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Mehta J, Montevecchi M, Garcia-Sanchez R, Onabolu O, Liñares A, Eriksson F, Ghezzi C, Donghi C, Lu EMC, Nibali L. Minimally invasive non-surgical periodontal therapy of intrabony defects: A prospective multi-centre cohort study. J Clin Periodontol 2024; 51:905-914. [PMID: 38710583 DOI: 10.1111/jcpe.13984] [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: 11/23/2023] [Revised: 03/10/2024] [Accepted: 03/14/2024] [Indexed: 05/08/2024]
Abstract
AIM To assess the potential benefits of minimally invasive non-surgical therapy (MINST) in teeth with intrabony defects and to explore factors associated with the outcomes. MATERIALS AND METHODS A multi-centre trial was conducted in 100 intrabony defects in periodontitis patients in private practice. Steps 1 and 2 periodontal therapy including MINST were provided. Clinical and radiographic data were analysed at baseline and 12 months after treatment, with the primary aim being change in radiographic defect depth at 12 months. RESULTS Eighty-four patients completed the 12-month follow up. The mean total radiographic defect depth reduced by 1.42 mm and the defect angle increased by 3° (both p < .05). Statistically significant improvements in probing pocket depth (PPD) and clinical attachment level (CAL) were seen at 12 months compared to baseline (p < .001). Fifty-six defects (66.7%) achieved pocket closure (PPD ≤ 4 mm) and 49 defects (58.3%) achieved the composite outcome (PPD ≤ 4 mm and CAL gain ≥3 mm). Deeper and narrower angled defects were positively correlated with radiographic and clinical improvements, respectively. CONCLUSIONS Improvements in clinical and radiographic outcomes were seen after MINST. This study highlights the generalizability and wide applicability of this approach, further supporting its effectiveness in the treatment of intrabony defects. CLINICAL TRIAL REGISTRATION NCT03741374. https://clinicaltrials.gov/study/NCT03741374?cond=minimally%20invasive%20non%20surgical%20therapy&locStr=UK&country=United%20Kingdom&distance=50&rank=2.
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Affiliation(s)
- Jaimini Mehta
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Marco Montevecchi
- Division of Periodontology and Implantology, Department of Biomedical and Neuromotor Sciences, School of Dentistry and Dental Hygiene, University of Bologna, Bologna, Italy
| | - Ruben Garcia-Sanchez
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Olanrewaju Onabolu
- Private Practice, Claremont Dental Practice, Twickenham & Ten Dental Clapham, London, UK
| | - Antonio Liñares
- Unit of Periodontology, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Carlo Ghezzi
- Private practice, "StudioCarloGhezzi", Milan, Italy
| | | | - Emily Ming-Chieh Lu
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Luigi Nibali
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
- 'Ravenscourt Dental Practice' & 'The Dentist', London, UK
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2
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Aimetti M, Stasikelyte M, Mariani GM, Cricenti L, Baima G, Romano F. The flapless approach with and without enamel matrix derivatives for the treatment of intrabony defects: A randomized controlled clinical trial. J Clin Periodontol 2024. [PMID: 38859627 DOI: 10.1111/jcpe.14028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/23/2024] [Accepted: 05/27/2024] [Indexed: 06/12/2024]
Abstract
AIM To compare the clinical and radiographic outcomes of flapless procedure alone or in combination with enamel matrix derivatives (EMD) in the treatment of deep intrabony defects. MATERIALS AND METHODS Forty-six patients re-evaluated after non-surgical therapy were randomly assigned to the test (flapless with EMD) or control group (flapless alone). Clinical measurements were recorded pre-surgery and at 6 and 12 months after surgery, and radiographic measurements were taken pre-surgery and after 12 months. RESULTS Forty-six patients completed the study. Improvements were observed in both groups at 12 months for mean clinical attachment level (CAL) gain, with significant differences between test (3.9 ± 1.1 mm) and control groups (3.0 ± 1.2) (p = .017). Probing pocket depth (PPD) reduction (4.0 ± 0.7 vs. 3.3 ± 1.4 mm) was also near to statistical significance (p = .051). Also, more sites achieved successful composite outcome measure (final PPD ≤ 4 mm and CAL gain ≥3 mm) for the regenerative treatment in the flapless + EMD group (82.6% vs. 52.2%; p = .028). In terms of radiographic outcomes, EMD yielded a greater defect bone fill than flapless treatment alone (3.0 ± 1.0 mm vs. 1.8 ± 1.5 mm; p < .001). CONCLUSIONS The additional application of EMD during the flapless procedure for intrabony defects slightly improved clinical and radiographic outcomes. CLINICALTRIALS gov identification number: NCT05456555.
