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Herz MM, Hoffmann N, Braun S, Lachmann S, Bartha V, Petsos H. Periodontal pockets: Predictors for site-related worsening after non-surgical therapy-A long-term retrospective cohort study. J Clin Periodontol 2024; 51:680-690. [PMID: 38385991 DOI: 10.1111/jcpe.13957] [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: 06/23/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/23/2024]
Abstract
AIM To evaluate site-related changes in periodontal pocket depth (PPD) after non-surgical periodontal therapy and to identify predictors for PPD changes in a retrospective patient data analysis. MATERIALS AND METHODS PPD, clinical attachment level, bleeding on probing, tooth mobility (TM), furcation involvement (FI), abutment status, adherence to supportive periodontal care (SPC) and SPC follow-ups were obtained from fully documented patient data before periodontal therapy (baseline, T0), after active periodontal therapy (APT, T1) and during SPC (T2). PPD changes were classified into deteriorated or unchanged/improved at the site level. Multi-level logistic regression analysis was performed to identify factors influencing PPD changes during SPC. RESULTS This retrospective study included 51 females and 65 males (mean T0 age: 54.8 ± 10.1 years, 25 smokers, 12 diabetics) suffering from Stage III/IV periodontitis. Evaluation outcome: T0/16,044 sampling sites/2674 teeth; T1/15,636/2606; T2/14,754/2459. During 9.0 ± 2.3 years SPC, PPD decreased (-1.33 ± 0.70 mm) by 21.8% of the sites, remained unchanged by 41.4% and increased (1.40 ± 0.78 mm) by 36.8%. Distopalatal FI (p < .001, odds ratio [OR]: 0.252, 95% confidence interval [CI] for OR: 0.118-0.540), residual pockets (p < .001, OR: 0.503, 95% CI: 0.429-0.590) and TM Degrees I-III (Degree I: p = .002, OR: 0.765, 95% CI: 0.646-0.905; Degree II: p = .006, OR: 0.658, 95% CI: 0.489-0.886; Degree III: p = .023, OR: 0.398, 95% CI: 0.180-0.879) correlated significantly with increasing PPD. CONCLUSIONS Over 75% of PPD remained unchanged or increased during SPC. Distopalatal FI, TM Degrees I-III and residual pockets after APT lead to worsening of periodontal pockets.
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Affiliation(s)
- Marco M Herz
- Department for Conservative Dentistry, University Hospital of Tuebingen, Tuebingen, Germany
| | | | | | | | - Valentin Bartha
- Department for Conservative Dentistry, University Hospital of Heidelberg, Heidelberg, Germany
| | - Hari Petsos
- Department of Periodontology, Center of Dentistry and Oral Medicine (Carolinum), Goethe University Frankfurt, Frankfurt am Main, Germany
- Private Practice, Butzbach, Germany
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2
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Silva FFVE, Chauca-Bajaña L, Caponio VCA, Cueva KAS, Velasquez-Ron B, Padín-Iruegas ME, Almeida LL, Lorenzo-Pouso AI, Suárez-Peñaranda JM, Pérez-Sayáns M. Regeneration of periodontal intrabony defects using platelet-rich fibrin (PRF): a systematic review and network meta-analysis. Odontology 2024:10.1007/s10266-024-00949-7. [PMID: 38771493 DOI: 10.1007/s10266-024-00949-7] [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: 02/21/2024] [Accepted: 05/04/2024] [Indexed: 05/22/2024]
Abstract
One of the most promising approaches to correct periodontal bone defects and achieve periodontal regeneration is platelet-rich fibrin (PRF). This systematic review and meta-analysis aimed to evaluate the regeneration of periodontal bone defects using PRF compared to other regenerative treatments. The data search and retrieval process followed the PRISMA guidelines. An electronic search of MEDLINE, Cochrane, and PubMed databases was performed, selecting exclusively randomized clinical trials where the following were measured: probing depth reduction (PD), clinical attachment level gain (CAL), and radiographic bone fill (RBF). Out of 284 selected articles, 32 were chosen based on inclusion criteria. The use of platelet-rich fibrin (PRF) + open flap debridement (OFD), PRF + metformin, PRF + platelet-rich plasma (PRP), and PRF + OFD/bone graft (BG) significantly reduced PD and improved CAL and RBF. However, the combination of PRF + BG, PRF + metformin, and PRF + STATINS reduced CAL. The intervention of PRF combined with different treatments such as metformin, OFD, PRP, BG, and STATINS has a significant impact on improving PD and CAL. The use of PRF significantly improved the regeneration of periodontal bone defects compared to other treatments.
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Affiliation(s)
- Fábio França Vieira E Silva
- Faculty of Medicine and Dentistry, Oral Surgery and Implantology Unit (MedOralRes, Oral Medicine, Universidade de Santiago de Compostela. Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela University Hospital Complex, Rúa da Choupana, S/N, 15706, Santiago de Compostela, A Coruña, Spain
| | - Luis Chauca-Bajaña
- Periodontics and Implantology Oral Research. College Dentistry, Ecuador. Faculty of Medicine and Dentistry, University of Guayaquil, Oral Medicine, Oral Surgery and Implantology Unit, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | | | | | - Byron Velasquez-Ron
- Dental Prosthesis Department Research. College Dentistry, University of the Americas. UDLA. Av, Colon y 6 de Diciembre, Campus Colón, Quito-Ecuador, Ecuador
| | - Maria Elena Padín-Iruegas
- Human Anatomy and Embryology Area, Department of Functional Biology and Health Sciences, Faculty of Physiotherapy, University of Vigo, 36001, Pontevedra, Spain
| | - Lays Lamolha Almeida
- Department of Dental Medicine, Federal Fluminense University, Rio de Janeiro, 28625650, Brazil
| | - Alejandro Ismael Lorenzo-Pouso
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, University of Santiago de Compostela, 15782, Santiago de Compostela, Spain
| | - José Manuel Suárez-Peñaranda
- Faculty of Medicine and Dentistry, Oral Surgery and Implantology Unit (MedOralRes, Oral Medicine, Universidade de Santiago de Compostela. Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela University Hospital Complex, Rúa da Choupana, S/N, 15706, Santiago de Compostela, A Coruña, Spain.
| | - Mario Pérez-Sayáns
- Faculty of Medicine and Dentistry, Oral Surgery and Implantology Unit (MedOralRes, Oral Medicine, Universidade de Santiago de Compostela. Health Research Institute of Santiago de Compostela (IDIS), Instituto de los Materiales de Santiago de Compostela (iMATUS), Avenida Do Mestre Mateo, 25, 15782, Santiago de Compostela, A Coruña, Spain
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Ciardo A, Rampf S, Kim TS. Vital root resection with radicular retrograde partial pulpotomy in furcation-involved maxillary molars in patients with periodontitis: Technique description and case series considering clinical and economic aspects. Int Endod J 2024; 57:617-628. [PMID: 38306111 DOI: 10.1111/iej.14031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/03/2024]
Abstract
AIM Conventional root resection in periodontally compromised furcation-involved maxillary molars requires preceding endodontic treatment and is therefore associated with loss of tooth vitality, higher invasiveness, treatment time and costs, and the risk of endodontic complications. Vital root resection (VRR) could overcome these disadvantages while establishing stable periodontal and endodontic conditions. This case series aimed to introduce the concept of one-stage VRR with radicular retrograde partial pulpotomy (VRRretro). SUMMARY Seven vital maxillary molars with residual probing pocket depths (PPD) ≥ 6 mm and furcation ≥ class 2 of five patients with stage III/IV periodontitis were treated with VRRretro using mineral trioxide aggregate. Teeth with residual through-and-through furcations were additionally tunnelled. Follow-up up to 2.5 years postoperatively during supportive periodontal care included full periodontal status, percussion and thermal sensitivity testing. Periapical radiographs were obtained to rule out possible periradicular radiolucencies. All seven treated molars were in-situ at an average of 26.84 ± 5.37 months postoperatively and were clinically and radiographically inconspicuous independent of tooth position, the resected root, the need for tunnelling and the restorative status. The mean PPD on the seven treated molars was 4.02 ± 0.85 mm (6-10 mm) preoperatively and 2.62 ± 0.42 mm (3-4 mm) at the last follow-up. Clinical attachment level and bleeding on probing could also be decreased. The teeth showed no mobility over time and furcations class 2 were reduced to class 1 while the tunnelled furcations were accessible with interdental brushes. All molars reacted negatively to percussion and positively to thermal sensitivity testing. KEY LEARNING POINTS In carefully selected cases considering patient- and tooth-related factors, VRRretro could be a promising treatment option to establish stable periodontal and endodontic conditions in furcation-involved maxillary molars while preserving tooth vitality.
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Affiliation(s)
- Antonio Ciardo
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg Faculty of Medicine, Heidelberg University, Heidelberg, Germany
| | - Sarah Rampf
- Section of Endodontology and Dental Traumatology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg Faculty of Medicine, Heidelberg University, Heidelberg, Germany
| | - Ti-Sun Kim
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg Faculty of Medicine, Heidelberg University, Heidelberg, Germany
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De Lauretis A, Øvrebø Ø, Romandini M, Lyngstadaas SP, Rossi F, Haugen HJ. From Basic Science to Clinical Practice: A Review of Current Periodontal/Mucogingival Regenerative Biomaterials. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2308848. [PMID: 38380549 PMCID: PMC11077667 DOI: 10.1002/advs.202308848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/23/2024] [Indexed: 02/22/2024]
Abstract
Periodontitis is a dysbiosis-driven inflammatory disease affecting the tooth-supporting tissues, characterized by their progressive resorption, which can ultimately lead to tooth loss. A step-wise therapeutic approach is employed for periodontitis. After an initial behavioral and non-surgical phase, intra-bony or furcation defects may be amenable to regenerative procedures. This review discusses the regenerative technologies employed for periodontal regeneration, highlighting the current limitations and future research areas. The search, performed on the MEDLINE database, has identified the available biomaterials, including biologicals (autologous platelet concentrates, hydrogels), bone grafts (pure or putty), and membranes. Biologicals and bone grafts have been critically analyzed in terms of composition, mechanism of action, and clinical applications. Although a certain degree of periodontal regeneration is predictable in intra-bony and class II furcation defects, complete defect closure is hardly achieved. Moreover, treating class III furcation defects remains challenging. The key properties required for functional regeneration are discussed, and none of the commercially available biomaterials possess all the ideal characteristics. Therefore, research is needed to promote the advancement of more effective and targeted regenerative therapies for periodontitis. Lastly, improving the design and reporting of clinical studies is suggested by strictly adhering to the Consolidated Standards of Reporting Trials (CONSORT) 2010 statement.
