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Luo Y, Li J, Liu L, Ye L, Song D, Huang D. Comparison of the Outcome of Intentional Replantation in Teeth with or without Periodontal Involvement: A Retrospective Study. J Endod 2024; 50:944-953. [PMID: 38588976 DOI: 10.1016/j.joen.2024.03.013] [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: 01/09/2024] [Revised: 03/25/2024] [Accepted: 03/31/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE Intentional replantation (IR) is considered as a viable treatment option to preserve the teeth with apical periodontitis. This study aimed to compare the treatment outcomes of IR in teeth with or without periodontal involvement, and to investigate the influence of related factors. METHODS A total of 157 teeth with a documented history of IR between September 2012 and November 2022 and a follow-up duration of more than 1 year were included. The samples included 100 teeth with simple apical periodontitis and 57 teeth with combined periodontal-endodontic lesions (CPEL). Clinical and radiographic criteria were used to evaluate treatment outcomes including functional retention and extraction. Chi-square analyses and Fisher's exact tests were used to compare bivariate associations between outcomes and clinical or demographic variables. Kaplan-Meier analyses were used to evaluate the cumulative survival rate of the intentionally replanted teeth. RESULTS The overall cumulative survival rates were 93.0% at 1 year, 76.7% at 5 years, and 56.2% at 10 years. Among the 100 teeth with simple apical periodontitis, the survival rates were 93.0%, 86.7%, and 78.8% at the same time points. In contrast, 57 teeth with CPEL exhibited survival rates of 93.0%, 65.0%, and 36.9%, respectively. The primary postoperative complications that led to extraction were periodontal involvement (51.9%), tooth fracture (18.5%), external root resorption (18.5%), and persistent apical periodontitis (11.1%). The outcomes of teeth with CPEL were significantly affected by the presence of a sinus tract and crown restoration. In contrast, no significant prognostic factors were identified for teeth without periodontal involvement. CONCLUSION The long-term prognosis of teeth with CPEL is significantly worse than those with simple apical periodontitis. The main reason of extraction was periodontal involvement. Regular periodontal maintenance and appropriate crown restoration may help to improve the prognosis for teeth with CPEL.
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Affiliation(s)
- Yu Luo
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Conservative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Jiatong Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Conservative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Liu Liu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Conservative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Ling Ye
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Conservative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Dongzhe Song
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Conservative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
| | - Dingming Huang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Conservative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
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Golob Deeb J, Elnakka L, Deeb GR. Systemic management and periodontal treatment of HIV-necrotizing periodontitis: A case report. Clin Adv Periodontics 2024; 14:127-133. [PMID: 37313786 DOI: 10.1002/cap.10252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/26/2023] [Accepted: 06/06/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Necrotizing periodontitis (NP) is a rare form of periodontal disease. It can manifest in immunocompromised patients and present as painful and rapidly progressing destruction with necrotic and ulcerated periodontal tissues. This case report describes a rare case of severe NP in human immunodeficiency virus (HIV)-positive patient including medical management and periodontal treatment. METHODS A 28-year-old male presented to the periodontal clinic with chief complaint of severe oral pain leading to loss of chewing ability, spontaneous gingival bleeding, generalized gingival recession, tooth mobility, and dentinal hypersensitivity. Clinical and radiographic examination revealed generalized tissue necrosis with severe periodontal destruction, extensive bleeding, spontaneous suppuration, and heavy biofilm. RESULTS Medical history was positive for perinatal HIV infection, which was treated and patient was asymptomatic until he discontinued antiviral medications nine years ago. Following initial examination, patient was referred to the Infectious disease clinic and multidisciplinary management was initiated with comprehensive management of primary disease including systemic antiviral, antibiotic, and antifungal therapy to establish immunocompetence compatible with providing mechanical nonsurgical periodontal treatment. CONCLUSIONS This case report highlights a severe and generalized form of NP in an HIV patient due to the cessation of antiviral therapy. Favorable course of interdisciplinary medical and periodontal therapy resulted in significant improvement in patient's systemic, oral, and periodontal health.
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Affiliation(s)
- Janina Golob Deeb
- Department of Periodontics, Virginia Commonwealth University, Richmond, Virginia
| | - Lina Elnakka
- Department of Periodontics, Virginia Commonwealth University, Richmond, Virginia
| | - George R Deeb
- Department of Oral and Maxillofacial Surgery, Virginia Commonwealth University, Richmond, Virginia
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Gandhi UH, Benjamin A, Gajjar S, Hirani T, Desai K, Suhagia BB, Ahmad R, Sinha S, Haque M, Kumar S. Alcohol and Periodontal Disease: A Narrative Review. Cureus 2024; 16:e62270. [PMID: 39006719 PMCID: PMC11246185 DOI: 10.7759/cureus.62270] [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: 05/19/2024] [Accepted: 06/12/2024] [Indexed: 07/16/2024] Open
Abstract
The scientific literature dealing with alcohol and alcoholic beverages revealed that these drinks possess an adverse impact on periodontal tissues. Additionally, other principal risk factors include tobacco, smoking, poor oral hygiene, etc. It has been observed that among chronic alcoholics, there are further issues, such as mental, social, and physical effects, that promote alcoholism. These people may have weak immunity for defense against pathogenic organisms and bacteria. Thus, chances of gingival bleeding, swollen gums, bad breath, and increased bone loss are there. Different alcoholic beverages in the market cause less salivation; these beverages contain sugars that promote acid production in the oral cavity by pathogens that demineralize the enamel and damage gum and teeth. This chronic alcohol consumption can progress into different types of oral disorders, including cancer, halitosis, and caries, and is also associated with tobacco and smoking. Chronic alcohol consumption can cause alteration of the oral microbiome and increase oral pathogens, which lead to periodontal disease and an environment of inflammation created in the body due to malnutrition, diminished immunity, altered liver condition, brain damage, and gut microbiota alteration. Heavily colored alcoholic beverages produce staining on teeth and, due to less saliva, may cause other toxic effects on the periodontium. Over-dependency on alcohol leads to necrotizing lesions such as necrotizing gingivitis, necrotizing periodontitis, and necrotizing stomatitis. These pathological impairments instigate severe damage to oral structures. Therefore, proper counseling by the attending dental surgeon and related health professionals is urgently required for the patient on the basis that the individual case needs to go away from the regular heavy consumption of alcohol.
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Affiliation(s)
- Utsav H Gandhi
- Department of Periodontology, School of Dentistry, Karnavati University, Gandhinagar, IND
| | - Amit Benjamin
- Department of Periodontology, School of Dentistry, Karnavati University, Gandhinagar, IND
| | - Shreya Gajjar
- Department of Periodontology, School of Dentistry, Karnavati University, Gandhinagar, IND
| | - Tanvi Hirani
- Department of Periodontology, School of Dentistry, Karnavati University, Gandhinagar, IND
| | - Khushboo Desai
- Department of Periodontology, School of Dentistry, Karnavati University, Gandhinagar, IND
| | - Bansariben B Suhagia
- Department of Periodontology, Ahmedabad Dental College and Hospital, Gujarat University, Ahmedabad, IND
| | - Rahnuma Ahmad
- Department of Physiology, Medical College for Women and Hospital, Dhaka, BGD
| | - Susmita Sinha
- Department of Physiology, Enam Medical College and Hospital, Dhaka, BGD
| | - Mainul Haque
- Department of Research, Karnavati Scientific Research Center, School of Dentistry, Karnavati University, Gandhinagar, IND
- Department of Pharmacology and Therapeutics, National Defence University of Malaysia, Kuala Lumpur, MYS
| | - Santosh Kumar
- Department of Periodontology, School of Dentistry, Karnavati University, Gandhinagar, IND
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Raza M, Abud DG, Wang J, Shariff JA. Ease and practicability of the 2017 classification of periodontal diseases and conditions: a study of dental electronic health records. BMC Oral Health 2024; 24:621. [PMID: 38807112 PMCID: PMC11131310 DOI: 10.1186/s12903-024-04385-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 05/20/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND A new classification for Periodontal and Peri-implant Diseases and Conditions was introduced in the 2017 World Workshop. In the past the 1999 Armitage Classification was commonly used in practice. This study aimed to assess the ease and practicability of retroactively diagnosing a subset of patients formerly diagnosed using the 1999 AAP/CDC classification with the 2017 AAP/EFP disease classification. METHODS A random subset of 10% of all patients referred over a 7-year period (2011-2018) to the Post-Doctoral Periodontics Clinic at Columbia University College of Dental Medicine were reviewed by accessing the Electronic Health Records (EHRs) on axiUm. Patients diagnosed with periodontal disease based on the 1999 AAP/CDC classification (including chronic and aggressive Periodontitis) were reclassified using the 2017 classification (stage: I, II, III and grade: A, B, C). RESULTS A sample of 336 patient records were examined. 132 were diagnosed with gingivitis, and 204 with periodontitis. Of these 204 patients, 68 (33.3%) were diagnosed with aggressive and 136 (66.7%) with chronic periodontitis. Patients diagnosed with aggressive periodontitis, 10% were reclassified as stage II, 47% as stage III, and 43% as stage IV periodontitis, and 100% were reclassified as grade C. Among patients with chronic periodontitis, 7% were reclassified as stage I, 65% as stage II, 21% as stage III, and 7% as stage IV; 11% of these were reclassified as grade A, 63% grade B, and 26% grade C. CONCLUSIONS The majority of those originally diagnosed with aggressive (90%) and chronic (80%) periodontitis were reclassified as either molar/incisor pattern stage III grade C or stage IV grade C periodontitis, and stage II or III periodontitis, respectively. The study demonstrated that it is practical to retroactively reassign a diagnosis according to the new 2017 classification using available information included in dental EHRs.
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Affiliation(s)
- Muhammad Raza
- Section Chief of Periodontics at Jamaica Hospital Medical Center, Jamaica, New York, NY, 11418, USA.
- Private Practice, New York, NY, 11375, USA.
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, NY, 10032, USA.
| | - Daniela Gurpegui Abud
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, NY, 10032, USA
- Touro University College of Dental Medicine at New York Medical College, Hawthorne, NY, 10532, USA
| | - Joseph Wang
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, NY, 10032, USA
| | - Jaffer Ahmed Shariff
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, NY, 10032, USA
- Touro University College of Dental Medicine at New York Medical College, Hawthorne, NY, 10532, USA
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Radu CM, Radu CC, Arbănaşi EM, Hogea T, Murvai VR, Chiș IA, Zaha DC. Exploring the Efficacy of Novel Therapeutic Strategies for Periodontitis: A Literature Review. Life (Basel) 2024; 14:468. [PMID: 38672739 PMCID: PMC11050937 DOI: 10.3390/life14040468] [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: 02/28/2024] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
Periodontitis, a prevalent oral condition, is facing difficulties in therapeutic approaches, sometimes leading to failure. This literature review was conducted to investigate the diversity of other therapeutic approaches and their potential contributions to the successful management of the disease. This research scrutinized the alterations in microbial diversity and imbalances in crucial microbial species, which contribute significantly to the pathogenesis of periodontitis. Within the limitations of this study, we highlight the importance of understanding the treatment plan's role in periodontitis disease, opening the way for further research and innovative treatment plans to mitigate the impact of periodontitis on oral health. This will aid both healthcare professionals and patients in preventing and effectively treating periodontitis, ultimately improving oral health outcomes and overall systemic health and well-being.
