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Chen Z, Lin CY, Wang HL. Patient-reported outcome measures and health economics in regenerative periodontal therapy: A systematic review and meta-analysis. Periodontol 2000 2024. [PMID: 39118280 DOI: 10.1111/prd.12601] [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: 02/10/2024] [Revised: 07/08/2024] [Accepted: 07/26/2024] [Indexed: 08/10/2024]
Abstract
Understanding patient responses to periodontal regeneration is crucial. This systematic review and meta-analysis addressed two key questions: (a) the impact of periodontal regeneration on patient-reported outcome measures (PROMs) for intrabony and furcation involvement and (b) the cost-effectiveness of periodontal regeneration for treating periodontal defects. Twenty-four studies were included, with 20 randomized clinical trials (RCTs) reporting patient-reported outcomes and five (three RCTs and two economic model-based studies) reporting cost-effectiveness outcomes. Results favored regeneration therapy over conventional flap surgery for intrabony defects, showing improvements in qualitative (i.e., amount of regenerated attachment apparatus) and quantitative parameters (i.e., probing and radiographic parameters). In terms of PROMs, regenerative treatments involving barrier membranes resulted in longer chair times and higher rates of complications (such as membrane exposure or edema) compared to flap with biologic agents or access flap alone. Despite this, oral health-related quality of life improved after both regenerative and extraction procedures. Economically, regeneration remained favorable compared to extraction and replacement or open flap debridement alone for periodontal defects. Single-flap variants in open flap debridement yielded similar outcomes to regenerative treatment, offering a potentially cost-effective option. Nevertheless, further discussion on the benefits of less-invasive flap designs is needed due to the lack of histological evaluation.
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Affiliation(s)
- Zhaozhao Chen
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Cho-Ying Lin
- Department of Periodontics, Chang Gung Memorial Hospital, Taipei, Taiwan
- Chang Gung University, Taoyuan city, Taiwan
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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2
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Wang D, Li Q, Xiao C, Wang H, Dong S. Nanoparticles in Periodontitis Therapy: A Review of the Current Situation. Int J Nanomedicine 2024; 19:6857-6893. [PMID: 39005956 PMCID: PMC11246087 DOI: 10.2147/ijn.s465089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/10/2024] [Indexed: 07/16/2024] Open
Abstract
Periodontitis is a disease of inflammation that affects the tissues supporting the periodontium. It is triggered by an immunological reaction of the gums to plaque, which leads to the destruction of periodontal attachment structures. Periodontitis is one of the most commonly recognized dental disorders in the world and a major factor in the loss of adult teeth. Scaling and root planing remain crucial for managing patients with persistent periodontitis. Nevertheless, exclusive reliance on mechanical interventions like periodontal surgery, extractions, and root planning is insufficient to halt the progression of periodontitis. In response to the problem of bacterial resistance, some researchers are committed to finding alternative therapies to antibiotics. In addition, some scholars focus on finding new materials to provide a powerful microenvironment for periodontal tissue regeneration and promote osteogenic repair. Nanoparticles possess distinct therapeutic qualities, including exceptional antibacterial, anti-inflammatory, and antioxidant properties, immunomodulatory capacities, and the promotion of bone regeneration ability, which made them can be used for the treatment of periodontitis. However, there are many problems that limit the clinical translation of nanoparticles, such as toxic accumulation in cells, poor correlation between in vitro and in vivo, and poor animal-to-human transmissibility. In this paper, we review the present researches on nanoparticles in periodontitis treatment from the perspective of three main categories: inorganic nanoparticles, organic nanoparticles, and nanocomposites (including nanofibers, hydrogels, and membranes). The aim of this review is to provide a comprehensive and recent update on nanoparticles-based therapies for periodontitis. The conclusion section summarizes the opportunities and challenges in the design and clinical translation of nanoparticles for the treatment of periodontitis.
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Affiliation(s)
- Di Wang
- The First Outpatient Department, Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun, 130021, People’s Republic of China
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, People’s Republic of China
| | - Qiqi Li
- The First Outpatient Department, Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun, 130021, People’s Republic of China
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, People’s Republic of China
| | - Chunsheng Xiao
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, People’s Republic of China
| | - Hao Wang
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, People’s Republic of China
| | - Shujun Dong
- The First Outpatient Department, Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun, 130021, People’s Republic of China
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3
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Wang Y, Xia Y, Qian J, Xie Y, Shu R, Lin Z. Native vs. ribosome-crosslinked collagen membranes for periodontal regeneration: A randomized clinical trial. J Periodontal Res 2024. [PMID: 38962931 DOI: 10.1111/jre.13321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 06/18/2024] [Accepted: 06/21/2024] [Indexed: 07/05/2024]
Abstract
AIM To evaluate whether the ribosome-crosslinked collagen membrane (RCCM) is non-inferior to the natural collagen membrane (NCM) used in regeneration surgery in terms of clinical attachment level (CAL) gain at 6 months. METHODS Eighty patients diagnosed as generalized periodontitis presenting with isolated infrabony defect (≥4 mm deep) were enrolled and randomized to receive regenerative surgery, either with NCM or RCCM, both combined with deproteinized bovine bone mineral (DBBM). CAL, pocket probing depth (PPD), and gingival recession (GR) were recorded at baseline, 3, and 6 months postoperatively. Periapical radiographs were taken at baseline, immediately, and 6 months after surgery. Early wound healing index (EHI) and patients' responses were recorded at 2 weeks postoperatively. RESULTS At 6 months post-surgery, the mean CAL gain was 3.1 ± 1.5 mm in the NCM group and 2.9 ± 1.5 mm in the RCCM group, while the mean PPD was 4.3 ± 1.1 mm in the NCM group and 4.2 ± 1.0 mm in the RCCM group. Both groups demonstrated a statistically significant improvement from the baseline (p < .01). RCCM was non-inferior to NCM concerning the primary outcome (CAL gain at 6 months). The GR at 6 months postoperatively was 1.3 ± 1.2 and 1.2 ± 1.1 mm, which showed no difference compared with baseline. At 6 months follow-up, the radiographic linear bone fill (RLBF) was 6.5 ± 2.8 and 5.5 ± 2.6 mm (p > .05), while the bone fill percentage (BF%) was 102.3 ± 53.5% and 92.3 ± 40.1% (p > .05), in the NCM and RCCM groups, respectively. There was no significant difference in EHI and postoperative responses between two groups. CONCLUSION RCCM + DBBM resulted in no-inferior clinical and radiographic outcomes to NCM + DBBM for the treatment of isolated infrabony defect in 6 months.
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Affiliation(s)
- Yiwei Wang
- Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yiru Xia
- Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
- Department of Periodontology, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
| | - Jielei Qian
- Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yufeng Xie
- Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
- Department of Periodontology, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
| | - Rong Shu
- Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Zhikai Lin
- Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
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Ng E, Tay JRH. Periodontal Regeneration of Vital Poor Prognosis Teeth with Attachment Loss Involving the Root Apex: Two Cases with up to 5 Years Follow-Up. Dent J (Basel) 2024; 12:170. [PMID: 38920871 PMCID: PMC11202695 DOI: 10.3390/dj12060170] [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: 04/23/2024] [Revised: 05/23/2024] [Accepted: 05/31/2024] [Indexed: 06/27/2024] Open
Abstract
Teeth with attachment loss involving the root apex are severely compromised and have a poor periodontal prognosis. In cases where periodontal regeneration is possible, current guidelines suggest that endodontic treatment is performed first. However, root canal treatment increases the overall treatment time and costs, has risks of endodontic complications, and could predispose teeth to mechanical failure. In this case report, two patients diagnosed with periodontitis stage III/IV grade C, no history of smoking or diabetes, and attachment loss involving the root apex of a tooth, were treated with guided tissue regeneration. These two cases are unique because successful periodontal regeneration was carried out without endodontic treatment, and the vitality of these teeth was maintained longitudinally. This report presents the management that led to this clinical outcome, and important guidelines for case selection are identified. Within the limitations of this study, vital teeth with radiographic bone loss involving the apex may be treated successfully with periodontal regeneration and remain vital at least in the short- to medium-term.
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Affiliation(s)
- Ethan Ng
- Department of Restorative Dentistry, National Dental Centre Singapore, 5 Second Hospital Ave, Singapore 168938, Singapore;
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Orishko A, Imber JC, Roccuzzo A, Stähli A, Salvi GE. Tooth- and implant-related prognostic factors in treatment planning. Periodontol 2000 2024; 95:102-128. [PMID: 39234949 DOI: 10.1111/prd.12597] [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: 02/08/2024] [Revised: 06/21/2024] [Accepted: 07/03/2024] [Indexed: 09/06/2024]
Abstract
Following a comprehensive patient examination, including the assessment of periodontal and peri-implant diseases as well as considering the patient's needs, a pretherapeutic prognosis for each tooth and implant is given. Teeth and implants with a secure pretherapeutic prognosis require simple procedures and may be regarded as secure abutments for function and with a doubtful pretherapeutic prognosis usually need a comprehensive therapy. Such teeth and implants must be brought into the category with a secure prognosis by means of additional therapy such as endodontic, restorative, and surgical procedures. Teeth and implants with a hopeless pretherapeutic prognosis should be extracted/explanted during the initial phase of cause-related therapy (i.e., infection control). For example, teeth with vertical root fracture or unrestorable caries and implants with mobility or unrestorable malposition fall into the category of hopeless units. The primary goal of periodontal and peri-implant therapy should be to arrest disease progression. The latest consensus statement highlights that periodontitis can be successfully controlled and treated teeth can be retained for life. Nevertheless, for patients with uncontrolled contributing factors, the endpoints might not always be achievable, and low disease activity may be an acceptable therapeutic goal. Similarly, the management of peri-implantitis frequently requires surgical intervention following nonsurgical therapy due to incomplete treatment outcomes. Different surgical modalities can be effective and lead to significant improvement; however, achieving complete resolution of peri-implantitis is challenging, not always predictable, and can depend on multiple baseline factors. Therefore, this review aims at summarising available evidence on the rationale for incorporating systemic, lifestyle-related, clinical, and radiographic prognostic factors into treatment planning of patients diagnosed with periodontal and peri-implant diseases.
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Affiliation(s)
- Anastasiya Orishko
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Periodontology Unit, University College London, Eastman Dental Institute, London, UK
| | - Jean-Claude Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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6
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Hsia TL, Lin Z, Xia Y, Shu R, Xie Y. A photoresponsive recombinant human amelogenin-loaded hyaluronic acid hydrogel promotes bone regeneration. J Periodontal Res 2024; 59:589-598. [PMID: 38481308 DOI: 10.1111/jre.13235] [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: 06/26/2023] [Revised: 12/02/2023] [Accepted: 12/25/2023] [Indexed: 05/24/2024]
Abstract
OBJECTIVES In order to evaluate the effect of methacrylated hyaluronic acid (HAMA) hydrogels containing the recombinant human amelogenin (rhAm) in vitro and in vivo. BACKGROUND The ultimate goal in treating periodontal disease is to control inflammation and achieve regeneration of periodontal tissues. In recent years, methacrylated hyaluronic acid (HAMA) containing recombinant human amyloid protein (rhAm) has been widely used as a new type of biomaterial in tissue engineering and regenerative medicine. However, there is a lack of comprehensive research on the periodontal regeneration effects of this hydrogel. This experiment aims to explore the application of photoresponsive recombinant human amelogenin-loaded hyaluronic acid hydrogel for periodontal tissue regeneration and provide valuable insights into its potential use in this field. MATERIALS AND METHODS The effects of rhAm-HAMA hydrogel on the proliferation of human periodontal ligament cells (hPDLCs) were assessed using the CCK-8 kit. The osteogenic differentiation of hPDLCs was evaluated through ALP staining and real-time PCR. Calvarial parietal defects were created in 4-week-old Sprague Dawley rats and implanted with deproteinized bovine bone matrix in different treatment groups. The animals were euthanized after 4 and 8 weeks of healing. The bone volume of the defect was observed by micro-CT and histological analysis. RESULTS Stimulating hPDLCs with rhAm-HAMA hydrogel did not significantly affect their proliferation (p > .05). ALP staining and real-time PCR results demonstrated that the rhAm-HAMA group exhibited a significant upregulation of osteoclastic gene expression (p < .05). Micro-CT results revealed a significant increase in mineralized tissue volume fraction (MTV/TV%), trabecular bone number (Tb.N), and mineralized tissue density (MTD) of the bone defect area in the rhAm-HAMA group compared to the other groups (p < .05). The results of hematoxylin and eosin staining and Masson staining at 8 weeks post-surgery further supported the results of the micro-CT. CONCLUSIONS The results of this study indicate that rhAm-HAMA hydrogel could effectively promote the osteogenic differentiation of hPDLCs and stabilize bone substitutes in the defects that enhance the bone regeneration in vivo.
