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Casarin RCV, Silva RVCD, Paz HEDS, Stolf CS, Carvalho LM, Noronha MF, Sallum AW, Monteiro MDF. Metatranscriptomic analysis shows functional alterations in subgingival biofilm in young smokers with periodontitis: a pilot study. J Appl Oral Sci 2024; 32:e20240031. [PMID: 39166556 PMCID: PMC11364450 DOI: 10.1590/1678-7757-2024-0031] [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: 01/27/2024] [Accepted: 06/24/2024] [Indexed: 08/23/2024] Open
Abstract
OBJECTIVE This study aimed to assess the influence of smoking on the subgingival metatranscriptomic profile of young patients affected by stage III/IV and generalized periodontal disease. METHODOLOGY In total, six young patients, both smokers and non-smokers (n=3/group), who were affected by periodontitis were chosen. The STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for case-control reporting were followed. Periodontal clinical measurements and subgingival biofilm samples were collected. RNA was extracted from the biofilm and sequenced via Illumina HiSeq. Differential expression analysis used Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment, and differentially expressed genes were identified using the Sleuth package in R, with a statistical cutoff of ≤0.05. RESULTS This study found 3351 KEGGs in the subgingival biofilm of both groups. Smoking habits altered the functional behavior of subgingival biofilm, resulting in 304 differentially expressed KEGGs between groups. Moreover, seven pathways were modulated: glycan degradation, galactose metabolism, glycosaminoglycan degradation, oxidative phosphorylation, peptidoglycan biosynthesis, butanoate metabolism, and glycosphingolipid biosynthesis. Smoking also altered antibiotic resistance gene levels in subgingival biofilm by significantly overexpressing genes related to beta-lactamase, permeability, antibiotic efflux pumps, and antibiotic-resistant synthetases. CONCLUSION Due to the limitations of a small sample size, our data suggest that smoking may influence the functional behavior of subgingival biofilm, modifying pathways that negatively impact the behavior of subgingival biofilm, which may lead to a more virulent community.
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Affiliation(s)
- Renato Corrêa Viana Casarin
- Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba, Departamento de Prótese e Periodontia, Piracicaba, Brasil
| | - Rafaela Videira Clima da Silva
- Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba, Departamento de Prótese e Periodontia, Piracicaba, Brasil
| | - Hélvis Enri de Sousa Paz
- Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba, Departamento de Prótese e Periodontia, Piracicaba, Brasil
| | - Camila Schmidt Stolf
- Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba, Departamento de Prótese e Periodontia, Piracicaba, Brasil
| | - Lucas Miguel Carvalho
- Universidade Estadual de Campinas, Centro de Pesquisas em Engenharias e Ciências Computacionais, Campinas, Brasil
| | - Melline Fontes Noronha
- University of Illinois at Chicago, Research Resource Center, Research Informatics Core, Illinois, USA
| | - Antonio Wilson Sallum
- Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba, Departamento de Prótese e Periodontia, Piracicaba, Brasil
| | - Mabelle de Freitas Monteiro
- Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba, Departamento de Prótese e Periodontia, Piracicaba, Brasil
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Khatri A, Khatri M, Bansal M, Batra P, Aziz SB. Periodontal and microbiological evaluation in cleft lip/palate patients undergoing orthodontic treatment: A cross-sectional study. J Periodontol 2024. [PMID: 38924066 DOI: 10.1002/jper.24-0085] [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: 02/12/2024] [Revised: 05/21/2024] [Accepted: 05/24/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The present cross-sectional study was undertaken to evaluate the periodontal and microbiological parameters in patients with surgically repaired unilateral cleft lip and palate (UCLP) undergoing orthodontic correction in comparison to patients without any cleft or orthodontic treatment. METHODS A total of 120 patients, out of initial 148 patients, between the age group 6 and 18 years were enrolled and divided into four groups with 30 patients each: non-cleft patients without orthodontic treatment in Group 1, non-cleft patients undergoing fixed orthodontic treatment in Group 2, patients with UCLP without any orthodontic treatment in Group 3, and patients with UCLP undergoing fixed orthodontic treatment in Group 4. Periodontal parameters including plaque index (PI), gingival index (GI), gingival bleeding index (GBI), community periodontal index of treatment needs (CPITN) index, pocket probing depth (PD), and tooth mobility were measured in all the groups. The subgingival plaque samples of all the patients were subjected to microbial evaluation using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF-MS) for clinical diagnosis. RESULTS The periodontal parameters were significantly raised in Group 4, followed by Group 3 and Group 2 in comparison to Group 1 (p < 0.01), thereby suggesting poor periodontal health in patients with UCLP undergoing orthodontic treatment. Statistically significant differences (p < 0.01) in counts of micro-organisms among the groups were observed for P. gingivalis, P. intermedia, Veillonella, and Capnocytophaga, with the highest proportions in Group 4, indicating a deteriorating oral health in these patients. CONCLUSION Poor periodontal and microbial health in patients with UCLP undergoing orthodontic treatment indicates a need for reinforcement of oral hygiene practices among these patients.