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Affiliation(s)
- Casandra-Maria Radu
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 1 University Street, 410087 Oradea, Romania
| | - Carmen Corina Radu
- Department of Forensic Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540139 Targu Mures, Romania
- Institute of Forensic Medicine, 540141 Targu Mures, Romania
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Emil-Marian Arbănaşi
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Clinic of Vascular Surgery, Mureș County Emergency Hospital, 540136 Targu Mures, Romania
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540139 Targu Mures, Romania
| | - Timur Hogea
- Department of Forensic Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540139 Targu Mures, Romania
- Institute of Forensic Medicine, 540141 Targu Mures, Romania
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Viorela Romina Murvai
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 1 University Street, 410087 Oradea, Romania
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq, 410028 Oradea, Romania
| | - Ioana-Andreea Chiș
- Department of Oral Rehabilitation, Faculty of Dentistry, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj-Napoca, Romania
| | - Dana Carmen Zaha
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 1 University Street, 410087 Oradea, Romania
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq, 410028 Oradea, Romania
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Benahmed AG, Tippairote T, Gasmi A, Noor S, Avdeev O, Shanaida Y, Mojgani N, Emadali A, Dadar M, Bjørklund G. Periodontitis Continuum: Antecedents, Triggers, Mediators, and Treatment Strategies. Curr Med Chem 2024; 31:6775-6800. [PMID: 39428847 DOI: 10.2174/0109298673265862231020051338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/28/2023] [Accepted: 09/11/2023] [Indexed: 10/22/2024]
Abstract
Periodontitis (PD) is a chronic inflammatory disease of the periodontium characterized by the formation of gingival pockets and gingival recession. The local inflammatory environment can lead to the destruction of the extracellular matrix and subsequent bone loss. The pathophysiology of PD involves interactions between genetic predisposition, lifestyle, environmental factors, the oral microbiota condition, systemic health disorders, innate and adaptive immune responses, and various host defenses. The review highlighted the importance of the oral cavity condition in systemic health. Thus, a correlation between harmful oral microbiota and cardiovascular disease (CVD)/diabetes/ arthritis, etc, progressions through inflammation and bacterial translocation was highlighted. Antecedents increase an individual's risk of developing PD, trigger initiate microbe-host immunologic responses, and mediators sustain inflammatory interactions. Generally, this review explores the antecedents, triggers, and mediators along the pathophysiological continuum of PD. An analysis of modern approaches to treating periodontitis, including antibiotics for systemic and local use, was carried out. The potential role of natural ingredients such as herbal extracts, phytoconstituents, propolis, and probiotics in preventing and treating PD was highlighted.
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Affiliation(s)
| | - Torsak Tippairote
- Department of Research, HP Medical Centre, Bangkok, Thailand
- Thailand Initiatives for Functional Medicine, Bangkok, Thailand
| | - Amin Gasmi
- Société Francophone de Nutrithérapie et de Nutrigénétique Appliquée, Villeurbanne, France
| | - Sadaf Noor
- Institute of Molecular Biology and Biotechnology, Bahauddin Zakariya University, Multan, Pakistan
| | - Oleksandr Avdeev
- Pediatric Dentistry Department, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Yurii Shanaida
- Pediatric Dentistry Department, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Naheed Mojgani
- Biotechnology Department, Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization, Karaj, Iran
| | - Alireza Emadali
- School of Dentistry Medicine, Ahvaz Jondishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Dadar
- Department of Research, CONEM Iran Microbiology Research Group, Tehran, Iran
| | - Geir Bjørklund
- Council for Nutritional and Environmental Medicine (CONEM), Mo i Rana, Norway
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Tietmann C, Tezer I, Youssef E, Jepsen S, Jepsen K. Management of Teeth with Grade 3 Endo-Periodontal Lesions by Combined Endodontic and Regenerative Periodontal Therapy. J Clin Med 2023; 13:93. [PMID: 38202100 PMCID: PMC10779476 DOI: 10.3390/jcm13010093] [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: 11/01/2023] [Revised: 12/07/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: Severely compromised teeth affected by endo-periodontal lesions are often assigned a "hopeless" prognosis, however, there is only limited evidence available. (2) Methods: In a retrospective study, we evaluated the long-term effectiveness of combined endodontic and regenerative periodontal therapy in teeth with advanced endo-periodontal lesions: 35 patients (age 47-83 years) with a total of 39 teeth diagnosed with grade 3 endo-periodontal lesions were treated by endodontists using an operating microscope followed by regenerative periodontal surgery. (3) Results: Changes in radiographic bone levels (rBl) and probing pocket depths (PPDs) were evaluated after 1 year (T1) and up to 7 years postoperatively (Tfinal). Mean rBL gain was significant with 4.87 ± 3.47 mm after 1 year (T1) and stable results with a mean rBL gain of 4.70 ± 3.37 mm at Tfinal. Mean PPD was significantly reduced from 9.74 ± 2.05 mm at baseline to 5.04 ± 1.61 mm at T1 and to 4.87 ± 2.32 mm at Tfinal. Tooth loss amounted to 10.3% (n = 4) and was due to root fracture. (4) Conclusion: The results suggest that the combined endodontic and regenerative periodontal therapy of endo-periodontal lesions of "hopeless" teeth can lead to favorable long-term results with tooth retention for up to 7 years.
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Affiliation(s)
- Christina Tietmann
- Private Practice for Periodontology, 52070 Aachen, Germany
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, 53111 Bonn, Germany
| | - Ivet Tezer
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, 53111 Bonn, Germany
| | - Emad Youssef
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, 53111 Bonn, Germany
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, 53111 Bonn, Germany
| | - Karin Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, 53111 Bonn, Germany
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8
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Oh SL, Kim JR, Engermann E, Shiau HJ. Survival analysis of root-resected molars from 1 to 13.4 years: A retrospective cohort study. J Prosthet Dent 2023:S0022-3913(23)00409-2. [PMID: 37468370 DOI: 10.1016/j.prosdent.2023.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 07/21/2023]
Abstract
STATEMENT OF PROBLEM While root resective therapy may extend the longevity of a molar, data on patient selection and outcomes of root resection are scarce. PURPOSE The purpose of this retrospective cohort study was to analyze the survival of root-resected molars and investigate factors affecting the decision and outcomes of the therapy. MATERIAL AND METHODS Patient- and tooth-related data from participants who had received root resection between 1999 and 2022 were collected. Cox regression was used to build predictive models for time-to-tooth loss based on predictors-initial diagnoses (carious, endodontic, periodontal, or endodontic-periodontal lesions), the presence of a complete-coverage crown, and the location of the tooth in the arch (P<.001). RESULTS Of 60 teeth, all from different participants, 31 molars were resected because of endodontic lesions. The failure rate was 35% with 21 teeth extracted. At 5 years, the survival probability was 0.58, considering all predictors. The survival of molars resected because of carious or endodontic lesions was significantly lower than those because of periodontal or endodontic-periodontal lesions (P<.05). The hazard ratio for tooth loss in the resected teeth was 15.6, 95% confidence interval (CI) (3.7 to 83.2) without complete-coverage crowns and 8.6, 95% CI (2.2 to 43.2) at the most posterior location. CONCLUSIONS Root resection provided to manage a localized periodontal lesion had the highest prognosis. The absence of a crown and the location as the most posterior tooth in the arch were associated with poor survival following resection.
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Affiliation(s)
- Se-Lim Oh
- Clinical Associate Professor, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, Md.
| | - Jong Ryul Kim
- Associate Professor, Department of Endodontology, Kornberg School of Dentistry, Temple University, Philadelphia, Pa
| | - Emmanuel Engermann
- Undergraduate student, School of Dentistry, University of Maryland, Baltimore, Md
| | - Harlan J Shiau
- Clinical Associate Professor, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, Md
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9
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Salvi GE, Roccuzzo A, Imber JC, Stähli A, Klinge B, Lang NP. Clinical periodontal diagnosis. Periodontol 2000 2023. [PMID: 37452444 DOI: 10.1111/prd.12487] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/16/2023] [Accepted: 03/14/2023] [Indexed: 07/18/2023]
Abstract
Periodontal diseases include pathological conditions elicited by the presence of bacterial biofilms leading to a host response. In the diagnostic process, clinical signs such as bleeding on probing, development of periodontal pockets and gingival recessions, furcation involvement and presence of radiographic bone loss should be assessed prior to periodontal therapy, following active therapy, and during long-term supportive care. In addition, patient-reported outcomes such as increased tooth mobility, migration, and tilting should also be considered. More important to the patient, however, is the fact that assessment of signs of periodontal diseases must be followed by an appropriate treatment plan. Furthermore, it should be realized that clinical and radiographic periodontal diagnosis is based on signs which may not reflect the presence of active disease but rather represent the sequelae of a previous bacterial challenge. Hence, the aim of the present review is to provide a summary of clinical and radiographic diagnostic criteria required to classify patients with periodontal health or disease.
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Affiliation(s)
- Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Jean-Claude Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Björn Klinge
- Department of Periodontology, Faculty of Odontology, Malmö University, Malmö, Sweden
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Niklaus P Lang
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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10
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Herrera D, van Winkelhoff AJ, Matesanz P, Lauwens K, Teughels W. Europe's contribution to the evaluation of the use of systemic antimicrobials in the treatment of periodontitis. Periodontol 2000 2023. [PMID: 37314038 DOI: 10.1111/prd.12492] [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: 02/04/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 06/15/2023]
Abstract
This narrative review celebrates Europe's contribution to the current knowledge on systemically administered antimicrobials in periodontal treatment. Periodontitis is the most frequent chronic noncommunicable human disease. It is caused by dysbiotic bacterial biofilms and is commonly treated with subgingival instrumentation. However, some sites/patients do not respond adequately, and its limitations and shortcomings have been recognized. This has led to the development of alternative or adjunctive therapies. One is the use of antimicrobials to target bacteria in subgingival biofilms in the periodontal pocket, which can be targeted directly through the pocket entrance with a locally delivered antibiotic or systemically by oral, intravenous, or intramuscular methods. Since the early 20th century, several studies on systemic antibiotics have been undertaken and published, especially between 1990 and 2010. Europe's latest contribution to this topic is the first European Federation of Periodontology, S3-level Clinical Practice Guideline, which incorporates recommendations related to the use of adjuncts to treat stage I-III periodontitis. Understanding the etiopathogenesis of periodontal diseases, specifically periodontitis, has influenced the use of systemic periodontal antibiotic therapy. Randomized clinical trials and systematic reviews with meta-analyses have demonstrated the clinical advantages of adjunctive systemic antimicrobials. However, current recommendations are restrictive due to concerns about antibiotic misuse and the increase in microbial antibiotic resistance. European researchers have contributed to the use of systemic antimicrobials in the treatment of periodontitis through clinical trials and by providing rational guidelines. Nowadays, European researchers are exploring alternatives and directing clinical practice by providing evidence-based guidelines to limit the use of systemic antimicrobials.
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Affiliation(s)
- David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Arie Jan van Winkelhoff
- Center for Dentistry and Oral Hygiene, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Paula Matesanz
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Katalina Lauwens
- Department of Oral Health Sciences, KU Leuven & Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Wim Teughels
- Department of Oral Health Sciences, KU Leuven & Dentistry, University Hospitals Leuven, Leuven, Belgium
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Kuoch P, Duplan MB, Berès F, Bonte É, Couvrechel C. Clinical identification and endodontic management of furcation canals: a case series. Braz Dent J 2023; 34:132-138. [PMID: 36888840 PMCID: PMC10027094 DOI: 10.1590/0103-6440202304817] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/25/2023] [Indexed: 03/08/2023] Open
Abstract
In the case of endodontic infection, the presence of furcation canals can be at the origin of a periodontal lesion located in the furcation. The furcation being very close to the marginal periodontium, this type of lesion can be favorable to the genesis of an endo-periodontal lesion. These furcation canals are lateral canals located on the pulp chamber floor and constitute one of the many physiological communication pathways between endodontic and periodontal tissues. These canals are most often difficult to localize, shape, and to fill because of their small diameter and length. The disinfection of the pulp chamber floor with sodium hypochlorite solution may contribute to the disinfection of furcation canals when they are not identified, shaped, and/or filled. This case series illustrates the endodontic management of visible furcation canals associated with an endo-periodontal lesion. These furcation canals had a large diameter which allowed their identification during the endodontic treatment.
