer Feld, 400 69120, Heidelberg, Germany
| |
Collapse
|
46
|
Nibali L, Akcalı A, Rüdiger SG. The importance of supportive periodontal therapy for molars treated with furcation tunnelling. J Clin Periodontol 2019; 46:1228-1235. [DOI: 10.1111/jcpe.13181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 07/27/2019] [Accepted: 08/05/2019] [Indexed: 01/18/2023]
Affiliation(s)
- Luigi Nibali
- Periodontology Unit Centre for Host Microbiome Interactions Faculty of Dentistry Oral & Craniofacial Sciences King’s College London London UK
| | - Aliye Akcalı
- Centre for Oral Clinical Research Institute of Dentistry Barts & The London School of Medicine and Dentistry Queen Mary University of London (QMUL) London UK
| | | |
Collapse
|
47
|
Alassadi M, Qazi M, Ravidà A, Siqueira R, Garaicoa-Pazmiño C, Wang HL. Outcomes of root resection therapy up to 16.8 years: A retrospective study in an academic setting. J Periodontol 2019; 91:493-500. [PMID: 31397897 DOI: 10.1002/jper.19-0033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/06/2019] [Accepted: 05/13/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Root resection has been considered a viable treatment option for molars with furcation defects. However, need of a multidisciplinary approach could potentially deem this procedure less successful. The aim of the present article was to determine survival rates of root resection procedure and reasons for failure in an academic setting. METHODS Patient-related demographic data, medical history information, and relevant data pertaining to the root-resected teeth performed from January 1990 to September 2017 were reviewed through electronic and paper chart. Survival rates were analyzed using Kaplan-Meier estimate. Association between the reasons for failure and independent variables was established by a Pearson Chi-squared and Kruskal-Wallis test. RESULTS A total of 85 patients with an average follow-up of 5 ± 4.3 years (range: 1 to 16.8 years) were included in the present article. A total of 47 molar teeth treated with root resection remained as part of the dentition (55.3%) and 38 (44.7%) failed. The mean survival time with the Kaplan-Mayer analysis was 109.9 months (9.1 years). Fracture (39.5%), caries (26.3%), and periodontal disease (23.7%) were the most common causes for failure. Interestingly, the majority of failures occurred in the first 4 years after therapy (n = 31; 81.5% of all failures). CONCLUSIONS Root resection therapy remains a treatment solution for molars with furcation defects. In an academic setting, >50% of teeth remained functional after 9 years of root resection therapy.
Collapse
Affiliation(s)
- Madi Alassadi
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
| | - Musa Qazi
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
| | - Andrea Ravidà
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
| | - Rafael Siqueira
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
| | - Carlos Garaicoa-Pazmiño
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
| |
Collapse
|
48
|
Pei X, Ouyang X, Luan Q, Suda R, Cao C. Natural 4‐year periodontal progression of mandibular first molars in Chinese villagers based on radiographic records. J Periodontol 2019; 90:1390-1398. [PMID: 31257589 DOI: 10.1002/jper.18-0194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 01/14/2019] [Accepted: 03/01/2019] [Indexed: 01/22/2023]
Affiliation(s)
- Xiyan Pei
- Department of PeriodontologyPeking University School and Hospital of Stomatology Beijing P. R. China
- First Clinic DivisionPeking University School and Hospital of Stomatology Beijing P. R. China
| | - Xiangying Ouyang
- Department of PeriodontologyPeking University School and Hospital of Stomatology Beijing P. R. China
| | - Qingxian Luan
- Department of PeriodontologyPeking University School and Hospital of Stomatology Beijing P. R. China
| | - Reiko Suda
- Departments of PeriodonticsShowa University School of Dentistry Tokyo Japan
| | - Caifang Cao
- Department of PeriodontologyPeking University School and Hospital of Stomatology Beijing P. R. China
| |
Collapse
|
49
|
Histologic evidence of periodontal regeneration in furcation defects: a systematic review. Clin Oral Investig 2019; 23:2861-2906. [PMID: 31165313 DOI: 10.1007/s00784-019-02964-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 05/16/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To systematically review the available histologic evidence on periodontal regeneration in class II and III furcations in animals and humans. MATERIALS AND METHODS A protocol including all aspects of a systematic review methodology was developed including definition of the focused question, defined search strategy, study inclusion criteria, determination of outcome measures, screening methods, data extraction and analysis, and data synthesis. The focused question was defined as follows: "What is the regenerative effect obtained by using or not several biomaterials as adjuncts to open flap surgery in the treatment of periodontal furcation defects as evaluated in animal and human histological studies?" SEARCH STRATEGY Using the MEDLINE database, the