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Liu J, Wang J, Wang Z, Ren H, Zhang Z, Fu Y, Li L, Shen Z, Li T, Tang S, Wei F. PGC-1α/LDHA signaling facilitates glycolysis initiation to regulate mechanically induced bone remodeling under inflammatory microenvironment. Bone 2024; 185:117132. [PMID: 38789096 DOI: 10.1016/j.bone.2024.117132] [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: 01/08/2024] [Revised: 04/29/2024] [Accepted: 05/20/2024] [Indexed: 05/26/2024]
Abstract
The mechanosensitivity of inflammation can alter cellular mechanotransduction. However, the underlying mechanism remains unclear. This study aims to investigate the metabolic mechanism of inflammation under mechanical force to guide tissue remodeling better. Herein, we found that inflammation hindered bone remodeling under mechanical force, accompanied by a simultaneous enhancement of oxidative phosphorylation (OXPHOS) and glycolysis. The control of metabolism direction through GNE-140 and Visomitin revealed that enhanced glycolysis might act as a compensatory mechanism to resist OXPHOS-induced osteoclastogenesis by promoting osteogenesis. The inhibited osteogenesis induced by inflammatory mechanical stimuli was concomitant with a reduced expression of peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α). PGC-1α knockdown impeded osteogenesis under mechanical force and facilitated osteoclastogenesis by enhancing OXPHOS. Conversely, PGC-1α overexpression attenuated the impairment of bone remodeling by inflammatory mechanical signals through promoting glycolysis. This process benefited from the PGC-1α regulation on the transcriptional and translational activity of lactate dehydrogenase A (LDHA) and the tight control of the extracellular acidic environment. Additionally, the increased binding between PGC-1α and LDHA proteins might contribute to the glycolysis promotion within the inflammatory mechanical environment. Notably, LDHA suppression effectively eliminated the bone repair effect mediated by PGC-1α overexpression within inflammatory mechanical environments. In conclusion, this study demonstrated a novel molecular mechanism illustrating how inflammation orchestrated glucose metabolism through glycolysis and OXPHOS to affect mechanically induced bone remodeling.
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Affiliation(s)
- Jiani Liu
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan 250012, Shandong, China
| | - Jixiao Wang
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan 250012, Shandong, China
| | - Ziyao Wang
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan 250012, Shandong, China
| | - Huiying Ren
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan 250012, Shandong, China
| | - Zijie Zhang
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan 250012, Shandong, China
| | - Yajing Fu
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan 250012, Shandong, China
| | - Lan Li
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan 250012, Shandong, China
| | - Zhiyuan Shen
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan 250012, Shandong, China
| | - Tianyi Li
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan 250012, Shandong, China
| | - Shuai Tang
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan 250012, Shandong, China
| | - Fulan Wei
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan 250012, Shandong, China.
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2
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Antonarakis GS, Alkisti Z, Stavros K, Catherine G. Periodontal considerations during orthodontic intrusion and extrusion in healthy and reduced periodontium. Periodontol 2000 2024. [PMID: 38831560 DOI: 10.1111/prd.12578] [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: 10/17/2023] [Revised: 04/30/2024] [Accepted: 05/13/2024] [Indexed: 06/05/2024]
Abstract
In patients with advanced periodontal disease, pathological tooth migration may occur, which may require subsequent orthodontic treatment for both aesthetic and functional purposes. When planning orthodontic treatment mechanics, intrusive or extrusive forces are frequently indicated. Understanding tissue reactions during these movements is essential for clinicians when devising a comprehensive orthodontic-periodontal treatment plan. This knowledge enables clinicians to be fully aware of and account for the potential effects on the surrounding tissues. The majority of our understanding regarding the behavior of periodontal tissues in both healthy and compromised periodontal conditions is derived from animal studies. These studies offer the advantage of conducting histological and other assessments that would not be feasible in human research. Human studies are nevertheless invaluable in being able to understand the clinically relevant response elicited by the periodontal tissues following orthodontic tooth movement. Animal and human data show that in dentitions with reduced periodontal support, orthodontic intrusion of the teeth does not induce periodontal damage, provided the periodontal tissues do not have inflammation and plaque control with excellent oral hygiene is maintained. On the contrary, when inflammation is not fully controlled, orthodontic intrusion may accelerate the progression of periodontal destruction, with bacterial plaque remnants being displaced subgingivally, leading to further loss of attachment. Orthodontic extrusion, on the other hand, does not seem to cause further periodontal breakdown in dentitions with reduced periodontal support, even in cases with deficient plaque control. This is attributed to the nature of the tooth movement, which directs any plaque remnants coronally (supragingivally), reducing the risk of adverse effects on the periodontal tissues. This specific type of tooth movement can be leveraged to benefit periodontal conditions by facilitating the regeneration of lost hard and soft periodontal tissues in a coronal direction. As a result, orthodontic extrusion can be employed in implant site development, offering an advantageous alternative to more invasive surgical procedures like bone grafting. Regardless of the tooth movement prescribed, when periodontal involvement is present, it is essential to prioritize periodontal therapy before commencing orthodontic treatment. Adequate plaque control is also imperative for successful outcomes. Additionally, utilizing light orthodontic forces is advisable to achieve efficient tooth movement while minimizing the risk of adverse effects, notably root resorption. By adhering to these principles, a more favorable and effective combined orthodontic-periodontal approach can be ensured. The present article describes indications, mechanisms, side effects, and histological and clinical evidence supporting orthodontic extrusion and intrusion in intact and reduced periodontal conditions.