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Affiliation(s)
- Mario Aimetti
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Morta Stasikelyte
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Giulia Maria Mariani
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Luca Cricenti
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Giacomo Baima
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Federica Romano
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
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3
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Kučič AC, Gašperšič R. Minimally invasive non-surgical therapy (MINST) in stage III periodontitis patients: 6-month results of a split-mouth, randomised controlled clinical trial. Clin Oral Investig 2023; 27:2075-2087. [PMID: 37014505 PMCID: PMC10071470 DOI: 10.1007/s00784-023-04994-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/28/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVES To determine if minimally invasive non-surgical therapy (MINST) outperforms classical non-surgical periodontal therapy for stage III periodontitis with primarily suprabony (horizontal) type defects. MATERIALS AND METHODS In a split-mouth randomised controlled trial, 20 patients' dental quadrants were randomly assigned to MINST or classical non-surgical treatment. The primary outcome variable was the number of sites with probing pocket depth ≥ 5 mm and BOP. Treatment method, tooth type, smoking status, and gender were evaluated using a multivariate multilevel logistic regression model. RESULTS After 6 months, the percentage of sites with PD ≥ 5 mm and BOP that healed (MINST = 75.5%; control group = 74.1%; p = 0.98), and the median number of persisting sites (MINST: 6.5, control group: 7.0; p = 0.925) were similar in both groups. In the test and control groups, respectively, median probing pocket depths (2.0 mm vs. 2.1 mm) and clinical attachment level (1.7 mm vs. 2.0 mm) changed significantly (p < 0.05) but similarly. Significantly less gingival recession occurred in the MINST group's deep molar pockets compared to the control group (p = 0.037). Men (OR = 0.52, p = 0.014) and non-molars (OR = 3.84, p 0.001) had altered odds for healing of sites with PD ≥ 5 mm and BOP. CONCLUSIONS MINST reduces gingival recession associated with molar teeth, although it performs similarly to traditional non-surgical therapy in treating stage III periodontitis with predominately horizontal-type defects. CLINICAL RELEVANCE MINST performs similarly to non-surgical periodontal therapy in stage III periodontitis with predominantly suprabony defects. TRIAL REGISTRATION Clinicaltrials.gov (NCT04036513) on June 29, 2019.
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Affiliation(s)
- Alja Cmok Kučič
- Public Health Centre Celje, Gregorčičeva 5, 3000, Celje, Slovenia
| | - Rok Gašperšič
- Department of Oral Medicine and Periodontology, Faculty of Medicine, University of Ljubljana, Hrvatski Trg 6, 1000, Ljubljana, Slovenia.
- Department of Oral Medicine and Periodontology, Dental Clinic, University Clinical Centre, Hrvatski Trg 6, 1000, LjubljanaLjubljana, Slovenia.
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4
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Ribeiro FV, Mehta JJ, Monteiro MF, Moore J, Casati MZ, Nibali L. Minimal invasiveness in nonsurgical periodontal therapy. Periodontol 2000 2023; 91:7-19. [PMID: 36661203 DOI: 10.1111/prd.12476] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/23/2022] [Accepted: 05/26/2022] [Indexed: 01/21/2023]
Abstract
Periodontal treatment is quickly moving towards a philosophy consisting of a less invasive approach. In this context, minimally invasive nonsurgical therapy (MINST) is a promising option. This paper reviews the concepts behind minimal invasiveness in nonsurgical periodontology and reports the state-of the art evidence for this topic. Instruments used and protocols suggested for these applications are introduced and discussed. The original papers reviewed show probing pocket depth (PPD) reductions and clinical attachment level (CAL) gains ranging from 2 to 4 mm between baseline and 6 months to 5 years posttreatment for intrabony defects and from 1.5 to 3 mm between baseline and 2-6 months of follow-up for full-mouth results. These clinical outcomes are accompanied by statistically significant reductions in radiographic bone defect depth and increases in intrabony defect angles posttreatment. Wound healing mechanisms following MINST are presented, and clinical applications and directions for future research are suggested.