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Affiliation(s)
- Angela De Lauretis
- Department of Biomaterials, Institute of Clinical Dentistry, Faculty of DentistryUniversity of OsloOslo0455Norway
- Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”Politecnico di MilanoMilan20133Italy
| | - Øystein Øvrebø
- Department of Biomaterials, Institute of Clinical Dentistry, Faculty of DentistryUniversity of OsloOslo0455Norway
- Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”Politecnico di MilanoMilan20133Italy
| | - Mario Romandini
- Department of Periodontology, Institute of Clinical Dentistry, Faculty of DentistryUniversity of OsloOslo0455Norway
| | - Ståle Petter Lyngstadaas
- Department of Biomaterials, Institute of Clinical Dentistry, Faculty of DentistryUniversity of OsloOslo0455Norway
| | - Filippo Rossi
- Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”Politecnico di MilanoMilan20133Italy
| | - Håvard Jostein Haugen
- Department of Biomaterials, Institute of Clinical Dentistry, Faculty of DentistryUniversity of OsloOslo0455Norway
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Mukherjee M, Nair V, Phull T, Jain A, Grover V, Ali ABM, Arora S, Das G, Hassan SAB, Sainudeen S, Saluja P. Biometric analysis of furcation area of molar teeth and its relationship with instrumentation. BMC Oral Health 2024; 24:436. [PMID: 38600486 PMCID: PMC11005133 DOI: 10.1186/s12903-024-04164-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/19/2024] [Indexed: 04/12/2024] Open
Abstract
The anatomy of furcation favours the bacterial retention and makes periodontal debridement as well as oral hygiene procedures difficult. Teeth that have lost attachment to a level of the furcation are said to have a furcal invasion or furcation involved.Involvement of furcation in a multi-rooted tooth poses a very different type of clinical situation in terms of establishment of diagnosis, determination of prognosis and of course planning the treatment modality.The present study was carried out on 200 selected extracted human first and second permanent molar teeth based on a predefined criteria. Teeth with prosthetic crowns, fused or fractured roots, those not fully developed, grossly carious or heavily restored at the cementoenamel junction (CEJ) were excluded from the study. The morphology of the root trunk was recorded by measuring various dimensions of the root trunk,including furcal angle and root trunk volume was calculated by using a custom made special apparatus. The furcation areas were debrided with different types of curettes in the market in order to see how best the instrument could be maneuvered in the furcation area. The data so obtained was statistically analysed using SPSS version 22. The highest root trunk volume and the longest root trunk length were found to be in the maxillary second molar. 48.60% furcations didn't allow instrument engagementof furcation area with standard area specific curettes. The proposal of inclusion of root trunk length (mm) is suggested in addition to classification of FI to have assess prognosis and appropriate treatment for of the involved tooth.
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Affiliation(s)
| | - Vineet Nair
- Dr. R Ahmed Dental College and Hospital, Kolkata, India
| | - Tanvi Phull
- Department of Oral and Maxillofacial Surgery, Gian Sagar Dental College, Rajpura, Patiala, India
| | - Ashish Jain
- Department of Periodontology and Oral Implantology Dr.H.S.J. Institute of Dental Sciences, Panjab University, Chandigarh, India
| | - Vishakha Grover
- Department of Periodontology and Oral Implantology Dr.H.S.J. Institute of Dental Sciences, Panjab University, Chandigarh, India
| | - Ahmed Babiker Mohamed Ali
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, 61421, Saudi Arabia
| | - Suraj Arora
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, 61421, Saudi Arabia
| | - Gotam Das
- Department of Prosthodontics, College of Dentistry, King Khalid University, Abha, 61421, Saudi Arabia.
| | - Saeed Awod Bin Hassan
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, 61421, Saudi Arabia
| | - Shan Sainudeen
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, 61421, Saudi Arabia
| | - Priyanka Saluja
- Department of Dentistry, University of Alberta, Edmonton, AB, Canada
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6
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Kim HJ, Kim SY. Cervical enamel projections from a periodontal perspective: A scoping review. Clin Anat 2024; 37:353-365. [PMID: 38348736 DOI: 10.1002/ca.24141] [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: 10/22/2023] [Revised: 12/16/2023] [Accepted: 01/29/2024] [Indexed: 03/16/2024]
Abstract
Cervical enamel projections (CEPs) represent a unique developmental and anatomical anomaly wherein the enamel structure extends apically beyond the cemento-enamel junction of the tooth. In this scoping review, the existing literature on CEPs was evaluated to delineate their characteristics, prevalence, predilection for specific teeth and surfaces, clinical significance, and management approaches. Searches were conducted on MEDLINE (PubMed), Cochrane Library, and Embase databases using the keywords "enamel projection(s)" or "ectopic enamel." In total, 24 studies meeting inclusion criteria were included in the review. The prevalence of CEPs varied widely (8.3%-85.1%), predominantly manifesting as grade I or grade III. Mandibular first and second molars exhibited a higher incidence of CEPs, with a notable predilection for buccal surfaces. The consensus in most studies was that CEPs are associated with localized periodontal diseases. Recommendations inclined toward the removal of ectopic enamel during periodontal surgery to enhance periodontal attachment formation. However, decision-making should involve careful consideration of the benefits and drawbacks based on individual circumstances.
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Affiliation(s)
- Hyun Ju Kim
- Department of Periodontics, Seoul National University Dental Hospital, Seoul, Republic of Korea
- Department of Periodontology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Sun-Young Kim
- Department of Conservative Dentistry and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
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Ruberu TLM, Braun D, Parmigiani G, Biswas S. Bayesian meta-analysis of penetrance for cancer risk. Biometrics 2024; 80:ujae038. [PMID: 38819308 PMCID: PMC11140851 DOI: 10.1093/biomtc/ujae038] [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: 09/05/2022] [Revised: 07/12/2023] [Accepted: 05/01/2024] [Indexed: 06/01/2024]
Abstract
Multi-gene panel testing allows many cancer susceptibility genes to be tested quickly at a lower cost making such testing accessible to a broader population. Thus, more patients carrying pathogenic germline mutations in various cancer-susceptibility genes are being identified. This creates a great opportunity, as well as an urgent need, to counsel these patients about appropriate risk-reducing management strategies. Counseling hinges on accurate estimates of age-specific risks of developing various cancers associated with mutations in a specific gene, ie, penetrance estimation. We propose a meta-analysis approach based on a Bayesian hierarchical random-effects model to obtain penetrance estimates by integrating studies reporting different types of risk measures (eg, penetrance, relative risk, odds ratio) while accounting for the associated uncertainties. After estimating posterior distributions of the parameters via a Markov chain Monte Carlo algorithm, we estimate penetrance and credible intervals. We investigate the proposed method and compare with an existing approach via simulations based on studies reporting risks for two moderate-risk breast cancer susceptibility genes, ATM and PALB2. Our proposed method is far superior in terms of coverage probability of credible intervals and mean square error of estimates. Finally, we apply our method to estimate the penetrance of breast cancer among carriers of pathogenic mutations in the ATM gene.
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Affiliation(s)
| | - Danielle Braun
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
- Department of Data Science, Dana Farber Cancer Institute, Boston, MA 02215, United States
| | - Giovanni Parmigiani
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
- Department of Data Science, Dana Farber Cancer Institute, Boston, MA 02215, United States
| | - Swati Biswas
- Department of Mathematical Sciences, University of Texas at Dallas, Richardson, TX 75080, United States
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Peeran SW, Ramalingam K, Sethuraman S, Thiruneervannan M. Furcation Involvement in Periodontal Disease: A Narrative Review. Cureus 2024; 16:e55924. [PMID: 38601385 PMCID: PMC11004587 DOI: 10.7759/cureus.55924] [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] [Accepted: 03/10/2024] [Indexed: 04/12/2024] Open
Abstract
Furcation-involved teeth, commonly seen in dental practice, have a higher likelihood of needing extraction as the severity of periodontal furcation involvement increases. Studies consistently show that periodontitis in teeth with multiple roots significantly increases the risk of tooth loss, especially in the area where the furcation is involved. These furcation defects pose a major problem for dentists because of their location, accessibility issues, and the unpredictable healing process. The biggest hurdle in treating furcation defects is their irregular shape, which makes it hard to achieve complete debridement. While various treatments have been explored, non-surgical methods have not shown much success. This article comprehensively provides a review and discussion on the classification, assessment, and treatment options, including surgical and non-surgical management of furcation-involved molar teeth. Properly understanding the severity of the disease and its confounding factors and managing and treating the lesions appropriately have been shown to impart satisfactory survival rates for these teeth. Enhancing the understanding of managing these teeth can also lead to better outcomes for patients.
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Affiliation(s)
| | - Karthikeyan Ramalingam
- Oral Pathology and Microbiology, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Sathya Sethuraman
- Dentistry, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Garg N, Lamba AK, Faraz F, Tandon S, Datta A, Dhingra S. Management of grade II and III furcation defects with intramarrow penetration along with indigenously prepared DFDBA and amniotic membrane: a clinical and radiographic study. Cell Tissue Bank 2024; 25:295-303. [PMID: 36627541 DOI: 10.1007/s10561-022-10068-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/29/2022] [Indexed: 01/12/2023]
Abstract
Managing furcation defects constitutes a problem in successful periodontal therapy. Guided tissue regeneration (GTR) is the mainstay for the management of such defects but is expensive. This study makes use of indigenously prepared demineralized freeze-dried bone allograft (DFDBA) and amniotic membrane (AM) as a cost-effective alternative. The purpose of the study was to compare the clinical outcome of grade II and III furcation defects with and without using indigenous DFDBA and AM prepared at Central Tissue Bank, MAIDS. 18 systemically healthy patients with chronic periodontitis displaying either grade II or III furcation defects were treated with open flap debridement (OFD) + intramarrow penetration (IMP) (control group) and OFD + IMP + DFDBA + AM (test group). The clinical and radiographic parameters were recorded at 3 and 6 months postoperatively. All parameters were statistically analyzed. Both treatment modalities resulted in improvement in all clinical variables evaluated. Radiographic dimensions evaluating bone fill showed a statistically significant difference in the test group compared to the control group. Within the limitations of this study, data suggest GTR using indigenously prepared DFDBA and amniotic membrane to be an economical and viable option for treating furcation defects.
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Affiliation(s)
- Neha Garg
- Department of Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India.
| | - Arundeep Kaur Lamba
- Department of Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Farrukh Faraz
- Department of Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Shruti Tandon
- Department of Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Archita Datta
- Department of Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Sachin Dhingra
- Department of Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
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Imber JC, Imber LC, Roccuzzo A, Stähli A, Muñoz F, Weusmann J, Bosshardt DD, Sculean A. Preclinical evaluation of a new synthetic carbonate apatite bone substitute on periodontal regeneration in intrabony defects. J Periodontal Res 2024; 59:42-52. [PMID: 37997207 DOI: 10.1111/jre.13203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 08/28/2023] [Accepted: 10/16/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE To evaluate the potential of a novel synthetic carbonate apatite bone substitute (CO3 Ap-BS) on periodontal regeneration. BACKGROUND The use of various synthetic bone substitutes as a monotherapy for periodontal regeneration mainly results in a reparative healing pattern. Since xenografts or allografts are not always accepted by patients for various reasons, a synthetic alternative would be desirable. METHODS Acute-type 3-wall intrabony defects were surgically created in 4 female beagle dogs. Defects were randomly allocated and filled with CO3 Ap-BS (test) and deproteinized bovine bone mineral (DBBM) or left empty (control). After 8 weeks, the retrieved specimens were scanned by micro-CT, and the percentages of new bone, bone substitute, and soft tissues were evaluated. Thereafter, the tissues were histologically and histometrically analyzed. RESULTS Healing was uneventful in all animals, and defects were present without any signs of adverse events. Formation of periodontal ligament and cementum occurred to varying extent in all groups without statistically significant differences between the groups. Residues of both bone substitutes were still present and showed integration into new bone. Histometry and micro-CT revealed that the total mineralized area or volume was higher with the use of CO3 Ap-BS compared to control (66.06 ± 9.34%, 36.11 ± 6.40%; p = .014, or 69.74 ± 2.95%, 42.68 ± 8.68%; p = .014). The percentage of bone substitute surface covered by new bone was higher for CO3 Ap-BS (47.22 ± 3.96%) than for DBBM (16.69 ± 5.66, p = .114). CONCLUSIONS CO3 Ap-BS and DBBM demonstrated similar effects on periodontal regeneration. However, away from the root surface, more new bone, total mineralized area/volume, and higher osteoconductivity were observed for the CO3 Ap-BS group compared to the DBBM group. These findings point to the potential of CO3 Ap-BS for periodontal and bone regeneration.