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Affiliation(s)
- Gregory S Antonarakis
- Division of Orthodontics, University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Zekeridou Alkisti
- Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Kiliaridis Stavros
- Division of Orthodontics, University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Orthodontics and Dentofacial Orthopaedics, University of Bern, Bern, Switzerland
| | - Giannopoulou Catherine
- Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Oruba Z, Gibas-Stanek M, Pihut M, Cześnikiewicz-Guzik M, Stós W. Orthodontic treatment in patients with periodontitis - a narrative literature review. Aust Dent J 2023; 68:238-246. [PMID: 37688346 DOI: 10.1111/adj.12974] [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] [Accepted: 08/09/2023] [Indexed: 09/10/2023]
Abstract
Patients with periodontitis often require an inter-disciplinary approach, including orthodontic treatment, for effective rehabilitation of masticatory function, aesthetics and quality of life. The aim of this narrative review was to comprehensively discuss literature focusing on the biology, indications and inter-disciplinary connections related to the orthodontic approach in patients with periodontitis and to present clinical concepts in accordance with valid guidelines. The outcomes of the experimental studies indicate that orthodontic tooth movement (OTM) can be performed safely for teeth with reduced periodontium, provided infection and inflammation are controlled. Orthodontic treatment can correct pathological tooth migration, is not associated with deterioration of clinical periodontal parameters and improves aesthetics. Intrusion is safe when performed with light forces and under a strict oral hygiene regimen. Teeth can be moved either towards or away from the intrabony defect previously subjected to regenerative procedures, and research suggests that OTM has the potential to enhance bone formation after regenerative therapy. The data on orthodontic movement of teeth with furcation involvement are very scarce. The improvement in furcation involvement following either combined periodontal and orthodontic treatment was only documented in animal model studies. Due to bone and tooth loss, special consideration should be given to orthodontic treatment mechanics. © 2023 Australian Dental Association.
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Affiliation(s)
- Z Oruba
- Faculty of Medicine, Department of Periodontology, Preventive Dentistry and Oral Pathology, Institute of Dentistry, Jagiellonian University Medical College, Kraków, Poland
| | - M Gibas-Stanek
- Faculty of Medicine, Institute of Dentistry, Jagiellonian University Medical College, Chair of Prosthodontics and Orthodontics, Kraków, Poland
| | - M Pihut
- Faculty of Medicine, Institute of Dentistry, Jagiellonian University Medical College, Chair of Prosthodontics and Orthodontics, Kraków, Poland
| | - M Cześnikiewicz-Guzik
- Faculty of Medicine, Department of Periodontology, Preventive Dentistry and Oral Pathology, Institute of Dentistry, Jagiellonian University Medical College, Kraków, Poland
| | - W Stós
- Faculty of Medicine, Institute of Dentistry, Jagiellonian University Medical College, Chair of Prosthodontics and Orthodontics, Kraków, Poland
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Zasčiurinskienė E, Bulotaitė S, Bjerklin K, Lodienė G, Šidlauskas A, Zaborskis A. Knowledge, attitudes, and interest in orthodontic treatment: a cross-sectional study in adults with stage III-IV periodontitis and secondary malocclusions. BMC Oral Health 2023; 23:853. [PMID: 37951899 PMCID: PMC10640755 DOI: 10.1186/s12903-023-03605-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 11/01/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND An increasing number of patients with advanced stages of periodontitis are seeking for treatment options. The study aimed to determine interest in orthodontic treatment (OT) and its association with oral health status and knowledge about the disease in adult subjects with stage III-IV periodontitis. METHODS 96 subjects ≥ 30 years, with stage III-IV periodontitis agreed to fill in a questionnaire and undergo a comprehensive periodontal-orthodontic examination. The questionnaire included 44 questions: demographic, dental, health related habits, self-perceived overall and oral health, knowledge of periodontitis, and attitude toward OT. The statistical analysis was performed using a paired-sample T-test, Receiver Operating Characteristic (ROC) and binary logistic regression analysis (LRA). RESULTS Stage IV periodontitis was observed in 32.3% of subjects and Class II malocclusion was most prevalent (53.1%). More than half of subjects were interested in OT. Oral health, knowledge about periodontitis and age were significant predictors for interest in OT. CONCLUSIONS Knowledge spread about OT possibilities in advanced stages of periodontitis is very important both for the dental community and older subjects to save natural dentition.