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Affiliation(s)
- Tung-Liang Hsia
- Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
- Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhikai Lin
- Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yiru Xia
- Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Rong Shu
- Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yufeng Xie
- Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
- Department of Periodontology, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
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7
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Saleh MHA, Dias DR, Kumar P. The economic and societal impact of periodontal and peri-implant diseases. Periodontol 2000 2024. [PMID: 38693603 DOI: 10.1111/prd.12568] [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: 02/01/2024] [Accepted: 03/26/2024] [Indexed: 05/03/2024]
Abstract
Periodontal and peri-implant diseases result from a chronic inflammatory response to dysbiotic microbial communities and are characterized by inflammation in the soft tissue and the ensuing progressive destruction of supporting bone, resulting in tooth or implant loss. These diseases' high prevalence, multifactorial etiology, extensive treatment costs, and significant detriment to patients' quality-of-life underscore their status as a critical public health burden. This review delineates the economic and sociocultural ramifications of periodontal and peri-implant diseases on patient welfare and healthcare economics. We delve into the implications of diagnosis, treatment, supportive care, and managing destructive tissue consequences, contrasting these aspects with healthy patients.
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Affiliation(s)
- Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Debora R Dias
- Department of Dentistry, State University of Maringá, Maringá, Paraná, Brazil
| | - Purnima Kumar
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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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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9
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Davidopoulou S, Karakostas P, Batas L, Barmpalexis P, Assimopoulou A, Angelopoulos C, Tsalikis L. Multidimensional 3D-Printed Scaffolds and Regeneration of Intrabony Periodontal Defects: A Systematic Review. J Funct Biomater 2024; 15:44. [PMID: 38391897 PMCID: PMC10889986 DOI: 10.3390/jfb15020044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/11/2024] [Accepted: 02/14/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The utilization of regenerative techniques in periodontology involves tailoring tissue engineering principles to suit the oral cavity's unique environment. Advancements in computer-assisted technology, specifically utilizing cone beam computed tomography (CBCT), enabled the fabrication of 3D-printed scaffolds. The current review aims to explore whether 3D-printed scaffolds are effective in promoting osteogenesis in patients with periodontal defects. METHODS A thorough exploration was undertaken across seven electronic databases (PubMed, Scopus, ScienceDirect, Google Scholar, Cochrane, Web of Science, Ovid) to detect pertinent research in accordance with specified eligibility criteria, aligning with the PRISMA guidelines. Two independent reviewers undertook the screening and selection of manuscripts, executed data extraction, and evaluated the bias risk using the Newcastle-Ottawa Scale for non-randomized clinical trials and SYRCLE's risk of bias tool for animal studies. RESULTS Initially, 799 articles were identified, refined by removing duplicates. After evaluating 471 articles based on title and abstract, 18 studies remained for full-text assessment. Eventually, merely two manuscripts fulfilled all the eligibility criteria concerning human trials. Both studies were prospective non-randomized clinical trials. Moreover, 11 animal studies were also included. CONCLUSIONS The use of multidimensional, 3D-printed, customized scaffolds appears to stimulate periodontal regeneration. While the reported results are encouraging, additional studies are required to identify the ideal characteristics of the 3D scaffold to be used in the regeneration of periodontal tissue.
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Affiliation(s)
- Sotiria Davidopoulou
- Department of Operative Dentistry, Dental School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Panagiotis Karakostas
- Department of Preventive Dentistry, Periodontology and Implant Biology, Dental School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Leonidas Batas
- Department of Preventive Dentistry, Periodontology and Implant Biology, Dental School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Panagiotis Barmpalexis
- Department of Pharmaceutical Technology, School of Pharmacy, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Andreana Assimopoulou
- Organic Chemistry Lab, School of Chemical Engineering, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Christos Angelopoulos
- Department of Oral Diagnosis & Radiology, School of Dentistry, National and Kapodistrian University of Athens, 10679 Athina, Greece
| | - Lazaros Tsalikis
- Department of Preventive Dentistry, Periodontology and Implant Biology, Dental School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
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10
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Wang Q, Fan R, Zhu Y, Lu X, Xin M, Ding X. Observation on improvement of dental function in patients with dentition defect by dental implant. Minerva Surg 2024; 79:113-115. [PMID: 35420284 DOI: 10.23736/s2724-5691.21.09328-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Qiong Wang
- Department of Stomatology, Second Affiliated Hospital of Bengbu Medical College, Bengbu, China -
| | - Rui Fan
- Department of Stomatology, Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Yongna Zhu
- Department of Stomatology, Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Xiaomiao Lu
- Department of Stomatology, Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Mingming Xin
- Department of Stomatology, First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Xiang Ding
- Department of Stomatology, Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
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11
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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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Monje A, Pons R, Sculean A, Nart J, Wang HL. Defect angle as prognostic indicator in the reconstructive therapy of peri-implantitis. Clin Implant Dent Relat Res 2023; 25:992-999. [PMID: 37405662 DOI: 10.1111/cid.13244] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 06/10/2023] [Accepted: 06/18/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE To analyze the influence of the characteristics of bone defects caused by peri-implantitis on the clinical resolution and radiographic bone gain following reconstructive surgery. METHODS This is a secondary analysis of a randomized clinical trial. Periapical x-rays of bone defects, caused by peri-implantitis exhibiting intrabony component, were analyzed at baseline and 12-month follow-up after reconstructive surgery. Therapy consisted of anti-infective therapy along with a mixture of allografts with or without a collagen barrier membrane. The association of defect configuration, defect angle (DA), defect width (DW), and baseline marginal bone level (MBL) with clinical resolution (based on a prior defined composite criteria) and radiographic bone gain was correlated by means of generalized estimating equations. RESULTS Overall, 33 patients with a total of 48 implants exhibiting peri-implantitis were included. None of the evaluated variables yielded statistical significance with disease resolution. Defect configuration demonstrated statistical significance when compared to class 1B and 3B, favoring radiographic bone gain for the former (p = 0.005). DW and MBL did not demonstrate statistical significance with radiographic bone gain. On the contrary, DA exhibited strong statistical significance with bone gain (p < 0.001) in the simple and multiple logistic regression analyses. Mean DA reported in this study was 40°, and this resulted in 1.85 mm radiographic bone gain. To achieve ≥1 mm of bone gain, DA must be <57°, while to attain ≥2 mm of bone gain, DA must be <30°. CONCLUSION Baseline DA of peri-implantitis intrabony components predicts radiographic bone gain in reconstructive therapy (NCT05282667-this clinical trial was not registered prior to participant recruitment and randomization).
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Affiliation(s)
- Alberto Monje
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Ramón Pons
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - José Nart
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Hom-Lay Wang
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Eggers B, Stope MB, Marciniak J, Mustea A, Eick S, Deschner J, Nokhbehsaim M, Kramer FJ. Non-Invasive Physical Plasma Reduces the Inflammatory Response in Microbially Prestimulated Human Gingival Fibroblasts. Int J Mol Sci 2023; 24:16156. [PMID: 38003346 PMCID: PMC10671174 DOI: 10.3390/ijms242216156] [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: 10/21/2023] [Revised: 11/04/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Non-invasive physical plasma (NIPP), an electrically conductive gas, is playing an increasingly important role in medicine due to its antimicrobial and regenerative properties. However, NIPP is not yet well established in dentistry, although it has promising potential, especially for periodontological applications. The aim of the present study was to investigate the effect of NIPP on a commercially available human gingival fibroblast (HGF) cell line and primary HGFs in the presence of periodontitis-associated bacteria. First, primary HGFs from eight patients were characterised by immunofluorescence, and cell numbers were examined by an automatic cell counter over 5 days. Then, HGFs that were preincubated with Fusobacterium nucleatum (F.n.) were treated with NIPP. Afterwards, the IL-6 and IL-8 levels in the cell supernatants were determined by ELISA. In HGFs, F.n. caused a significant increase in IL-6 and IL-8, and this F.n.-induced upregulation of both cytokines was counteracted by NIPP, suggesting a beneficial effect of physical plasma on periodontal cells in a microbial environment. The application of NIPP in periodontal therapy could therefore represent a novel and promising strategy and deserves further investigation.
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Affiliation(s)
- Benedikt Eggers
- Department of Oral, Maxillofacial and Plastic Surgery, University Hospital Bonn, 53111 Bonn, Germany;
| | - Matthias Bernhard Stope
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, 53127 Bonn, Germany; (M.B.S.); (A.M.)
| | - Jana Marciniak
- Department of Orthodontics, University Hospital Bonn, 53111 Bonn, Germany;
| | - Alexander Mustea
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, 53127 Bonn, Germany; (M.B.S.); (A.M.)
| | - Sigrun Eick
- Department of Periodontology, School of Dental Medicine, University of Bern, 3010 Bern, Switzerland;
| | - James Deschner
- Department of Periodontology and Operative Dentistry, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany;
| | - Marjan Nokhbehsaim
- Section of Experimental Dento-Maxillo-Facial Medicine, University Hospital Bonn, 53111 Bonn, Germany;
| | - Franz-Josef Kramer
- Department of Oral, Maxillofacial and Plastic Surgery, University Hospital Bonn, 53111 Bonn, Germany;
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14
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Rattu V, Raindi D, Antonoglou G, Nibali L. Prevalence of stable and successfully treated periodontitis subjects and incidence of subsequent tooth loss within supportive periodontal care: A systematic review with meta-analyses. J Clin Periodontol 2023; 50:1371-1389. [PMID: 37402624 DOI: 10.1111/jcpe.13835] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 04/24/2023] [Accepted: 05/16/2023] [Indexed: 07/06/2023]
Abstract
AIM To identify (i) the prevalence of meeting the endpoints of 'stable periodontitis' (probing pocket depth [PPD] ≤ 4 mm, bleeding on probing [BoP] < 10%, no BoP at 4 mm sites), 'endpoints of therapy' (no PPD > 4 mm with BoP, no PPD ≥ 6 mm), 'controlled periodontitis' (≤4 sites with PPD ≥ 5 mm), 'PPD < 5 mm' and 'PPD < 6 mm' at the start of supportive periodontal care [SPC]) and (ii) the incidence of tooth loss in relation to not meeting these endpoints within a minimum of 5 years of SPC. MATERIALS AND METHODS Systematic electronic and manual searches were conducted to identify studies where subjects, upon completion of active periodontal therapy, entered into SPC. Duplicate screening was performed to find relevant articles. Corresponding authors were contacted to confirm inclusion and retrieve required clinical data for further analyses to assess the prevalence of reaching endpoints and incidence of subsequent tooth loss, if available, within at least 5 years of SPC. Meta-analyses were carried out to evaluate risk ratios for tooth loss in relation to not reaching the various endpoints. RESULTS Fifteen studies including 12,884 patients and 323,111 teeth were retrieved. Achievement of endpoints at baseline SPC was rare (1.35%, 11.00% and 34.62%, respectively, for 'stable periodontitis', 'endpoints of therapy' and 'controlled periodontitis'). Less than a third of the 1190 subjects with 5 years of SPC data lost teeth-a total of 3.14% of all teeth were lost. Statistically significant associations with tooth loss, at the subject-level, were found for not achieving 'controlled periodontitis' (relative risk [RR] = 2.57), PPD < 5 mm (RR = 1.59) and PPD < 6 mm (RR = 1.98). CONCLUSIONS An overwhelming majority of subjects and teeth do not achieve the proposed endpoints for periodontal stability, yet most periodontal patients preserve most of their teeth during an average of 10-13 years in SPC.