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Affiliation(s)
- Jean-Claude Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Robert K. Schenk Laboratory of Oral Histology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Larissa Carmela Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Robert K. Schenk Laboratory of Oral Histology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Andrea Roccuzzo
- 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
| | - Fernando Muñoz
- Department of Veterinary Clinical Sciences, University of Santiago de Compostela, Ibonelab SL, Lugo, Spain
| | - Jens Weusmann
- Department of Periodontology and Operative Dentistry, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Dieter Daniel Bosshardt
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Robert K. Schenk Laboratory of Oral Histology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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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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12
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Fukuba S, Okada M, Iwata T. Clinical outcomes of periodontal regenerative therapy with carbonate apatite granules for treatments of intrabony defects, Class II and Class III furcation involvements: A 9-month prospective pilot clinical study. Regen Ther 2023; 24:343-350. [PMID: 37674693 PMCID: PMC10477744 DOI: 10.1016/j.reth.2023.08.002] [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: 06/15/2023] [Revised: 07/13/2023] [Accepted: 08/13/2023] [Indexed: 09/08/2023] Open
Abstract
Introduction Carbonated apatite (CO3Ap) has unique properties as an alloplastic bone substitute and has been reported the safety and efficacy for bone regeneration. However, no previous studies reported the clinical application of CO3Ap for periodontal regeneration therapy. The aim of this study was to evaluate the safety and efficacy of periodontal regeneration with CO3Ap in treating intrabony defects, Class II and Class III furcation involvement (FI). Methods A single-arm and single-center prospective pilot clinical study was performed to verify the safety and efficacy of CO3Ap in patients with periodontitis. A total of four patients with seven teeth, including three deep intrabony defects, two Class II FI, and two Class III FI, were treated with CO3Ap. The clinical parameters, including probing pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP), tooth mobility (Mo), Plaque index (PI), and Gingival index (GI) were evaluated at baseline, 6 months, and 9 months after the surgery. Radiographic analysis was conducted on images of dental X-ray and cone beam computed tomography (CBCT) at baseline and 9 months post-surgery. Results The postoperative healing in all cases was uneventful, with no abnormal bleeding, pain, or swelling. The mean PPD reduction and CAL gain were 5.0 ± 1.0 mm, 4.5 ± 0.7 mm, 1.5 ± 0.7 mm, and 4.7 ± 1.2 mm, 4.5 ± 0.7 mm, 0.0 mm for intrabony defect, Class II and Class III FI, respectively. According to radiographic analysis, linear bone height in intrabony defects and vertical subclassification of FI in Class II FI were improved. Conclusions The clinical application of CO3Ap for the treatment of intrabony defects and Class II FI could be effective for periodontal regeneration, although its efficacy in treating Class III FI might be limited. Despite the limitations of this study, the findings in this study suggested that CO3Ap has the potential to be a promising bone graft substitute for periodontal regeneration.
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Affiliation(s)
- Shunsuke Fukuba
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Switzerland
| | - Munehiro Okada
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Takanori Iwata
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
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13
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Tella EA, Aldahlawi SA, Azab ET, Yaghmoor WE, Fansa HA. Evaluation of hyaluronic acid gel with or without acellular dermal matrix allograft in the treatment of class II furcation defects in dogs: A histologic and histomorphometric study. Saudi Dent J 2023; 35:845-853. [PMID: 38025597 PMCID: PMC10658385 DOI: 10.1016/j.sdentj.2023.07.007] [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: 03/17/2023] [Revised: 06/17/2023] [Accepted: 07/02/2023] [Indexed: 12/01/2023] Open
Abstract
Aim To evaluate the histologic and histomorphometric effects of hyaluronic acid (HA) gel with or without acellular dermal matrix allograft (ADMA) on periodontal regeneration in Class II furcation defects in dogs. Materials and methods Class II furcation defects were surgically created in the mandibular first and second premolars bilaterally in eight beagle dogs. The Class II furcation defects were assigned randomly, using the split-mouth design, into the test and control sides. The teeth on the test sides were equally and randomly divided into the HA/ADMA group (n = 8) treated with 0.8% HA gel followed by ADMA, and the HA-only group (n = 8) treated with 0.8% HA only. The furcation defects of the control sides (n = 16) were subjected to open flap debridement (OFD group). The animals were euthanized for histologic and histomorphometric analyses after one month (n = 4) and three months (n = 4). Results At one month, the newly formed bone area (NFBA) was larger in the HA/ADMA (6.23 ± 1.41 mm2) and HA-only (5.90 ± 1.43 mm2) groups than in the OFD group (2.42 ± 1.62 mm2) (p < 0.05). The newly formed cementum (NFAC) and periodontal ligament (NFPL) were similar in the HA/ADMA and HA-only groups but significantly lesser in the OFD group (p < 0.05.) At three months, the NFBA, NFAC, and NFPL were greater in the HA/ADMA group than in the HA-only group (p < 0.05). New regenerative tissue was significantly greater in both the test groups than in the OFD group (p < 0.05), while epithelial downgrowth predominated the healing in the latter. Conclusions These results suggest that HA with ADMA positively affects the periodontal regeneration and wound healing in Class II furcation defects.
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Affiliation(s)
- Eman A. Tella
- Department of Basic and Clinical Oral Sciences, Faculty of Dental Medicine, Umm Al-Qura University, Saudi Arabia
| | - Salwa A. Aldahlawi
- Department of Basic and Clinical Oral Sciences, Faculty of Dental Medicine, Umm Al-Qura University, Saudi Arabia
| | - Ehab T. Azab
- Department of Basic and Clinical Oral Sciences, Faculty of Dental Medicine, Umm Al-Qura University, Saudi Arabia
| | - Wael E. Yaghmoor
- Department of Basic and Clinical Oral Sciences, Faculty of Dental Medicine, Umm Al-Qura University, Saudi Arabia
| | - Hoda A. Fansa
- Department of Basic and Clinical Oral Sciences, Faculty of Dental Medicine, Umm Al-Qura University, Saudi Arabia
- Department of Oral Biology, Faculty of Dentistry, Alexandra University, Egypt
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14
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Montagner AF, Angst PDM, Raggio DP, VAN DE Sande FH, Tedesco TK. Methodological quality of network meta-analysis in dentistry: a meta-research. Braz Oral Res 2023; 37:e062. [PMID: 37436290 DOI: 10.1590/1807-3107bor-2023.vol37.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/27/2023] [Indexed: 07/13/2023] Open
Abstract
This meta-research aimed to provide an overview of the methodological quality and risk of bias of network meta-analyses (NMA) in dentistry. Searches for NMA of randomized clinical trials with clinical outcomes in dentistry were performed in databases up to January 2022. Two reviewers independently screened titles/abstracts, selected full texts, and extracted the data. The adherence to PRISMA-NMA reporting guideline, the AMSTAR-2 methodological quality tool, and the ROBIS risk of bias tool were assessed in the studies. Correlation between the PRISMA-NMA adherence and the AMSTAR-2 and ROBIS results was also investigated. Sixty-two NMA studies were included and presented varied methodological quality. According to AMSTAR-2, half of the NMA presented moderate quality (n = 32; 51.6%). The adherence to PRISMA-NMA also varied. Only 36 studies (58.1%) prospectively registered the protocol. Other issues lacking of reporting were data related were data related to the NMA geometry and the assessment of results consistency, and the evaluation of risk of bias across the studies. ROBIS assessment showed a high risk of bias mainly for domains 1 (study eligibility criteria) and 2 (identification and selection of studies). Correlation coefficients between the PRISMA-NMA adherence and the AMSTAR-2 and ROBIS results showed moderate correlation (rho < 0.6). Overall, NMA studies in dentistry were of moderate quality and at high risk of bias in several domains, especially study selection. Future reviews should be better planned and conducted and have higher compliance with reporting and quality assessment tools.
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Affiliation(s)
| | | | | | | | - Tamara Kerber Tedesco
- Univesidade Cruzeiro do Sul - Unicsul, Graduate Program in Dentistry, São Paulo, SP, Brazil
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15
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Damanaki A, Beisel-Memmert S, Nokhbehsaim M, Abedi A, Rath-Deschner B, Nogueira AVB, Deschner J. Influence of Occlusal Hypofunction on Alveolar Bone Healing in Rats. Int J Mol Sci 2023; 24:9744. [PMID: 37298695 PMCID: PMC10253992 DOI: 10.3390/ijms24119744] [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: 01/31/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023] Open
Abstract
The aim of this in vivo study was to investigate the effect of occlusal hypofunction on alveolar bone healing in the absence or presence of an enamel matrix derivative (EMD). A standardized fenestration defect over the root of the mandibular first molar in 15 Wistar rats was created. Occlusal hypofunction was induced by extraction of the antagonist. Regenerative therapy was performed by applying EMD to the fenestration defect. The following three groups were established: (a) normal occlusion without EMD treatment, (b) occlusal hypofunction without EMD treatment, and (c) occlusal hypofunction with EMD treatment. After four weeks, all animals were sacrificed, and histological (hematoxylin and eosin, tartrate-resistant acid phosphatase) as well as immunohistochemical analyses (periostin, osteopontin, osteocalcin) were performed. The occlusal hypofunction group showed delayed bone regeneration compared to the group with normal occlusion. The application of EMD could partially, but not completely, compensate for the inhibitory effects of occlusal hypofunction on bone healing, as evidenced by hematoxylin and eosin and immunohistochemistry for the aforementioned molecules. Our results suggest that normal occlusal loading, but not occlusal hypofunction, is beneficial to alveolar bone healing. Adequate occlusal loading appears to be as advantageous for alveolar bone healing as the regenerative potential of EMD.