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Affiliation(s)
- Eglė Zasčiurinskienė
- Department of Orthodontics, Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, LT-44307, Lithuania.
| | - Skirgailė Bulotaitė
- Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, LT-44307, Lithuania
| | - Krister Bjerklin
- Department of Orthodontics, Institute for Postgraduate Dental Education, Jönköping, SE-55111, Sweden
| | - Greta Lodienė
- Department of Dental and Oral Pathology, Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, LT-44307, Lithuania
| | - Antanas Šidlauskas
- Department of Orthodontics, Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, LT-44307, Lithuania
| | - Apolinaras Zaborskis
- Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, LT-44307, Lithuania
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Zhao N, Zhang Q, Guo Y, Cui S, Tian Y, Zhou Y, Wang X. Analysis of oral microbiome on temporary anchorage devices under different periodontal conditions. Prog Orthod 2023; 24:42. [PMID: 37899378 PMCID: PMC10613604 DOI: 10.1186/s40510-023-00488-x] [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: 12/27/2022] [Accepted: 08/15/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Temporary anchorage devices (TADs) are maximum anchorages that have been widely used in orthodontic treatment. The aim of the study was to uncover whether a history of periodontitis would influence microbiome colonization on the TAD surface. RESULTS Patients were grouped by periodontal evaluations before the orthodontic treatment. Patients with healthy periodontal conditions were classified as the healthy group, and patients diagnosed with periodontitis stage II or even worse were classified as the periodontitis group. Scanning electron microscopy (SEM) was used to analyze the existence of biofilm on the surface of 4 TADs from the healthy group and 4 TADs from the periodontitis group. Fifteen TADs from the healthy group and 12 TADs from the periodontitis group were collected. The microorganisms on the surface of TADs were harvested and analyzed by 16S rRNA gene sequencing. α-diversity indices and β-diversity indices were calculated. Wilcoxon's test was used to determine differences between genera, species as well as KEGG functions. SEM analysis revealed bacteria colonization on the surface of TADs from both groups. Principal coordinate analysis (PCoA) based on β diversity revealed differential sample clusters depending on periodontal conditions (P < 0.01). When comparing specific genera, Fusobacterium, Porphyromonas, Saccharibacteria_(TM7)_[G-1], Dialister, Parvimonas, Fretibacterium, Treponema were more enriched in TADs in the periodontitis group. In the KEGG analysis, TADs in the periodontitis group demonstrated enriched microbial activities involved with translation, genetic information processing, metabolism, and cell motility. CONCLUSIONS This analysis elucidated the difference in total composition and function of TADs oral microorganisms between patients periodontally healthy and with periodontitis.
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Affiliation(s)
- Ningrui Zhao
- Department of Orthodontics, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Beijing, 100081, China
- National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, 100081, China
| | - Qian Zhang
- Central Laboratory, Peking University School and Hospital of Stomatology, Haidian District, Beijing, China
| | - Yanning Guo
- Department of Orthodontics, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Beijing, 100081, China
- National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, 100081, China
| | - Shengjie Cui
- Department of Orthodontics, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Beijing, 100081, China
- National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, 100081, China
| | - Yajing Tian
- Department of Orthodontics, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Beijing, 100081, China
- National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, 100081, China
| | - Yanheng Zhou
- Department of Orthodontics, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Beijing, 100081, China.
- National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, 100081, China.
| | - Xuedong Wang
- Department of Orthodontics, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Beijing, 100081, China.
- National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, 100081, China.