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Affiliation(s)
- Ayush Khatri
- Department of Periodontology, Institute of Dental Studies & Technologies, Modinagar, Uttar Pradesh, India
| | - Manish Khatri
- Department of Periodontology, Institute of Dental Studies & Technologies, Modinagar, Uttar Pradesh, India
| | - Mansi Bansal
- Department of Periodontology, Institute of Dental Studies & Technologies, Modinagar, Uttar Pradesh, India
| | - Puneet Batra
- Department of Orthodontics & Dentofacial Orthopaedics, School of Dental Sciences, Manav Rachna International Institute of Research & Studies, Faridabad, Haryana, India
| | - Sana Bint Aziz
- Department of Orthodontics & Dentofacial Orthopaedics, School of Dental Sciences, Manav Rachna International Institute of Research & Studies, Faridabad, Haryana, India
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Chow DY, Tay JRH, Nascimento GG. Systematic Review of Prognosis Models in Predicting Tooth Loss in Periodontitis. J Dent Res 2024; 103:596-604. [PMID: 38726948 DOI: 10.1177/00220345241237448] [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] [Indexed: 05/24/2024] Open
Abstract
This study reviews and appraises the methodological and reporting quality of prediction models for tooth loss in periodontitis patients, including the use of regression and machine learning models. Studies involving prediction modeling for tooth loss in periodontitis patients were screened. A search was performed in MEDLINE via PubMed, Embase, and CENTRAL up to 12 February 2022, with citation chasing. Studies exploring model development or external validation studies for models assessing tooth loss in periodontitis patients for clinical use at any time point, with all prediction horizons in English, were considered. Studies were excluded if models were not developed for use in periodontitis patients, were not developed or validated on any data set, predicted outcomes other than tooth loss, or were prognostic factor studies. The CHARMS checklist was used for data extraction, TRIPOD to assess reporting quality, and PROBAST to assess the risk of bias. In total, 4,661 records were screened, and 45 studies were included. Only 26 studies reported any kind of performance measure. The median C-statistic reported was 0.671 (range, 0.57-0.97). All studies were at a high risk of bias due to inappropriate handling of missing data (96%), inappropriate evaluation of model performance (92%), and lack of accounting for model overfitting in evaluating model performance (68%). Many models predicting tooth loss in periodontitis are available, but studies evaluating these models are at a high risk of bias. Model performance measures are likely to be overly optimistic and might not be replicated in clinical use. While this review is unable to recommend any model for clinical practice, it has collated the existing models and their model performance at external validation and their associated sample sizes, which would be helpful to identify promising models for future external validation studies.