literature was searched for articles published up to and including September 2018: combinations of several search terms were applied to identify appropriate studies. Reference lists of review articles and of the included articles in the present review were screened. A hand search of the most important dental journals was also performed. CRITERIA FOR STUDY SELECTION AND INCLUSION Only articles published in English describing animal and human histological studies evaluating the effect of surgical treatment, with or without the adjunctive use of potentially regenerative materials (i.e., barrier membranes, grafting materials, growth factors/proteins, and combinations thereof) for the treatment of periodontal furcation defects were considered. Only studies reporting a minimum of 8 weeks healing following reconstructive surgery were included. The primary outcome variable was formation of periodontal supporting tissues [e.g., periodontal ligament, root cementum, and alveolar bone, given as linear measurements (in mm) or as a percentage of the instrumented root length (%)] following surgical treatment with or without regenerative materials, as determined histologically/histomorphometrically. Healing type and defect resolution (i.e., complete regeneration, long junctional epithelium, connective tissue attachment, connective tissue adhesion, or osseous repair) were also recorded. RESULTS In animals, periodontal regeneration was reported in class II and III defects with open flap debridement alone or combined with various types of bone grafts/bone substitues, biological factors, guided tissue regeneration, and different combinations thereof. The use of biological factors and combination approaches provided the best outcomes for class II defects whereas in class III defects, the combination approaches seem to offer the highest regenerative outcomes. In human class II furcations, the best outcomes were obtained with DFDBA combined with rhPDGF-BB and with GTR. In class III furcations, evidence from two case reports indicated very limited to no periodontal regeneration. CONCLUSIONS Within their limits, the present results suggest that (a) in animals, complete periodontal regeneration has been demonstrated in class II and class III furcation defects, and (b) in humans, the evidence for substantial periodontal regeneration is limited to class II furcations. CLINICAL RELEVANCE At present, regenerative periodontal surgery represents a valuable treatment option only for human class II furcation defects but not for class III furcations.
Collapse
|
50
|
Helal O, Göstemeyer G, Krois J, Fawzy El Sayed K, Graetz C, Schwendicke F. Predictors for tooth loss in periodontitis patients: Systematic review and meta-analysis. J Clin Periodontol 2019; 46:699-712. [PMID: 31025366 DOI: 10.1111/jcpe.13118] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/19/2019] [Accepted: 04/22/2019] [Indexed: 02/06/2023]
Abstract
AIM A range of predictors for tooth loss in periodontitis patients have been reported. We performed a systematic review and meta-analysis to assess the consistency and magnitude of any association between a total of 12 predictors and tooth loss. MATERIALS AND METHODS Medline/Embase/Central were searched for longitudinal studies investigating the association between predictors and tooth loss in periodontitis patients. Random-effects meta-analysis was performed, and study quality assessed. RESULTS Twenty studies (15,422 patients, mean follow-up: 12 years) were included. The mean annual tooth loss/patient was 0.12 (min./max: 0.01/0.36). Older patients (n = 8 studies; OR: 1.05, 95% CI: 1.03-1.08/year), non-compliant ones (n = 11; 1.51, 1.06-2.16), diabetics (n = 7; 1.80, 1.26-2.57), those with IL-1-polymorphism (n = 3; 1.80; 1.29-2.52) and smokers (n = 15; 1.98, 1.58-2.48) had a significantly higher risk of tooth loss. Teeth with bone loss (n = 3; 1.04, 1.03-1.05/%), high probing pocket depth (n = 6; 3.19, 1.70-5.98), mobility (n = 4; 3.71, 1.65-8.38) and molars (n = 4; 4.22, 2.12-8.39), especially with furcation involvement (n = 5; 2.68, 1.75-4.08) also showed higher risks. Gender (n = 16; 0.95, 0.86-1.05) and endodontic affection (n = 3; 3.62, 0.99-13.2) were not significantly associated with tooth loss. CONCLUSIONS Older, non-compliant, smoking or diabetic patients, and teeth with bone loss, high probing pocket depth, mobility, or molars, especially with furcation involvement showed higher risks of tooth loss.
Collapse
Affiliation(s)
- Omar Helal
- Department of Operative and Preventive Dentistry, Charité University of Berlin, Berlin, Germany
| | - Gerd Göstemeyer
- Department of Operative and Preventive Dentistry, Charité University of Berlin, Berlin, Germany
| | - Joachim Krois
- Department of Operative and Preventive Dentistry, Charité University of Berlin, Berlin, Germany
| | - Karim Fawzy El Sayed
- Clinic of Conservative Dentistry and Periodontology, University of Kiel, Kiel, Germany.,Oral Medicine and Periodontology Department, Faculty of Oral and Dental Medicine, Cairo, Egypt
| | - Christian Graetz
- 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
| |
Collapse
|