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Tietmann C, Jepsen S, Heibrok H, Wenzel S, Jepsen K. Long-term stability of regenerative periodontal surgery and orthodontic tooth movement in stage IV periodontitis: 10-year data of a retrospective study. J Periodontol 2023; 94:1176-1186. [PMID: 37010261 DOI: 10.1002/jper.23-0081] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND This study aimed to evaluate the long-term effectiveness of regenerative treatment of intra-bony defects in combination with consecutive orthodontic therapy (OT) in stage IV periodontitis. METHODS Twenty-two patients with a total of 256 intra-bony defects were analyzed after regenerative surgery followed by OT initiated 3 months later. Changes in radiographic bone level (rBL) and probing pocket depths (PPD) were evaluated after 1 year (T1), final splinting (T2), and 10 years (T10). RESULTS Mean rBL gain was significant with 4.63 mm (±2.43 mm) after 1 year (T1), 4.19 mm (±2.61 mm) at final splinting (T2), and 4.48 mm (±2.62 mm) after 10 years (T10). Mean PPD was significantly reduced from 5.84 mm (±2.05 mm) at baseline to 3.19 mm (±1.23 mm) at T1, to 3.07 mm (±1.23 mm) at T2, and to 2.93 mm (±1.24 mm) at T10. Pocket closure (PPD ≤ 4 mm) was achieved in 90% of all defects. Tooth loss amounted to 4.5%. CONCLUSIONS Within the limitations of this retrospective study design, these 10-year findings suggest that in motivated and compliant patients with stage IV periodontitis and in need of OT an inter-disciplinary treatment can lead to favorable and stable long-term results.
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Affiliation(s)
- Christina Tietmann
- Private Practice for Periodontology, Aachen, Germany
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | | | - Sven Wenzel
- Private Practice for Periodontology, Aachen, Germany
| | - Karin Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
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Jepsen K, Tietmann C, Martin C, Kutschera E, Jäger A, Wüllenweber P, Gaveglio L, Cardaropoli D, Sanz-Sánchez I, Fimmers R, Jepsen S. Synergy of Regenerative Periodontal Surgery and Orthodontics Improves Quality of Life of Patients with Stage IV Periodontitis: 24-Month Outcomes of a Multicenter RCT. Bioengineering (Basel) 2023; 10:695. [PMID: 37370626 PMCID: PMC10295428 DOI: 10.3390/bioengineering10060695] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/15/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
In stage IV periodontitis patients with pathologic tooth migration (PTM), interdisciplinary treatment includes regenerative periodontal surgery (RPS) with an application of biomaterials and orthodontic therapy (OT) to restore function, esthetics and thereby quality of life (QoL). In a 24-month randomized trial we explored the synergy between regenerative medicine and biomechanical force application. The following methods were used: Forty-three patients had been randomized to a combined treatment comprising RPS and subsequent OT starting either 4 weeks (early OT) or 6 months (late OT) post-operatively. Clinical periodontal parameters and oral health-related QoL (GOHAI) were recorded up to 24 months. We obtained the following results: Mean clinical attachment gain (∆CAL ± SD) was significantly higher with early OT (5.96 ± 2.1 mm) versus late OT (4.65 ± 1.76 mm) (p = 0.034). Pocket closure (PPD ≤ 4 mm) was obtained in 91% of defects with early OT compared to 90% with late OT. GOHAI-scores decreased significantly from 26.1 ± 7.5 to 9.6 ± 4.7 (early OT) and 25.1 ± 7.1 to 12.7 ± 5.6 (late OT). Inconclusion, teeth severely compromised by intrabony defects and PTM can be treated successfully by RPS followed by early OT with the advantage of an overall reduced treatment time. As a result of the combined periodontal-orthodontic therapy, the oral health-related QoL of patients was significantly improved. Early stimulation of wound healing with orthodontic forces had a favorable impact on the outcomes of regenerative periodontal surgery.
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Affiliation(s)
- Karin Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Welschnonnenstrasse 17, 53111 Bonn, Germany; (C.T.)
| | - Christina Tietmann
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Welschnonnenstrasse 17, 53111 Bonn, Germany; (C.T.)
- Private Practice for Periodontology, Krefelder Strasse 73, 52070 Aachen, Germany
| | - Conchita Martin
- BIOCRAN Research Group, University Complutense of Madrid, 28040 Madrid, Spain
| | - Eric Kutschera
- Department of Orthodontics, University of Bonn, Welschnonnenstrasse 17, 53111 Bonn, Germany
| | - Andreas Jäger
- Department of Orthodontics, University of Bonn, Welschnonnenstrasse 17, 53111 Bonn, Germany
| | - Peter Wüllenweber
- Private Practice for Orthodontics, Theaterstraße 98-102, 52062 Aachen, Germany
| | - Lorena Gaveglio
- Private Practice, Corso Galileo Ferraris 148, 10129 Turino, Italy
| | | | | | - Rolf Fimmers
- Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, 53127 Bonn, Germany
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Welschnonnenstrasse 17, 53111 Bonn, Germany; (C.T.)