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Affiliation(s)
- Anna Damanaki
- Department of Periodontology and Operative Dentistry, University Medical Center, University of Mainz, 55131 Mainz, Germany
| | - Svenja Beisel-Memmert
- Department of Orthodontics, Center of Dento-Maxillo-Facial Medicine, University of Bonn, 53111 Bonn, Germany
| | - Marjan Nokhbehsaim
- Section of Experimental Dento-Maxillo-Facial Medicine, Center of Dento-Maxillo-Facial Medicine, University of Bonn, 53111 Bonn, Germany
| | - Ali Abedi
- Department of Periodontology and Operative Dentistry, University Medical Center, University of Mainz, 55131 Mainz, Germany
| | - Birgit Rath-Deschner
- Department of Orthodontics, Center of Dento-Maxillo-Facial Medicine, University of Bonn, 53111 Bonn, Germany
| | - Andressa V. B. Nogueira
- Department of Periodontology and Operative Dentistry, University Medical Center, University of Mainz, 55131 Mainz, Germany
| | - James Deschner
- Department of Periodontology and Operative Dentistry, University Medical Center, University of Mainz, 55131 Mainz, Germany
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16
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Jepsen K, Sculean A, Jepsen S. Complications and treatment errors related to regenerative periodontal surgery. Periodontol 2000 2023; 92:120-134. [PMID: 37435999 DOI: 10.1111/prd.12504] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/03/2023] [Indexed: 07/13/2023]
Abstract
Regenerative periodontal surgical procedures are an important component in the treatment of advanced periodontitis. They aim to improve the long-term prognosis of teeth that are periodontally compromised by the presence of intrabony and/or furcation defects, resulting biologically in formation of root cementum, periodontal ligament, and alveolar bone and evidenced clinically by reduction of deep pockets to maintainable probing depths and/or improvements of vertical and horizontal furcation depth. Over the last 25 years, substantial clinical evidence has been accumulated to support the value of regenerative procedures in periodontally compromised dentitions. However, treatment success requires close attention to certain factors on the level of the patient, the tooth/defect, and the operator. Ignoring these factors in case selection, treatment planning, and treatment execution will increase the risk of complications that may jeopardize clinical success and may even be considered as treatment errors. Based on the currently available evidence from clinical practice guidelines, treatment algorithms, and on expert opinion, the present article provides an overview on the main factors, which influence the outcomes of regenerative periodontal surgery and gives recommendations on how to prevent complications and treatment errors.
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Affiliation(s)
- Karin Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
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17
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Limiroli E, Calò A, Cortellini P, Eickholz P, Katayama A, Majzoub J, Wong J, McClain P, Cortinovis I, Rasperini G. The influence of interradicular anatomy on the predictability of periodontal regenerative therapy of furcation defects: a retrospective, multicenter clinical study. Clin Oral Investig 2023:10.1007/s00784-023-04995-3. [PMID: 37052671 DOI: 10.1007/s00784-023-04995-3] [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: 12/28/2022] [Accepted: 03/28/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND The relationship between the anatomy of the interradicular space and success in regenerative therapy of furcation defects is discussed in this paper. The goal of this retrospective, multicenter clinical study is to clinically evaluate the relationship between the interradicular conformation and regenerative therapy success with the use of a novel measurement method. METHODS One hundred thirty-eight radiographs of mandibular molars with furcation defects that had been treated with regenerative therapy were collected from six clinical centers. Data on the type of therapy and clinical parameters before and after treatment (follow-up of at least 12 months) were collected. The radiographs (before surgery and at least 12 months postoperatively) were measured with a visual evaluation method by a blind operator using graphics software. RESULTS Success, defined as a reduction in horizontal and vertical furcation involvement, decrease in probing depths, and increase in clinical attachment level, was statistically assessed on 138 regenerated molars sites and were related to clinical variables such as age, sex, center, and treatment. No correlation was found between success in regenerative therapy and the conformation of the interradicular space, measured with a visual ratio method and a standard linear measurement. At the univariate analysis, the parameters that had a correlation with success were center, extent of furcation involvement, treatment, and sex. The use of enamel matrix derivative (EMD) seemed to be the most favorable therapy, with increase in CAL gain and reduction of vertical or horizontal furcation involvement. CONCLUSIONS The regenerative outcome was not significantly influenced by the anatomy of furcation. The center, the degree of furcation involvement, sex, and treatment (EMD) were significantly associated with higher success of periodontal regeneration.
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Affiliation(s)
- Enrico Limiroli
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
- Foundation IRCCS Ca' Granda Polyclinic, Via Della Commenda 10, 20122, Milan, Italy.
| | - Andrea Calò
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Foundation IRCCS Ca' Granda Polyclinic, Via Della Commenda 10, 20122, Milan, Italy
| | | | - Peter Eickholz
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt Am Main, 60596, Frankfurt Am Main, Germany
| | | | - Jad Majzoub
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer Wong
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology at the Harvard School of Dental Medicine, Boston, MA, USA
| | | | - Ivan Cortinovis
- Laboratory G.A. Maccacaro, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giulio Rasperini
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Foundation IRCCS Ca' Granda Polyclinic, Via Della Commenda 10, 20122, Milan, Italy
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18
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Sigusch B, Kranz S, von Hohenberg AC, Wehle S, Guellmar A, Steen D, Berg A, Rabe U, Heyder M, Reise M. Histological and Histomorphometric Evaluation of Implanted Photodynamic Active Biomaterials for Periodontal Bone Regeneration in an Animal Study. Int J Mol Sci 2023; 24:ijms24076200. [PMID: 37047171 PMCID: PMC10094716 DOI: 10.3390/ijms24076200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/17/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
Recently, our group developed two different polymeric biomaterials with photodynamic antimicrobial surface activity for periodontal bone regeneration. The aim of the present study was to analyze the biocompatibility and osseointegration of these materials in vivo. Two biomaterials based on urethane dimethacrylate (BioM1) and tri-armed oligoester-urethane methacrylate (BioM2) that additionally contained ß-tricalcium phosphate and the photosensitizer mTHPC (meso-tetra(hydroxyphenyl)chlorin) were implanted in non-critical size bone defects in the femur (n = 16) and tibia (n = 8) of eight female domestic sheep. Bone specimens were harvested and histomorphometrically analyzed after 12 months. BioM1 degraded to a lower extent which resulted in a mean remnant square size of 17.4 mm², while 12.2 mm² was estimated for BioM2 (p = 0.007). For BioM1, a total percentage of new formed bone by 30.3% was found which was significant higher compared to BioM2 (8.4%, p < 0.001). Furthermore, BioM1 was afflicted by significant lower soft tissue formation (3.3%) as compared to BioM2 (29.5%). Additionally, a bone-to-biomaterial ratio of 81.9% was detected for BioM1, while 8.5% was recorded for BioM2. Implantation of BioM2 caused accumulation of inflammatory cells and led to fibrous encapsulation. BioM1 (photosensitizer-armed urethane dimethacrylate) showed favorable regenerative characteristics and can be recommended for further studies.
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Affiliation(s)
- Bernd Sigusch
- Department of Conservative Dentistry and Periodontology, University Hospitals Jena, An der alten Post 4, 07743 Jena, Germany (A.C.v.H.)
| | - Stefan Kranz
- Department of Conservative Dentistry and Periodontology, University Hospitals Jena, An der alten Post 4, 07743 Jena, Germany (A.C.v.H.)
- Correspondence:
| | - Andreas Clemm von Hohenberg
- Department of Conservative Dentistry and Periodontology, University Hospitals Jena, An der alten Post 4, 07743 Jena, Germany (A.C.v.H.)
| | - Sabine Wehle
- Department of Conservative Dentistry and Periodontology, University Hospitals Jena, An der alten Post 4, 07743 Jena, Germany (A.C.v.H.)
| | - André Guellmar
- Department of Conservative Dentistry and Periodontology, University Hospitals Jena, An der alten Post 4, 07743 Jena, Germany (A.C.v.H.)
| | | | - Albrecht Berg
- Innovent Technologieentwicklung e.V., 07745 Jena, Germany
| | - Ute Rabe
- Department of Conservative Dentistry and Periodontology, University Hospitals Jena, An der alten Post 4, 07743 Jena, Germany (A.C.v.H.)
| | - Markus Heyder
- Department of Conservative Dentistry and Periodontology, University Hospitals Jena, An der alten Post 4, 07743 Jena, Germany (A.C.v.H.)
| | - Markus Reise
- Department of Conservative Dentistry and Periodontology, University Hospitals Jena, An der alten Post 4, 07743 Jena, Germany (A.C.v.H.)
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Histologic and histomorphometric evaluation of Aloe vera adjunctive to β-tricalcium phosphate in class II furcation defects in dogs. Sci Rep 2023; 13:4198. [PMID: 36918622 PMCID: PMC10015024 DOI: 10.1038/s41598-023-31282-8] [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: 11/16/2022] [Accepted: 03/09/2023] [Indexed: 03/16/2023] Open
Abstract
Aloe vera has antimicrobial activity and enhances the osseointegration process, thus it may have the potential in treating periodontal defects. This study aimed to evaluate the effect of Aloe vera as an adjunction to Beta-tricalcium phosphate (β-TCP) bone graft in Grade II furcation defects. A randomized study was conducted on six healthy mongrel dogs' premolars. A total of twenty-four Grade II furcation critical-sized defects were surgically created after reflecting a full-thickness flap, twelve defects were filled with β-TCP while the other twelve defects were filled with Aloe vera mixed with β-TCP and both covered by collagen membrane. Animals were euthanized at the end of the fourth and eighth week and defects were analyzed histologically and histomorphometrically. Histologically, Aloe vera mixed with β-TCP resulted in more bone formation and new PDL fibers compared to β-TCP alone. After 2 and 4 weeks, the experimental group had significantly higher newly formed interradicular bone height (p < 0.0001, and p < 0.0001, respectively), bone thickness (p < 0.0001, and p < 0.0001, respectively), and percentage of the surface area (p = 0.009, and p = 0.023, respectively). Aloe vera gel adjunctive to β-TCP is an effective bioactive agent that enhances periodontal tissue regeneration and bone formation in critically sized defects.
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20
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Furcation-involved molar teeth - part 2: management and prognosis. Br Dent J 2022; 233:923-928. [PMID: 36494531 DOI: 10.1038/s41415-022-5254-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 05/23/2022] [Indexed: 12/13/2022]
Abstract
Furcation-involved molars are a common presentation in general dental practice. Teeth with increasing degrees of furcation involvement are at a higher risk of requiring extraction. This second article reviews management and prognosis of furcation-involved molar teeth. An improved understanding of how to appropriately manage these teeth can result in improved outcomes for patients.
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21
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Jolivet G, Huck O, Petit C. Evaluation of furcation involvement with diagnostic imaging methods: a systematic review. Dentomaxillofac Radiol 2022; 51:20210529. [PMID: 35787071 PMCID: PMC9717400 DOI: 10.1259/dmfr.20210529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 06/09/2022] [Accepted: 07/01/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Multirooted teeth respond less favorably to non-surgical periodontal treatment and long-term tooth prognosis is influenced by the degree of furcation involvement (FI). Therapeutic strategy for multirooted teeth is essentially based on accurate diagnosis of the FI. The aim of this systematic review is to evaluate the accuracy of the different furcation assessment methods and to determine if radiographic help is needed to determine early stage of FI. METHODS Electronic databases were searched up to March 2021. Comparative studies describing the reliability of different clinical and/or radiological furcation assessment methods were identified. RESULTS A total of 22 studies comparing at least 2 furcation assessment methods, among which 15 retrospective studies, 5 prospective studies, 1 randomized controlled trial and 1 case series, were included in this review. The reliability of cone beam CT (CBCT), intraoral radiographs (IOs), orthopantomograms (OPGs) and MRI to identify FI was evaluated. Using OFS as a reference for FI detection and diagnosis, agreement ranged from 43.3 to 63% for OPG, 38.7 to 83.1% for IO and 82.4 to 84% for CBCT. The validity of the measurements was mainly influenced by the location of the furcation entrance. For radiological diagnosis, CBCT displayed the closest agreement with OFS while the accuracy of IO and OPG showed modest agreement and were influenced by the examiner's experience. CONCLUSION Altogether, it appears that the use of IO, OPG or CBCT allows detection of FI but could not be considered as gold-standard techniques.