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Affiliation(s)
- Fernanda V Ribeiro
- Dental Research Division, School of Dentistry, Paulista University, São Paulo, Brazil
| | - Jaimini J Mehta
- Periodontology Unit, Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Mabelle F Monteiro
- Dental Research Division, School of Dentistry, Paulista University, São Paulo, Brazil.,Periodontics Division, Department of Prosthodontics and Periodontics, Piracicaba Dental School, University of Campinas, São Paulo, Brazil
| | - Jatinder Moore
- Periodontology Unit, Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Marcio Z Casati
- Dental Research Division, School of Dentistry, Paulista University, São Paulo, Brazil.,Periodontics Division, Department of Prosthodontics and Periodontics, Piracicaba Dental School, University of Campinas, São Paulo, Brazil
| | - Luigi Nibali
- Periodontology Unit, Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
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5
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Anoixiadou S, Parashis A, Vouros I. Enamel matrix derivative as an adjunct to minimally invasive non-surgical treatment of intrabony defects: A randomized clinical trial. J Clin Periodontol 2021; 49:134-143. [PMID: 34708441 DOI: 10.1111/jcpe.13567] [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: 09/01/2021] [Revised: 10/10/2021] [Accepted: 10/12/2021] [Indexed: 12/18/2022]
Abstract
AIM To compare the efficacy of minimally invasive non-surgical technique (MINST) with or without enamel matrix derivative (EMD) in the treatment of intrabony defects ≤7 mm. MATERIALS AND METHODS Thirty-six patients were randomly assigned to the two groups. The control group received MINST, while the experimental MINST+EMD. Clinical measurements were recorded at baseline and at 6 and 12 months, and radiographic measurements were made at baseline and 12 months. RESULTS All subjects completed the study, 18 in each group. Significant improvements were observed in both groups at 12 months (p < .001) with no differences in mean PD reduction (4.0 ± 1.4 vs. 4.2 ± 1.7 mm), CAL gain (3.5 ± 1.4 vs. 3.4 ± 1.6 mm), and defect resolution (1.9 ± 1.1 vs. 1.8 ± 0.9 mm) for the MINST and the MINST+EMD groups, respectively (p > .05). A trend for greater pocket closure (PD ≤4 mm and no BoP) was achieved with the application of EMD (77.8% vs. 55.6% sites), particularly for sites with baseline PD ≤8 mm (92.3% vs. 69.2% sites), accompanied by an increased number of successful composite outcome results (61.1% vs. 44.4% sites). CONCLUSIONS MINST demonstrates significant improvements 12 months after treatment of intrabony defects ≤7 mm. The additional application of EMD does not further improve the mean clinical or radiographic outcomes. This study is registered in ClinicalTrials.gov (NCT03622255).
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Affiliation(s)
- Styliani Anoixiadou
- Department of Preventive Dentistry Periodontology and Implant Biology, Faculty of Dentistry, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Parashis
- Department of Preventive Dentistry Periodontology and Implant Biology, Faculty of Dentistry, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Private Practice, Athens, Greece
| | - Ioannis Vouros
- Department of Preventive Dentistry Periodontology and Implant Biology, Faculty of Dentistry, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Ng E, Tay JRH, Ong MMA. Minimally Invasive Periodontology: A Treatment Philosophy and Suggested Approach. Int J Dent 2021; 2021:2810264. [PMID: 34257659 PMCID: PMC8245214 DOI: 10.1155/2021/2810264] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 01/20/2023] Open
Abstract
Severe periodontitis is a highly prevalent dental disease. With the advent of implant dentistry, teeth are often extracted and replaced. Periodontal surgery, where indicated, could also result in increased trauma to the patient. This literature review discusses different treatment modalities for periodontitis and proposes a treatment approach emphasizing maximum preservation of teeth while minimizing morbidity to the patient. Scientific articles were retrieved from the MEDLINE/PubMed database up to January 2021 to identify appropriate articles that addressed the objectives of this review. This was supplemented with hand searching using reference lists from relevant articles. As tooth prognostication does not have a high predictive value, a more conservative approach in extracting teeth should be abided by. This may involve repeated rounds of nonsurgical periodontal therapy, and adjuncts such as locally delivered statin gels and subantimicrobial-dose doxycycline appear to be effective. Periodontal surgery should not be carried out at an early phase in therapy as improvements in nonsurgical therapy may be observed up to 12 months from initial treatment. Periodontal surgery, where indicated, should also be minimally invasive, with periodontal regeneration being shown to be effective over 20 years of follow-up. Biomarkers provide an opportunity for early detection of disease activity and personalised treatment. Quality of life is proposed as an alternative end point to the traditional biomedical paradigm focused on the disease state and clinical outcomes. In summary, minimally invasive therapy aims to preserve health and function of the natural dentition, thus improving the quality of life for patients with periodontitis.