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Affiliation(s)
- D Y Chow
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore
| | - J R H Tay
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore
| | - G G Nascimento
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore
- ORH ACP, Duke-NUS Medical School Singapore, Singapore
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Peditto M, Rupe C, Gambino G, Di Martino M, Barbato L, Cairo F, Oteri G, Cavalcanti R. Influence of mobility on the long-term risk of tooth extraction/loss in periodontitis patients. A systematic review and meta-analysis. J Periodontal Res 2024. [PMID: 38766764 DOI: 10.1111/jre.13286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/22/2024]
Abstract
The aim of this systematic review (SR) was to assess whether tooth mobility (TM) increases the risk of tooth extraction/loss. The protocol was registered in PROSPERO database (CRD42023485425). The focused PECO questions were as follows: (1) "In patients with periodontitis, undergoing periodontal treatment, are teeth affected by mobility at higher risk of being extracted/lost compared to non-mobile teeth, with a minimum follow-up of 10 years?" and (2) "In these patients, does varying degrees of tooth mobility increase the risk of tooth extraction/loss, with a minimum follow-up of 10 years?". Results were reported according to PRISMA statement. Electronic and manual searches were conducted to identify longitudinal studies. The different assessments of tooth mobility were pooled into three groups: TM0: Undetectable tooth mobility, TM1: Horizontal/Mesio-distal mobility ≤1 mm, TM2: Horizontal/Mesio-distal mobility >1 mm or vertical tooth mobility. Tooth loss was the primary outcome. Various meta-analyses were conducted, including subgroup analyses considering different follow-up lengths and the timing of TM assessment, along with sensitivity analyses. A trial sequential analysis was also performed. Eleven studies were included (1883 patients). The mean follow-up range was 10-25 years. The weighted total of included teeth, based on the sample size, was 18 918, with a total of 1604 (8.47%) extracted/lost teeth. The overall rate of tooth extraction/loss increased with increasing mobility: TM0 was associated with a 5.85% rate (866/14822), TM1 with the 11.8% (384/3255), TM2 with the 40.3% (339/841). Mobile teeth (TM1/TM2) were at an increased risk for tooth extraction/loss, compared to TM0 (HR: 2.85; [95% CI 1.88-4.32]; p < .00001). TM1 had a higher risk than TM0 (HR: 1.96; [95% CI 1.09-3.53]; p < .00001). TM2 had a higher risk than TM1 (HR: 2.85; [95% CI 2.19-3.70]; p < .00001) and TM0 (HR: 7.12; [95% CI 3.27-15.51]; p < .00001). The results of the tests for subgroup differences were not significant. Sensitivity meta-analyses yielded consistent results with other meta-analyses. Within the limits of the quality of the studies included in the meta-analyses, mobile teeth were at higher risk of being extracted/lost in the long-term and higher degrees of TM significantly influenced clinicians' decision to extract a tooth. However, most teeth can be retained in the long-term and thus TM should not be considered a reason for extraction or a risk factor for tooth loss, regardless of the degree of TM.
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Affiliation(s)
- Matteo Peditto
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy
| | - Cosimo Rupe
- Research Unit in Periodontology and Periodontal Medicine-Department of Clinical and Experimental Medicine, University of Florence, Firenze, Italy
| | - Giorgia Gambino
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy
| | - Maria Di Martino
- Research Unit in Periodontology and Periodontal Medicine-Department of Clinical and Experimental Medicine, University of Florence, Firenze, Italy
| | - Luigi Barbato
- Research Unit in Periodontology and Periodontal Medicine-Department of Clinical and Experimental Medicine, University of Florence, Firenze, Italy
| | - Francesco Cairo
- Research Unit in Periodontology and Periodontal Medicine-Department of Clinical and Experimental Medicine, University of Florence, Firenze, Italy
| | - Giacomo Oteri
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy
| | - Raffaele Cavalcanti
- Private Practice Bari, Bari, Italy
- Department of General Surgery and Surgical-Medical Specialties, University of Catania, Catania, Italy
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Gopalakrishnan D. Do patients deserve more information in deciding whether to extract their teeth or to maintain their teeth? J Indian Soc Periodontol 2024; 28:3-4. [PMID: 38988955 PMCID: PMC11232799 DOI: 10.4103/jisp.jisp_86_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024] Open
Affiliation(s)
- Dharmarajan Gopalakrishnan