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Affiliation(s)
- V Rattu
- Periodontology Unit, Centre for Host-Microbiome Interactions, Dental Institute, King's College London, London, UK
| | - D Raindi
- Periodontal Research Group, University of Birmingham, Birmingham, UK
| | - G Antonoglou
- Periodontology Unit, Centre for Host-Microbiome Interactions, Dental Institute, King's College London, London, UK
| | - L Nibali
- Periodontology Unit, Centre for Host-Microbiome Interactions, Dental Institute, King's College London, London, UK
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15
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Simonelli A, Farina R, Minenna L, Tomasi C, Trombelli L. Prognostic value of a composite outcome measure for periodontal stability following periodontal regenerative treatment: A retrospective analysis at 4 years. J Periodontol 2023; 94:1090-1099. [PMID: 37070225 DOI: 10.1002/jper.22-0645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Recently, a composite outcome measure (COM) was proposed to describe the short-term results of periodontal regenerative treatment. The present retrospective study aimed at evaluating the prognostic value of COM on clinical attachment level (CAL) change over a 4-year period of supportive periodontal care (SPC). METHODS Seventy-four intraosseous defects in 59 patients were evaluated at 6 months and 4 years following regenerative treatment. Based on 6-month CAL change and probing depth (PD), defects were classified as: COM1 (CAL gain ≥3 mm, PD ≤4 mm); COM2 (CAL gain <3 mm, PD ≤4 mm); COM3 (CAL gain ≥3 mm, PD >4 mm); or COM4 (CAL gain <3 mm, PD >4 mm). COM groups were compared for "stability" (i.e., CAL gain, no change in CAL or CAL loss <1 mm) at 4 years. Also, groups were compared for mean change in PD and CAL, need for surgical retreatment, and tooth survival. RESULTS At 4 years, the proportion of stable defects in COM1, COM2, COM3, and COM4 group was 69.2%, 75%, 50%, and 28.6%, respectively, with a substantially higher probability for a defect to show stability for COM1, COM2, and COM3 compared with COM4 (odds ratio 4.6, 9.1, and 2.4, respectively). Although higher prevalence of surgical reinterventions and lower tooth survival were observed in COM4, no significant differences were detected among COM groups. CONCLUSIONS COM may be of value in predicting CAL change at sites undergoing SPC following periodontal regenerative surgery. Studies on larger cohorts, however, are needed to substantiate the present findings.
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Affiliation(s)
- Anna Simonelli
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy
- Operative Unit of Dentistry, AUSL of Ferrara, Ferrara, Italy
| | - Roberto Farina
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy
- Operative Unit of Dentistry, AUSL of Ferrara, Ferrara, Italy
| | - Luigi Minenna
- Operative Unit of Dentistry, AUSL of Ferrara, Ferrara, Italy
| | - Cristiano Tomasi
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Leonardo Trombelli
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy
- Operative Unit of Dentistry, AUSL of Ferrara, Ferrara, Italy
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Na L, Hai B, Quan Y, Qiang Z. Application of orthodontics combined with porcelain laminate veneers in the aesthetic restoration and flora regulation of anterior teeth. Medicine (Baltimore) 2023; 102:e34340. [PMID: 37478279 PMCID: PMC10662840 DOI: 10.1097/md.0000000000034340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/23/2023] [Indexed: 07/23/2023] Open
Abstract
To evaluate the effectiveness of orthodontics in combination with porcelain laminate veneers (PLV) in the aesthetic restoration and flora regulation of anterior teeth. A retrospective analysis of 336 patients who underwent aesthetic restoration of anterior teeth in our hospital from April 2019 to September 2022 was performed and divided into a control group (n = 168) and an observation group (n = 168) according to the restorative modality. The restorative modality in the control group was conventional restorative remediation, while the restorative modality in the observation group was orthodontic combined with PLV treatment. To evaluate the excellent rate of aesthetic restoration of anterior teeth in the 2 groups, and compare the color, shape, degree of translucency, edge aesthetic score, complications and satisfaction rate of restoration of anterior teeth in the 2 groups before and after restoration. The observation group had a significantly higher rate of excellent aesthetic restorations (95.23%) compared to the control group (80.95%) (P < .001). The scores of anterior tooth color, morphology, degree of translucency and marginal aesthetics were improved in both groups after restoration compared to before restoration, and the scores were significantly higher in the observation group (P < .05). After restoration, the subgingival Digestive streptococcus, Campylobacter and Propionibacterium increased in both groups, but the number of bacterial strains was significantly less in the observation group (P < .05). Compared with the total complication rate in the control group (16.66%), the total complication rate in the observation group (2.38%) was significantly lower (P < .001). Compared with the control group (85.71%), the observation group had a significantly higher restoration satisfaction rate of 97.61%, with a statistically significant difference (P < .001). The application of orthodontics combined with PLV in the aesthetic restoration of anterior teeth has a significant clinical effect, which is conducive to improving the aesthetic restoration and satisfaction rate of anterior teeth, reducing the subgingival microbial imbalance and decreasing the incidence of complications.
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Affiliation(s)
- Lu Na
- Department of Stomatology, North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China
| | - Bai Hai
- Department of Stomatology, North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China
| | - Yuan Quan
- Department of Stomatology, North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China
| | - Zhang Qiang
- Department of Stomatology, North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China
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Koronna I, Schacher B, Dahmer I, Nickles K, Sonnenschein SK, Kim TS, Eickholz P, Petsos H. Long-term stability of infrabony defects treated with enamel matrix derivative alone: A retrospective two-centre cohort study. J Clin Periodontol 2023; 50:996-1009. [PMID: 37051653 DOI: 10.1111/jcpe.13814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/05/2023] [Accepted: 03/27/2023] [Indexed: 04/14/2023]
Abstract
AIM To assess the long-term stability of attachment gain in infrabony defects (IBDs) 10 years after regenerative treatment with an enamel matrix derivative (EMD) alone. MATERIALS AND METHODS Two centres (Frankfurt [F] and Heidelberg [HD]) invited patients for re-examination 120 ± 12 months after regenerative therapy. Re-examination included clinical examination (periodontal probing depths (PPD), vertical clinical attachment level (CAL), plaque index (PlI), gingival index (GI), plaque control record, gingival bleeding index and periodontal risk assessment) and review of patient charts (number of supportive periodontal care [SPC] visits). RESULTS Both centres included 52 patients (29 female; median baseline age: 52.0 years; lower/upper quartile: 45.0/58.8 years; eight smokers), each contributing one IBD. Nine teeth were lost. For the remaining 43 teeth, regenerative therapy showed significant CAL gain after 1 year (3.0; 2.0/4.4 mm; p < .001) and 10 years (3.0; 1.5/4.1 mm; p < .001) during which CAL remained stable (-0.5; -1.0/1.0 mm; p = 1.000) after an average SPC of 9 years. Mixed-model regression analyses revealed a positive association of CAL gain from 1 to 10 years with CAL 12 months post operation (logistic: p = .01) as well as a higher probability for CAL loss with an increasing vertical extent of a three-walled defect component (linear: p = .008). Cox proportional hazard analysis showed a positive association between PlI after 12 months and tooth loss (p = .046). CONCLUSION Regenerative therapy of IBDs showed stable results over 9 years. CAL gain is associated with CAL after 12 months and decreasing initial defect depth in a three-walled defect morphology. Tooth loss is associated with PlI 12 months post operation. CLINICAL TRIAL NUMBER DRKS00021148 (URL: https://drks.de).
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Affiliation(s)
- Ilona Koronna
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Goethe University Frankfurt, Frankfurt, Germany
- Private Practice, Hanau, Germany
| | - Beate Schacher
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Goethe University Frankfurt, Frankfurt, Germany
| | - Iulia Dahmer
- Institute of Biostatistics and Mathematical Modeling, Goethe University Frankfurt, Frankfurt, Germany
- Center of Dentistry and Oral Medicine (Carolinum), Goethe University Frankfurt, Frankfurt, Germany
| | - Katrin Nickles
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Goethe University Frankfurt, Frankfurt, Germany
- Private Practice, Mannheim, Germany
| | - Sarah K Sonnenschein
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, Frankfurt, Germany
| | - Ti-Sun Kim
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, Frankfurt, Germany
| | - Peter Eickholz
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Goethe University Frankfurt, Frankfurt, Germany
| | - Hari Petsos
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Goethe University Frankfurt, Frankfurt, Germany
- Private Practice, Butzbach, Germany
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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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Karlsson K, Trullenque-Eriksson A, Tomasi C, Derks J. Efficacy of access flap and pocket elimination procedures in the management of peri-implantitis: A systematic review and meta-analysis. J Clin Periodontol 2023; 50 Suppl 26:244-284. [PMID: 36217689 DOI: 10.1111/jcpe.13732] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/16/2022] [Accepted: 10/04/2022] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the efficacy of access flap and pocket elimination procedures in the surgical treatment of peri-implantitis. MATERIALS AND METHODS Systematic electronic searches (Central/MEDLINE/EMBASE) up to March 2022 were conducted to identify prospective clinical studies evaluating surgical therapy (access flap or pocket elimination procedures) of peri-implantitis. Primary outcome measures were reduction of probing depth (PD) and bleeding on probing (BOP). Risk of bias was evaluated according to study design. Meta-analysis and meta-regression were performed. Results were expressed as standardized mean effect with 95% confidence interval (CI). RESULTS Evidence from studies directly comparing surgical with non-surgical therapy is lacking. Based on pre-post data originating from 13 prospective patient cohorts, pronounced reductions of PD (standardized mean effect: 2.2 mm; 95% CI 1.8-2.7) and BOP% (27.0; 95% CI 19.8-34.2) as well as marginal bone level gain (0.2 mm; 95% CI -0.0 to 0.5) were observed at evaluation time points ranging from 1 to 5 years. Wide prediction intervals suggested a high degree of heterogeneity. Reduction of mean PD increased by 0.7 mm (95% CI 0.5-0.9) for every millimetre in increase of mean PD at baseline. During the follow-up period ranging from 1 to 5 years, disease recurrence occurred frequently and implant loss was not uncommon. CONCLUSIONS Access flap and pocket elimination surgery are effective procedures in the management of peri-implantitis, although rates of disease recurrence during 5 years were high. Treatment outcomes were affected by baseline conditions.
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Affiliation(s)
- Karolina Karlsson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Anna Trullenque-Eriksson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Cristiano Tomasi
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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20
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Rug J, Holtfreter B, Völzke H, Kocher T. Have extraction patterns in German adults with severe periodontitis changed between 2000 and 2010? Results from two cohort studies. J Clin Periodontol 2023; 50:463-475. [PMID: 36574775 DOI: 10.1111/jcpe.13765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/30/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Abstract
AIM The aim of this study was to evaluate whether extraction thresholds in persons with severe periodontitis have changed between 2000 and 2010 and whether potential shifts have contributed to the reported decrease in tooth extractions in German adults over the last decades. MATERIALS AND METHODS Data from two German population-based cohort studies in Northeast Germany (Studies of Health in Pomerania; SHIP-START [baseline 1997-2001; 11-year follow-up] and SHIP-TREND [baseline 2008-2012; 7-year follow-up]) were used. In SHIP-START (SHIP-TREND), 522 (478) participants with severe periodontitis according to the CDC/AAP case definition were included. Patterns of maximum probing depth (PD) and maximum clinical attachment level (CAL) for retained and extracted teeth were compared between SHIP-START and SHIP-TREND participants. RESULTS No major differences in patterns of baseline maximum CAL of retained or extracted teeth were detected between SHIP-START and SHIP-TREND. Extraction thresholds were identified at the baseline at maximum CAL ≥6 and ≥9 mm. Tooth-level incidence rates for extraction for baseline maximum CAL of 6 mm were comparable between SHIP-START and SHIP-TREND (17.1 vs. 15.9 events per 1000 person-years). CONCLUSIONS After a decade, teeth in persons with severe periodontitis were still undergoing extraction with minor or moderate attachment loss. A change in extraction pattern did not contribute to the higher tooth retention rate.