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Jepsen K, Sculean A, Jepsen S. Complications and treatment errors involving periodontal tissues related to orthodontic therapy. Periodontol 2000 2023; 92:135-158. [PMID: 36920050 DOI: 10.1111/prd.12484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/25/2022] [Accepted: 01/04/2023] [Indexed: 03/16/2023]
Abstract
In this review, typical clinical complications involving periodontal tissues are illustrated that can be encountered in conjunction with orthodontic therapy (OT). Special considerations are given for various clinical scenarios, such as the patient presenting in periodontal health, with periodontitis, or with mucogingival conditions. While some of the complications are seen as common side effects of OT, other, more severe, problems that could have been avoided may be viewed as treatment errors. Recommendations are made on how to prevent these complications, based on the currently available evidence, on clinical practice guidelines, and on expert opinion. In conclusion, while there are several areas in which OT can have unwanted adverse effects on periodontal/mucogingival conditions, there is also great potential for synergies, offering opportunities for close cooperation between the two specialties (periodontics and orthodontics) for the benefit of patients affected by tooth malpositioning and/or periodontal or mucogingival problems.
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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, University of Bern, Bern, Switzerland
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
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Di Spirito F, D'Ambrosio F, Cannatà D, D'Antò V, Giordano F, Martina S. Impact of Clear Aligners versus Fixed Appliances on Periodontal Status of Patients Undergoing Orthodontic Treatment: A Systematic Review of Systematic Reviews. Healthcare (Basel) 2023; 11:healthcare11091340. [PMID: 37174882 PMCID: PMC10178428 DOI: 10.3390/healthcare11091340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/28/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
The present umbrella review of four systematic reviews with meta-analysis aimed to assess whether clear aligners are associated with better periodontal conditions compared with fixed appliances in patients undergoing orthodontic treatment. The present study protocol was developed in accordance with the PRISMA statement before the literature search, data extraction, and analysis and was registered on PROSPERO (CRD42023401808). The question formulation, search, and study selection strategies were developed according to the PICO model. Systematic reviews with a meta-analysis published in English without date restriction were electronically searched across the Cochrane Library, Web of Science (Core Collection), Scopus, EMBASE, and MEDLINE/PubMed databases until 10 February 2023. An assessment of study quality was performed using the AMSTAR 2 tool. Differences in the PI, GI, and BOP in the short- and medium-term follow-ups, in the PPD in long-term follow-up, and the gingival recessions in the short-term follow-up were found between subjects with clear aligners and fixed appliances, revealing a slight tendency for clear aligners to be associated with healthier periodontal conditions. However, even if statistically significant, such differences would be negligible in a clinical environment. Therefore, the impact of orthodontic treatment with clear aligners and fixed appliances on periodontal health status should be considered comparable.
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Affiliation(s)
- Federica Di Spirito
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Via S. Allende, 84081 Baronissi, Italy
| | - Francesco D'Ambrosio
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Via S. Allende, 84081 Baronissi, Italy
| | - Davide Cannatà
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Via S. Allende, 84081 Baronissi, Italy
| | - Vincenzo D'Antò
- School of Orthodontics, Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Francesco Giordano
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Via S. Allende, 84081 Baronissi, Italy
| | - Stefano Martina
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Via S. Allende, 84081 Baronissi, Italy
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Navarrete C, Riquelme A, Baksai N, Pérez R, González C, Michea M, von Mühlenbrock H, Cafferata EA, Vernal R. Levels of Pro-Inflammatory and Bone-Resorptive Mediators in Periodontally Compromised Patients under Orthodontic Treatment Involving Intermittent Forces of Low Intensities. Int J Mol Sci 2023; 24:ijms24054807. [PMID: 36902236 PMCID: PMC10002573 DOI: 10.3390/ijms24054807] [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: 01/15/2023] [Revised: 02/14/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023] Open
Abstract
During orthodontic treatment, diverse cytokines, enzymes, and osteolytic mediators produced within the teeth surrounding periodontal tissues determine the rate of alveolar bone remodeling and consequent teeth movement. In patients with teeth presenting reduced periodontal support, periodontal stability should be ensured during orthodontic treatment. Thus, therapies based on the application of low-intensity intermittent orthodontic forces are recommended. To determine if this kind of treatment is periodontally well tolerated, this study aimed to analyze the production of receptor activator of nuclear factor kappa-B ligand (RANKL), osteoprotegerin (OPG), interleukin (IL)-6, IL-17A, and matrix metalloproteinase (MMP)-8 in periodontal tissues of protruded anterior teeth with reduced periodontal support and undergoing orthodontic treatment. Patients with periodontitis-associated anterior teeth migration received non-surgical periodontal therapy and a specific orthodontic treatment involving controlled low-intensity intermittent orthodontic forces. Samples were collected before periodontitis treatment, after periodontitis treatment, and at 1 week to 24 months of the orthodontic treatment. During the 2 years of orthodontic treatment, no significant differences were detected in the probing depth, clinical attachment level, supragingival bacterial plaque, and bleeding on probing. In line with this, the gingival crevicular levels of RANKL, OPG, IL-6, IL-17A, and MMP-8 did not vary between the different evaluation time-points of the orthodontic treatment. When compared with the levels detected during the periodontitis, the RANKL/OPG ratio was significantly lower at all the analyzed time-points of the orthodontic treatment. In conclusion, the patient-specific orthodontic treatment based on intermittent orthodontic forces of low intensities was well tolerated by periodontally compromised teeth with pathological migration.