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Affiliation(s)
- Pierre Kuoch
- Service de Médecine Bucco-Dentaire, Hôpital Bretonneau (AP-HP),
Paris, France
- Pratique privée, Paris, France
| | - Martin Biosse Duplan
- Service de Médecine Bucco-Dentaire, Hôpital Bretonneau (AP-HP),
Paris, France
- 3 UFR d’Odontologie - Montrouge, Université Paris Cité, Paris,
France
| | - Fleur Berès
- Service de Médecine Bucco-Dentaire, Hôpital Bretonneau (AP-HP),
Paris, France
- 3 UFR d’Odontologie - Montrouge, Université Paris Cité, Paris,
France
| | - Éric Bonte
- Service de Médecine Bucco-Dentaire, Hôpital Bretonneau (AP-HP),
Paris, France
- 3 UFR d’Odontologie - Montrouge, Université Paris Cité, Paris,
France
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Noh JW, Jang JH, Yoon HS, Kim KB, Heo MH, Jang HE, Kim YJ, Lee Y. Evaluation of Salivary Biomarkers of Periodontal Disease Based on Smoking Status: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14619. [PMID: 36361498 PMCID: PMC9657317 DOI: 10.3390/ijerph192114619] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
Saliva is a useful biomarker for diagnosing oral health conditions, including periodontal disease (PD). Smoking is a risk factor for PD. The aim of this systematic review was to summarize the salivary biomarkers associated with PD based on smoking status. A comprehensive search of the MEDLINE (via PubMed), EMBASE, Cochrane, SCOPUS, and Web of Sciences databases was conducted up to 1 January 2021 using key terms relevant to the topic of our research and Cochrane methodology and improved with searching a gray literature resource. The methodological quality of all included studies was assessed with the revised Quality Assessment of Diagnostic Accuracy Studies-2. Seven studies were included. Smokers had increased levels of malondialdehyde, sialic acid, salivary cortisol, salivary interleukin 1β, albumin, tissue inhibitor of matrix metalloproteinase (TIMP), and the pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP), as well as decreased levels of superoxide dismutase, activity of lactate dehydrogenase, activity of enzyme activity of β-glucuronidase, uric acid, matrix metalloproteinase-8 (MMP-8)/TIMP-1 ratio, and combinations of MMP-8 and ICTP. However, mixed results were observed some studies in detecting glutathione peroxidase, MMP-8, and MMP-14. The results were interpreted with caution because of limitations in the number of included studies and the study design. Some salivary biomarkers are potentially useful in combination or alone for diagnosing PD. Methodological and systematic studies are needed to develop more effective biomarkers.
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Affiliation(s)
- Jin-won Noh
- Division of Health Administration, College of Software and Digital Healthcare Convergence, Yonsei University, Gangwon-do, Wonju 26493, Korea
| | - Jong-Hwa Jang
- Department of Dental Hygiene, College of Health Science, Dankook University, Chungcheongnam-do, Cheonan 31116, Korea
- Department of Public Health Science, Dankook University Graduate School, Chungcheongnam-do, Cheonan 31116, Korea
| | - Hae-Soo Yoon
- Department of Public Health Science, Dankook University Graduate School, Chungcheongnam-do, Cheonan 31116, Korea
| | - Kyoung-Beom Kim
- Department of Health Administration, Dankook University, Chungcheongnam-do, Cheonan 31116, Korea
- Industry-Academic Cooperation Foundation, Yonsei University, Gangwon-do, Wonju 26493, Korea
| | - Min-Hee Heo
- Department of Health Administration, Yonsei University Graduate School, Gangwon-do, Wonju 26493, Korea
| | - Ha-eun Jang
- Department of Healthcare Management, College of Bio Convergence, Eulji University, Gyeonggi-do, Seongnam 13135, Korea
| | - Young-Jin Kim
- Department of Health Administration, Yonsei University Graduate School, Gangwon-do, Wonju 26493, Korea
| | - Yejin Lee
- Department of Public Health Graduate School, Korea University, Seoul 02841, Korea
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13
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Nagahara T, Takeda K, Inoue S, Wada K, Shiba H. Successful regenerative response of a severe bone defect in a right lower central incisor affected by a cemental tear. Clin Case Rep 2022; 10:e6472. [PMID: 36381039 PMCID: PMC9637247 DOI: 10.1002/ccr3.6472] [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: 06/13/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/09/2022] Open
Abstract
Cone-beam computed tomography and clinical examinations including pulp vital testing and pocket probing depth showed a cemental tear with a severe labial alveolar bony defect, but no endodontic lesions, in #25, which had a sinus tract at the labial site, in a 75-year-old woman.
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Affiliation(s)
- Takayoshi Nagahara
- Nippon Kokan Fukuyama HospitalHiroshimaJapan
- Department of Biological Endodontics, Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Katsuhiro Takeda
- Department of Biological Endodontics, Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | | | | | - Hideki Shiba
- Department of Biological Endodontics, Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
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14
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Comparison Study of Diagnosis and Treatment Planning for Dental Infections between Dental Students and Practitioners. Healthcare (Basel) 2022; 10:healthcare10081393. [PMID: 35893215 PMCID: PMC9330809 DOI: 10.3390/healthcare10081393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/18/2022] [Accepted: 07/22/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to access the knowledge in diagnosing dental infections and the practice in treatment planning for the affected teeth among dental practitioners (DPs) and senior (final-year) students. A survey questionnaire containing two cases (Case A; periodontal abscess and Case B; periapical abscess) with four questions per case was delivered to potential participants. Fifty-nine DPs voluntarily participated in the survey. For senior students, the case study was a part of their course requirements; one of the two cases (either Case A or B) was randomly assigned to the 126 seniors. The distribution of responses was significantly different between the DP and senior groups except for the diagnosis of Case B (Fisher’s exact test; p = 0.05). Only 31% of the participants diagnosed Case A as periodontal abscess; most of them selected periodontal surgery as the first treatment option. Despite a high agreement in diagnosing Case B, the choice of treatment was significantly different; the most frequent treatment option was extraction (51%) from the DP group and root canal retreatment (57%) from the senior group. The study revealed that the diagnosis of periodontal abscess was more challenging than that of periapical abscess among dental professionals.
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15
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Salinas-Azuceno C, Martínez-Hernández M, Maldonado-Noriega JI, Rodríguez-Hernández AP, Ximenez-Fyvie LA. Probiotic Monotherapy with Lactobacillus reuteri (Prodentis) as a Coadjutant to Reduce Subgingival Dysbiosis in a Patient with Periodontitis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137835. [PMID: 35805491 PMCID: PMC9265494 DOI: 10.3390/ijerph19137835] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/16/2022] [Accepted: 06/22/2022] [Indexed: 12/20/2022]
Abstract
(1) Background: Probiotics can be considered a non-invasive periodontal monotherapy for the modulation of microbiota when periodontal treatment is not accessible. The aim was to evaluate the ability of Lactobacillus reuteri Prodentis as monotherapy to modulate periodontal parameters and subgingival biofilm dysbiosis. (2) Methods: A 30-year-old patient with periodontitis was followed longitudinally after one month of daily consumption of L. reuteri Prodentis (T0). Periodontal measurements and microbial identification by Checkerboard DNA−DNA hybridization of 40 bacteria were compared between baseline (T0) and 30 days (T1) or 90 days (T2), using the Kruskal−Wallis (KW) and Mann−Whitney U (MW) tests. (3) Results: Low values of pocket depth, attachment level, dental plaque, gingival erythema (GE), and suppuration were observed at T0 vs. T1, with the clinical improvement of GE (p < 0.05, MW) and the recovery of tooth 46 fistulation. T1 vs. T0 comparisons showed lower levels (Lev) or proportions (Prop) of Parvimonas micra (Lev: p < 0.05, MW; Prop: p < 0.01, MW) and Streptococcus gordonii (Prop: p < 0.05, MW), and a predominance (Lev/Prop) of Actinomyces odontolyticus and Streptococcus mitis; lower levels and proportions of P. micra, Eubacterium saburreum, Porphyromonas gingivalis, and Tannerella forsythia were observed in tooth 46 (T1/T2 vs. T0). (4) Conclusions: Under monotherapy with L. reuteri Prodentis, periodontal measurements of the patient were maintained, with selective changes in the subgingival microbiota that were proportional to the time of probiotic administration, with any additional periodontal treatment.
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Affiliation(s)
- Claudia Salinas-Azuceno
- Laboratorio de Genética Molecular, Facultad de Odontología, Universidad Nacional Autónoma de México (UNAM), Ciudad de México 04360, Mexico; (C.S.-A.); (M.M.-H.); (L.-A.X.-F.)
| | - Miryam Martínez-Hernández
- Laboratorio de Genética Molecular, Facultad de Odontología, Universidad Nacional Autónoma de México (UNAM), Ciudad de México 04360, Mexico; (C.S.-A.); (M.M.-H.); (L.-A.X.-F.)
| | | | - Adriana-Patricia Rodríguez-Hernández
- Laboratorio de Genética Molecular, Facultad de Odontología, Universidad Nacional Autónoma de México (UNAM), Ciudad de México 04360, Mexico; (C.S.-A.); (M.M.-H.); (L.-A.X.-F.)
- Correspondence: ; Tel.: +52-5543-575763
| | - Laurie-Ann Ximenez-Fyvie
- Laboratorio de Genética Molecular, Facultad de Odontología, Universidad Nacional Autónoma de México (UNAM), Ciudad de México 04360, Mexico; (C.S.-A.); (M.M.-H.); (L.-A.X.-F.)
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16
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Abstract
Noma is a bacterial, non-communicable, grossly destructive and disfiguring necrotising oro-facial disease. It is rare, but occurs most commonly in chronically malnourished children with other debilitating illnesses, in remote, poverty-stricken communities, mainly in sub-Saharan Africa, and much more rarely in central Latin America and in parts of Asia. In South Africa and in Zimbabwe, noma is observed, again rarely, in immunosuppressed HIV-seropositive subjects. The World Health Organization (WHO) has classified noma into five sequential stages: stage 1, acute necrotising ulcerative gingivitis; stage 2, oedema; stage 3, gangrene; stage 4, scarring; stage 5, sequela. In the opinion of the authors, this WHO classification requires fundamental re-appraisal. The purpose of this viewpoint article is to highlight the weaknesses of this classification, and to propose a simpler, more logical and practical evidence-based staging of noma, which if used should improve the quality and value of future epidemiological data about noma.