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Affiliation(s)
- Joey Rug
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Birte Holtfreter
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- German Center for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
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21
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Agudio G, Buti J, Bonaccini D, Pini Prato G, Cortellini P. Longevity of teeth in patients susceptible to periodontitis: Clinical outcomes and risk factors associated with tooth loss after active therapy and 30 years of supportive periodontal care. J Clin Periodontol 2023; 50:520-532. [PMID: 36631984 DOI: 10.1111/jcpe.13770] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/23/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
AIM (i) To evaluate the efficacy of active periodontal therapy supplemented by supportive periodontal care (SPC) in retaining dentition during a 30-year follow-up period in patients susceptible to periodontitis, and (ii) to assess the prognostic factors associated with tooth loss. MATERIALS AND METHODS One-hundred and fifty-four patients with periodontitis, retrospectively classified as stage I-IV and grade B-C periodontitis, treated between 1984 and 1986 in a private practice, were enrolled in this study. After periodontal assessment, patients received non-surgical treatment followed by surgical periodontal therapy, orthodontic treatment, and tooth-splinting, where appropriate. SPC consisted of a strict recall programme every 3-6 months over a 30-year period. Recurrences were treated either with subgingival root planing or flap surgery. Dental and periodontal variables were measured at baseline (T0), end of active therapy (T1), and after 25 (T2) and 30 (T3) years. Generalized mixed models were analysed to assess the prognostic factors associated with and survival analyses for tooth loss. RESULTS Data on 154 patients (4083 teeth) were available at baseline (T0). Teeth considered unworthy of treatment were extracted during active therapy (160, 3.9%) and at re-assessment (13, 0.3%; T1). After 25 years of SPC, 140 teeth out of 3910 in 154 patients (3.6%) were lost (24 in 18 patients for periodontal reasons). Between 25 and 30 years, 20 patients (482 teeth) dropped out, and 61 teeth (2%) were lost (15 in 14 patients for periodontal reasons). Overall, 201 teeth (5.1%) were lost (39 for periodontal reasons) in 30 years of SPC. Generalized mixed models showed that stage III or stage IV periodontitis was associated with greater tooth loss during SPC compared to stage I or stage II (OR = 2.10; p = .048). Generalized periodontitis showed a statistically significant OR = 3.24 (p = .016) compared to the localized one. In SPC (T1-T3), age (p = .011), gender (male; p = .038), molar teeth (p = < .001), T0 and T1 pocket depth (p = < .001), tooth mobility grades 2 (p = .018) and 3 (p = .050), T0 and T1 bone loss (p = < .001), and presence of a root canal treatment (p = < .001) and a crown (p = .009) were statistically significantly associated with tooth loss. CONCLUSION (i) Periodontal therapy and a stringent SPC are effective in maintaining most of the teeth in patients with moderate/advanced periodontitis for 30 years, and (ii) age, gender, molar teeth, pocket depth, bone loss, and the presence of a root canal treatment and a crown are prognostic factors associated with tooth loss.
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Affiliation(s)
| | - Jacopo Buti
- Unit of Periodontology, UCL Eastman Dental Institute, London, UK
| | | | - Giovanpaolo Pini Prato
- Private Practice, Florence, Italy
- Accademia Toscana di Ricerca Odontostomatologica (ATRO), Florence, Italy
| | - Pierpaolo Cortellini
- Private Practice, Florence, Italy
- Accademia Toscana di Ricerca Odontostomatologica (ATRO), Florence, Italy
- European Research Group on Periodontology (ERGOPERIO), Bern, Switzerland
- Department of Oral Health Sciences, KU Leuven and Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium
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22
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Ren J, Fok MR, Zhang Y, Han B, Lin Y. The role of non-steroidal anti-inflammatory drugs as adjuncts to periodontal treatment and in periodontal regeneration. J Transl Med 2023; 21:149. [PMID: 36829232 PMCID: PMC9960225 DOI: 10.1186/s12967-023-03990-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/14/2023] [Indexed: 02/26/2023] Open
Abstract
Periodontitis is the sixth most prevalent chronic disease globally and places significant burdens on societies and economies worldwide. Behavioral modification, risk factor control, coupled with cause-related therapy have been the "gold standard" treatment for managing periodontitis. Given that host inflammatory and immunological responses play critical roles in the pathogenesis of periodontitis and impact treatment responses, several adjunctive strategies aimed at modulating host responses and improving the results of periodontal therapy and maintenance have been proposed. Of the many pharmacological host modulators, we focused on non-steroidal anti-inflammatory drugs (NSAIDs), due to their long history and extensive use in relieving inflammation and pain and reducing platelet aggregation. NSAIDs have been routinely indicated for treating rheumatic fever and osteoarthritis and utilized for the prevention of cardiovascular events. Although several efforts have been made to incorporate NSAIDs into the treatment of periodontitis, their effects on periodontal health remain poorly characterized, and concerns over the risk-benefit ratio were also raised. Moreover, there is emerging evidence highlighting the potential of NSAIDs, especially aspirin, for use in periodontal regeneration. This review summarizes and discusses the use of NSAIDs in various aspects of periodontal therapy and regeneration, demonstrating that the benefits of NSAIDs as adjuncts to conventional periodontal therapy remain controversial. More recent evidence suggests a promising role for NSAIDs in periodontal tissue engineering and regeneration.
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Affiliation(s)
- Jianhan Ren
- grid.194645.b0000000121742757Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, the University of Hong Kong, Hong Kong SAR, China
| | - Melissa Rachel Fok
- grid.194645.b0000000121742757Division of Periodontology and Implant Dentistry, Faculty of Dentistry, the University of Hong Kong, Hong Kong SAR, China
| | - Yunfan Zhang
- grid.11135.370000 0001 2256 9319Department of Orthodontics, Cranial-Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China
| | - Bing Han
- Department of Orthodontics, Cranial-Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China.
| | - Yifan Lin
- Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, the University of Hong Kong, Hong Kong SAR, China.
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23
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Yuan H, Liu Q, Tang T, Qin H, Zhao L, Chen W, Guo S. Assessment of early wound healing, pain intensity, quality of life and related influencing factors during periodontal surgery: a cross-sectional study. BMC Oral Health 2022; 22:596. [PMID: 36496401 PMCID: PMC9741525 DOI: 10.1186/s12903-022-02630-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This cross-sectional study assessed early wound healing, pain intensity, quality of life, surgical satisfaction, and related factors during periodontal surgery. METHODS A total of 369 patients completed the questionnaire before undergoing periodontal surgery (baseline), immediately after the operation (phase I), on the day of suture removal (phase II), and one month later (phase III). The Early Wound Healing Score (EHS) was assessed, and the short-form McGill Pain Questionnaire (SF-MPQ), tooth hypersensitivity visual analog scale (VAS), oral health-related quality of life measure (OHQoL-UK), and surgical satisfaction VAS were administered and analysed. RESULTS The EHS was 8.41 ± 2.74 and was influenced by disease severity and surgical factors. Scores on the SF-MPQ, pain intensity scores, and OHQoL-UK scores were significantly increased in phase I and decreased later. Tooth sensitivity decreased significantly one month after periodontal surgery. Psychological factors were positively related to SF-MPQ, pain intensity, OHQoL-UK and tooth sensitivity VAS scores in all phases, while disease severity and surgical factors were only related to these scores at baseline or in phases I/II/III. Surgical acceptance and reoperation willingness continuously decreased after surgery, and all these scores were related to surgical satisfaction. CONCLUSIONS EHS, pain intensity and quality of life were closely related to disease severity, psychological factors and surgical factors in phase I (i.e., immediately after surgery). The findings suggest that surgical details should be enhanced and that behavioural and psychological interventions measures should be implemented to improve outcomes during periodontal operation and during the early postoperative period as well as to improve patient-oriented periodontal surgery experiences. Trial registration This cross-sectional study did not include interventions with human participants, and all the experimental procedures involving humans in this study were approved by the Ethics Committee of West China College of Stomatology, Sichuan University (WCHSIRB-D-2020-284).
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Affiliation(s)
- Hongmei Yuan
- grid.13291.380000 0001 0807 1581Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041 China
| | - Qian Liu
- grid.13291.380000 0001 0807 1581Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041 China ,grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041 China
| | - Tian Tang
- grid.13291.380000 0001 0807 1581Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041 China
| | - Huan Qin
- grid.13291.380000 0001 0807 1581Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041 China
| | - Lei Zhao
- grid.13291.380000 0001 0807 1581Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041 China ,grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041 China
| | - Wen Chen
- grid.13291.380000 0001 0807 1581Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041 China
| | - Shujuan Guo
- grid.13291.380000 0001 0807 1581Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041 China ,grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041 China
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24
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Zhang XM, Liu BL, Qian SJ, Shi JY, Zhang X, Lai HC. Clinical evaluation of narrow-diameter implants versus standard-diameter implants with lateral bone augmentation in posterior jaws: Three-year results of a randomized controlled trial. Clin Oral Implants Res 2022; 33:1245-1253. [PMID: 36203410 DOI: 10.1111/clr.14006] [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: 05/16/2022] [Revised: 07/31/2022] [Accepted: 08/28/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of this study was to compare the 3-year clinical outcomes of narrow-diameter implants (NDI) with standard-diameter implants (SDI) in conjunction with lateral bone augmentation in atrophic posterior jaws. MATERIALS AND METHODS Fifty patients were included and randomly assigned into two groups: Patients in Group 1 received NDI (Ø3.5 mm); patients in Group 2 received SDI (Ø4.3 mm) with simultaneous lateral bone augmentation. Implant survival rates, complications, crestal bone loss, peri-implant conditions, treatment cost, and patient satisfaction were compared. RESULTS Three patients dropped out the follow-up. No implant loss was observed. The difference in technical complication rates between the two groups was 3.8% (95% CI: -13.7% to 21.3%). No significant differences in crestal bone loss were found between two groups at 3-year follow-up (0.55 ± 0.76 vs 0.41 ± 0.41 mm, p = .429). A total of 20.8% (5/24) of NDI were diagnosed with mucositis and 8.3% (2/24) with peri-implantitis. A total of 17.4% (4/23) of SDI showed mucositis and (1/23) 4.3% showed peri-implantitis. The total cumulative cost of treatment per patient in Group 1 (2849.6 USD, 95% CI: 2726.8-2972.4) was significantly lower than that in Group 2 (3581.4 USD, 95% CI, 3460.9-3701.9) over the 3-year follow-up (p < .01). The patient satisfaction rating of operation was significantly higher in Group 1 (85.42 ± 7.41 vs 80.48 ± 7.95, p = .033). DISCUSSION NDI yielded favorable implant survival, acceptable technical and biological complications, and high patient satisfaction supporting single crowns in the atrophic posterior region after 3-year follow-up. NDI might be a reasonable alternative in horizontally deficient posterior jaws. TRIAL REGISTRATION Clinicaltrials.gov identifier: ChiCTR1800020426.