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Affiliation(s)
- Cristian Navarrete
- Orthodontics-Periodontics Center, Faculty of Dentistry, Universidad de Chile, Santiago 8380492, Chile
| | - Alejandro Riquelme
- Orthodontics-Periodontics Center, Faculty of Dentistry, Universidad de Chile, Santiago 8380492, Chile
| | - Natalia Baksai
- Orthodontics-Periodontics Center, Faculty of Dentistry, Universidad de Chile, Santiago 8380492, Chile
| | - Romina Pérez
- Orthodontics-Periodontics Center, Faculty of Dentistry, Universidad de Chile, Santiago 8380492, Chile
| | - Claudia González
- Orthodontics-Periodontics Center, Faculty of Dentistry, Universidad de Chile, Santiago 8380492, Chile
| | - María Michea
- Orthodontics-Periodontics Center, Faculty of Dentistry, Universidad de Chile, Santiago 8380492, Chile
| | - Hans von Mühlenbrock
- Orthodontics-Periodontics Center, Faculty of Dentistry, Universidad de Chile, Santiago 8380492, Chile
| | - Emilio A. Cafferata
- Department of Periodontology, School of Dentistry, Universidad Científica del Sur, Lima 15067, Peru
- Periodontal Biology Laboratory, Faculty of Dentistry, Universidad de Chile, Santiago 8380492, Chile
| | - Rolando Vernal
- Periodontal Biology Laboratory, Faculty of Dentistry, Universidad de Chile, Santiago 8380492, Chile
- Department of Conservative Dentistry, Faculty of Dentistry, Universidad de Chile, Santiago 8380492, Chile
- Correspondence:
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11
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Di Spirito F, Amato A, Di Palo MP, Cannatà D, Giordano F, D’Ambrosio F, Martina S. Periodontal Management in Periodontally Healthy Orthodontic Patients with Fixed Appliances: An Umbrella Review of Self-Care Instructions and Evidence-Based Recommendations. Dent J (Basel) 2023; 11:dj11020035. [PMID: 36826180 PMCID: PMC9954872 DOI: 10.3390/dj11020035] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/17/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
The present umbrella review aimed to characterize periodontal self-care instructions, prescriptions, and motivational methods; evaluate the associated periodontal outcomes; and provide integrated, evidence-based recommendations for periodontal self-care in periodontally healthy orthodontic patients with fixed appliances. The presently applied study protocol was developed in advance, compliant with the PRISMA statement, and registered on PROSPERO (CRD42022367204). Systematic reviews published in English without date restrictions were electronically searched until 21 November 2022 across the PROSPERO Register and Cochrane Library, Web of Science (Core Collection), Scopus, and MED-LINE/PubMed databases. The study quality assessment was conducted through the AMSTAR 2 tool. Seventeen systematic reviews were included. Powered and manual toothbrushes showed no significant differences in biofilm accumulation, although some evidence revealed significant improvements in inflammatory, bleeding, and periodontal pocket depth values in the short term with powered toothbrushes. Chlorhexidine mouthwashes, but no gels, varnishes, or pastes, controlled better biofilm accumulation and gingival inflammation as adjuncts to toothbrushing, although only for a limited period. Organic products, such as aloe vera and chamomile, proved their antimicrobial properties, and herbal-based mouthwashes seemed comparable to CHX without its side effects. Motivational methods also showed beneficial effects on periodontal biofilm control and inflammation, while no evidence supported probiotics administration.