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Affiliation(s)
- Razia Abdool Gafaar Khammissa
- Department of Periodontics and Oral Medicine, School of Dentistry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
| | - Johan Lemmer
- Department of Oral Medicine and Periodontology, University of the Witwatersrand, Johannesburg, South Africa
| | - Liviu Feller
- , 111 Portman Place, Fir Avenue, Bantry Bay, Cape Town, 8005, South Africa
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17
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Herrera D, Sanz M, Kebschull M, Jepsen S, Sculean A, Berglundh T, Papapanou PN, Chapple I, Tonetti MS. Treatment of stage IV periodontitis: The EFP S3 level clinical practice guideline. J Clin Periodontol 2022; 49 Suppl 24:4-71. [PMID: 35688447 DOI: 10.1111/jcpe.13639] [Citation(s) in RCA: 112] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/22/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND The recently published clinical practice guideline (CPG) for the treatment of periodontitis in stages I-III provided evidence-based recommendations for the treatment of periodontitis patients, defined according to the 2018 classification. Stage IV periodontitis shares the severity and complexity characteristics of stage III periodontitis, but includes the anatomical and functional sequelae of tooth and periodontal attachment loss (tooth flaring and drifting, bite collapse, etc.), which require additional interventions following completion of active periodontal therapy. AIM To develop an S3 Level CPG for the treatment of stage IV periodontitis, focusing on the implementation of inter-disciplinary treatment approaches required to treat/rehabilitate patients following associated sequelae and tooth loss. MATERIALS AND METHODS This S3 Level CPG was developed by the European Federation of Periodontology (EFP), following methodological guidance from the Association of Scientific Medical Societies in Germany and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process. A rigorous and transparent process included synthesis of relevant research in 13 specifically commissioned systematic reviews, evaluation of the quality and strength of evidence, the formulation of specific recommendations and a structured consensus process with leading experts and a broad base of stakeholders. RESULTS The S3 Level CPG for the treatment of stage IV periodontitis culminated in recommendations for different interventions, including orthodontic tooth movement, tooth splinting, occlusal adjustment, tooth- or implant-supported fixed or removable dental prostheses and supportive periodontal care. Prior to treatment planning, it is critically important to undertake a definitive and comprehensive diagnosis and case evaluation, obtain relevant patient information, and engage in frequent re-evaluations during and after treatment. The periodontal component of therapy should follow the CPG for the treatment of periodontitis in stages I-III. CONCLUSIONS The present S3 Level CPG informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to treat patients with stage IV periodontitis and to maintain a healthy dentition over lifetime, according to the available evidence at the time of publication.
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Affiliation(s)
- David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Moritz Kebschull
- Periodontal Research Group, Institute of Clinical Sciences, College of Medical & Dental Sciences, The University of Birmingham, Birmingham, UK.,Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK.,Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, New York, USA
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University Hospital Bonn, Bonn, Germany
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Tord Berglundh
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Panos N Papapanou
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, New York, USA
| | - Iain Chapple
- Periodontal Research Group, Institute of Clinical Sciences, College of Medical & Dental Sciences, The University of Birmingham, Birmingham, UK.,Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | - Maurizio S Tonetti
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillo-facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Centre for Oral Diseases, Shanghai Ninth People Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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18
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A Case of Necrotizing Periodontitis in a Care-Requiring Elderly Person Treated and Managed by Interprofessional Collaboration. Dent J (Basel) 2022; 10:dj10050079. [PMID: 35621532 PMCID: PMC9140147 DOI: 10.3390/dj10050079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/23/2022] [Accepted: 05/06/2022] [Indexed: 12/01/2022] Open
Abstract
Background: Necrotizing periodontitis (NP) is a reactive and destructive inflammatory process that occurs in response to bacterial infection. Predisposing factors such as compromised host immune responses contribute significantly to NP pathogenesis. NP occasionally progresses to a more advanced and life-threatening state. Case presentation: A 73-year-old man in need of nursing care visited our dental clinic with severe gingival pain and intraoral bleeding. He had a disability and was immunocompromised because his medical history included cerebral infarction and type 2 diabetes mellitus. He was diagnosed with NP based on his typical symptoms, such as prominent bleeding and suppurative discharge from the gingiva, in addition to crater-shaped ulcerations of the interdental papillae. To improve daily oral hygiene, periodontists, dentists, and dental hygienists educated care workers and other staff at the nursing home on appropriate oral cleansing, including brushing three times a day using the Bass technique. Basic periodontal therapy, including whole-mouth scaling and debridement of the root surfaces using hand and ultrasonic instruments, was also performed. After this basic treatment of NP, we extracted the hopeless teeth. Currently, dentists visit the patient fortnightly to manage his oral hygiene. To date, good oral health has been maintained.
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Mofidi A, Perez A, Kornerup I, Levin L, Ortiz S, Lai H, Green J, Kim S, Gibson MP. Dental Students’ Knowledge, Confidence, Ability, and Self-Reported Difficulties in Periodontal Education: A Mixed Method Pilot Study. Dent J (Basel) 2022; 10:dj10040063. [PMID: 35448057 PMCID: PMC9026102 DOI: 10.3390/dj10040063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/15/2022] [Accepted: 03/28/2022] [Indexed: 12/10/2022] Open
Abstract
Evidence on periodontal education areas in which students have difficulties and their factors are limited. In this study, third- and fourth-year dental students’ knowledge was assessed as well as their confidence and ability in five periodontal educational areas using a mixed-method approach. A survey was used to collect data related to history-taking, medical examination, diagnosis, treatment planning, and follow-up. Student answers were compared to the consensual answers of an expert panel using the cosine-similarity index (CSI). Descriptive statistics assessed confidence and ability for diagnosis. Semi-structured individual interviews were used to collect data on reported reasons for difficulties in periodontal education. A content analysis was employed to analyze the interview data. Eighteen third- and fourth-year dental students completed the survey and eleven were interviewed. Students’ knowledge was adequate regarding diagnosis and treatment planning. Third-year students’ median CSI were 0.93 and 0.89, respectively. Fourth-year students’ median CSI were 0.9 and 0.93, respectively. Students felt confident in history-taking and examination but lacked confidence and ability in diagnosis and treatment planning. Reported reasons for difficulties in periodontal education were linked to both preclinical and clinical pedagogical issues. Further improvements in preclinical and clinical periodontal education are needed to address students’ lack of knowledge, confidence, and skills in key periodontal areas.
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D’Ambrosio F, Caggiano M, Schiavo L, Savarese G, Carpinelli L, Amato A, Iandolo A. Chronic Stress and Depression in Periodontitis and Peri-Implantitis: A Narrative Review on Neurobiological, Neurobehavioral and Immune-Microbiome Interplays and Clinical Management Implications. Dent J (Basel) 2022; 10:49. [PMID: 35323251 PMCID: PMC8947556 DOI: 10.3390/dj10030049] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 02/06/2023] Open
Abstract
Besides the well-known systemic factors for periodontal and peri-implant diseases, additional co-factors, such as chronic stress and depression, may also affect disease onset and progression as well as treatment responsiveness. Neurobiological and neurobehavioral pathogenic links between chronic stress and depression, on the one side, and periodontitis and peri-implantitis, on the other side, which have been little investigated and principally related to necrotizing periodontal disease, have been reviewed, along with their putative interconnections with periodontal immune-microbiome balance. Rising evidence suggest that dysregulated neurobiological and neurobehavioral factors, as well as periodontal immune-microbiome unbalance, all related to chronic stress and depression, may crucially interact and thus represent contributing factors in the genesis and worsening not only of necrotizing periodontal lesions, but also of chronic periodontitis and peri-implantitis. Such potential interconnections may be even more relevant in recurrent and aggressive cases of periodontal and peri-implant disease, which are frequently refractory to therapy, and may, if corroborated, coherently pave the way for personalized prevention and treatment strategies, possibly targeting immune-microbiome unbalance and neurobehavioral factors and focusing on neurobiological ones, especially in chronically stressed and depressed subjects with periodontitis and peri-implantitis.
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Affiliation(s)
- Francesco D’Ambrosio
- Department of Medicine, Surgery and Dentistry “Schola Medica Salernitana”, University of Salerno, Via S. Allende, 84081 Baronissi, Italy; (M.C.); (L.S.); (G.S.); (L.C.); (A.A.); (A.I.)
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21
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Photodynamic Therapy Using 5-Aminolevulinic Acid (Ala) for the Treatment of Chronic Periodontitis: A Prospective Case Series. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12063102] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Aim: The objective of this study was to compare the efficacy of supportive periodontal therapy (i.e., scaling and root planning, SRP) alone versus ALADENT medical device used in association with SRP in the treatment of chronic periodontitis in adult patients. Materials and Methods: A total of 20 patients with a diagnosis of chronic periodontitis (40 localized chronic periodontitis sites) aged between 35 and 55 were selected. None of these patients previously received any surgical or non-surgical periodontal therapy, and they presented radiographic evidence of moderate bone loss. Two non-adjacent sites in different quadrants were identified and observed in each patient, analyzing treatment effectiveness (split-mouth design). Clinical pocket depth, clinical attachment loss, and bleeding on probing were evaluated at time 0 and after 6 months, while microbial analysis (MA) was conducted at baseline and after 15 days. Significant differences were calculated using SPSS program and paired simple statistic t-test. Results: Total bacteria loadings had a statistically significant reduction before and after treatment with SRP (left site) (total average decrease of 27%). The sites treated with SRP plus ALADENT (right) showed a significantly reduced total bacterial loading compared to the untreated sites (right) (total average decrease of 75%). Mean values of CAL/PD and percentages data of BOP, recorded after SRP + ALADENT therapy, showed a higher reduction (CAL = 2.42, PD = 2.87 mm, 90% of sites with no bleeding) than those obtained after SRP treatment (CAL = 4.08 mm, PD = 4.73 mm, 70% of sites with no bleeding). Conclusion: The treatment of moderate and severe chronic periodontitis should include, beside SRP, the use of ALADENT medical device, which has been proved to be a useful adjuvant therapy.
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22
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Jayawardena DS, Yates R, West NX, Pollard AJ. Implementing the 2017 Classification of Periodontal and Peri-Implant Diseases - how are we doing in the South West region of the UK? Br Dent J 2021:10.1038/s41415-021-3716-2. [PMID: 34887553 DOI: 10.1038/s41415-021-3716-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/04/2021] [Indexed: 11/09/2022]
Abstract
Background A new world classification of periodontal diseases and conditions was developed in 2017 and implemented throughout the United Kingdom by the British Society of Periodontology and Implant Dentistry.Method A retrospective audit was undertaken at Bristol Dental Hospital (BDH) (December 2019 to March 2020) to assess uptake of the new classification in referral letters and its implementation by staff. In total, 75 consecutive new patient referrals seen at BDH were manually searched for diagnosis/classification. Additionally, the 75 most recent referrals where both the referring practitioner and BDH staff used the 2017 classification were analysed for agreeability.Results Within South West England, there was a positive uptake of the new classification in general practice, with 85% of referrals using the 2017 periodontal classification. Further, 98% of patients attending BDH for periodontology consultations were diagnosed using the 2017 classification. Results indicate 50.7% and 57.3% agreement for staging and grading, respectively, when comparing consultants to referring clinicians.Discussion The new classification has been widely conveyed to the profession and is being adopted quickly by specialists, general practitioners and dental health professionals. There is an underestimation of both stage and grade by referring practitioners, with 40% of referrals underestimating the stage and 38.7% underestimating the grade.
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Affiliation(s)
- Don S Jayawardena
- Dental Core Trainee 2, Bristol Dental Hospital, Lower Maudlin St, Bristol, BS1 2LY, UK.
| | - Roger Yates
- Consultant in Restorative Dentistry/Periodontology, MCN South West Lead for Periodontology, Bristol Dental Hospital, Lower Maudlin St, Bristol, BS1 2LY, UK
| | - Nicola X West
- Professor and Honorary Consultant in Periodontology, Bristol Dental Hospital, Lower Maudlin St, Bristol, BS1 2LY, UK
| | - Alexander J Pollard
- Specialty Registrar in Periodontology, Bristol Dental Hospital, Lower Maudlin St, Bristol, BS1 2LY, UK
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23
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Decker AM, Kapila YL, Wang HL. The psychobiological links between chronic stress-related diseases, periodontal/peri-implant diseases, and wound healing. Periodontol 2000 2021; 87:94-106. [PMID: 34463997 PMCID: PMC8459609 DOI: 10.1111/prd.12381] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic stress is a relevant disease to periodontal practice, encompassing 25%-28% of the US population (American Psychological Association 2015). While it is well established that chronic psychologic stress can have significant deleterious systemic effects, only in recent decades have we begun to explore the biochemical, microbial, and physiologic impacts of chronic stress diseases on oral tissues. Currently, chronic stress is classified as a "risk indicator" for periodontal disease. However, as the evidence in this field matures with additional clinically controlled trials, more homogeneous data collection methods, and a better grasp of the biologic underpinnings of stress-mediated dysbiosis, emerging evidence suggests that chronic stress and related diseases (depression, anxiety) may be significant contributing factors in periodontal/peri-implant disease progression and inconsistent wound healing following periodontal-related therapeutics. Ideal solutions for these patients include classification of the disease process and de-escalation of chronic stress conditions through coping strategies. This paper also summarizes periodontal/implant-related therapeutic approaches to ensure predictable results for this specific patient subpopulation.