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Affiliation(s)
- Xiao-Meng Zhang
- Department of Oral and Maxillo-Facial Implantology, National Center for Stomatology; National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
| | - Bei-Lei Liu
- Department of Oral and Maxillo-Facial Implantology, National Center for Stomatology; National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
| | - Shu-Jiao Qian
- Department of Oral and Maxillo-Facial Implantology, National Center for Stomatology; National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
| | - Jun-Yu Shi
- Department of Oral and Maxillo-Facial Implantology, National Center for Stomatology; National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao Zhang
- Department of Oral and Maxillo-Facial Implantology, National Center for Stomatology; National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
| | - Hong-Chang Lai
- Department of Oral and Maxillo-Facial Implantology, National Center for Stomatology; National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
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25
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Takahashi K, Yamazaki K, Yamazaki M, Kato Y, Baba Y. Personalized Medicine Based on the Pathogenesis and Risk Assessment of Endodontic-Periodontal Lesions. J Pers Med 2022; 12:jpm12101688. [PMID: 36294826 PMCID: PMC9604566 DOI: 10.3390/jpm12101688] [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: 09/22/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 11/16/2022] Open
Abstract
Endodontic-periodontal lesions (EPLs) are chronic inflammatory lesions in the mouth caused by multiple factors. Both periapical and marginal periodontitis are characterized by infection and inflammation around the affected teeth, suggesting that the theory of complex systems might describe the progression of EPL. The diagnosis and treatment of EPLs are complicated by variations of this condition and difficulties distinguishing EPLs from other diseases. Technological advances in diagnostic and treatment methods, including cone beam computed tomography, microscopy, mineral trioxide aggregates, and periodontal regenerative treatment, have improved outcomes, even in untreatable teeth. However, treating EPLs with iatrogenic problems and/or severe periodontitis remains challenging. Assessing the risk of each EPL based on the possible pathogenesis of each EPL is essential for determining individualized treatment and optimizing personalized medicine for individual patients.
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Affiliation(s)
- Keiso Takahashi
- Division of Periodontics, Department of Conservative Dentistry, Ohu University School of Dentistry, 31-1, Misumido, Tomita-machi, Koriyama City 963-8611, Fukushima, Japan
- Correspondence: ; Tel.: +81-24-932-9365
| | - Kousaku Yamazaki
- Division of Periodontics, Department of Conservative Dentistry, Ohu University School of Dentistry, 31-1, Misumido, Tomita-machi, Koriyama City 963-8611, Fukushima, Japan
| | - Mikiko Yamazaki
- Division of Oral Pathology, Department of Oral Medical Science, Ohu University School of Dentistry, 31-1, Misumido, Tomita-machi, Koriyama City 963-8611, Fukushima, Japan
| | - Yasumasa Kato
- Department of Oral Function and Molecular Biology, Ohu University School of Dentistry, 31-1, Misumido, Tomita-machi, Koriyama City 963-8611, Fukushima, Japan
| | - Yuh Baba
- Department of General Clinical Medicine, Ohu University School of Dentistry, 31-1, Misumido, Tomita-machi, Koriyama City 963-8611, Fukushima, Japan
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26
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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: 11] [Impact Index Per Article: 5.5] [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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27
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Sarafidou K, Lazaridi I, Gotsis S, Kirmanidou Y, Vasilaki D, Hirayama H, Michalakis K. Tooth preservation vs. extraction and implant placement in periodontally compromised patients: A systematic review and analysis of studies. J Prosthodont 2022; 31:e87-e99. [PMID: 35794083 DOI: 10.1111/jopr.13560] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/11/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The aim of this systematic review was to identify studies with a minimum of 5-years follow-up, reporting on the management of periodontally compromised teeth with either extraction and subsequent implant placement or teeth preservation with conventional periodontal treatment and application of regenerative procedures. The outcomes of these two approaches, based on clinical and radiographic data and the incidence of tooth- and implant-loss, were also investigated. MATERIAL AND METHODS A systematic search for studies reporting on clinical and radiographic outcomes of periodontal treatment or replacement of periodontally compromised teeth with implants was conducted in 3 electronic databases, followed by a hand-search in 8 journals. Only randomized controlled trials (RCTs), cohort studies, and case series with prospective design were included. RESULTS The initial search resulted in 1080 papers. After the first two screenings, 24 publications were selected for inclusion in this systematic review. The treatment protocols for the teeth preservation group contained nonsurgical and/or surgical periodontal treatment with or without regeneration procedures. The implant studies included extraction of periodontally involved teeth and implant placement with or without bone and soft tissue augmentation, followed by restoration with fixed dental prostheses (FDPs). Survival rates ranged between 81.8% and 100% in the tooth retention group, and between 94.8% and 100% in the implant group. In the extraction group, no complications were reported for 76.09% of the implants. Similarly, no complications were reported for 86.83% of the tooth retention group. The lack of standardized comparable studies prohibited conduction of a metaanalysis. CONCLUSION Both treatment approaches, treatment of periodontally compromised teeth, or tooth extraction followed by implant placement, present high survival rates. The application of bone regeneration techniques improves the long-term prognosis of periodontally involved teeth. Hence, treatment of periodontally involved teeth with subsequent application of a rigorous maintenance protocol can be a viable alternative for a number of years, before proceeding to extraction and replacement with dental implants. More well-designed randomized controlled trials are needed in order to draw definite conclusions on the subject.
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Affiliation(s)
- Katia Sarafidou
- Department of Prosthodontics, Aristotle University of Thessaloniki, Faculty of Health Sciences, School of Dentistry, Thessaloniki, Greece
| | - Ioanna Lazaridi
- Division of Regenerative Dentistry and Periodontology, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Sotirios Gotsis
- Graduate and Postgraduate Prosthodontics, Tufts University School of Dental Medicine, Boston, MA, USA
| | - Yvoni Kirmanidou
- Private Practice limited to Prosthodontics, Thessaloniki, Greece
| | - Dimitra Vasilaki
- Private Practice limited to Prosthodontics, Thessaloniki, Greece
| | - Hiroshi Hirayama
- Department of Restorative Sciences and Biomaterials, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA
| | - Konstantinos Michalakis
- Department of Restorative Sciences and Biomaterials, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
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28
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Investigation of the Effect of Oral Implant Surgery on Clinical Treatment and Oral Function of Patients with Dentition Loss. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:1698842. [PMID: 36213563 PMCID: PMC9519293 DOI: 10.1155/2022/1698842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/14/2022] [Accepted: 08/24/2022] [Indexed: 01/26/2023]
Abstract
In order to investigate the effect of oral implant surgery on clinical treatment and oral function of patients with dentition loss, a total of 118 patients with dentition loss in the Department of Stomatology of our hospital from January 2019 to January 2022 are retrospectively analyzed. They are randomly divided into the conventional group and the implant group. The conventional group is treated with conventional dentition restoration, and the implant group is treated with oral implant restoration. The repair efficiency of the two groups is compared. The swallowing function of the 2 groups is assessed by Standard Swallowing Assessment (SSA) table before and after treatment. Self-rating depression scale (SDS) and self-rating anxiety scale (SAS) are used to compare the negative emotions of the two groups before and after treatment. Experimental results show that the total effective rate of the implant group is significantly higher than that of the conventional group, but no invalid cases occurred in the two groups after treatment.
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29
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Zhang T, Chen Z, Zhu M, Jing X, Xu X, Yuan X, Zhou M, Zhang Y, Lu M, Chen D, Xu S, Song J. Extracellular vesicles derived from human dental mesenchymal stem cells stimulated with low-intensity pulsed ultrasound alleviate inflammation-induced bone loss in a mouse model of periodontitis. Genes Dis 2022. [DOI: 10.1016/j.gendis.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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30
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Herrera D, Sanz M, Kebschull M, Jepsen S, Sculean A, Berglundh T, Papapanou PN, Chapple I, Tonetti MS. Treatment of stage IV periodontitis: The EFP S3 level clinical practice guideline. J Clin Periodontol 2022; 49 Suppl 24:4-71. [PMID: 35688447 DOI: 10.1111/jcpe.13639] [Citation(s) in RCA: 107] [Impact Index Per Article: 53.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/22/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND The recently published clinical practice guideline (CPG) for the treatment of periodontitis in stages I-III provided evidence-based recommendations for the treatment of periodontitis patients, defined according to the 2018 classification. Stage IV periodontitis shares the severity and complexity characteristics of stage III periodontitis, but includes the anatomical and functional sequelae of tooth and periodontal attachment loss (tooth flaring and drifting, bite collapse, etc.), which require additional interventions following completion of active periodontal therapy. AIM To develop an S3 Level CPG for the treatment of stage IV periodontitis, focusing on the implementation of inter-disciplinary treatment approaches required to treat/rehabilitate patients following associated sequelae and tooth loss. MATERIALS AND METHODS This S3 Level CPG was developed by the European Federation of Periodontology (EFP), following methodological guidance from the Association of Scientific Medical Societies in Germany and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process. A rigorous and transparent process included synthesis of relevant research in 13 specifically commissioned systematic reviews, evaluation of the quality and strength of evidence, the formulation of specific recommendations and a structured consensus process with leading experts and a broad base of stakeholders. RESULTS The S3 Level CPG for the treatment of stage IV periodontitis culminated in recommendations for different interventions, including orthodontic tooth movement, tooth splinting, occlusal adjustment, tooth- or implant-supported fixed or removable dental prostheses and supportive periodontal care. Prior to treatment planning, it is critically important to undertake a definitive and comprehensive diagnosis and case evaluation, obtain relevant patient information, and engage in frequent re-evaluations during and after treatment. The periodontal component of therapy should follow the CPG for the treatment of periodontitis in stages I-III. CONCLUSIONS The present S3 Level CPG informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to treat patients with stage IV periodontitis and to maintain a healthy dentition over lifetime, according to the available evidence at the time of publication.
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Affiliation(s)
- David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Moritz Kebschull
- Periodontal Research Group, Institute of Clinical Sciences, College of Medical & Dental Sciences, The University of Birmingham, Birmingham, UK.,Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK.,Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, New York, USA
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University Hospital Bonn, Bonn, Germany
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Tord Berglundh
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Panos N Papapanou
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, New York, USA
| | - Iain Chapple
- Periodontal Research Group, Institute of Clinical Sciences, College of Medical & Dental Sciences, The University of Birmingham, Birmingham, UK.,Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | - Maurizio S Tonetti
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillo-facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Centre for Oral Diseases, Shanghai Ninth People Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Cortellini P, Cortellini S, Bonaccini D, Tonetti MS. Modified minimally invasive surgical technique in human intrabony defects with or without regenerative materials-10-year follow-up of a randomized clinical trial: Tooth retention, periodontitis recurrence, and costs. J Clin Periodontol 2022; 49:528-536. [PMID: 35415940 DOI: 10.1111/jcpe.13627] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/03/2022] [Accepted: 04/05/2022] [Indexed: 01/09/2023]
Abstract
AIM The modified minimally invasive surgical technique (M-MIST) optimizes wound stability in the treatment of intrabony defects. Short-term observations show similar results as with flap alone or adjunctive regenerative materials. This study aims to compare the stability of the long-term outcomes, complication-free survival, and costs of the three treatment options. MATERIALS AND METHODS Forty-five intrabony defects in 45 patients were randomized to M-MIST alone (N = 15), combined with enamel matrix derivative (M-MIST + EMD, N = 15), or EMD plus bone-mineral-derived xenograph (M-MIST + EMD + BMDX, N = 15). Supportive periodontal care (SPC) and necessary re-treatment were provided for 10 years. RESULTS Three subjects were lost to follow-up. Clinical attachment level differences between 1 and 10 years were -0.1 ± 0.7 mm for M-MIST, -0.1 ± 0.8 mm for M-MIST + EMD, and -0.3 ± 0.6 mm for M-MIST + EMD + BMDX (p > .05 for within- and between-group differences). Four episodes of recurrence occurred in the M-MIST group, four in the M-MIST + EMD group, and five in the M-MIST + EMD + BMDX group. No significant differences in complication-free survival were observed between the three groups (p = .47). Complication-free survival was 7.46 years (95% confidence interval: 7.05-7.87) for the whole population. The M-MIST + EMD + BMDX group lost one treated tooth. Data indicated no significant inter-group difference of the total cost of recurrence over 10 years. When the baseline cost of treatment was considered, the total cost was lower for M-MIST alone. CONCLUSIONS Teeth with deep pockets associated with intrabony defects can be successfully maintained over the long term with either M-MIST alone or by adding a regenerative material in the context of a careful SPC programme. M-MIST alone provided similar short- and long-term benefits as regeneration, at a lower cost. These findings need to be confirmed in larger, independent studies.