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Affiliation(s)
- Ethan Ng
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore 168938, Singapore
| | - John Rong Hao Tay
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore 168938, Singapore
| | - Marianne Meng Ann Ong
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore 168938, Singapore
- Oral Health Academic Clinical Programme, Duke-NUS Medical School, Singapore 169857, Singapore
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7
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Pei X. New surgery approaches preserving entire papilla to treat isolated interdental intrabony defects: A narrative review. Clin Exp Dent Res 2021; 7:719-725. [PMID: 33594801 PMCID: PMC8543449 DOI: 10.1002/cre2.410] [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: 11/10/2020] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To review novel techniques of preserving the entire papilla to minimize the trauma of fragile papilla in periodontal regeneration surgeries. MATERIAL AND METHODS Electronic databases (Pubmed) and relevant journals were searched until September 4, 2020. Randomized controlled trials, cross-sectional and cohort studies in English were included. Three novel approaches of preserving the entire papilla were applied to bone regeneration for intrabony defects, which were entire papilla preservations (EPP), nonincised papillae surgical approach (NIPSA) and modified vestibular incision subperiosteal tunnel access (M-VISTA). RESULTS Randomized control trials of the novel preserving entire papilla techniques were rarely reported. There were only case series or cohort studies. Several papilla preservation techniques (PPT) or minimally invasiveness surgical techniques (MIST) have existed for a long time. However, these techniques still have dissection at the papilla. There were no related RCTs comparing the three novel approaches of keeping the entire papilla with PPT and MIST. All three techniques showed totally primary wound closure. Compared with PPT/MIST, EPP and NIPSA seemed to have better clinical outcomes in reducing probing depth (PD) and clinical attachment level (CAL) gain. CONCLUSIONS EPP and NIPSA seemed to have advanced results of PD reduction and CAL gain than PPT and MIST. This is needed to be confirmed by further research.
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Affiliation(s)
- Xiyan Pei
- First Clinic Division, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
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8
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Nibali L. Guest Editorial: Time to reflect on new evidence about periodontal regenerative surgery of intrabony defects. J Clin Periodontol 2021; 48:557-559. [PMID: 33512724 DOI: 10.1111/jcpe.13434] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 11/30/2022]
Abstract
This editorial provides a summary of new evidence derived from four recent systematic reviews on regenerative/reconstructive periodontal surgery recently published in the Journal of Clinical Periodontology. We hereby discuss how the results of these papers combined can be useful for the clinical periodontist, in the light of the recent European Federation of Periodontology (EFP) guidelines, and for researcher involved in this field of investigation.