- President - Indian Society of Periodontology, Dean - Professor and Head (Chair) - Department of Periodontology, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Sant Tukaram Nagar, Pimpri, Pune-411 018, Maharashtra, India. E-mail:
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Gopalakrishnan D, Miller PD, Levine RA, Sidharthan S, Mahuli AV, Saleh MHA, Miller W, Buranawat B. Ten-year prognostic outcomes of molar survival using the Miller-Mcentire Periodontal Prognostic Index - A longitudinal prospective study. J Indian Soc Periodontol 2024; 28:75-78. [PMID: 38988965 PMCID: PMC11232806 DOI: 10.4103/jisp.jisp_542_23] [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: 12/08/2023] [Revised: 01/08/2024] [Accepted: 01/29/2024] [Indexed: 07/12/2024] Open
Abstract
Background A 10-year survival analysis was performed to assess the predictive validity of the periodontal risk score (formerly known as Miller-McEntire Periodontal Prognostic Index [MMPPI]) to predict long-term survival of periodontally diseased molars in a longitudinally assessed cohort. Materials and Methods The MMPPI scores were computed at baseline by summarizing scores allocated for individual factors. The cohort was treated, followed up, and placed under regular periodontal maintenance. Molar survival data collected up to 10 years of follow-up were analyzed. Cox proportional regression was performed, and hazards ratio (HR) were computed for each prognostic factor and the MMPPI score. To estimate the predictive value of MMPPI, a receiver operating curve (ROC) curve analysis was performed. Results From 1032 molars, 155 molars were extracted over the 10-year follow-up duration. Cox proportional hazard analysis showed significant hazard ratios for tooth loss for the component variables significant HR was noted for age: 4.92 (3.34:7.27), smoking: 1.74 (1.38-2.22), diabetes: 1.66 (1.49-1.86), molar type: 1.39 (1.15-1.67), probing depth: 2.00 (1.63-2.46), furcation: 2.64 (2.30-3.03), mobility: 3.45 (2.98-4.01), and total MMPPI score: 1.98 (1.85-2.12). ROC curve analysis showed an area under the curve value of 0.94 for the MMPPI index as a predictor of molar loss at 8 years, and the Youden index was maximized at the optimal cutoff point score of 7. Conclusions All component scores of MMPPI showed significant hazard ratios at 10 years. These findings support the previous results from the 5-year analysis of this university-based cohort and warrant validation in independent cohorts.
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Affiliation(s)
- Dharmarajan Gopalakrishnan
- Department of Periodontology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Preston Dallas Miller
- Division of Periodontics, Medical University of South Carolina, Charleston, South Carolina
| | - Robert A Levine
- Department of Periodontology and Implantology, Kornberg School of Dentistry, Temple University, Philadelphia, Pennsylvania
| | - Sangamithra Sidharthan
- Department of Periodontology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Amit Vasant Mahuli
- Department of Public Health Dentistry, Dental Institute, RIMS, Ranchi, Jharkhand, India
| | - Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Whitney Miller
- Department of Technology, Hutchison School, Memphis, Tennessee, USA
| | - Borvornwut Buranawat
- Department of Periodontics and Implant Dentistry, Faculty of Dentistry, Thammasat University, Rangsit Campus, Phatum Thani, Thailand
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7
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Kim GY, Kim S, Chang JS, Pyo SW. Advancements in Methods of Classification and Measurement Used to Assess Tooth Mobility: A Narrative Review. J Clin Med 2023; 13:142. [PMID: 38202149 PMCID: PMC10779763 DOI: 10.3390/jcm13010142] [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: 11/01/2023] [Revised: 12/07/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Evaluating tooth mobility is clinically significant, not only for diagnosing periodontal tissues but also in determining the overall periodontal treatment plan. Numerous studies related to tooth mobility have been conducted over the years, including the proposal of various classifications as well as the development of electronic devices for objective measurement. However, there is still no consensus on the measurement methods and criteria for assessing tooth mobility. In this study, we provide a comprehensive review of past and current tooth mobility classification and measurement methods. In order to propose a new method to intuitively evaluate tooth mobility based on previous studies, a digital approach capable of recording tooth micromovements induced by dynamic load should be considered.
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Affiliation(s)
| | | | | | - Se-Wook Pyo
- Department of Prosthodontics, Gangnam Severance Dental Hospital, Yonsei University College of Dentistry, Seoul 06273, Republic of Korea; (G.Y.K.); (S.K.); (J.-S.C.)