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Affiliation(s)
- Pierpaolo Cortellini
- Accademia Toscana di Ricerca Odontostomatologica (ATRO), Florence, Italy.,European Research Group on Periodontology (ERGOPERIO), Genova, Italy.,Private Practice, Florence, Italy.,Department of Oral Health Sciences, KU Leuven and Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium
| | - Simone Cortellini
- Department of Oral Health Sciences, KU Leuven and Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium.,Private Practice, The Hague, The Netherlands
| | | | - Maurizio S Tonetti
- Accademia Toscana di Ricerca Odontostomatologica (ATRO), Florence, Italy.,European Research Group on Periodontology (ERGOPERIO), Genova, Italy.,Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, Shanghai Ninth People Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center of Oral Diseases, National Center of Stomatology, College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
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32
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Ten-Year Stability of Clinical Attachment after Regenerative Treatment of Infrabony Defects and Controls. J Clin Med 2022; 11:jcm11030543. [PMID: 35159996 PMCID: PMC8836894 DOI: 10.3390/jcm11030543] [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: 12/20/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background: A similar long-term stable clinical attachment level (CAL) of infrabony defects (IBDs) after regenerative treatment compared to control teeth would indicate a high level of stability resulting from the regenerative approach. Methods: Patients with a regeneratively treated IBD were screened 120 ± 12 months postoperatively for eligibility for study participation, and were included if complete baseline and 12-month examinations (plaque (PlI), periodontal probing depth (PPD), CAL) were available and a respective control tooth could be identified. Re-examination included clinical examination (PPD, CAL, PlI/GI, bleeding on probing, plaque control record, gingival bleeding index). Results: A total of 27 patients (16 females; age (median; lower/upper quartile): 57.0; 44.0/60.0 years; 6 smokers) contributed 27 IBDs (test), for each of which a control tooth was identified. Five test teeth (18.5%) were lost between 12 and 120 months. The remaining 22 test teeth revealed a significant CAL gain after 1 (2.5 mm; 1.0/4.0 mm, p < 0.0001) and 10 (2.5 mm; 0.5/3.5 mm, p < 0.0001) years, whereas control teeth were stable (1 year: 0.0 mm; 0.0/1.0 mm, p = 0.396; 10 years: 0.0 mm; −1.0/1.5 mm, p = 0.215). The study did not detect any significant CAL change between 1 and 10 years for test (−0.5 mm; −1.0/0.5 mm, p = 0.414) and control teeth (0.0 mm; −1.0/1.0 mm, p = 0.739). In 15 patients, test and control teeth revealed stable CAL values between 12 and 120 months. Conclusion: Regenerative treatment of IBDs exhibited stability comparable to non-surgically treated, periodontally reduced sites over a 10-year period.
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33
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Karlsson K, Derks J, Wennström JL, Petzold M, Berglundh T. Health economic aspects of implant-supported restorative therapy. Clin Oral Implants Res 2021; 33:221-230. [PMID: 34888933 DOI: 10.1111/clr.13885] [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: 07/05/2021] [Revised: 09/10/2021] [Accepted: 11/25/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND It is poorly understood how much additional dental care patients consume subsequent to implant therapy. The aim of the present study is to evaluate costs associated with implant-supported restorative therapy during the long-term follow-up. MATERIAL AND METHODS Costs associated with preventive measures and complication-related procedures over a mean follow-up period of 8.2 years were assessed in patient files of 514 Swedish subjects provided with implant-supported restorative therapy. The restorative therapy and each of the subsequent interventions were assigned a specific cost. Accumulated costs were calculated in three categories: (i) total cost including initial restorative therapy and complication-related interventions, (ii) cost of preventive measures alone, and (iii) cost of complication-related procedures alone. Potential differences by background variables were analyzed using growth curve models. RESULTS In the whole sample, costs during follow-up ranged from 878 € (95% CI 743; 1,014) for patients with single-tooth restoration(s) to 1,210 € (95% CI 1,091; 1,329) for subjects with full-jaw restoration(s). The majority of costs during follow-up originated from preventive measures (741 € 95% CI 716; 766). Among individuals receiving ≥1 intervention dealing with a complication (n = 253), complication-related costs amounted to 557 € (95% CI 480; 634). For patients with full-jaw restorations, the corresponding amount was 769 € (95% CI 622; 916). Procedures related to peri-implantitis and technical complications resulted in costs similar to each other. Implant loss generated greater costs than any other type of complication. CONCLUSIONS Costs related to implant-supported restorative therapy during follow-up were associated with the extent of initial therapy. The higher costs during follow-up noted in patients provided with full-jaw restorations were explained by complication-associated procedures. Implant loss was the most costly type of complication.
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Affiliation(s)
- Karolina Karlsson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jan L Wennström
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Tord Berglundh
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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34
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Leow NM, Moreno F, Marletta D, Hussain SB, Buti J, Almond N, Needleman I. Recurrence and progression of periodontitis and methods of management in long-term care: A systematic review and meta-analysis. J Clin Periodontol 2021; 49 Suppl 24:291-313. [PMID: 34761412 DOI: 10.1111/jcpe.13553] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/02/2021] [Indexed: 12/13/2022]
Abstract
AIM To systematically review the literature to evaluate the recurrence of disease of people in long-term supportive periodontal care (SPC), previously treated for periodontitis, and determine the effect of different methods of managing recurrence. The review focused on stage IV periodontitis. MATERIALS AND METHODS An electronic search was conducted (until May 2020) for prospective clinical trials. Tooth loss was the primary outcome. RESULTS Twenty-four publications were retrieved to address recurrence of disease in long-term SPC. Eight studies were included in the meta-analyses for tooth loss, and three studies for disease progression/recurrence (clinical attachment level [CAL] loss ≥2 mm). For patients in SPC of 5-20 years, prevalence of losing more than one tooth was 9.6% (95% confidence interval [CI] 5%-14%), while experiencing more than one site of CAL loss ≥2 mm was 24.8% (95% CI 11%-38%). Six studies informed on the effect of different methods of managing recurrence, with no clear evidence of superiority between methods. No data was found specifically for stage IV periodontitis. CONCLUSIONS A small proportion of patients with stage III/IV periodontitis will experience tooth loss in long-term SPC (tendency for greater prevalence with time). Regular SPC appears to be important for reduction of tooth loss. No superior method to manage disease recurrence was found.
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Affiliation(s)
- Natalie M Leow
- Unit of Periodontology, University College London, Eastman Dental Institute, London, UK
| | - Federico Moreno
- Unit of Periodontology, University College London, Eastman Dental Institute, London, UK
| | | | - Syed Basit Hussain
- Unit of Periodontology, University College London, Eastman Dental Institute, London, UK
| | - Jacopo Buti
- Unit of Periodontology, University College London, Eastman Dental Institute, London, UK
| | - Neil Almond
- British Society of Periodontology Patient Forum, UK
| | - Ian Needleman
- Unit of Periodontology, University College London, Eastman Dental Institute, London, UK
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35
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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: 7] [Impact Index Per Article: 2.3] [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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36
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Saleh MHA, Dukka H, Troiano G, Ravidà A, Galli M, Qazi M, Greenwell H, Wang HL. External validation and comparison of the predictive performance of 10 different tooth-level prognostic systems. J Clin Periodontol 2021; 48:1421-1429. [PMID: 34472120 DOI: 10.1111/jcpe.13542] [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: 06/21/2021] [Accepted: 08/15/2021] [Indexed: 12/21/2022]
Abstract
AIM Tooth-level prognostic systems can be used for treatment planning and risk assessment. This retrospective longitudinal study aimed to evaluate the prognostic performance of 10 different tooth-level risk assessment systems in terms of their ability to predict periodontal-related tooth loss (TLP). MATERIALS AND METHODS Data were retrieved retrospectively from patients who received surgical and non-surgical periodontal treatment. Data on medical history and smoking status at baseline and the last maintenance visit were collected. Ten tooth-level prognostic systems were compared using both univariate and multivariate Cox proportional hazard regression models to analyse the prognostic capability of each system for predicting TLP risk. RESULTS One-hundred and forty-eight patients with 3787 teeth, followed-up for a mean period of 26.5 ± 7.4 years, were evaluated according to 10 different tooth-level prognostic systems, making up a total of 37,870 individual measurements. All compared prognostic systems were able to stratify the risk of TLP at baseline when different classes of association were compared. After controlling for maintenance, age, and gender, all systems exhibited excellent predictive capacity for TLP with no system scoring a Harrell's C-index less than 0.925. CONCLUSIONS All tooth-level prognostic systems displayed excellent predictive capability for TLP. Overall, the Miller and McEntire system may have shown the best discrimination and model fit, followed by the Nunn et al. system.
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Affiliation(s)
- Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA.,Department of Periodontics, University of Louisville School of Dentistry, Louisville, Kentucky, USA
| | - Himabindu Dukka
- Department of Periodontics, University of Louisville School of Dentistry, Louisville, Kentucky, USA
| | - Giuseppe Troiano
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Andrea Ravidà
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Matthew Galli
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Musa Qazi
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Henry Greenwell
- Department of Periodontics, University of Louisville School of Dentistry, Louisville, Kentucky, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Kao RT, Lin GH, Kapila Y, Sadowsky S, Curtis DA. A commentary on strategic extraction. J Periodontol 2021; 93:11-19. [PMID: 34435680 DOI: 10.1002/jper.20-0855] [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: 02/16/2021] [Revised: 07/23/2021] [Accepted: 08/10/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Advancements in strategies to maintain compromised teeth combined with a greater understanding of risks associated with dental implants invite a reassessment of the benefits of strategic extraction of a tooth with a questionable prognosis or of limited strategic value. METHODS Evidence of the management of compromised teeth and decision making for strategic extraction was reviewed. Additionally, the risks for peri-implantitis were evaluated from the perspective of patient centric, biologic, and biomechanical complications. RESULTS Recent clinical innovations support a more predictable maintenance of compromised dentition, and the clinical literature provides evidence of the risks associated with dental implants. CONCLUSIONS Because of the improvements in dental management of compromised dentition, strategic extraction should be deferred, whenever possible, to avoid complications associated with peri-implantitis.
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Affiliation(s)
- Richard T Kao
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, California.,Private Practice, San Jose, California
| | - Guo-Hao Lin
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, California
| | - Yvonne Kapila
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, California
| | - Steven Sadowsky
- Department of Preventive and Restorative Dentistry, School of Dentistry, University of the Pacific, San Francisco, California
| | - Donald A Curtis
- Department of Restorative Dentistry, School of Dentistry, University of California, San Francisco, California
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Lee AHC, Neelakantan P, Dummer PMH, Zhang C. Cemental tear: Literature review, proposed classification and recommendations for treatment. Int Endod J 2021; 54:2044-2073. [PMID: 34403513 DOI: 10.1111/iej.13611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/16/2021] [Indexed: 11/29/2022]
Abstract
Cemental tears are an important condition of relevance to Endodontics but are often overlooked. A cemental tear is the partial or complete detachment of the cementum from the cemento-dentinal junction or along the incremental line within the body of cementum. The limited attention received is most likely due to the limited awareness amongst dental professionals and challenges in accurately diagnosing them, resulting in misdiagnosis and erroneous treatment. The aim of this review is to describe the: (i) epidemiology and predisposing factors; (ii) clinical, radiographic and histological features and (iii) the clinical management and treatment outcomes of cemental tear. The review included 37 articles published in English that comprised eight observational studies and 29 case reports. The prevalence of cemental tears was reported to be lower than 2%; whilst the incidence remains unknown. Internal factors due to the inherent structural weakness of cementum and its interface with the dentine, and external factors that are associated with stress have been proposed as the two mechanisms responsible for the development and propagation of cemental tears. Predisposing factors that have been implicated were tooth type, gender, age, previous root canal treatment, history of dental trauma, occlusal trauma and excessive occlusal force; however, evidence is limited. Common clinical and radiographic manifestations of cemental tears resemble the presentations of primary endodontic diseases, primary periodontal diseases and combined endodontic-periodontal lesions. Clinical management tended to focus on complete removal of the torn fragments and periodontal treatment, often combined with regenerative treatment. In this article, a new classification for cemental tears is developed that consists of classes 0 to 6 and stages A, B, C and D based on the: (i) location and accessibility of the torn cemental fragment; (ii) the pattern and extension of the associated bony defect in relation to the root length and (iii) the number of root surface/s affected by the cemental tear/s and the associated bony defect. Recommendations for treatment strategies are also provided and linked to the classification to aid in streamlining the process of treatment decision making.