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Affiliation(s)
- Luigi Nibali
- Periodontology Unit, Centre for Host-Microbiome Interactions, Dental Institute, King's College London, London, UK
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9
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Sanz‐Sánchez I, Montero E, Citterio F, Romano F, Molina A, Aimetti M. Efficacy of access flap procedures compared to subgingival debridement in the treatment of periodontitis. A systematic review and meta‐analysis. J Clin Periodontol 2020; 47 Suppl 22:282-302. [DOI: 10.1111/jcpe.13259] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 01/09/2020] [Accepted: 01/13/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Ignacio Sanz‐Sánchez
- Etiology and Therapy of Periodontal Diseases (ETEP) Research Group University Complutense Madrid Spain
| | - Eduardo Montero
- Etiology and Therapy of Periodontal Diseases (ETEP) Research Group University Complutense Madrid Spain
| | - Filippo Citterio
- Department of Surgical Sciences, C.I.R. Dental School University of Turin Turin Italy
| | - Federica Romano
- Department of Surgical Sciences, C.I.R. Dental School University of Turin Turin Italy
| | - Ana Molina
- Etiology and Therapy of Periodontal Diseases (ETEP) Research Group University Complutense Madrid Spain
| | - Mario Aimetti
- Department of Surgical Sciences, C.I.R. Dental School University of Turin Turin Italy
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Nibali L, Koidou VP, Nieri M, Barbato L, Pagliaro U, Cairo F. Regenerative surgery versus access flap for the treatment of intra‐bony periodontal defects: A systematic review and meta‐analysis. J Clin Periodontol 2020; 47 Suppl 22:320-351. [DOI: 10.1111/jcpe.13237] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 12/12/2019] [Accepted: 12/14/2019] [Indexed: 01/05/2023]
Affiliation(s)
- Luigi Nibali
- Periodontology Unit Faculty of Dentistry, Oral & Craniofacial Sciences Centre for Host‐Microbiome Interactions King's College London London UK
| | - Vasiliki P. Koidou
- Centre for Oral Immunobiology and Regenerative Medicine and Centre for Oral Clinical Research Institute of Dentistry Queen Mary University London (QMUL) London UK
| | - Michele Nieri
- Research Unit in Periodontology and Periodontal Medicine Department of Clinical and Experimental Medicine University of Florence Florence Italy
| | - Luigi Barbato
- Research Unit in Periodontology and Periodontal Medicine Department of Clinical and Experimental Medicine University of Florence Florence Italy
| | - Umberto Pagliaro
- Research Unit in Periodontology and Periodontal Medicine Department of Clinical and Experimental Medicine University of Florence Florence Italy
| | - Francesco Cairo
- Research Unit in Periodontology and Periodontal Medicine Department of Clinical and Experimental Medicine University of Florence Florence Italy
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Barbato L, Selvaggi F, Kalemaj Z, Buti J, Bendinelli E, Marca ML, Cairo F. Clinical efficacy of minimally invasive surgical (MIS) and non-surgical (MINST) treatments of periodontal intra-bony defect. A systematic review and network meta-analysis of RCT’s. Clin Oral Investig 2020; 24:1125-1135. [DOI: 10.1007/s00784-020-03229-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/09/2020] [Indexed: 01/23/2023]
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12
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Ghuman MS. Non-Surgical Periodontal Therapy - Evidence and Opinion. Prim Dent J 2020; 8:28-33. [PMID: 32127091 DOI: 10.1308/205016820828463825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Effective non-surgical periodontal therapy is fundamental to achieve and maintain periodontal health, particularly in individuals who are susceptible to periodontitis. This article aims to highlight current evidence and published guidance, together with personal insights and suggestions from the author's clinical experience to help with management of patients utilising this common treatment modality.
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13
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Guided tissue regeneration combined with bone allograft in infrabony defects: Clinical outcomes and assessment of prognostic factors. J Periodontol 2019; 91:746-755. [DOI: 10.1002/jper.19-0336] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/05/2019] [Accepted: 08/11/2019] [Indexed: 02/02/2023]
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14
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Nibali L, Koidou V, Salomone S, Hamborg T, Allaker R, Ezra R, Zou L, Tsakos G, Gkranias N, Donos N. Minimally invasive non-surgical vs. surgical approach for periodontal intrabony defects: a randomised controlled trial. Trials 2019; 20:461. [PMID: 31351492 PMCID: PMC6660941 DOI: 10.1186/s13063-019-3544-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 06/29/2019] [Indexed: 12/03/2022] Open
Abstract
Background Periodontal intrabony defects are usually treated surgically with the aim of increasing attachment and bone levels and reducing risk of progression. However, recent studies have suggested that a minimally invasive non-surgical therapy (MINST) leads to considerable clinical and radiographic defect depth reductions in intrabony defects. The aim of this study is to compare the efficacy of a modified MINST approach with a surgical approach (modified minimally invasive surgical therapy, M-MIST) for the treatment of intrabony defects. Methods This is a parallel-group, single-centre, examiner-blind non-inferiority randomised controlled trial with a sample size of 66 patients. Inclusion criteria are age 25–70, diagnosis of periodontitis stage III or IV (grades A to C), presence of ≥ 1 ‘intrabony defect’ with probing pocket depth (PPD) > 5 mm and intrabony defect depth ≥ 3 mm. Smokers and patients who received previous periodontal treatment to the study site within the last 12 months will be excluded. Patients will be randomly assigned to either the modified MINST or the M-MIST protocol and will be assessed up to 15 months following initial therapy. The primary outcome of the study is radiographic intrabony defect depth change at 15 months follow-up. Secondary outcomes are PPD and clinical attachment level change, inflammatory markers and growth factors in gingival crevicular fluid, bacterial detection, gingival inflammation and healing (as measured by geometric thermal camera imaging in a subset of 10 test and 10 control patients) and patient-reported outcomes. Discussion This study will produce evidence about the clinical efficacy and potential applicability of a modified MINST protocol for the treatment of periodontal intrabony defects, as a less invasive alternative to the use of surgical procedures. Trial registration ClinicalTrials.gov, NCT03797807. Registered on 9 January 2019.