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Affiliation(s)
- Ann M Decker
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan
| | - Yvonne L Kapila
- Department of Orofacial Sciences, University of California San Francisco School of Dentistry, San Francisco, California
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan
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Gerhard N, Thurnheer T, Kreutzer S, Gmür RD, Attin T, Russo G, Karygianni L. Necrotizing Gingivitis: Microbial Diversity and Quantification of Protein Secretion in Necrotizing Gingivitis. Antibiotics (Basel) 2021; 10:antibiotics10101197. [PMID: 34680779 PMCID: PMC8532655 DOI: 10.3390/antibiotics10101197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 11/18/2022] Open
Abstract
Necrotizing gingivitis (NG) is a necrotizing periodontal disease that differs from chronic gingivitis (CG). To date, both the microbiological causes and the involved host cytokine response of NG still remain unclear. Here, we investigated corresponding interdental plaque and serum samples from two groups of Chinese patients with CG (n = 21) or NG (n = 21). The microbiota were studied by 16S rRNA Illumina MiSeq sequencing of the microbial metagenome and by assessing quantitatively the abundance of the phylum Bacteroidetes, the genus Prevotella and the species T. forsythia, P. endodontalis, and P. gingivalis using fluorescence in situ hybridization (FISH). With respect to the associated host response, the levels of 30 inflammatory mediators were quantified by multiplex immunoassay analysis. Differential microbial abundance analysis of the two disease groups revealed at the phylum level that Proteobacteria accounted for 67% of the differentially abundant organisms, followed by organisms of Firmicutes (21%) and Actinobacteria (9%). At the species level, significant differences in abundance were seen for 75 species of which 58 species were significantly more abundant in CG patients. Notably, the FISH analysis revealed that Bacteroidetes was the most prevalent phylum in NG. The multiplex cytokine assay showed significant quantitative differences between the disease groups for eight analytes (GM–CSF, G–CSF, IFN–α, IL–4, IL–13, TNF–α, MIG, and HGF). The G–CSF was found to be the most significantly increased inflammatory protein marker in NG. The next-generation sequencing (NGS) data supported the understanding of NG as a multi-microbial infection with distinct differences to CG in regard to the microbial composition.
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Affiliation(s)
- Nicolas Gerhard
- Clinic for Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032 Zurich, Switzerland; (N.G.); (T.T.); (R.D.G.); (T.A.)
| | - Thomas Thurnheer
- Clinic for Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032 Zurich, Switzerland; (N.G.); (T.T.); (R.D.G.); (T.A.)
| | - Susanne Kreutzer
- Functional Genomics Center Zurich, University of Zurich/ETH Zurich, 8057 Zurich, Switzerland; (S.K.); (G.R.)
| | - Rudolf Dominik Gmür
- Clinic for Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032 Zurich, Switzerland; (N.G.); (T.T.); (R.D.G.); (T.A.)
| | - Thomas Attin
- Clinic for Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032 Zurich, Switzerland; (N.G.); (T.T.); (R.D.G.); (T.A.)
| | - Giancarlo Russo
- Functional Genomics Center Zurich, University of Zurich/ETH Zurich, 8057 Zurich, Switzerland; (S.K.); (G.R.)
| | - Lamprini Karygianni
- Clinic for Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032 Zurich, Switzerland; (N.G.); (T.T.); (R.D.G.); (T.A.)
- Correspondence: ; Tel.: +0041-44-634-3275
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Impact of Periodontal Attachment Loss on the Outcome of Endodontic Microsurgery: A Systematic Review and Meta-Analysis. MEDICINA-LITHUANIA 2021; 57:medicina57090922. [PMID: 34577845 PMCID: PMC8465214 DOI: 10.3390/medicina57090922] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 11/28/2022]
Abstract
Background and Objectives: Endodontic microsurgery (EMS) aims to eradicate the sources of infection once the apical root resection removes most of the infected anatomical structures and repairs potential procedural errors in the apical region. An endodontic-periodontal lesion yields a pathological communication between the pulp and the periodontium. The purpose of this systematic review and meta-analysis is to evaluate the impact of periodontal attachment loss on the outcome of teeth submitted to EMS. Materials and Methods: PRISMA guidelines were followed. An electronic search was performed in EBSCOhost, Embase and PubMed databases with the following search key: (“endodontic microsurgery” AND “outcome”). No filters were used concerning the year of publication or language. Only randomized clinical trials, prospective and retrospective clinical studies in humans, with a minimum one-year follow-up, defined clinical and radiographic outcome criteria and estimable success rate for endodontic-periodontal lesion were included. Statistical analysis was performed using OpenMeta[Analyst] software. Results: Of a total of 113 articles, 34 were selected for full-text reading after duplicates deletion and title and abstract analysis. Thirteen and six studies were included in the systematic review and meta-analysis, respectively. A total of 2775 pooled teeth were submitted to EMS, of which 492 teeth and 4 roots had periodontal involvement. According to the qualitative analysis, success rates of the endodontic-periodontal group ranged from 67.6% to 88.2%. Meta-analysis revealed that the absence of periodontal attachment loss was predictive of a higher likelihood of success with an odds ratio of 3.14. Conclusions: Periodontal attachment loss presents a risk factor for EMS outcome. Although endodontic-periodontal lesions were associated with lower success rates considering a 1 to 10 years follow-up period, long-term successful prognosis following EMS has been reported, therefore presenting a fully valid and viable therapeutic option for the management of this type of lesions.
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The Chairside Periodontal Diagnostic Toolkit: Past, Present, and Future. Diagnostics (Basel) 2021; 11:diagnostics11060932. [PMID: 34067332 PMCID: PMC8224643 DOI: 10.3390/diagnostics11060932] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/07/2021] [Accepted: 05/19/2021] [Indexed: 12/22/2022] Open
Abstract
Periodontal diseases comprise a group of globally prevalent, chronic oral inflammatory conditions caused by microbial dysbiosis and the host immune response. These diseases specifically affect the tooth-supporting tissues (i.e., the periodontium) but are also known to contribute to systemic inflammation. If left untreated, periodontal diseases can ultimately progress to tooth loss, lead to compromised oral function, and negatively impact the overall quality of life. Therefore, it is important for the clinician to accurately diagnose these diseases both early and accurately chairside. Currently, the staging and grading of periodontal diseases are based on recording medical and dental histories, thorough oral examination, and multiple clinical and radiographic analyses of the periodontium. There have been numerous attempts to improve, automate, and digitize the collection of this information with varied success. Recent studies focused on the subgingival microbiome and the host immune response suggest there is an untapped potential for non-invasive oral sampling to assist clinicians in the chairside diagnosis and, potentially, prognosis. Here, we review the available toolkit available for diagnosing periodontal diseases, discuss commercially available options, and highlight the need for collaborative research initiatives and state-of-the-art technology development across disciplines to overcome the challenges of rapid periodontal disease diagnosis.
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Pedercini A, Weitz DF, Heyse JD, Pedercini C, Kormas I, Koutlas IG, Johnson DK, McClanahan SB. Cemental tear: An overlooked finding associated with rapid periodontal destruction. A case series. Aust Dent J 2021; 66 Suppl 1:S82-S87. [PMID: 33864270 DOI: 10.1111/adj.12844] [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: 03/23/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 11/30/2022]
Abstract
Cemental tear is defined as cementum fragment completely or partially detached from the root surface, and it has been associated with localized rapid periodontal breakdown. Although history of trauma and/or attrition may be risk factors, the etiopathology of cemental tear remains unknown. This case series aims to discuss the clinical, radiographic and histopathologic features of cemental tears to aid clinicians in making differential diagnosis. Three teeth from three patients presenting a periradicular lesion underwent an exploratory surgery to determine the cause and provide treatment. Soft and hard tissue biopsies were obtained from each lesion and forwarded for histopathologic evaluation. Two patients received a guided tissue regeneration (GTR) procedure, which allowed the tooth to be retained. One patient received an extraction with simultaneous guided bone regeneration (GBR) due to a hopeless prognosis of the tooth. The results after histopathologic evaluation yielded a final diagnosis of cemental tear for all three patients. Cemental tears may be overlooked, and therefore, they should be included in the differential diagnosis of periapical periodontitis, endodontic-periodontal lesion and vertical root fracture (VRF).
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Affiliation(s)
- A Pedercini
- Division of Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - D F Weitz
- Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - J D Heyse
- Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - C Pedercini
- School of Oral Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - I Kormas
- Division of Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - I G Koutlas
- Oral Pathology Laboratories, Department of Diagnostic and Biological Sciences, Division of Oral and Maxillofacial Pathology, University of Minnesota, Minneapolis, MN, USA
| | - D K Johnson
- Division of Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - S B McClanahan
- Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
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Rapone B, Ferrara E, Corsalini M, Qorri E, Converti I, Lorusso F, Delvecchio M, Gnoni A, Scacco S, Scarano A. Inflammatory Status and Glycemic Control Level of Patients with Type 2 Diabetes and Periodontitis: A Randomized Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063018. [PMID: 33804123 PMCID: PMC7998112 DOI: 10.3390/ijerph18063018] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 12/15/2022]
Abstract
Background: Based on the holistic approach to prevention diabetic disease, the role of periodontal inflammation in type 2 diabetes mellitus (T2DM) is under intensive scrutiny. Data from clinical trials have shown benefit from a periodontal therapy in providing patients with type 2 diabetes improvement despite relatively disappointing long-terms response rates. The aim of this study was to investigate the short-term glycemic control level and systemic inflammatory status after periodontal therapy. Methods: This was a randomized trial with a 6-months follow-up. Participants aged 56.4 ± 7.9 years with diagnosed type 2 diabetes and periodontitis were enrolled. Among the 187 type 2 diabetic patients, 93 were randomly assigned to receive non-surgical periodontal treatment immediately and 94 to receive the delayed treatment. Within and between groups comparison was done during the study period, and the differences between groups were assessed. Results: The difference between HbA1c values at baseline (Mdn = 7.7) and 6 months after non-surgical periodontal treatment (Mdn = 7.2) was statistically significant, U = 3174.5, p = 0.012, r = 0.187. However, although technically a positive correlation, the relationship between the glycated hemoglobin value and periodontal variables was weak. The differences between both the groups over 6 months were not statistically considerable, failing to reach statistical significance. At 6 months the difference between groups about the C-reactive protein (CRP) levels was statistically significant, U=1839.5, p = 0, r = 0.472, with a lower concentration for the intervention group. Furthermore, the intervention group showed a statistically significant difference between baseline and 6 months evaluation (U = 2606.5, p = 0, r = 0.308). Conclusions: The periodontal intervention potentially may allow individuals with type 2 diabetes to improve glycemic control and CRP concentrations, and diabetes alters the periodontal status.
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Affiliation(s)
- Biagio Rapone
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, “Aldo Moro” University of Bari, 70121 Bari, Italy; (A.G.); (S.S.)