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Affiliation(s)
- Angeline H C Lee
- Division of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Prasanna Neelakantan
- Division of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Paul M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Chengfei Zhang
- Division of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
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39
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Petsos H, Ramich T, Nickles K, Dannewitz B, Pfeifer L, Zuhr O, Eickholz P. Tooth loss in periodontally compromised patients: Retrospective long-term results 10 years after active periodontal therapy. Tooth-related outcomes. J Periodontol 2021; 92:1761-1775. [PMID: 33748997 DOI: 10.1002/jper.21-0056] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/16/2021] [Accepted: 03/16/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Estimating prognosis of periodontally affected teeth at the beginning of supportive periodontal care (SPC) is an important component for further treatment planning. This study aimed to evaluate tooth loss (TL) during 10 years of SPC in periodontally compromised patients and to identify tooth-related factors affecting TL. METHODS Patients were re-examined 120 ± 12 months after accomplishment of active periodontal therapy. TL was defined as primary outcome variable and tooth-related factors (abutment status, furcation involvement [FI], tooth mobility, mean periodontal probing depth [PD], and clinical attachment level [CAL] at beginning of SPC, and initial bone loss [BL]) were estimated based on an adjusted regression analyses model. RESULTS Ninety-seven patients (51 females and 46 males; mean age, 65.3 ± 11 years) lost 119 of 2,323 teeth (overall TL [OTL]: 0.12 teeth/patient/y) during 10 years of SPC. Forty of these teeth (33.6%) were lost for periodontal reasons (TLP; 0.04 teeth/patient/y). Significantly more teeth were lost due to other reasons (P <0.0001). TLP (OTL) only occurred in 5.9% (14.7%) of all teeth, when BL was at least 80%. Use as abutment tooth, FI degree III, tooth mobility degrees I and II, mean PD, and CAL positively correlated with OTL (P <0.05). For TLP, FI and tooth mobility degree III as well as mean CAL were identified as tooth-related prognostic factors (P <0.05). CONCLUSIONS During 10 years of SPC, most of the teeth (93.4%) of periodontally compromised patients were retained, showing the positive effect of a well-established treatment concept. Well-known tooth-related prognostic factors were confirmed.
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Affiliation(s)
- Hari Petsos
- Private practice, Soest, Germany.,Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt am Main, Germany
| | - Tatjana Ramich
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt am Main, Germany
| | - Katrin Nickles
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt am Main, Germany.,Private practice, Mannheim, Germany
| | - Bettina Dannewitz
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt am Main, Germany.,Private practice, Weilburg, Germany
| | - Leon Pfeifer
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt am Main, Germany
| | - Otto Zuhr
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt am Main, Germany.,Private practice, Münich, Germany
| | - Peter Eickholz
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt am Main, Germany
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40
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Shi JY, Lai YR, Qian SJ, Qiao SC, Tonetti MS, Lai HC. Clinical, radiographic and economic evaluation of short-6-mm implants and longer implants combined with osteotome sinus floor elevation in moderately atrophic maxillae: A 3-year randomized clinical trial. J Clin Periodontol 2021; 48:695-704. [PMID: 33570787 DOI: 10.1111/jcpe.13444] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/06/2021] [Accepted: 02/08/2021] [Indexed: 12/25/2022]
Abstract
AIM To compare the 3-year clinical, radiographic and economic outcomes of short-6-mm implants and longer implants combined with osteotome sinus floor elevation (OSFE) in the posterior maxilla. MATERIAL AND METHODS This study enrolled 225 patients (225 implants with diameter of 4.1 mm and 4.8 mm) with a posterior maxillary residual bone height (RBH) of 6-8 mm. Patients were randomly divided into three groups: Group 1 (6 mm implants alone), Group 2 (8 mm implants + OSFE) and Group 3 (10 mm implants + OSFE). The following outcomes were recorded at 1 and 3-year examinations: implant survival, probing pocket depth (PPD), bleeding on probing (BOP), modified plaque index (mPI), marginal bone loss (MBL), biological and technical complications, complication-free survival and treatment costs. RESULTS At the 3-year follow-up, 199 patients (Group 1: 67; Group 2: 62; Group 3: 70) were re-examined. Implant survival rates were 91.80%, 97.08% and 100.00% in groups 1, 2 and 3. Implant survival rate in Group 1 was significantly lower than that in Group 3 (p = 0.029). A multivariate Cox model showed that the short-6-mm implants with wide diameter had a protective effect on implant survival (hazard ratio: 0.59, p = 0.001). No significant differences in BOP%, PPD, mPI, MBL and complication-free survival rate were found among the three groups. The average costs of retreatment were 8.31%, 1.96% and 0.56% of the total costs in groups 1, 2 and 3. The cost to avoid a 1% increase in implant loss associated with 6-mm implants over a 3-year period was 369 CNY (56 USD) using a 10-mm implant with OSFE and 484 CNY (74 USD) using an 8-mm implant with OSFE. CONCLUSION In the moderately atrophic posterior maxillae, the three treatments showed acceptable clinical, radiographic and economic outcomes with up to 3-year follow-up. 10-mm implants combined with OSFE showed more favourable implant survival and fewer maintenance costs in comparison with short-6-mm implants, which were less expensive.
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Affiliation(s)
- Jun-Yu Shi
- Department of Oral and Maxillo-facial Implantology, National Clinical Research Center for Oral Diseases, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yi-Rao Lai
- Department of Oral and Maxillo-facial Implantology, National Clinical Research Center for Oral Diseases, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Shu-Jiao Qian
- Department of Oral and Maxillo-facial Implantology, National Clinical Research Center for Oral Diseases, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Shi-Chong Qiao
- Department of Oral and Maxillo-facial Implantology, National Clinical Research Center for Oral Diseases, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Maurizio S Tonetti
- Department of Oral and Maxillo-facial Implantology, National Clinical Research Center for Oral Diseases, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Hong-Chang Lai
- Department of Oral and Maxillo-facial Implantology, National Clinical Research Center for Oral Diseases, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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41
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Barbagallo G, D'Urso U, Psaila A, Cultrera D. Minimally Invasive Surgical Strategies in Regenerative/Reconstructive Periodontal Therapy. Clin Adv Periodontics 2021; 11:116-123. [PMID: 33301215 DOI: 10.1002/cap.10140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 10/27/2020] [Indexed: 02/03/2023]
Abstract
FOCUSED CLINICAL QUESTION After a quick overview on the original principles of guided periodontal regeneration (GTR), the aim of this paper focuses on the advantages of minimally invasive surgical techniques for periodontal regeneration/reconstruction. The specific clinical question to answer is: Are there new clinical parameters useful to choose the best minimal invasive surgery approach for each periodontal defect? An update of the decision trees is to propose after highlighting some clinical parameters deemed relevant for the choice of the most suitable minimally invasive surgical approach and which therefore are considered by us having a place in the new decision trees. SUMMARY Starting from the paper of Evian dated 1985 until that of Aslan in 2017, we have analyzed the minimal periodontal surgical techniques proposed for the periodontal regeneration. In addition to the parameters set in the various flowcharts, we have highlighted the following additional parameters: papilla height loss; supra bone component of the defect; Δ Bone Sounding; width of keratinized tissue. CONCLUSION The decision-making chart improved with the new clinically relevant factors may serve as a useful guideline for dentists, but to definitively validate it, further studies need to be developed in the future. In order to clarify the proposed flow chart, the authors present two different clinical cases.
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Affiliation(s)
- Giovanni Barbagallo
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry Italy, University of Catania, Catania, Italy
| | | | - Alessandro Psaila
- Department of Biomedical, Surgical and Dental Sciences, Dental Clinic ASST, Santi Paolo e Carlo University of Milan, Italy
| | - Dario Cultrera
- Graduating School of Dentistry, University of Catania, Catania, Italy
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Rasperini G, Tavelli L, Barootchi S, McGuire MK, Zucchelli G, Pagni G, Stefanini M, Wang HL, Giannobile WV. Interproximal attachment gain: The challenge of periodontal regeneration. J Periodontol 2020; 92:931-946. [PMID: 33152103 DOI: 10.1002/jper.20-0587] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/27/2020] [Accepted: 10/24/2020] [Indexed: 11/08/2022]
Abstract
The new classification of periodontal diseases recognizes the key role of the interdental clinical attachment for defining the periodontal status and the extent of disease severity. Regenerating interdental clinical attachment not only improves the prognosis of the tooth, but it also lessens the severity of the disease condition. This manuscript provides a state-of-the-art review on surgical reconstructive approaches for treating papillary deficiency associated with soft and hard tissue interproximal defects. Combination therapy of papilla preservation, connective tissue grafting, and coronally advanced flaps may result in regeneration of the intrabony defect coupled with root coverage. Future research highlighted here may have the potential, especially in combination approaches, to repair challenging interproximal soft and hard tissue deficiencies.
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Affiliation(s)
- Giulio Rasperini
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Foundation IRCCS Ca' Granda Policlinic, Milan, Italy.,Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Lorenzo Tavelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Shayan Barootchi
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Michael K McGuire
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Private practice, Houston, TX, USA.,Department of Periodontics, Dental Branch Houston and Health Science Center at San Antonio, University of Texas, San Antonio, TX, USA
| | - Giovanni Zucchelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giorgio Pagni
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Foundation IRCCS Ca' Granda Policlinic, Milan, Italy
| | - Martina Stefanini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Hom-Lay Wang
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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Nibali L, Sultan D, Arena C, Pelekos G, Lin GH, Tonetti M. Periodontal infrabony defects: Systematic review of healing by defect morphology following regenerative surgery. J Clin Periodontol 2020; 48:100-113. [PMID: 33025619 DOI: 10.1111/jcpe.13381] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/05/2020] [Accepted: 09/29/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND It is thought that infrabony defect morphology affects the outcome of periodontal regenerative surgery. However, this has not been systematically investigated. AIMS To investigate how well defect morphology is described in papers reporting regenerative therapy of periodontal infrabony defects and to investigate its effect on clinical and radiographic outcomes. MATERIALS AND METHODS A search was conducted in 3 electronic databases for publications reporting clinical and radiographic outcomes of periodontal intra-bony defects after regenerative therapy, divided by defect morphology. RESULTS The initial search resulted in 4487 papers, reduced to 143 after first and second screening. Fifteen of these publications were suitable for a fixed-effects meta-analysis. Initial defect depth was found to influence radiographic bone gain 12 months post-surgery, while narrower angles and increased number of walls influenced both radiographic bone gain and clinical attachment level (CAL) gain at 12 months. These associations seemed to occur irrespective of biomaterials used. Risk of bias ranged from low to high. CONCLUSION Deeper defects with narrower angles and increased number of walls exhibit improved CAL and radiographic bone gain at 12 months post-regenerative surgery. More data are needed about other aspects of defect morphology such as extension to buccal/lingual surfaces.