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22
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Gallo S, Pascadopoli M, Pellegrini M, Pulicari F, Manfredini M, Zampetti P, Spadari F, Maiorana C, Scribante A. Latest Findings of the Regenerative Materials Application in Periodontal and Peri-Implant Surgery: A Scoping Review. Bioengineering (Basel) 2022; 9:594. [PMID: 36290567 PMCID: PMC9598513 DOI: 10.3390/bioengineering9100594] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/15/2022] [Accepted: 10/18/2022] [Indexed: 07/30/2023] Open
Abstract
Regenerative dentistry represents a therapeutic modern approach involving biomaterials and biologics such as mesenchymal stem cells. The role of regenerative dentistry is promising in all branches of dentistry, especially in periodontology and implantology for the treatment of bony defects around teeth and implants, respectively. Due to the number of different materials that can be used for this purpose, the aim of the present review is to evidence the regenerative properties of different materials both in periodontitis and peri-implantitis as well as to compare their efficacy. Clinical trials, case-control studies, cross-sectional studies, and cohort studies have been considered in this review. The outcome assessed is represented by the regenerative properties of bone grafts, barrier membranes, and biological materials in the treatment of intrabony and furcation defects, peri-implantitis sites, alveolar ridge preservation, and implant site development. Based on the studies included, it can be stated that in the last years regenerative materials in periodontal and peri-implant defects treatments have shown excellent results, thus providing valuable support to surgical therapy. To achieve optimal and predictable results, clinicians should always consider factors like occlusal load control, prevention of microbial contamination, and wound dehiscence. Further evidence is required about the use of enamel matrix derivative in alveolar ridge preservation, as well as of stem cells and bone morphogenetic proteins-2 in furcation defects and peri-implantitis sites. Considering the high amount of research being conducted in this field, further evidence is expected to be obtained soon.
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Affiliation(s)
- Simone Gallo
- Unit of Orthodontics and Pediatric Dentistry, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Maurizio Pascadopoli
- Unit of Orthodontics and Pediatric Dentistry, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Matteo Pellegrini
- Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Federica Pulicari
- Maxillo-Facial and Odontostomatology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
| | - Mattia Manfredini
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
- Implant Center for Edentulism and Jawbone Atrophies, Maxillofacial Surgery and Odontostomatology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Paolo Zampetti
- Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Francesco Spadari
- Maxillo-Facial and Odontostomatology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
| | - Carlo Maiorana
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
- Implant Center for Edentulism and Jawbone Atrophies, Maxillofacial Surgery and Odontostomatology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Andrea Scribante
- Unit of Orthodontics and Pediatric Dentistry, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
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Shirakata Y, Imafuji T, Nakamura T, Shinohara Y, Iwata M, Setoguchi F, Noguchi K, Sculean A, Dent M. Cross-linked hyaluronic acid gel with or without a collagen matrix in the treatment of class III furcation defects: A histologic and histomorphometric study in dogs. J Clin Periodontol 2022; 49:1079-1089. [PMID: 35817414 PMCID: PMC9796036 DOI: 10.1111/jcpe.13694] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 06/11/2022] [Accepted: 07/03/2022] [Indexed: 12/30/2022]
Abstract
AIM To histologically evaluate the effects of cross-linked hyaluronic acid (xHyA) with or without a collagen matrix (CM) on periodontal wound healing/regeneration in class III furcation defects in dogs. MATERIALS AND METHODS Class III furcation defects were surgically created in the mandibular premolars in six beagle dogs. The defects were randomly treated as follows: open flap debridement (OFD) + CM (CM), OFD + xHyA (xHyA), OFD + xHyA + CM (xHyA/CM) and OFD alone (OFD). At 10 weeks, the animals were euthanized for histological evaluation. RESULTS The newly formed bone areas in the xHyA (4.04 ± 1.51 mm2 ) and xHyA/CM (4.32 ± 1.14 mm2 ) groups were larger than those in the OFD (3.25 ± 0.81 mm2 ) and CM (3.31 ± 2.26 mm2 ) groups. The xHyA (6.25 ± 1.45 mm) and xHyA/CM (6.40 ± 1.35 mm) groups yielded statistically significantly (p < .05) greater formation of new connective tissue attachment (i.e., new cementum, with inserting connective tissue fibres) compared with the OFD (1.47 ± 0.85 mm) group. No significant differences were observed in any of the histomorphometric parameters between the xHyA and xHyA/CM groups. Complete furcation closure was not observed in any of the four treatment modalities. CONCLUSIONS Within their limits, the present results suggest that the use of xHyA with or without CM positively influences periodontal wound healing in surgically created, acute-type class III furcation defects.
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Affiliation(s)
- Yoshinori Shirakata
- Department of PeriodontologyKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Takatomo Imafuji
- Department of PeriodontologyKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Toshiaki Nakamura
- Department of PeriodontologyKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Yukiya Shinohara
- Department of PeriodontologyKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Masayuki Iwata
- Department of PeriodontologyKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Fumiaki Setoguchi
- Department of PeriodontologyKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Kazuyuki Noguchi
- Department of PeriodontologyKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Anton Sculean
- Department of Periodontology, School of Dental MedicineUniversity of BernBernSwitzerland
| | - Med Dent
- Department of Periodontology, School of Dental Medicine, University of Bern, Switzerland
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Li M, Lv J, Yang Y, Cheng G, Guo S, Liu C, Ding Y. Advances of Hydrogel Therapy in Periodontal Regeneration-A Materials Perspective Review. Gels 2022; 8:gels8100624. [PMID: 36286125 PMCID: PMC9602018 DOI: 10.3390/gels8100624] [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: 08/26/2022] [Revised: 09/18/2022] [Accepted: 09/27/2022] [Indexed: 11/04/2022] Open
Abstract
Hydrogel, a functional polymer material, has emerged as a promising technology for therapies for periodontal diseases. It has the potential to mimic the extracellular matrix and provide suitable attachment sites and growth environments for periodontal cells, with high biocompatibility, water retention, and slow release. In this paper, we have summarized the main components of hydrogel in periodontal tissue regeneration and have discussed the primary construction strategies of hydrogels as a reference for future work. Hydrogels provide an ideal microenvironment for cells and play a significant role in periodontal tissue engineering. The development of intelligent and multifunctional hydrogels for periodontal tissue regeneration is essential for future research.
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Kormas I, Pedercini A, Alassy H, Wolff LF. The Use of Biocompatible Membranes in Oral Surgery: The Past, Present & Future Directions. A Narrative Review. MEMBRANES 2022; 12:841. [PMID: 36135860 PMCID: PMC9503881 DOI: 10.3390/membranes12090841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 06/16/2023]
Abstract
The use of biocompatible membranes in periodontal and oral surgery is an important part of regeneration. Over the years, several different membranes have been developed, ranging from non-resorbable membranes that have to be removed in a separate procedure, to collagen membranes that completely resorb on their own, thus avoiding the need for a second surgery. Autogenous membranes are becoming increasingly popular in more recent years. These membranes can be used with a great variety of techniques in the four main hard tissue regenerative procedures: guided tissue regeneration, alveolar ridge preservation, guided bone regeneration and sinus floor augmentation. A review of the literature was conducted in order to identify the most commonly used membranes in clinical practice, as well as the most promising ones for regeneration procedures in the future. The information provided in this review may serve as a guide to clinicians, in order to select the most applicable membrane for the clinical case treated as the correct choice of materials may be critical in the procedure's success.
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Affiliation(s)
- Ioannis Kormas
- Department of Periodontics, School of Dentistry, Texas A&M University, Dallas, TX 75246, USA
| | | | | | - Larry F. Wolff
- Division of Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA
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Alasqah M, Alotaibi FD, Gufran K. The Radiographic Assessment of Furcation Area in Maxillary and Mandibular First Molars while Considering the New Classification of Periodontal Disease. Healthcare (Basel) 2022; 10:healthcare10081464. [PMID: 36011121 PMCID: PMC9408343 DOI: 10.3390/healthcare10081464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/02/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to evaluate the radiographic reliability in the diagnosis of furcation involvement in first molars. A total of 52 subjects were included in the current study. Personal history regarding smoking was recorded and a periodontal examination was performed. Pocket depth (PD), clinical attachment level (CAL), gingival recession, and furcation involvement in all first molars were assessed for each patient. Periodontal staging and grading were evaluated using the new classification of periodontal disease. Class II and Class III furcation classification were more frequently observed in radiographs than the Class I furcation; however, no significant differences were observed. Radiographic observation of the furcation was seen more when PD and CAL were >5 mm in all molars. The presence of gingival recession and its relation to the radiographic assessment did not reveal any statistically significant association (p > 0.05) except for tooth #16. The trend of visibility of furcation radiographically was more as the grade of staging was increased. Moreover, the presence of smoking habits and visibility of furcation radiographically did not have any statistical significance. Smoking may not be a factor in the furcation involvement. There is a direct relationship between the staging and grading of the periodontitis and furcation involvement.
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Affiliation(s)
- Mohammed Alasqah
- Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia
| | | | - Khalid Gufran
- Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia
- Correspondence:
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Techniques and Materials for Treatment of Bone
Loss Due to Periodontitis: A Review. JOURNAL OF RESEARCH IN DENTAL AND MAXILLOFACIAL SCIENCES 2022. [DOI: 10.52547/jrdms.7.3.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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The predictive performance of surgical treatment in upper molars with combined bony defect and furcation involvement: a retrospective cohort study. BMC Oral Health 2022; 22:156. [PMID: 35524218 PMCID: PMC9074367 DOI: 10.1186/s12903-022-02196-0] [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: 02/03/2022] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the impact of combined defects, bony destruction and furcation involvement, on disease resolution after surgery in terms of pocket elimination, absence of inflammation, furcation improvement and predictive performance. METHODS Combined bony (intrabony (+) or (-)) and furcation defects (FI degree 1 or 2) at maxillary molars in patients diagnosed as periodontitis stage III to IV, being through periodontal surgery and at least 6 months follow-up were retrospectively screened. Cumulative predictability (CR, %), failure of treatment and the change of clinical parameters from baseline at pre-operative visit to the latest maintenance care, including pocket depth (PD), horizontal and vertical furcation involvement (FI) were analyzed. Failure of treatment with low predictability was defined as residual PD > 4 mm with bleeding on probing during maintenance period. RESULTS Thirty-three patients with fifty-one combined defects were included. Statistical analysis showed significant overall PD reduction and FI improvement (p < 0.001). Combined FI degree 2 with intrabony (+) defects revealed more horizontal furcation improvement compared with FI degree 2 with suprabony defect (p = 0.007). However, type of combined defects was not relevant to CR (p = 0.702) and PD reduction (p = 0.707). Among all parameters, baseline PD with proximal FI degree 2 was indicated to failure of treatment. CONCLUSIONS Different types of combined defects, deep baseline pocket and proximal FI degree 2 would compromise the predictability of treatment outcomes in upper molars. Nevertheless, the combination of surgical treatment and strict maintenance care could still yield high predictability and survival rate. TRIAL REGISTRATION retrospectively registered.