- Correspondence: ; Tel.: +39-3477619817
| | - Elisabetta Ferrara
- Complex Operative Unit of Odontostomatology, Hospital S.S. Annunziata, 66100 Chieti, Italy;
| | - Massimo Corsalini
- Interdisciplinary Department of Medicine, University of Bari, 70121 Bari, Italy;
| | - Erda Qorri
- Dean Faculty of Medical Sciences, Albanian University, Bulevardi Zogu I, 1001 Tirana, Albania;
| | - Ilaria Converti
- Department of Emergency and Organ Transplantation, Division of Plastic and Reconstructive Surgery, “Aldo Moro” University of Bari, 70121 Bari, Italy;
| | - Felice Lorusso
- Department of Oral Science, Nano and Biotechnology and CeSi-Met University of Chieti-Pescara, 66100 Chieti, Italy; (F.L.); (A.S.)
| | - Maurizio Delvecchio
- Department of Metabolic and Genetic Diseases, Giovanni XXIII Children’s Hospital, 70126 Bari, Italy;
| | - Antonio Gnoni
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, “Aldo Moro” University of Bari, 70121 Bari, Italy; (A.G.); (S.S.)
| | - Salvatore Scacco
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, “Aldo Moro” University of Bari, 70121 Bari, Italy; (A.G.); (S.S.)
| | - Antonio Scarano
- Department of Oral Science, Nano and Biotechnology and CeSi-Met University of Chieti-Pescara, 66100 Chieti, Italy; (F.L.); (A.S.)
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West N, Chapple I, Claydon N, D'Aiuto F, Donos N, Ide M, Needleman I, Kebschull M. BSP implementation of European S3 - level evidence-based treatment guidelines for stage I-III periodontitis in UK clinical practice. J Dent 2021; 106:103562. [PMID: 33573801 DOI: 10.1016/j.jdent.2020.103562] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/16/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To adapt the supranational European Federation for Periodontology (EFP) S3-Level Clinical Practice Guideline for treatment of periodontitis (stage I-III) to a UK healthcare environment, taking into account the views of a broad range of stakeholders, and patients. SOURCES This UK version is based on the supranational EFP guideline (Sanz et al., 2020) published in the Journal of Clinical Periodontology. The source guideline was developed using the S3-level methodology, which combined the assessment of formal evidence from 15 systematic reviews with a moderated consensus process of a representative group of stakeholders, and accounts for health equality, environmental factors and clinical effectiveness. It encompasses 62 clinical recommendations for the treatment of stage I-III periodontitis, based on a step-wise process mapped to the 2017 classification system. METHODOLOGY The UK version was developed from the source guideline using a formal process called the GRADE ADOLOPMENT framework. This framework allows for the adoption (unmodified acceptance), adaptation (acceptance with modifications) and the de novo development of clinical recommendations. Using this framework and following the S3-process, the underlying systematic reviews were updated and a representative guideline group of 75 delegates from 17 stakeholder organisations was assembled into three working groups. Following the formal S3-process, all clinical recommendations were formally assessed for their applicability to the UK and adoloped accordingly. RESULTS AND CONCLUSION Using the ADOLOPMENT protocol, a UK version of the EFP S3-level clinical practice guideline was developed. This guideline delivers evidence- and consensus-based clinical recommendations of direct relevance to the dental community in the UK. CLINICAL SIGNIFICANCE The aim of S3-level guidelines is to combine the evaluation of formal evidence, grading and synthesis with the clinical expertise of a broad range of stakeholders to form clinical recommendations. Herein, the first major international S3-level guideline in dentistry, the EFP guideline, was implemented for direct clinical applicability in the UK healthcare system.
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Affiliation(s)
- Nicola West
- Periodontology, Bristol Dental School, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY, UK.
| | - Iain Chapple
- Periodontal Research Group, Institute of Clinical Sciences, College of Medical & Dental Sciences, The University of Birmingham, Birmingham, UK; Birmingham Community Healthcare NHS Trust, Birmingham, UK.
| | - Nick Claydon
- Periodontology, Bristol Dental School, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY, UK.
| | - Francesco D'Aiuto
- Periodontology, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Nikos Donos
- Periodontology, Institute of Dentistry, Barts and The London School of Medicine & Dentistry, Queen Mary University, Turner Street, London E1 2AD, UK.
| | - Mark Ide
- Periodontology, Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, Kings College London, London SE1 9RT, UK.
| | - Ian Needleman
- Periodontology, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Moritz Kebschull
- Periodontal Research Group, Institute of Clinical Sciences, College of Medical & Dental Sciences, The University of Birmingham, Birmingham, UK; Birmingham Community Healthcare NHS Trust, Birmingham, UK; Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, NY, USA.
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30
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Marini L, Tonetti MS, Nibali L, Rojas MA, Aimetti M, Cairo F, Cavalcanti R, Crea A, Ferrarotti F, Graziani F, Landi L, Sforza NM, Tomasi C, Pilloni A. The staging and grading system in defining periodontitis cases: consistency and accuracy amongst periodontal experts, general dentists and undergraduate students. J Clin Periodontol 2020; 48:205-215. [PMID: 33260273 DOI: 10.1111/jcpe.13406] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/28/2020] [Accepted: 11/24/2020] [Indexed: 12/29/2022]
Abstract
AIM The objective of this study was to evaluate consistency and accuracy of the periodontitis staging and grading classification system. METHODS Thirty participants (10 periodontal experts, 10 general dentists and 10 undergraduate students) and a gold-standard examiner were asked to classify 25 fully documented periodontitis cases twice. Fleiss kappa was used to estimate consistency across examiners. Intraclass correlation coefficient (ICC) was used to calculate consistency across time. Quadratic weighted kappa and percentage of complete agreement versus gold standard were computed to assess accuracy. RESULTS Fleiss kappa for stage, extent and grade were 0.48, 0.37 and 0.45 respectively. The highest ICC was provided by students for stage (0.91), whereas the lowest ICC by general dentists for extent (0.79). Pairwise comparisons against gold standard showed mean value of kappa >0.81 for stage and >0.41 for grade and extent. Agreement with the gold standard for all three components of the case definition was achieved in 47.2% of cases. The study identified specific factors associated with lower consistency and accuracy. CONCLUSIONS Diagnosis was highly consistent across time and moderately between examiners. Accuracy was almost perfect for stage and moderate for grade and extent. Additional efforts are required to improve training of general dentists.
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Affiliation(s)
- Lorenzo Marini
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Maurizio S Tonetti
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, the University of Hong Kong, Hong Kong, China.,Department of Oral and Maxillo-facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Centre for Stomatology, Shanghai Ninth People Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Luigi Nibali
- Periodontology Unit, Centre for Host-Microbiome Interactions, Faculty of Dental and Craniofacial Sciences, King's College London, London, UK
| | - Mariana A Rojas
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Mario Aimetti
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, Turin, Italy
| | - Francesco Cairo
- Research Unit in Periodontology and Periodontal Medicine, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Raffaele Cavalcanti
- Section of Periodontology, Department of General Surgery and Medical-Surgical Specialties, School of Dentistry, University of Catania, Catania, Italy
| | | | - Francesco Ferrarotti
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, Turin, Italy
| | - Filippo Graziani
- Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Luca Landi
- Private Practice, Rome and Verona, Italy
| | | | - Cristiano Tomasi
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Andrea Pilloni
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
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Sonde N, Edwards M. Perio-Endo Lesions: A Guide to Diagnosis and Clinical Management. Prim Dent J 2020; 9:45-51. [PMID: 33225855 DOI: 10.1177/2050168420963305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Dentists are likely to encounter lesions that have both periodontal and endodontic aetiological components; the so called 'perio-endo lesions'. A thorough examination with appropriate investigations remains pivotal to diagnosing a perio-endo lesion. Correct diagnosis of such lesions is therefore important as it enables the most suitable clinical management to be treatment planned. It is still recommended that for the treatment of perio-endo lesions, initial endodontic therapy is completed.
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Affiliation(s)
- Nargis Sonde
- Clinical Lecturer in Restorative Dentistry, School of Dentistry, Faculty of Clinical and Biomedical Sciences, University of Central Lancashire
| | - Malcolm Edwards
- Head, School of Dentistry, Specialist in Restorative Dentistry, Specialist Prosthodontics, Faculty of Clinical and Biomedical Sciences, University of Central Lancashire
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Schmalz G, Wolf C, Merle C, Kottmann T, Haak R, Ziebolz D. Evaluation of a questionnaire-based diabetes screening concept in German patients with Stage III or IV periodontitis: A practice-based study. J Periodontol 2020; 92:1163-1170. [PMID: 33155276 DOI: 10.1002/jper.20-0297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/13/2020] [Accepted: 10/05/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND This practice-based retrospective study evaluated a screening method for diabetes mellitus (DM) in patients with Stage III or IV periodontitis using the FINDRISC questionnaire. METHODS Patients with Stage III or IV periodontitis who received FINDRISC screening in a German private dental practice were recruited. Individuals with positive FINDRISC scores (≥12, FINDRISC+) were referred for diabetological examination. Several general and periodontal findings from the patients' documentation were recorded and analyzed. RESULTS A total of 179 patients (52.65 ± 11.49 years) were included. In DM screening, 24.6% (n = 44) patients were FINDRISC+, including all patients with currently known DM (21 of 21). Of the remaining FINDRISC+ patients, 82.6% (19 of 23) visited their general practitioner, and 63.2% (12 of 19, 7.6% of total cohort) had an HbA1c ≥5.7%. Accordingly, 75% of the FINDRISC+ patients were diabetologically conspicuous (HbA1c ≥ 5.7%), including those with already known DM. Patients with previously unknown DM showed higher mean age, more missing teeth, a higher periodontitis stage (more Stage IV) and more frequently teeth with suppuration compared with the diabetologically inconspicuous individuals (P <0.01). CONCLUSION The FINDRISC questionnaire is appropriate for patients with Stage III or IV periodontitis and can be recommended in dental practice setting.
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Affiliation(s)
- Gerhard Schmalz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | | | - Cordula Merle
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | | | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
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33
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Almoznino G, Kedem R, Turgeman R, Bader T, Yavnai N, Zur D, Shay B. The Dental, Oral, Medical Epidemiological (DOME) Study: Protocol and Study Methods. Methods Inf Med 2020; 59:119-130. [PMID: 33080627 DOI: 10.1055/s-0040-1718582] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To develop and present the methods utilized for the Dental, Oral, Medical Epidemiological (DOME) study. METHODS The DOME is an electronic record-based cross-sectional study, that was conducted to measure the dental, periodontal, and oral morbidities and their associations with systemic morbidities, among a nationally representative sample of young to middle-aged adults military personnel from the IDF (Israel Defense Forces). To that end, we developed a strict protocol including standardized terminology, data collection, and handling. RESULTS Data for the DOME study was derived simultaneously from three electronic records of the IDF: (1) a central demographic database, (2) the dental patient record (DPR), and (3) the medical computerized patient record (CPR). The established DOME repository includes socio-demographic, dental and medical records of 132,354 young to middle-age military personnel from the IDF, who attended the dental clinics during the year 2015. Records of general military personnel (N > 50,000), with no recorded dental visits during the study period, served as a control group regarding all other parameters except dental. The DOME study continues and is currently collecting longitudinal data from the year 2010 until 2020. The IDF employs a standardized uniform administrative and clinical work-up and treatment protocols as well as uniform computerized codes. We describe the standardized definitions for all the parameters that were included: socio-demographics, health-related habits, medical and dental attendance patterns, and general and dental health status. Multicollinearity analysis results of the sociodemographic and medical study parameters are presented. CONCLUSION Standardized work-up and definitions are essential to establish the centralized DOME data repository to study the extent of dental and systemic morbidities and their associations.