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Affiliation(s)
- L Nibali
- Centre for Oral Immunobiology and Regenerative Medicine, Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London (QMUL), London, UK. .,Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.
| | - V Koidou
- Centre for Oral Immunobiology and Regenerative Medicine, Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London (QMUL), London, UK
| | - S Salomone
- Centre for Oral Immunobiology and Regenerative Medicine, Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London (QMUL), London, UK
| | - T Hamborg
- Pragmatic Clinical Trials Unit, Centre for Primary Care and Public Health, Queen Mary University of London (QMUL), London, UK
| | - R Allaker
- Centre for Oral Immunobiology and Regenerative Medicine, Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London (QMUL), London, UK
| | - R Ezra
- Centre for Oral Immunobiology and Regenerative Medicine, Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London (QMUL), London, UK
| | - L Zou
- Centre for Oral Immunobiology and Regenerative Medicine, Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London (QMUL), London, UK
| | - G Tsakos
- Department of Epidemiology and Public Health, University College London (UCL), London, UK
| | - N Gkranias
- Centre for Oral Immunobiology and Regenerative Medicine, Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London (QMUL), London, UK
| | - N Donos
- Centre for Oral Immunobiology and Regenerative Medicine, Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London (QMUL), London, UK
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Nart J, Pons R, Valles C, Esmatges A, Sanz-Martín I, Monje A. Non-surgical therapeutic outcomes of peri-implantitis: 12-month results. Clin Oral Investig 2019; 24:675-682. [PMID: 31123873 DOI: 10.1007/s00784-019-02943-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/02/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To assess the clinical and radiographic outcomes of implants treated by means of non-surgical debridement with systemic antibiotic therapy. MATERIALS AND METHODS A prospective case series study evaluating the 12-month clinical and radiographic outcomes of peri-implantitis lesions treated with ultrasonic scaler debridement, a glycine air abrasive, and metronidazole followed by supportive maintenance. Clinical and radiographic variables and success criteria were defined a priori. RESULTS Overall, 21 patients were included. One implant failed during the study period (implant survival rate 95.24%). Substantial changes occurred at 12 months in all the clinical and radiographic variables, reaching strong statistical significance in the majority of them. According to the success criteria applied, 40.90% of the peri-implantitis were arrested and resolved, while 59.1% presented with at least one probed site with bleeding on probing (BoP). Moreover, 95.45% exhibited peri-implant pocket depth (PPD) < 5 mm at the end of the study. None of the implants presented with progressive bone loss. CONCLUSION Non-surgical therapy of peri-implantitis is effective to arrest progressive bone loss, reduce PPD and suppuration, and achieve radiographic bone fill in the majority of cases. Nevertheless, it failed to be completely efficacious in the achievement of successful therapeutic outcomes as BoP remained frequently present. CLINICAL RELEVANCE Non-surgical therapy achieved significant clinical and radiological improvements.
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Affiliation(s)
- José Nart
- Department of Periodontology, School of Dentistry, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, 08195, Sant Cugat del Vallès, Barcelona, Spain.
| | - Ramón Pons
- Department of Periodontology, School of Dentistry, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, 08195, Sant Cugat del Vallès, Barcelona, Spain
| | - Cristina Valles
- Department of Periodontology, School of Dentistry, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, 08195, Sant Cugat del Vallès, Barcelona, Spain
| | | | - Ignacio Sanz-Martín
- Department of Periodontology, School of Dentistry, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, 08195, Sant Cugat del Vallès, Barcelona, Spain
| | - Alberto Monje
- Department of Periodontology, School of Dentistry, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, 08195, Sant Cugat del Vallès, Barcelona, Spain
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