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Georgiou GO, Tarallo F, Marchetti E, Bizzarro S. Overview of the Effect of Different Regenerative Materials in Class II Furcation Defects in Periodontal Patients. MATERIALS 2022; 15:ma15093194. [PMID: 35591533 PMCID: PMC9103580 DOI: 10.3390/ma15093194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/14/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022]
Abstract
The aim of this review was to give an overview of the outcomes of the use of different regenerative materials to treat molars with class II furcation defects in patients with periodontitis in comparison with open flap debridement (OFD). A search of five databases (PubMed-Medline, Embase, Cochrane, Scopus and Web of Science) was conducted up to and including January 2022. According to the PICOS guidelines, only randomized control trials (S) considering periodontal patients with at least one molar with a class II furcation involvement (P) treated with regenerative materials (I) in comparison to OFD as control treatment (C) and a minimum follow-up period of 6 months were included. Vertical clinical attachment level (VCAL) was considered as the primary outcome (O), while horizontal clinical attachment level (HCAL), horizontal probing depth (HPD) and vertical probing depth (VPD) were considered as secondary outcomes. The search through the databases initially identified 1315 articles. Only 25 of them met the eligibility criteria and were included. The studies were grouped in four macro-categories according to the material used: absorbable and non-absorbable membranes, blood derivatives and a combination of different materials. The greater part of the included studies reported a statistically significant difference in using regenerative materials when compared to OFD. The blood derivatives groups reported a range of mean changes in VCAL of 0.86–4.6 mm, absorbable membrane groups reported −0.6–3.75 mm, non-absorbable membranes groups reported −2.47–4.1 mm, multiple materials groups reported −1.5–4.87 mm and enamel matrix derivatives reported a mean change in VCAL of 1.45 mm. OFD showed a range of mean VCAL changes of −1.86–2.81 mm. Although no statistical analysis was performed, the use of regenerative materials may be considered moderately beneficial in the treatment of molars with grade II furcation involvement. However, the substantial heterogeneity in the protocols’ design does not allow us to draw definitive conclusions. In addition, low levels of evidence for morbidity and patient-centered outcomes were reported.
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Affiliation(s)
- Gerasimos Odysseas Georgiou
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, 1081 LA Amsterdam, The Netherlands; (G.O.G.); (S.B.)
| | - Francesco Tarallo
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Coppito, 67100 L’Aquila, Italy;
| | - Enrico Marchetti
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Coppito, 67100 L’Aquila, Italy;
- Correspondence:
| | - Sergio Bizzarro
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, 1081 LA Amsterdam, The Netherlands; (G.O.G.); (S.B.)
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30
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Enamel matrix derivative as adjunctive to non-surgical periodontal therapy: a systematic review and meta-analysis of randomized controlled trials. Clin Oral Investig 2022; 26:4263-4280. [PMID: 35389113 PMCID: PMC9203394 DOI: 10.1007/s00784-022-04474-1] [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: 02/01/2022] [Accepted: 03/22/2022] [Indexed: 11/24/2022]
Abstract
Objectives To assess the potential additional benefit of the local application of enamel matrix derivative (EMD) on the clinical outcomes following non-surgical periodontal therapy (NSPT) (steps 1 and 2 periodontal therapy). Materials and Methods A systematic literature search was performed in several electronic databases, including Medline/PubMed, Embase, The Cochrane Register of Central Trials (CENTRAL), LILACS, and grey literature. Only randomized controlled clinical trials (RCTs) were eligible for inclusion. Clinical attachment level (CAL) change (primary outcome), probing pocket depth (PPD), and bleeding on probing (BoP) reductions (secondary outcomes) were evaluated. The Cochrane Risk of Bias tool (RoB 2.0) was used to assess the quality of the included trials. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) between test and control sites were estimated using a random-effect model for amount of mean CAL and PPD change. Results Six RCTs were included for the qualitative analysis, while data from 4 studies were used for meta-analysis. Overall analysis of CAL gain (3 studies) and PPD reduction (4 studies) presented WMD of 0.14 mm (p = 0.74; CI 95% − 0.66; 0.94) and 0.46 mm (p = 0.25; CI 95% − 0.33; 1.26) in favor of NSPT + EMD compared to NSPT alone respectively. Statistical heterogeneity was found to be high in both cases (I2 = 79% and 87%, respectively). Conclusions Within their limitations, the present data indicate that the local application of EMD does not lead to additional clinical benefits after 3 to 12 months when used as an adjunctive to NSPT. However, due to the high heterogeneity among the studies, additional well-designed RCTs are needed to provide further evidence on this clinical indication for the use of EMD. Clinical relevance The adjunctive use of EMD to NSPT does not seem to additionally improve the clinical outcomes obtained with NSPT alone. Supplementary Information The online version contains supplementary material available at 10.1007/s00784-022-04474-1.
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Huang HL, Ma YH, Tu CC, Chang PC. Radiographic Evaluation of Regeneration Strategies for the Treatment of Advanced Mandibular Furcation Defects: A Retrospective Study. MEMBRANES 2022; 12:membranes12020219. [PMID: 35207140 PMCID: PMC8880529 DOI: 10.3390/membranes12020219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 01/30/2022] [Accepted: 02/09/2022] [Indexed: 01/10/2023]
Abstract
Teeth with furcation involvement (FI) present a higher risk of loss and are difficult to maintain. This study evaluated the efficacy of furcation defect regeneration (FDR) as a regeneration strategy. Pre-operative and 6-month postoperative radiographs were collected from patients receiving regeneration therapy for mandibular teeth with degree II and early degree III FI. The linear furcation involvement (LFI), ratio of LFI (RLI), LFI and RLI adjusted bythe alveolar bone crest (ABC), and radiographic intensity were assessed. The effects of demographic characteristics, regeneration treatment strategies, the relationship between furcation and ABC, and adjacent intrabony defect regeneration (AIDR) were evaluated using a generalized linear model and logistic regression. The results demonstrated that 1.5 mm adjusted LFI and 40% adjusted RLI were achieved in both pure furcation defects and combined furcation–angular defects by the combination of bone replacement grafts (BRG) and enamel matrix derivatives (EMD) or collagen membrane (CM); deproteinized bovine bone matrix (DBBM) showed a superior outcome among BRG. In combined furcation–angular defects, EMD appeared more beneficial than CM, and AIDR significantly promoted adjusted LFI and RLI. In conclusion, DBBM with EMD or CM was effective for FDR, and AIDR had a positive effect on FDR in the combined furcation–angular defect.
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Affiliation(s)
- Hsiang-Ling Huang
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei 10048, Taiwan; (H.-L.H.); (C.-C.T.)
- Department of Dentistry, National Taiwan University Hospital, Taipei 10048, Taiwan;
| | - Yun-Han Ma
- Department of Dentistry, National Taiwan University Hospital, Taipei 10048, Taiwan;
| | - Che-Chang Tu
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei 10048, Taiwan; (H.-L.H.); (C.-C.T.)
- Department of Dentistry, National Taiwan University Hospital, Taipei 10048, Taiwan;
| | - Po-Chun Chang
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei 10048, Taiwan; (H.-L.H.); (C.-C.T.)
- Department of Dentistry, National Taiwan University Hospital, Taipei 10048, Taiwan;
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Correspondence:
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Huidrom E, Srivastava V, Meenawat A, Srivastava A, Khan Y, Shahni R. Evaluation of the efficacy of concentrated growth factor along with bovine-derived xenograft and collagen membrane in the treatment of Degree II mandibular molar furcation defect – A clinicoradiographic study. J Indian Soc Periodontol 2022; 26:130-136. [PMID: 35321290 PMCID: PMC8936011 DOI: 10.4103/jisp.jisp_44_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 07/18/2021] [Accepted: 08/01/2021] [Indexed: 11/28/2022] Open
Abstract
Background: The ultimate goal of furcation defect therapy is furcation closure via periodontal regeneration. However, the process of periodontal regeneration is affected by the regenerative environment of signaling molecules and growth factors due to which consistent findings of complete furcation closure could not be attained. In this study, we have evaluated the use of concentrated growth factor (CGF) which provides sustained release growth factors in conjunction with bovine-derived xenograft anorganic bovine bone (ABB) in guided tissue regeneration (GTR) of Degree II mandibular molar furcation defect. Materials and Methods: Twenty patients with Degree II mandibular molar furcation defects were selected for the study. Each group consisted of 10 patients and a total of 10 sites were treated in each group. The control sites were treated with GTR and ABB, while the experimental sites received CGF mixed with ABB along with GTR. Clinical parameters recorded were Plaque Index, Gingival Index, vertical probing depth, and horizontal probing depth measured at baseline and 6 months. Radiographic parameters such as the vertical height of defect, horizontal depth of defect, and percentage of vertical and horizontal bone fill were recorded at baseline and 6 months. Results: All the parameters recorded showed a significant reduction from baseline to 6 months in both the groups. Significantly higher vertical and horizontal bone fill was observed in the experimental group as compared to the control group. Conclusion: The use of CGF showed a positive additive efficacy in enhancing the events of periodontal regeneration in the treatment of Degree II mandibular molar furcation defect.
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Nibali L, Buti J, Barbato L, Cairo F, Graziani F, Jepsen S. Adjunctive Effect of Systemic Antibiotics in Regenerative/Reconstructive Periodontal Surgery-A Systematic Review with Meta-Analysis. Antibiotics (Basel) 2021; 11:antibiotics11010008. [PMID: 35052886 PMCID: PMC8772828 DOI: 10.3390/antibiotics11010008] [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: 10/30/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 11/27/2022] Open
Abstract
Background and Objective: Systemic antibiotics (AB) are often used in conjunction with regenerative/reconstructive periodontal surgery of intrabony defects and furcations; however, their potential benefits have not been systematically assessed. Materials and Methods: Data were retrieved from two recent systematic reviews (a total of 105 randomized clinical trials (RCTs) on clinical and radiographic outcomes in intrabony defects (ID) and molars with furcation involvement (FI) treated by surgical access with regenerative techniques. Pair-wise meta-analysis of RCTs with and without AB was performed. Meta-regressions from single-arm (subgroup) RCTs including study arms with or without adjunctive AB were also conducted. Results: No statistically significant benefits of systemic AB with regard to PPD, CAL and bone gain were detected in ID by pair-wise meta-analysis. Meta-regression revealed increased PPD reduction (−0.91 mm, 95% CI = −1.30; −0.51, p < 0.001), CAL gain (−0.92 mm, 95% CI = −1.32; −0.52, p < 0.001) and bone gain (−1.08 mm, 95% CI = −1.63; −0.53, p < 0.001) in ID but not in any of the outcomes in FI for arms treated with AB vs. study arms treated with no AB. No clear differences in adverse events were detected between AB and non-AB groups. Conclusion: There is only weak indirect evidence that AB may provide additional benefits in terms of clinical improvements in the regenerative/reconstructive periodontal surgery of intrabony defects and no evidence for a benefit in furcations. Until new data are gained and in the context of antibiotic stewardship, it may be questionable to justify the adjunctive use of systemic antibiotics.