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Affiliation(s)
- Galit Almoznino
- Big Biomedical Data Research Laboratory, Hebrew University, Hadassah School of Dental Medicine, Jerusalem, Israel.,Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hebrew University, Hadassah School of Dental Medicine, Jerusalem, Israel.,Department of Endodontics, Hebrew University, Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Ron Kedem
- Medical Information Department, Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel
| | - Ronit Turgeman
- Chief Dental Surgeon Headquarters, Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel
| | - Tarif Bader
- Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan and Department of Military Medicine, Hebrew University, Jerusalem, Israel
| | - Nirit Yavnai
- Medical Research and Academy Section, Medical Corps, Israel Defense Forces, Israel
| | - Dorit Zur
- Medical Information Department, Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel
| | - Boaz Shay
- Department of Endodontics, Hebrew University, Hadassah School of Dental Medicine, Jerusalem, Israel
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34
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Ren R, Meng H, Lu R. A case of acute necrotizing periodontitis with not known origin. Clin Case Rep 2020; 8:2034-2039. [PMID: 33088546 PMCID: PMC7562895 DOI: 10.1002/ccr3.3062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/26/2020] [Accepted: 06/02/2020] [Indexed: 11/11/2022] Open
Abstract
In cases of aggressive periodontal bone destruction, subgingival microbial analysis should be done, tooth extractions should be planned to control disease progression if non‐surgical periodontal treatment is ineffective.
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Affiliation(s)
- Rui Ren
- Department of Periodontology Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology Beijing China.,Third clinical division Peking University School and Hospital of Stomatology Beijing China
| | - Huanxin Meng
- Department of Periodontology Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology Beijing China
| | - Ruifang Lu
- Department of Periodontology Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology Beijing China
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Sanz M, Herrera D, Kebschull M, Chapple I, Jepsen S, Berglundh T, Sculean A, Tonetti MS. Treatment of stage I-III periodontitis-The EFP S3 level clinical practice guideline. J Clin Periodontol 2020; 47 Suppl 22:4-60. [PMID: 32383274 PMCID: PMC7891343 DOI: 10.1111/jcpe.13290] [Citation(s) in RCA: 686] [Impact Index Per Article: 171.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 04/03/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The recently introduced 2017 World Workshop on the classification of periodontitis, incorporating stages and grades of disease, aims to link disease classification with approaches to prevention and treatment, as it describes not only disease severity and extent but also the degree of complexity and an individual's risk. There is, therefore, a need for evidence-based clinical guidelines providing recommendations to treat periodontitis. AIM The objective of the current project was to develop a S3 Level Clinical Practice Guideline (CPG) for the treatment of Stage I-III periodontitis. MATERIAL AND METHODS This S3 CPG was developed under the auspices of the European Federation of Periodontology (EFP), following the methodological guidance of the Association of Scientific Medical Societies in Germany and the Grading of Recommendations Assessment, Development and Evaluation (GRADE). The rigorous and transparent process included synthesis of relevant research in 15 specifically commissioned systematic reviews, evaluation of the quality and strength of evidence, the formulation of specific recommendations and consensus, on those recommendations, by leading experts and a broad base of stakeholders. RESULTS The S3 CPG approaches the treatment of periodontitis (stages I, II and III) using a pre-established stepwise approach to therapy that, depending on the disease stage, should be incremental, each including different interventions. Consensus was achieved on recommendations covering different interventions, aimed at (a) behavioural changes, supragingival biofilm, gingival inflammation and risk factor control; (b) supra- and sub-gingival instrumentation, with and without adjunctive therapies; (c) different types of periodontal surgical interventions; and (d) the necessary supportive periodontal care to extend benefits over time. CONCLUSION This S3 guideline informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to treat periodontitis and to maintain a healthy dentition for a lifetime, according to the available evidence at the time of publication.
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Affiliation(s)
- Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri‐implant Diseases) Research GroupUniversity Complutense of MadridMadridSpain
| | - David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri‐implant Diseases) Research GroupUniversity Complutense of MadridMadridSpain
| | - Moritz Kebschull
- Periodontal Research GroupInstitute of Clinical SciencesCollege of Medical and Dental SciencesThe University of BirminghamBirminghamUK
- Birmingham Community Healthcare NHS TrustBirminghamUK
- Division of PeriodonticsSection of Oral, Diagnostic and Rehabilitation SciencesCollege of Dental MedicineColumbia UniversityNew YorkNYUSA
| | - Iain Chapple
- Periodontal Research GroupInstitute of Clinical SciencesCollege of Medical and Dental SciencesThe University of BirminghamBirminghamUK
- Birmingham Community Healthcare NHS TrustBirminghamUK
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive DentistryUniversity Hospital BonnBonnGermany
| | - Tord Berglundh
- Department of PeriodontologyInstitute of OdontologyThe Sahlgrenska AcademyUniversity of GothenburgGöteborgSweden
| | - Anton Sculean
- Department of PeriodontologySchool of Dental MedicineUniversity of BernBernSwitzerland
| | - Maurizio S. Tonetti
- Division of Periodontology and Implant DentistryFaculty of DentistryThe University of Hong KongHong KongHong Kong
- Department of Oral and Maxillo‐facial ImplantologyShanghai Key Laboratory of StomatologyNational Clinical Research Centre for StomatologyShanghai Ninth People HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghaiChina
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Metwally S, Stachewicz U. Teeth resorption at cement - enamel junction (CEJ) - Microscopy analysis. Micron 2020; 137:102913. [PMID: 32590194 DOI: 10.1016/j.micron.2020.102913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/09/2020] [Accepted: 06/15/2020] [Indexed: 10/24/2022]
Abstract
The cement - enamel junction (CEJ) gains a growing interest in clinical dentistry, due to an increasing number of idiopathic tooth resorption leading to the inevitable loss of permanent dentition. Therefore, in this research study, we investigated healthy and under resorption teeth to verify junctions' morphology in relation to the resorption process, its initiation, and propagation. Using light and scanning electron microscopy we examined the three types of CEJ: 1) coronal cementum, 2) abutment) and 3) the gap between cementum and enamel. With energy-dispersive X-ray spectroscopy (EDX) we analyzed the Ca and P concentration along the CEJ border. The study indicated the strict correlation between the gap junction and tooth resorption, due to the dentine exposure to the oral environment.
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Affiliation(s)
- Sara Metwally
- International Centre of Electron Microscopy for Materials Science, Faculty of Metals Engineering and Industrial Computer Science, AGH University of Science and Technology Al. A. Mickiewicz 30, 30-059 Kraków, Poland
| | - Urszula Stachewicz
- International Centre of Electron Microscopy for Materials Science, Faculty of Metals Engineering and Industrial Computer Science, AGH University of Science and Technology Al. A. Mickiewicz 30, 30-059 Kraków, Poland.
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Bumm CV, Folwaczny M, Wölfle UC. Necrotizing periodontitis or medication-related osteonecrosis of the jaw (MRONJ) in a patient receiving Bemcentinib-a case report. Oral Maxillofac Surg 2020; 24:353-358. [PMID: 32440898 PMCID: PMC7413899 DOI: 10.1007/s10006-020-00851-w] [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: 03/03/2020] [Accepted: 05/07/2020] [Indexed: 12/12/2022]
Abstract
Bemcentinib is a newly developed AXL inhibitor that is currently under investigation in phase II trails for the treatment of acute myeloblastic leukemia (AML). Clinical and radiographic findings in this case were very similar to cases of MRONJ in patients receiving Sunitinib or other anti-angiogenetic substances, assuming that Bemcentinib may cause similar oral side effects. We present a male 81-year-old patient with a manifestation of alveolar bone necrosis at the central upper incisors following a 2-month regimen with the AXL-inhibitor Bemcentinib, administered for the treatment of secondary acute myeloblastic leukemia (sAML). Due to the duration of less than 8 weeks, the osteonecrosis was diagnosed as necrotizing periodontitis, but the intraoral clinical and radiographic findings were also compatible with the differential diagnosis of medication-related osteonecrosis of the jaw (MRONJ, stage II). Following to discontinuation of Bemcentinib, the affected bone was surgically revised including the removal of a demarcated bone sequester under preventive antibiotic treatment (metronidazole 400 mg t.i.d.). We hypothesize that Bemcentinib might increase the susceptibility for osteonecrosis of the jaw, probably related to its antiangiogenic effects and the resulting modulation of host immune response. Based on the current observations, it can be assumed that oro-dental health might be significant also prior and during treatment with Bemcentinib for the prevention of MRONJ.
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Affiliation(s)
- Caspar V Bumm
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU, Goethestraße 70, 80336, Munich, Germany
| | - Matthias Folwaczny
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU, Goethestraße 70, 80336, Munich, Germany
| | - Uta C Wölfle
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU, Goethestraße 70, 80336, Munich, Germany.
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Kato T, Fujiwara N, Kuraji R, Numabe Y. Relationship between periodontal parameters and non-vital pulp in dental clinic patients: a cross-sectional study. BMC Oral Health 2020; 20:109. [PMID: 32295592 PMCID: PMC7161001 DOI: 10.1186/s12903-020-01103-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 04/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Endodontic diseases, such as apical periodontitis, communicate with periodontitis and mutually exacerbate them. However, it remains unclear whether pulp condition is a risk factor for periodontal disease. The purpose of this retrospective study was to examine relations between pulp condition and periodontal parameters in Japanese patients who visited a general dental clinic. METHODS Patients who visited a Japanese general dental clinic from 2016 to 2018 and aged 18 to 81 years were analyzed. Periodontal parameters, tooth condition, and general status of all teeth excluding third molars at the initial visit to the clinic were abstracted. A total of 7105 teeth were analyzed in this study by multiple classification analysis and the Mann-Whitney U test. We also performed a sub-analysis of non-vital teeth, which evaluated the presence or absence of unfavorable root canal obturation and apical periodontitis diagnosed by X-ray. RESULTS Significant relations between periodontal parameters and non-vital pulp were observed by multiple logistic regression analyses (odds ratio = 1.48; 95% CI = 1.03-2.14) and multiple linear regression analysis (p < 0.001). Significant relations between unfavorable root canal obturation tooth with periodontal pocket depth (p = 0.00837) and BOP (p = 0.0145) were also observed by the Mann-Whitney U test. CONCLUSIONS We demonstrated potential relations between periodontal disease and non-vital pulp.
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Affiliation(s)
- Tomotaka Kato
- Department of Oral Health Sciences, School of Dentistry, University of Washington, 8901 Meridian Ave. N, Seattle, WA USA
- Division of General Dentistry, Nippon Dental University Hospital, Tokyo, Japan
| | | | - Ryutaro Kuraji
- Department of Life Science Dentistry, The Nippon Dental University, Tokyo, Japan
- Department of Periodontology, The Nippon Dental University School of Life Dentistry at Tokyo, Tokyo, Japan
| | - Yukihiro Numabe
- Department of Periodontology, The Nippon Dental University School of Life Dentistry at Tokyo, Tokyo, Japan
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Fonseca RRS, Carvalho CA, Rodrigues TMS, Cavaleiro RMS, Menezes SAF, Machado LFA. Severe Necrotizing Periodontitis in an HIV-Infected Patient: Case Report and Non-Surgical Treatment. Clin Adv Periodontics 2020; 11:59-63. [PMID: 32277739 DOI: 10.1002/cap.10105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 03/27/2020] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Necrotizing periodontitis (NP) is an atypical and painful form of periodontal disease, it is described by a promptly progress of ulceration and destruction of periodontal tissues; the NP is commonly linked to HIV-positive patients. The aim of this report is to present a rare case of severe necrotizing ulcerative periodontitis treated non-surgically. CASE PRESENTATION A 28-year-old dark skin female patient was referred to a dentistry college with the main complaint of spontaneous gingival bleeding and enlargement, oral pain during deglutition and dental hypersensitivity. Clinical and radiographic examination revealed generalized severe periodontal destruction, extensive bleeding, increased biofilm presence and spontaneous suppuration. Medical exams were requested, red and white blood cells were evaluated and among those exams an enzyme-linked immunosorbent assay for HIV-1 antibodies, the result reveled reagent to HIV-1. The diagnosis of NP was assigned based on periodontal parameters such as necrosis and ulceration of the coronal portion of interdental papillae and gingival margin. Treatment established was scaling and root planning plus antibiotics. At 3 months of treatment the clinical and periodontal condition were stable. CONCLUSION This case report highlights a severe and generalized form of NP, where periodontal non-surgical associated with antimicrobials resulted in elimination of the gingival enlargement, necrosis and ulceration of the coronal portion of interdental papillae and significant improvement of periodontal parameters.