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Affiliation(s)
- Federica Di Spirito
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy
- Correspondence:
| | - Alessandra Amato
- Department of Neuroscience, Reproductive Science and Dentistry, University of Naples Federico II, 80138 Naples, Italy
| | - Maria Pia Di Palo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy
| | - Davide Cannatà
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy
| | - Francesco Giordano
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy
| | - Francesco D’Ambrosio
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy
| | - Stefano Martina
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy
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12
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Orthodontic treatment in periodontally compromised patients: a systematic review. Clin Oral Investig 2023; 27:79-89. [PMID: 36502508 PMCID: PMC9877066 DOI: 10.1007/s00784-022-04822-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of this systematic review was to examine the literature on aggressive and chronic periodontitis and orthodontics to clarify the therapy-relevant aspects of orthodontic treatment with altered biomechanics in periodontally compromised dentition. MATERIALS AND METHODS Literature searches were conducted in the electronic databases "PubMed" and "DIMDI" using the keywords "aggressive periodontitis AND ortho*," "aggressive periodontitis AND orthodontics," "chronic periodontitis AND ortho*," and "chronic periodontitis AND orthodontics" for the publication period from January 1990 to July 2022. In addition, a manual search was carried out in the selected trade journals "Community Dental Health," "European Journal of Oral Sciences," and "Parodontologie." Human clinical trials were included, whereas animal experimental studies, case reports, and reviews were generally excluded. The appropriate studies were selected, and the relevant data was tabulated according to different parameters, regarding the study design, the study structure, and the conduct of the study. RESULTS A total of 1067 articles were found in the preliminary electronic search. The manual search and review of all related bibliographies resulted in an additional 1591 hits. After the first screening, 43 articles were classified as potentially relevant and reviewed in their original form. After the suitability test, 5 studies with a total of 366 participants were included in the final evaluation. These included one randomized controlled trial and four low-evidence intervention studies. The studies were conducted in two university hospitals and three private practices. All participants underwent scaling and root plaining and periodontal surgery before the orthodontic treatment started. Mean probing pocket depth reduction before and after the interdisciplinary treatment was analyzed in all the included studies; mean difference in clinical attachment level in four of the studies was also included. All participants were enrolled in a continuous recall system. In all studies, orthodontic therapy in periodontally compromised patients improved function and esthetics, resulting in lower probing depths and clinical attachment gains. CONCLUSIONS Orthodontic treatment can be used for patients with reduced periodontal support to stabilize clinical findings and improve function and esthetics. The prerequisite for this is a profound knowledge of altered biomechanics and an adapted interdisciplinary treatment approach. Due to the large heterogeneity of the included studies and their limited methodological quality, the results obtained in this review must be considered critically. Further randomized controlled long-term studies with comparable study designs are necessary to obtain reliable and reproducible treatment results. CLINICAL RELEVANCE Patients with periodontal impairment can be successfully treated with orthodontics as part of interdisciplinary therapy. Orthodontic treatment has no negative impact on the periodontium; if minimal, controlled forces are used under non-inflammatory conditions.
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13
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Periodontal and Orthodontic Synergy in the Management of Stage IV Periodontitis: Challenges, Indications and Limits. LIFE (BASEL, SWITZERLAND) 2022; 12:life12122131. [PMID: 36556496 PMCID: PMC9782082 DOI: 10.3390/life12122131] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
This retrospective study described the clinical and radiographic long-term outcomes of combined periodontal and orthodontic treatment (OT) with fixed appliances in patients with Stage IV periodontitis and pathologic tooth migration (PTM) in the anterior sextants. OT was performed in either one or both arches, using tooth-supported or skeletal anchorage, following completion of active periodontal treatment and accurate planning of tooth movement biomechanics. Twenty-nine patients were identified and retrospectively examined when presenting for a supportive periodontal care (SPC) appointment. The mean SPC duration was 8.9 years (range 5 to 12 years). All anterior-migrated teeth showed statistically significant periodontal improvement compared to baseline values and stable radiographic bone levels at the final follow-up. Residual probing depths were 2.9 ± 0.5 mm at the end of active periodontal treatment, and they remained stable at the completion of OT (2.9 ± 0.6 mm) and at the last follow-up visit (2.8 ± 0.5 mm). These findings suggest that OT is a safe and effective treatment in improving the long-term prognosis of teeth with PTM in Stage IV periodontitis provided that periodontal health has been re-established and maintained with individualized SPC sessions.
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14
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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: 95] [Impact Index Per Article: 47.5] [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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15
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Motta ATSD. Orthodontic treatment in the presence of aggressive periodontitis. Dental Press J Orthod 2021; 26:e21bbo6. [PMID: 34932773 PMCID: PMC8690590 DOI: 10.1590/2177-6709.26.6.e21bbo6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/27/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: Aggressive periodontitis causes periodontal destruction, with loss of supporting alveolar bone. The common symptom is rapid attachment loss in the first molar and incisor area, in young adults. Objective: The aim of this study was to discuss the challenges, implications and the impact of orthodontic treatment in patients affected by severe periodontal problems, specifically aggressive periodontitis. Discussion: In addition to other bacteria, the main pathogen involved in aggressive periodontitis is the Aggregatibacter actinomycetemcomitans. However, the susceptibility to the disease differs among individuals, being immune deficiencies the main reason for this variability. Many orthodontists are not comfortable about performing treatments on individuals with aggressive periodontitis. Conclusion: Orthodontic treatment is feasible in young patients with severe and localized aggressive periodontitis, as long as the limitations imposed by the disease are respected. An interdisciplinary approach is required, with frequent periodontal follow-up before, during and after orthodontic treatment, allowing the correction of dental positions without aggravating bone loss.