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Affiliation(s)
- Luigi Nibali
- Periodontology Unit, Centre for Host Microbiome Interactions, King’s College London, London SE1 9RT, UK
- Correspondence:
| | - Jacopo Buti
- Periodontology Department, UCL Eastman Dental Institute, University College London, London WC1E 6BT, UK;
| | - Luigi Barbato
- Research Unit in Periodontology and Periodontal Medicine, Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy; (L.B.); (F.C.)
| | - Francesco Cairo
- Research Unit in Periodontology and Periodontal Medicine, Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy; (L.B.); (F.C.)
| | - Filippo Graziani
- Unit of Dentistry and Oral Surgery, Department of Surgical, Medical and Molecular Pathology and CriticalCare Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Søren Jepsen
- Department of Periodontology, Operative & Preventive Dentistry, University Hospital Bonn, 53127 Bonn, Germany;
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Serroni M, Paolantonio M, Romano L, Santamaria P, Rexhepi I, Sinjari B, Paolantonio G, Secondi L, De Ninis P, Femminella B. The added benefit of L-PRF to autogenous bone grafts in the treatment of degree II furcation involvement in mandibular molars. J Periodontol 2021; 93:1486-1499. [PMID: 34910825 DOI: 10.1002/jper.21-0369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Tissue regeneration within the periodontally involved furcation area is one of the most challenging aspects of periodontal surgery. The aim of this study was to evaluate the additional benefit of leukocyte and platelet-rich fibrin (L-PRF) to autogenous bone grafts (ABGs) in the treatment of mandibular molar degree II furcation involvement, comparing the clinical outcomes with those from open flap debridement (OFD)+ABG and OFD alone treatments. METHODS Fifty-four patients, exhibiting one buccal or lingual mandibular molar furcation defect, were randomly assigned to three treatment groups: OFD+ABG+L-PRF(n = 18); OFD+ABG (n = 18); and OFD (n = 18). Clinical [probing pocket depth (PPD), horizontal clinical attachment level (HCAL), vertical clinical attachment level (VCAL), gingival recession (GR)] and radiographic [vertical bone level (VBL)] parameters were evaluated at baseline and 6 months after treatment. HCAL change was the primary outcome. RESULTS No significant differences within each group were reported for GR changes, but statistically significant improvements in HCAL, VCAL, PPD and VBL were observed in all groups, except for VBL in the OFD group. At 6 months, the mean HCAL gain was 2.29±0.18 mm in the OFD+ABG+L-PRF group, which was significantly greater than that in the OFD+ABG (1.61±0.18 mm) and OFD (0.86±0.18 mm) groups. Both OFD+ABG+L-PRF and OFD+ABG therapies produced a significantly greater clinical and radiographic improvement than OFD. CONCLUSION The addition of L-PRF to ABG produces a significantly greater HCAL gain and PPD reduction as compared to OFD+ABG treatment in mandibular degree II furcation involvements. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Matteo Serroni
- Department of Innovative Technologies in Medicine and Dentistry, "G. D'Annunzio" University, Chieti-Pescara, Italy
| | - Michele Paolantonio
- Department of Innovative Technologies in Medicine and Dentistry, "G. D'Annunzio" University, Chieti-Pescara, Italy
| | - Luigi Romano
- Department of Innovative Technologies in Medicine and Dentistry, "G. D'Annunzio" University, Chieti-Pescara, Italy
| | - Pasquale Santamaria
- Department of Innovative Technologies in Medicine and Dentistry, "G. D'Annunzio" University, Chieti-Pescara, Italy
| | - Imena Rexhepi
- Department of Innovative Technologies in Medicine and Dentistry, "G. D'Annunzio" University, Chieti-Pescara, Italy
| | - Bruna Sinjari
- Department of Innovative Technologies in Medicine and Dentistry, "G. D'Annunzio" University, Chieti-Pescara, Italy
| | - Giulia Paolantonio
- Department of Innovative Technologies in Medicine and Dentistry, "G. D'Annunzio" University, Chieti-Pescara, Italy
| | - Lorenzo Secondi
- Department of Surgical Science, Plastic and Reconstructive Surgery, Tor Vergara University, Rome, Italy
| | - Paolo De Ninis
- "Luisa D'Annunzio" Institute for High Culture, Pescara, Italy
| | - Beatrice Femminella
- Department of Innovative Technologies in Medicine and Dentistry, "G. D'Annunzio" University, Chieti-Pescara, Italy
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Cirelli JA, Fiorini T, Moreira CHC, Molon RSD, Dutra TP, Sallum EA. Periodontal regeneration: is it still a goal in clinical periodontology? Braz Oral Res 2021; 35:e09. [PMID: 34586211 DOI: 10.1590/1807-3107bor-2021.vol35.0097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/31/2021] [Indexed: 11/22/2022] Open
Abstract
In the last decades, Periodontal Regeneration has been one of the most discussed topics in Periodontics, attracting the attention of researchers and clinicians. This can be justified by the evident and continuous progress observed in the field, characterized by a better understanding of the biological mechanisms involved, significant improvement of operative and technical principles, and the emergence of a wide range of biomaterials available for this purpose. Together, these aspects put the theme much in evidence in the search for functional and esthetic therapeutic solutions for periodontal tissue destruction. Despite the evident evolution, periodontal regeneration may be challenging and require the clinician to carefully evaluate each case before making a therapeutic decision. With a critical reassessment of the clinical and preclinical literature, the present study aimed to discuss the topic to answer whether Periodontal Regeneration is still a goal in clinical periodontology. The main aspects involved in the probability of success or failure of regenerative approaches were considered. A greater focus was given to intrabony and furcation defects, clinical conditions with greater therapeutic predictability. Aspects such as more appropriate materials/approaches, long-term benefits and their justification for a higher initial cost were discussed for each condition. In general, deep intrabony defects associated with residual pockets and buccal/lingual class II furcation lesions have predictable and clinically relevant results. Careful selection of the case (based on patient and defect characteristics) and excellent maintenance are essential conditions to ensure initial and long-term success.
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Affiliation(s)
- Joni Augusto Cirelli
- Universidade Estadual Paulista - Unesp, School of Dentistry at Araraquara, Department of Diagnosis and Surgery, Araraquara, SP, Brazil
| | - Tiago Fiorini
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Department of Conservative Dentistry, Porto Alegre, RS, Brazil
| | - Carlos Heitor Cunha Moreira
- Universidade Federal de Santa Maria - UFSM, School of Dentistry, Department of Stomatology, Santa Maria, RS, Brazil
| | - Rafael Scaf de Molon
- Universidade Estadual Paulista - Unesp, School of Dentistry at Araraquara, Department of Diagnosis and Surgery, Araraquara, SP, Brazil
| | - Tamires Pereira Dutra
- Universidade Estadual de Campinas - Unicamp, Piracicaba Dental School - Department of Prosthodontics and Periodontics, Piracicaba, SP, Brazil
| | - Enílson Antonio Sallum
- Universidade Estadual de Campinas - Unicamp, Piracicaba Dental School - Department of Prosthodontics and Periodontics, Piracicaba, SP, Brazil
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Eickholz P, Runschke M, Dannewitz B, Nickles K, Petsos H, Kronsteiner D, Pretzl B. Long-term prognosis of teeth with class III furcation involvement. J Clin Periodontol 2021; 48:1528-1536. [PMID: 34545596 DOI: 10.1111/jcpe.13551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/16/2021] [Accepted: 09/08/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Evaluation of survival of teeth with class III furcation involvement (FI) ≥5 years after active periodontal treatment (APT) and identification of prognostic factors. METHODS All charts of patients who completed APT at the Department of Periodontology of Goethe-University Frankfurt, Germany, beginning October 2004 were screened for teeth with class III FI. APT had to be accomplished for ≥5 years. Charts were analysed for data of class III FI teeth at baseline (T0), at accomplishment of APT (T1), and at the last supportive periodontal care (T2). Baseline radiographic bone loss (RBL) and treatment were assessed. RESULTS One-hundred and sixty patients (age: 54.4 ± 9.8 years; 82 females; 39 active smokers; 9 diabetics, 85 stage III, 75 stage IV, 59 grade B, 101 grade C) presented 265 teeth with class III FI. Ninety-eight teeth (37%) were lost during 110, 78/137 (median, lower/upper quartile) months. Logistic mixed-model regression and mixed Cox proportional hazard model associated adjunctive systemic antibiotics with fewer tooth loss (26% vs. 42%; p = .019/.004) and RBL (p = .014/.024) and mean probing pocket depth (PPD) at T1 (p < .001) with more tooth loss. CONCLUSIONS Subgingival instrumentation with adjunctive systemic antibiotics favours retention of class III furcation-involved teeth. Baseline RBL and PPD at T1 deteriorate long-term prognosis.
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Affiliation(s)
- Peter Eickholz
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Maren Runschke
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Bettina Dannewitz
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Katrin Nickles
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Hari Petsos
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Dorothea Kronsteiner
- Institute of Medical Biometry and Informatics (IMBI), University Hospital Heidelberg, Heidelberg, Germany
| | - Bernadette Pretzl
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, Heidelberg, Germany
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Nibali L, Shemie M, Li G, Ting R, Asimakopoulou K, Barbagallo G, Lee R, Eickholz P, Kocher T, Walter C, Aimetti M, Rüdiger S. Periodontal furcation lesions: A survey of diagnosis and management by general dental practitioners. J Clin Periodontol 2021; 48:1441-1448. [PMID: 34472119 DOI: 10.1111/jcpe.13543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/19/2021] [Indexed: 12/27/2022]
Abstract
AIM The aim of this study was to explore general dental practitioners' (GDPs) attitude to periodontal furcation involvement (FI). MATERIALS AND METHODS An online survey focused on diagnosis and management of periodontal FI was circulated to GDPs in seven different countries. RESULTS A total of 400 responses were collected. Nearly a fifth of participants reported rarely or never taking 6-point pocket charts; 65.8% of participants had access to a Nabers probe in their practice. When shown clinical pictures and radiographs of FI-involved molars, the majority of participants correctly diagnosed it. Although 47.1% of participants were very/extremely confident in detecting FI, only 8.9% felt very/extremely confident at treating it. Differences in responses were detected according to country and year of qualification, with a trend towards less interest in periodontal diagnosis and treatment in younger generations. Lack of knowledge of management/referral pathways (reported by 22.8%) and lack of correct equipment were considered the biggest barriers to FI management. Most participants (80.9%) were interested in learning more about FI, ideally face to face followed by online tutorials. CONCLUSIONS Plans should be put in place to improve general dentists' knowledge and ability to manage FI, as this can have a significant impact on public health.