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Affiliation(s)
- Ricardo R S Fonseca
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará, Belém, PA, Brazil
| | - Carlos A Carvalho
- Department of Periodontology, University Center of State of Pará, Belém, PA, Brazil
| | - Tânia M S Rodrigues
- Department of Periodontology, University Center of State of Pará, Belém, PA, Brazil
| | - Rosely M S Cavaleiro
- Department of Special Needs Care, University Center of State of Pará, Belém, PA, Brazil
| | - Silvio A F Menezes
- Department of Periodontology, University Center of State of Pará, Belém, PA, Brazil
| | - Luiz F A Machado
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará, Belém, PA, Brazil
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Gou H, Fan R, Chen X, Li L, Wang X, Xu Y, Svensson P, Wang K. Adjunctive effects of laser therapy on somatosensory function and vasomotor regulation of periodontal tissues in patients with periodontitis: A randomized controlled clinical trial. J Periodontol 2020; 91:1307-1317. [PMID: 32146720 DOI: 10.1002/jper.19-0562] [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: 10/02/2019] [Revised: 01/12/2020] [Accepted: 01/30/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The purpose of this prospective study was to compare the changes in periodontal somatosensory function and microcirculation in patients with periodontitis following initial treatment with scaling and root planing (SRP) with or without adjuvant laser therapy. METHODS Twenty-four patients suffering from periodontitis were recruited and randomly allocated into a split-mouth design to either SRP combined laser therapy side (test side) or SRP only side (control side). All treatments were performed by the same investigator at a single visit. Laser Doppler Flowmetry (LDF) and Quantitative Sensory Testing (QST) were performed at baseline (W0), 1 week (1W), 2 weeks (2W), and 4 weeks (4W) after treatment on both sides of the attached gingiva of the maxillary lateral incisor. Clinical examination including probing depth (PD) and bleeding on probing (BOP) was performed at W0, 2W, and 4W on both sides. Data were analyzed with two-way analysis of variance. RESULTS PD and BOP significantly improved after treatment (P <0.001). LDF values were significantly decreased on both sides at all follow-up time points (P <0.001), temperature was increased only on the test side (P = 0.017) whereas there was no significant change on the control side (P = 0.792). Significantly less sensitivity was observed for all QST parameters (P <0.030) except for warmth detection after treatment. CONCLUSION Adjunctive use of laser therapy did not provide any significant clinical advantage or additional effects on the recovery of periodontal somatosensory function or gingival microcirculation in the present study.
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Affiliation(s)
- Huiqing Gou
- Jiangsu Key Laboratory of Oral Disease, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Ruyi Fan
- Jiangsu Key Laboratory of Oral Disease, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Xu Chen
- Jiangsu Key Laboratory of Oral Disease, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China.,Department of Periodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Lu Li
- Jiangsu Key Laboratory of Oral Disease, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China.,Department of Periodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Xiaoqian Wang
- Jiangsu Key Laboratory of Oral Disease, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China.,Department of Periodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Yan Xu
- Jiangsu Key Laboratory of Oral Disease, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China.,Department of Periodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Peter Svensson
- Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.,Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmø University, Malmø, Sweden.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
| | - Kelun Wang
- Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.,Center for Sensory-Motor Interaction (SMI), Department of Health Science & Technology, Aalborg University, Aalborg, Denmark
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Papapanou PN, Sanz M, Buduneli N, Dietrich T, Feres M, Fine DH, Flemmig TF, Garcia R, Giannobile WV, Graziani F, Greenwell H, Herrera D, Kao RT, Kebschull M, Kinane DF, Kirkwood KL, Kocher T, Kornman KS, Kumar PS, Loos BG, Machtei E, Meng H, Mombelli A, Needleman I, Offenbacher S, Seymour GJ, Teles R, Tonetti MS. Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Clin Periodontol 2019; 45 Suppl 20:S162-S170. [PMID: 29926490 DOI: 10.1111/jcpe.12946] [Citation(s) in RCA: 623] [Impact Index Per Article: 124.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 03/12/2018] [Accepted: 03/13/2018] [Indexed: 12/21/2022]
Abstract
A new periodontitis classification scheme has been adopted, in which forms of the disease previously recognized as "chronic" or "aggressive" are now grouped under a single category ("periodontitis") and are further characterized based on a multi-dimensional staging and grading system. Staging is largely dependent upon the severity of disease at presentation as well as on the complexity of disease management, while grading provides supplemental information about biological features of the disease including a history-based analysis of the rate of periodontitis progression; assessment of the risk for further progression; analysis of possible poor outcomes of treatment; and assessment of the risk that the disease or its treatment may negatively affect the general health of the patient. Necrotizing periodontal diseases, whose characteristic clinical phenotype includes typical features (papilla necrosis, bleeding, and pain) and are associated with host immune response impairments, remain a distinct periodontitis category. Endodontic-periodontal lesions, defined by a pathological communication between the pulpal and periodontal tissues at a given tooth, occur in either an acute or a chronic form, and are classified according to signs and symptoms that have direct impact on their prognosis and treatment. Periodontal abscesses are defined as acute lesions characterized by localized accumulation of pus within the gingival wall of the periodontal pocket/sulcus, rapid tissue destruction and are associated with risk for systemic dissemination.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Moritz Kebschull
- Columbia University, New York, NY, USA.,Bonn University, Bonn, Germany
| | | | | | | | | | | | - Bruno G Loos
- Academic Center for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eli Machtei
- Rambam Health Care Campus & Israel Institute of Technology, Haifa, Israel
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Cortellini P, Cortellini S, Tonetti MS. Papilla preservation flaps for periodontal regeneration of molars severely compromised by combined furcation and intrabony defects: Retrospective analysis of a registry‐based cohort. J Periodontol 2019; 91:165-173. [DOI: 10.1002/jper.19-0010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 06/26/2019] [Accepted: 07/09/2019] [Indexed: 02/06/2023]
Affiliation(s)
| | - Simone Cortellini
- Department of Oral Health SciencesSection of PeriodontologyKU Leuven Leuven Belgium
| | - Maurizio S. Tonetti
- European Research Group on Periodontology Genoa Italy
- Department of PeriodontologyHong Kong University Hong Kong SAR China
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43
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Tonetti MS, Sanz M. Implementation of the new classification of periodontal diseases: Decision‐making algorithms for clinical practice and education. J Clin Periodontol 2019; 46:398-405. [DOI: 10.1111/jcpe.13104] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 03/11/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Maurizio S. Tonetti
- Periodontology, Faculty of Dentistry Hong Kong University Hong Kong Hong Kong SAR China
- European Research Group on Periodontology Genova Italy
| | - Mariano Sanz
- European Research Group on Periodontology Genova Italy
- ETEP Research Group, Faculty of Odontology University Complutense of Madrid Madrid Spain
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44
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Rare Diseases with Periodontal Manifestations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050867. [PMID: 30857312 PMCID: PMC6427617 DOI: 10.3390/ijerph16050867] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 12/13/2022]
Abstract
Background: The object of this paper was to provide an overview of rare diseases (RDs) with periodontal manifestations and allocate them to relevant categories. Methods: In ROMSE, a database for “Rare Diseases with Orofacial Involvement”, all 541 entities were analyzed with respect to manifestations of periodontal relevance. Inclusion criteria were periodontally relevant changes to the oral cavity, in accordance with the 2018 version of the Classification of Periodontal and Peri-Implant Diseases and Conditions. Rare diseases were recorded, using the methodology described, and subsequently compared with the Orphanet Classification of Rare Diseases. Results: A total of 76 RDs with periodontal involvement were recorded and allocated in accordance with the Classification of Periodontal and Peri-Implant Diseases and Conditions. Of the 541 RDs analyzed as having known orofacial manifestations, almost 14 percent indicated a periodontally compromised dentition. Conclusions: Around 14 percent of RDs with an orofacial involvement showed periodontally relevant manifestations, which present not only as a result of gingivitis and periodontitis, but also gingival hyperplasia in connection with an underlying disease. Thus, dentists play an important role in therapy and early diagnoses of underlying diseases based on periodontally relevant manifestations.
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Abstract
Dental emergencies present frequently to the emergency department and urgent care centers. Trauma to the teeth includes fractures, luxations, and avulsions, which can be reduced in most cases. Avulsed primary teeth should never be replaced. Mouthguards should be worn in most youth sports to prevent many dental injuries. Dental caries can progress to worsening infection and should be diagnosed and promptly referred. More severe infections may require antibiotics, imaging, or incision and drainage. Dental blocks can assist with analgesia and patient comfort during other procedures.
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Affiliation(s)
- Jean M Hammel
- Department of Emergency Medicine, Norwalk Hospital, 34 Maple Street, Norwalk, CT 06850, USA.
| | - Jason Fischel
- Department of Emergency Medicine, Norwalk Hospital, 34 Maple Street, Norwalk, CT 06850, USA
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46
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STEFFENS JP, MARCANTONIO RAC. Classificação das Doenças e Condições Periodontais e Peri-implantares 2018: guia Prático e Pontos-Chave. REVISTA DE ODONTOLOGIA DA UNESP 2018. [DOI: 10.1590/1807-2577.04704] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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47
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Caton JG, Armitage G, Berglundh T, Chapple IL, Jepsen S, Kornman KS, Mealey BL, Papapanou PN, Sanz M, Tonetti MS. A new classification scheme for periodontal and peri-implant diseases and conditions - Introduction and key changes from the 1999 classification. J Clin Periodontol 2018; 45 Suppl 20:S1-S8. [DOI: 10.1111/jcpe.12935] [Citation(s) in RCA: 397] [Impact Index Per Article: 66.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 03/19/2018] [Accepted: 03/19/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Jack G. Caton
- Periodontics; Eastman Institute for Oral Health; University of Rochester; Rochester NY USA
| | - Gary Armitage
- School of Dentistry; University of California San Francisco; San Francisco CA USA
| | - Tord Berglundh
- Department of Periodontology; Institute of Odontology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Iain L.C. Chapple
- Periodontal Research Group; Institute of Clinical Sciences; College of Medical & Dental Sciences; University of Birmingham; Birmingham UK
| | - Søren Jepsen
- Department of Periodontology; Operative and Preventive Dentistry; University of Bonn; Bonn Germany
| | | | - Brian L. Mealey
- University of Texas Health Science Center; San Antonio TX USA
| | | | - Mariano Sanz
- Facultad de Odontologia; Universidad Complutense Madrid; Madrid Spain
| | - Maurizio S. Tonetti
- Periodontology; Faculty of Dentistry; University of Hong Kong; Hong Kong SAR China
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48
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Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. J Clin Periodontol 2018; 45 Suppl 20:S149-S161. [DOI: 10.1111/jcpe.12945] [Citation(s) in RCA: 460] [Impact Index Per Article: 76.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 02/11/2018] [Accepted: 02/11/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Maurizio S. Tonetti
- Periodontology; Faculty of Dentistry; University of Hong Kong; Hong Kong SAR China
| | - Henry Greenwell
- Graduate Periodontics; School of Dentistry; University of Louisville; Louisville KY, USA
| | - Kenneth S. Kornman
- Department of Periodontics and Oral Medicine; University of Michigan School of Dentistry; Ann Arbor MI, USA
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