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16
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Papageorgiou SN, Antonoglou GN, Michelogiannakis D, Kakali L, Eliades T, Madianos P. Effect of periodontal-orthodontic treatment of teeth with pathological tooth flaring, drifting, and elongation in patients with severe periodontitis: A systematic review with meta-analysis. J Clin Periodontol 2021; 49 Suppl 24:102-120. [PMID: 34327710 PMCID: PMC9290963 DOI: 10.1111/jcpe.13529] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/25/2021] [Indexed: 12/28/2022]
Abstract
Aim To assess the beneficial and adverse effects on the dental and periodontal issues of periodontal–orthodontic treatment of teeth with pathological tooth flaring, drifting, and elongation in patients with severe periodontitis. Materials and methods Nine databases were searched in April 2020 for randomized/non‐randomized clinical studies. After duplicate study selection, data extraction, and risk‐of‐bias assessment, random‐effect meta‐analyses of mean differences (MDs) and their 95% confidence intervals (CIs) were performed, followed by subgroup/meta‐regression analyses. Results A total of 30 randomized and non‐randomized clinical studies including 914 patients (29.7% male; mean age 43.4 years) were identified. Orthodontic treatment of pathologically migrated teeth was associated with clinical attachment gain (−0.24 mm; seven studies), pocket probing depth reduction (−0.23 mm; seven studies), marginal bone gain (−0.36 mm; seven studies), and papilla height gain (−1.42 mm; two studies) without considerable adverse effects, while patient sex, gingival phenotype, baseline disease severity, interval between periodontal and orthodontic treatment, and orthodontic treatment duration affected the results. Greater marginal bone level gains were seen by additional circumferential fiberotomy (two studies; MD = –0.98 mm; 95% CI = –1.87 to −0.10 mm; p = .03), but the quality of evidence was low. Conclusions Limited evidence of poor quality indicates that orthodontic treatment might be associated with small improvements of periodontal parameters, which do not seem to affect prognosis, but more research is needed.
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Affiliation(s)
- Spyridon N Papageorgiou
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Georgios N Antonoglou
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, Department of Periodontology, Faculty of Dentistry, University Complutense, Madrid, Spain
| | - Dimitrios Michelogiannakis
- Division of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, Rochester, New York, USA
| | - Lydia Kakali
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodore Eliades
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Phoebus Madianos
- Department of Periodontology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
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17
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Jepsen K, Tietmann C, Kutschera E, Wüllenweber P, Jäger A, Cardaropoli D, Gaveglio L, Sanz Sanchez I, Martin C, Fimmers R, Jepsen S. The effect of timing of orthodontic therapy on the outcomes of regenerative periodontal surgery in patients with stage IV periodontitis: A multicenter randomized trial. J Clin Periodontol 2021; 48:1282-1292. [PMID: 34312872 DOI: 10.1111/jcpe.13528] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 12/29/2022]
Abstract
AIM To compare the outcomes after early (4 weeks post surgery) or late (6 months post surgery) orthodontic therapy (OT) following regenerative surgery of intra-bony defects (IDs). MATERIALS AND METHODS In a multi-center, parallel-group, randomized clinical trial, 43 patients with stage IV periodontitis were randomized to receive either early (n = 23) or late OT (n = 20) following regenerative surgery of IDs. Primary outcome was change in clinical attachment level (CAL) in one target ID at 12 months after surgery. Secondary outcomes were changes of probing pocket depth (PPD), bleeding on probing (BOP), and frequency of pocket closure. RESULTS No statistically significant differences between groups could be observed for CAL gain (5.4 mm [±2.1 mm] for early; 4.5 mm [±1.7 mm] for late OT). PPD was reduced by 4.2 mm (±1.9 mm) in the early group and by 3.9 mm (±1.5 mm) in the late group (p > .05). Pocket closure (PPD ≤ 4 mm) was obtained in 91% of defects in early compared to 85% in late OT. CONCLUSION In the inter-disciplinary treatment of periodontitis stage IV, OT can be initiated already 4 weeks after regenerative surgery of IDs with favourable results, thus reducing the overall treatment time.
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Affiliation(s)
- Karin Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University Hospital of Bonn, Bonn, Germany
| | | | - Eric Kutschera
- Department of Orthodontics, University of Bonn, Bonn, Germany
| | | | - Andreas Jäger
- Department of Orthodontics, University of Bonn, Bonn, Germany
| | | | | | | | - Conchita Martin
- BIOCRAN Research Group, University Complutense of Madrid, Madrid, Spain
| | - Rolf Fimmers
- Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University Hospital of Bonn, Bonn, Germany
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