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Affiliation(s)
- Luigi Nibali
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Melissa Shemie
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Guanhong Li
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Rachel Ting
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Koula Asimakopoulou
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Giovanni Barbagallo
- Department of General Surgery and Surgical-Medical Specialties, University of Catania, Catania, Italy
| | - Ryan Lee
- School of Dentistry, University of Queensland, Brisbane, Australia
| | - Peter Eickholz
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt am Main, Frankfurt, Germany
| | - Thomas Kocher
- Department of Periodontology, University of Greifswald, Greifswald, Germany
| | - Clemens Walter
- Department of Periodontology, Endodontology and Cariology, University of Basel, Basel, Switzerland
| | - Mario Aimetti
- Department of Periodontology, University of Torino, Turin, Italy
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Guided Tissue Regeneration Treatment Yields Better Results in Class II Furcations in the Mandible Than in the Maxilla: A Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147447. [PMID: 34299898 PMCID: PMC8303943 DOI: 10.3390/ijerph18147447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/29/2021] [Accepted: 07/07/2021] [Indexed: 02/05/2023]
Abstract
Absorbable porcine collagen membrane with a bovine bone graft can be considered for regenerative treatment in periodontal class II furcation defects. We evaluated the clinical efficacy of guided tissue regeneration (GTR) treatment with bovine bone xenograft and a porcine collagen membrane in molars with class II furcations. Probing depth (PD), clinical attachment level (CAL), and bone level (BL) were recorded at baseline and at 3, 6, and 9 months postoperatively. Thirty class II furcation defects from the lower and upper molars were assessed. Significant improvements in PD and CAL were observed from baseline to 9 months in all groups (p < 0.01). BL improved in all groups except group A in the upper molars in radiographic assessment (p < 0.05). The lower and upper molars showed PD reduction of 50.5% ± 7.44% and 46.2% ± 11.2%, respectively, at 9 months (p = 0.044). In furcations of 1–3 mm, the lower and upper molars showed PD reductions of 51.2% ± 4.49% and 36.5% ± 16.14%, respectively (p = 0.035). The lower and upper molars showed a CAL gain of 51.1% ± 4.64% and 33.6% ± 18.8%, respectively (p = 0.037). Thus, GTR with bovine bone graft and porcine collagen membrane yielded good results in class II furcations, with better results in the lower than in the upper molars.
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[Periodontitis-therapy of a widespread disease]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:931-940. [PMID: 34236451 PMCID: PMC8264996 DOI: 10.1007/s00103-021-03373-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/08/2021] [Indexed: 01/19/2023]
Abstract
Parodontitis ist eine chronisch entzündliche nichtübertragbare Erkrankung, die alle Anteile des Zahnhalteapparates (Parodonts) betrifft und dort weitgehend irreversible Schäden verursacht. Schätzungen legen nahe, dass in Deutschland ca. 10 Mio. Menschen an einer schweren Parodontitis erkrankt sind. Parodontitis zeigt über viele Jahre zumeist wenige oder nur milde Symptome, die von den Patienten oft nicht wahrgenommen oder richtig eingeordnet werden. Fehlendes Bewusstsein kann dazu führen, dass zahnärztliche Behandlung erst in einem fortgeschrittenen Erkrankungsverlauf in Anspruch genommen wird, wenn umfangreiche Therapiemaßnahmen notwendig geworden sind und sich die Prognose für den Erhalt der Zähne verschlechtert hat. Der parodontale Screeningindex (PSI) ist ein einfaches und schnelles Instrument, mit dem die Notwendigkeit weiterführender diagnostischer Maßnahmen beurteilt werden kann. Der Index wird mittlerweile bei vielen Patienten durchgeführt. Trotzdem bleiben die Versorgungszahlen niedrig und hinter dem zurück, was für das Absenken der bestehenden Parodontitislast notwendig wäre. Jede Zahnarztpraxis muss in der Lage sein, Parodontitistherapie umzusetzen. Fachzahnärzte oder Spezialisten können die allgemeinzahnärztlichen Kollegen wesentlich bei der Behandlung von schweren Formen von Parodontitis unterstützen. Dazu ist eine Aufwertung des Faches in der universitären Ausbildung erforderlich, aber auch die zunehmende postgraduale Ausdifferenzierung von Spezialisten oder Fachzahnärzten für Parodontologie. Die neuen Behandlungsrichtlinien für die Parodontaltherapie (PAR-Therapie) erlauben die Versorgung der parodontal erkrankten Patienten auf Basis international anerkannter wissenschaftlicher Standards und verbessern damit die Rahmenbedingungen für die Parodontitistherapie in der zahnärztlichen Praxis.
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Jentsch HFR, Roccuzzo M, Pilloni A, Kasaj A, Fimmers R, Jepsen S. Flapless application of enamel matrix derivative in periodontal retreatment: A multicentre randomized feasibility trial. J Clin Periodontol 2021; 48:659-667. [PMID: 33529381 DOI: 10.1111/jcpe.13438] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/04/2021] [Accepted: 01/26/2021] [Indexed: 01/16/2023]
Abstract
AIM To investigate the potential benefit of enamel matrix derivative (EMD) as adjunct to re-instrumentation of residual pockets persisting after steps 1 and 2 of periodontal therapy. MATERIAL AND METHODS 44 adult patients participated in a multicentre feasibility randomized clinical trial with split-mouth design. They had presented at re-evaluation after initial non-surgical periodontal therapy (steps 1 and 2 of periodontal therapy) for generalized periodontitis with at least 2 teeth with residual probing pocket depths (PPD) ≥5 and ≤8 mm, with bleeding on probing (BOP). Two teeth with similar PPD were randomized to receive re-instrumentation either with (test) or without (control) adjunctive flapless administration of EMD. Differences in the changes of PPD and BOP from baseline to 6 and 12 months were analysed, and the frequencies of pocket closure (PPD ≤4 mm and no BOP) compared. RESULTS For the primary outcome "change of mean PPD after 6 months," a significant additional benefit of 0.79 ± 1.3 mm (p < .0001) could be observed for the test group. At 12 months, this difference could be maintained (0.85 ± 1.1 mm; p < .0001). The frequency of pocket closure in the test group was 69% at 6 and 80% at 12 months and significantly higher than in the control group with 34% and 42%, respectively (p < .01). CONCLUSIONS The results of the present feasibility study indicate a benefit of adjunctive EMD during non-surgical retreatment (step 3 of periodontal therapy) of residual deep pockets.
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Affiliation(s)
- Holger F R Jentsch
- Centre of Periodontology, Department for Cariology, Endodontology and Periodontology, University Hospital of Leipzig, Leipzig, Germany
| | | | - Andrea Pilloni
- Sapienza, Department of Dental and Maxillo-Facial Sciences - Section of Periodontology, University of Rome, Rome, Italy
| | - Adrian Kasaj
- Department of Periodontology and Conservative Dentistry, University of Mainz, Mainz, Germany
| | - Rolf Fimmers
- Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
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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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GTR Treatment in Furcation Grade II Periodontal Defects with the Recently Reintroduced Guidor PLA Matrix Barrier: A Case Series with Chronological Step-by-Step Illustrations. Case Rep Dent 2020; 2020:8856049. [PMID: 33381325 PMCID: PMC7758137 DOI: 10.1155/2020/8856049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 01/19/2023] Open
Abstract
Molars with a furcation involvement (FI) exceeding grade 1 according to Hamp's classification are at approximately doubled risk of tooth loss. Guided tissue regeneration (GTR) is a regenerative approach in the treatment of periodontal defects and is aimed at achieving new clinical attachment formation. The aim of this case series was to assess the efficacy of a newly reintroduced polylactic acid (PLA) matrix barrier and to evaluate the feasibility of the surgical approach. 11 patients with an average age of 58.7 years were treated with GTR using a PLA matrix barrier. Patients were instructed not to brush and chew on the treated side for 4 weeks. A gentle clinical probing was performed after 6 months for the first time after surgery. The patients were included into individual maintenance program at three months' interval. The clinical improvement was expressed by reduced horizontal penetration of the probe accompanied by vast resolution of the vertical defect component. The change from grade II to grade I or complete resolution of the FI could be seen in 8 from 11 sites included. The newly reintroduced PLA matrix barrier showed promising results after a 12-month observation period with clinical attachment gain.
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Evidence-based, personalised and minimally invasive treatment for periodontitis patients - the new EFP S3-level clinical treatment guidelines. Br Dent J 2020; 229:443-449. [PMID: 33037364 DOI: 10.1038/s41415-020-2173-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/21/2020] [Indexed: 12/20/2022]
Abstract
The 2017 international classification system for periodontal diseases characterises periodontitis patients based upon disease extent, severity and past experience, and in stage IV includes a treatment complexity component. In addition, taking into account well-established risk factors, it aims to estimate the risk for future attachment loss. This classification system draws upon current understanding of disease pathobiology and reflects the complex, multifactorial nature of the periodontitis. It also acknowledges individual patients' risk profiles.Classification and diagnosis are distinct but linked entities, and the inclusion of established risk factors in the system helps signpost the clinician and patient towards a more personalised approach to care provision. The European Federation of Periodontology (EFP) has recently developed an S3-level clinical treatment guideline for stages I to III periodontitis, based upon a rigorous standardised process involving 15 systematic reviews of current evidence and their synthesis by a representative group of experts and stakeholders. The aim is to guide the practitioner through the complex plethora of periodontal management options and to facilitate pragmatic decision-making in full knowledge of the evidence base.Here, we present the structured, stepwise treatment protocols developed by the EFP guideline group and highlight selected specific clinical recommendations. The adapted guidelines for the UK healthcare system will be published in early 2021.
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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: 592] [Impact Index Per Article: 148.0] [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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Jepsen K, Dommisch E, Jepsen S, Dommisch H. Vital root resection in severely furcation-involved maxillary molars: Outcomes after up to 7 years. J Clin Periodontol 2020; 47:970-979. [PMID: 32412133 DOI: 10.1111/jcpe.13306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 04/27/2020] [Accepted: 05/04/2020] [Indexed: 12/20/2022]
Abstract
AIMS To introduce a novel therapeutic approach for the treatment of furcation-involved maxillary molars by vital root resection and report longer-term outcomes of a case series. METHODS Eleven patients with 15 maxillary molars affected by double/triple class II (n = 10) or single/double class III (n = 5) furcation defects and advanced vertical bone loss around one root participated. Teeth were treated with deep pulpotomy using a calcium silicate-based cement. After 4 weeks, the affected roots were removed by periodontal microsurgery and processed for histological evaluation of the pulp. All patients were enrolled into a supportive periodontal care programme. During the follow-up period, assessments of tooth sensitivity, response to percussion, mobility, pocket probing depth (PPD) and bleeding on probing (BOP) were made, periapical radiographs obtained and patient-reported outcomes collected. RESULTS All teeth remained sensitive to pulp testing. After 1 year and 3-7 years of follow-up, PD was ≤5 mm at all resected teeth. Furcation status was much improved. Neither increasing mobility nor clinical or radiographic signs of periapical pathology were observed throughout the individual observation period. All patients were pleased with the result of therapy. Histologic sections revealed a functional dentin-pulp complex. CONCLUSIONS This case series demonstrates the possibility of maintaining severely furcation-involved molars by vital root resection for up to 7 years. Root canal therapy and its associated costs and complications can thus be avoided.
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Affiliation(s)
- Karin Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | | | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Henrik Dommisch
- Department of Periodontology and Synoptic Dentistry, Universitätsmedizin Berlin, Berlin, Germany
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