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Affiliation(s)
- Luigi Nibali
- Periodontology Unit, Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Duaa Sultan
- Periodontology Unit, Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | | | - George Pelekos
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
| | - Guo-Hao Lin
- University of California, San Francisco, USA
| | - Maurizio Tonetti
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong.,Department of Oral and Maxillofacial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Centre of Stomatology, Shanghai 9th People Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China
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Fileto Mazzonetto AL, Casarin RCV, Santamaria MP, Andere NMRB, Araújo CF, Videira Clima da Silva R, Purisaca JEV, Sallum EA, Sallum AW. Clinical, radiographic, and patient-centered outcomes after use of enamel matrix proteins for the treatment of intrabony defects in patients with aggressive periodontitis: A 12-month multicenter clinical trial. J Periodontol 2020; 92:995-1006. [PMID: 33107596 DOI: 10.1002/jper.20-0493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/01/2020] [Accepted: 10/01/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the clinical, radiographic and patient-centered results of enamel matrix derivative (EMD) therapy in intrabony defects in aggressive periodontitis (AgP) patients and compare them with those in chronic periodontitis (CP) patients. METHODS Sixty intrabony defects in AgP and CP patients associated with ≥ 6 mm residual probing pocket depth (PPD) were included and randomly assigned to one of three groups: AgP+CS (conservative surgery) (n = 20); AgP+CS/EMD (n = 20); CP+CS/EMD (n = 20). Clinical parameters were measured at baseline and after 6 and 12 months. Defect resolution (DR) and bone filling (BF) were used for radiographic analysis. The quality of life was recorded at baseline and 6 months using OHIP-14 and VAS scale in the early post-therapy period. RESULTS PPD and relative clinical attachment level (rCAL) improved for all groups during follow-up (P ≤ 0.05), and AgP+CS/EMD presented a higher rCAL gain (2.4 ± 1.0 mm) when compared to AgP control patients (1.6 ± 1.6 mm, P ≤ 0.05) after 12 months. No difference was observed between AgP+CS/EMD and CP+CS/EMD groups (P > 0.05). No radiographic differences were observed among groups at any time point (P > 0.05). All the groups reported a positive impact on OHIP-14 total score, without differences among them. CONCLUSIONS EMD therapy of intrabony defects promotes additional benefits in AgP patients, presenting a similar regeneration rate compared to CP patients, and has proven to be a viable therapy for the treatment of individuals with AgP.
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Affiliation(s)
| | | | | | | | - Cássia Fernandes Araújo
- Department of Diagnosis and Surgery, State University of São Paulo, São José dos Campos, Brazil
| | | | | | - Enilson Antonio Sallum
- Department of Prosthesis and Periodontology, State University of Campinas, Piracicaba, Brazil
| | - Antonio Wilson Sallum
- Department of Prosthesis and Periodontology, State University of Campinas, Piracicaba, Brazil
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Nguyen L, Krish G, Alsaleh A, Mailoa J, Kapila Y, Kao RT, Lin GH. Analyzing the predictability of the Kwok and Caton periodontal prognosis system: A retrospective study. J Periodontol 2020; 92:662-669. [PMID: 33011996 DOI: 10.1002/jper.20-0411] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/18/2020] [Accepted: 08/26/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to analyze the predictability of the Kwok and Caton periodontal prognosis system by investigating tooth survival within a 64-month period and to compare this to other well-established prognosis systems. METHODS This retrospective study included the records of patients who had a minimum of two dental exams at least 12 months apart at a single University-affiliated Dental Center. Data including patients' age, sex, length of follow-up period, initial tooth prognosis, revised tooth prognosis, tooth type, and number of teeth lost at the latest exam were recorded. Descriptive analysis was used for data interpretation. RESULTS A total of 4,046 teeth from 174 patients qualified for the study. Teeth with initial poorer prognosis had a higher chance of being extracted compared with those with a better initial prognosis. Tooth survival rate at the latest follow-up for those with an initial favorable, questionable, unfavorable, and hopeless prognosis was 97.9%, 90.7%, 62.5%, and 17.7%, respectively. Teeth initially assigned to a poorer prognosis category had a higher proportion that changed to a worse prognosis at the latest periodontal exam. CONCLUSIONS The Kwok and Caton prognosis system can predictably determine tooth survivability within a 5-year period. The defined categories of this prognosis system are more reliable than that of other systems in the short-term. However, long-term (>5 years) prediction accuracy of this prognosis system needs further investigation.
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Affiliation(s)
- Lincoln Nguyen
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - Goutam Krish
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - Ahmed Alsaleh
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | | | - Yvonne Kapila
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - Richard T Kao
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA.,Private practice, Cupertino, CA, USA
| | - Guo-Hao Lin
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA
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Shi JY, Qian SJ, Gu YX, Qiao SC, Tonetti MS, Lai HC. Long-term outcomes of osteotome sinus floor elevation without grafting in severely atrophic maxilla: A 10-year prospective study. J Clin Periodontol 2020; 47:1528-1535. [PMID: 32929768 DOI: 10.1111/jcpe.13365] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/27/2020] [Accepted: 09/04/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The aim of the present study was to report 10-year results of osteotome sinus floor elevation (OSFE) without grafting severely atrophic maxilla (residual bone height ≤4 mm). MATERIALS AND METHODS Patients undergoing OSFE without grafting and implant placement were included for 10-year examinations. Implant survival, complication-free survival, modified bleeding index (mBI), modified plaque index (mPI), pocket probing depth (PPD), peri-implant marginal bone loss (MBL), endo-sinus bone gain (ESBG) and mean cost of recurrence were evaluated. RESULTS Overall, 23 patients with 35 implants attended 10-year examination. Cemented implant crowns or implant-supported fixed dental prostheses were delivered to the patients. Kaplan-Meier implant survival was 89.2% at implant level and 84.1% at patient level. Complication-free survival was 26.0% at patient level and 37.0% at implant level. The average complication-free survival time was 74.6 months (95% CI: 63.2-86.0 months) at implant level and 69.1 months (95% CI: 54.8-83.4 months) at patient level. The mBI, mPI, PPD, MBL and ESBG at 10-year follow-up were 0.91 ± 0.58, 0.48 ± 0.51, 2.94 ± 0.79 mm, 1.63 ± 0.83 mm and 2.72 ± 0.51 mm, respectively. The cost of managing recurrence was 43.6% of the initial cost of treatment. CONCLUSION The results of the present study indicate that OSFE without grafting is a reliable treatment option in severely atrophic maxilla. Acceptable survival rate, stable MBL and ESBG could be achieved within 10 years. Low complication-free survival and high costs of recurrence management need to be considered.
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Affiliation(s)
- Jun-Yu Shi
- Department of Oral and Maxillo-facial Implantology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,European Research Group on Periodontology, Berne, Switzerland
| | - Shu-Jiao Qian
- Department of Oral and Maxillo-facial Implantology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,European Research Group on Periodontology, Berne, Switzerland
| | - Ying-Xin Gu
- Department of Oral and Maxillo-facial Implantology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,European Research Group on Periodontology, Berne, Switzerland
| | - Shi-Chong Qiao
- Department of Oral and Maxillo-facial Implantology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,European Research Group on Periodontology, Berne, Switzerland
| | - Maurizio S Tonetti
- Department of Oral and Maxillo-facial Implantology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,European Research Group on Periodontology, Berne, Switzerland
| | - Hong-Chang Lai
- Department of Oral and Maxillo-facial Implantology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,European Research Group on Periodontology, Berne, Switzerland
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Sadowsky SJ, Brunski JB. Are teeth superior to implants? A mapping review. J Prosthet Dent 2020; 126:181-187. [PMID: 32862999 DOI: 10.1016/j.prosdent.2020.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
STATEMENT OF PROBLEM There is a long-held assumption that teeth are superior to implants because the periodontal ligament (PDL) confers a preeminent defense against biologic and mechanical challenges. However, adequate analysis of the literature is lacking. As a result, differential treatment planning of tooth- and implant-supported restorations has been compromised. PURPOSE Given an abundance and diversity of research, the purpose of this mapping review was to identify basic scientific gaps in the knowledge of how teeth and implants respond to biologic and mechanical loads. The findings will offer enhanced evidence-based clinical decision-making when considering replacement of periodontally compromised teeth and the design of implant prostheses. MATERIAL AND METHODS The online databases PubMed, Science Direct, and Web of Science were searched. Published work from 1965 to 2020 was collected and independently analyzed by both authors for inclusion in this review. RESULTS A total of 108 articles met the inclusion criteria of clinical, in vivo, and in vitro studies in the English language on the periradicular and peri-implant bone response to biologic and mechanical loads. The qualitative analysis found that the PDL's enhanced vascularity, stem cell ability, and resident cells that respond to inflammation allow for a more robust defense against biologic threats compared with implants. While the suspensory PDL acts to mediate moderate loads to the bone, higher compressive stress and strain within the PDL itself can initiate a biologic sequence of osteoclastic activity that can affect changes in the adjacent bone. Conversely, the peri-implant bone is more resistant to similar loads and the threshold for overload is higher because of the absence of a stress or strain sensitivity inherent in the PDL. CONCLUSIONS Based on this mapping review, teeth are superior to implants in their ability to resist biologic challenges, but implants are superior to teeth in managing higher compressive loads without prompting bone resorption.
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Affiliation(s)
- Steven J Sadowsky
- Professor, Preventive and Restorative Department, University of the Pacific Arthur A. Dugoni School of Dentistry, San Francisco, Calif.
| | - John B Brunski
- Professor, Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Stanford University, Stanford, Calif
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Cortellini P, Stalpers G, Mollo A, Tonetti MS. Periodontal regeneration versus extraction and dental implant or prosthetic replacement of teeth severely compromised by attachment loss to the apex: A randomized controlled clinical trial reporting 10-year outcomes, survival analysis and mean cumulative cost of recurrence. J Clin Periodontol 2020; 47:768-776. [PMID: 32249446 PMCID: PMC7384072 DOI: 10.1111/jcpe.13289] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/07/2020] [Accepted: 03/25/2020] [Indexed: 12/19/2022]
Abstract
Background Periodontal regeneration can change tooth prognosis and represents an alternative to extraction in teeth compromised by severe intra‐bony defects. The aim of this study was to compare periodontal regeneration (PR) with tooth extraction and replacement (TER) in a population with attachment loss to or beyond the apex of the root in terms of professional, patient‐reported and economic outcomes. Methods This was a 10‐year randomized controlled clinical trial. 50 stage III or stage IV periodontitis subjects with a severely compromised tooth with attachment loss to or beyond the apex were randomized to PR or TER with either an implant‐ or a tooth‐supported fixed partial denture. Subjects were kept on a strict periodontal supportive care regimen every 3 months and examined yearly. Survival and recurrence analysis were performed. Results 88% and 100% survival rates were observed in the PR and TER groups. Complication‐free survival was not significantly different: 6.7–9.1 years for PR and 7.3–9.1 years for TER (p = .788). In PR, the observed 10‐year attachment gain was 7.3 ± 2.3 mm and the residual probing depths were 3.4 ± 0.8 mm. Recurrence analysis showed that the 95% confidence interval of the costs was significantly lower for PR compared with TER throughout the whole 10‐year period. Patient‐reported outcomes and oral health‐related quality‐of‐life measurements improved in both groups. Conclusions Periodontal regeneration can change the prognosis of hopeless teeth and is a less costly alternative to tooth extraction and replacement. The complexity of the treatment limits widespread application to the most complex cases but provides powerful proof of principle for the benefits of PR in deep intra‐bony defect.
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Affiliation(s)
- Pierpaolo Cortellini
- Accademia Toscana di Ricerca Odontostomatologia (ATRO), Florence, Italy.,European Research Group on Periodontology (ERGOPERIO), Genova, Italy
| | | | | | - Maurizio S Tonetti
- European Research Group on Periodontology (ERGOPERIO), Genova, Italy.,Division of Periodontology and Implant Dentistry, Faculty of Dentistry, University of Hong Kong, Hong Kong, SAR China
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