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Machine Learning in Predicting Tooth Loss: A Systematic Review and Risk of Bias Assessment. J Pers Med 2022; 12:jpm12101682. [PMID: 36294820 PMCID: PMC9605501 DOI: 10.3390/jpm12101682] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022] Open
Abstract
Predicting tooth loss is a persistent clinical challenge in the 21st century. While an emerging field in dentistry, computational solutions that employ machine learning are promising for enhancing clinical outcomes, including the chairside prognostication of tooth loss. We aimed to evaluate the risk of bias in prognostic prediction models of tooth loss that use machine learning. To do this, literature was searched in two electronic databases (MEDLINE via PubMed; Google Scholar) for studies that reported the accuracy or area under the curve (AUC) of prediction models. AUC measures the entire two-dimensional area underneath the entire receiver operating characteristic (ROC) curves. AUC provides an aggregate measure of performance across all possible classification thresholds. Although both development and validation were included in this review, studies that did not assess the accuracy or validation of boosting models (AdaBoosting, Gradient-boosting decision tree, XGBoost, LightGBM, CatBoost) were excluded. Five studies met criteria for inclusion and revealed high accuracy; however, models displayed a high risk of bias. Importantly, patient-level assessments combined with socioeconomic predictors performed better than clinical predictors alone. While there are current limitations, machine-learning-assisted models for tooth loss may enhance prognostication accuracy in combination with clinical and patient metadata in the future.
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Comparison Study of Diagnosis and Treatment Planning for Dental Infections between Dental Students and Practitioners. Healthcare (Basel) 2022; 10:healthcare10081393. [PMID: 35893215 PMCID: PMC9330809 DOI: 10.3390/healthcare10081393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/18/2022] [Accepted: 07/22/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to access the knowledge in diagnosing dental infections and the practice in treatment planning for the affected teeth among dental practitioners (DPs) and senior (final-year) students. A survey questionnaire containing two cases (Case A; periodontal abscess and Case B; periapical abscess) with four questions per case was delivered to potential participants. Fifty-nine DPs voluntarily participated in the survey. For senior students, the case study was a part of their course requirements; one of the two cases (either Case A or B) was randomly assigned to the 126 seniors. The distribution of responses was significantly different between the DP and senior groups except for the diagnosis of Case B (Fisher’s exact test; p = 0.05). Only 31% of the participants diagnosed Case A as periodontal abscess; most of them selected periodontal surgery as the first treatment option. Despite a high agreement in diagnosing Case B, the choice of treatment was significantly different; the most frequent treatment option was extraction (51%) from the DP group and root canal retreatment (57%) from the senior group. The study revealed that the diagnosis of periodontal abscess was more challenging than that of periapical abscess among dental professionals.
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Dharmarajan G, Miller P, Levine R, Sidharthan S, Mahuli A, Phantumvanit P, Buranawat B. A 5-year prospective validation of the Miller–McEntire Periodontal Prognostic Index. J Indian Soc Periodontol 2022; 26:157-161. [PMID: 35321294 PMCID: PMC8936013 DOI: 10.4103/jisp.jisp_356_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/05/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Materials and Methods: Results: Conclusions:
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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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12
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Majzoub J, Salami A, Barootchi S, Tavelli L, Wang HL, Chan HL. Multivariate outcome evaluation of furcation-involved molars treated with non-surgical mechanical therapy alone or combined with open flap debridement: A retrospective study. J Periodontol 2021; 93:673-686. [PMID: 34449893 DOI: 10.1002/jper.21-0113] [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: 02/22/2021] [Revised: 08/04/2021] [Accepted: 08/09/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND This retrospective study assessed the effect of non-surgical and surgical mechanical therapy for furcation-involved molars. METHODS Furcation defects treated and followed for at least 1 year were selected. Data relative to the clinical outcomes were recorded. The immediate (3- to 6-month) clinical outcomes and the long-term survival of the treated molars were assessed. The potential variables influencing the treatment outcomes through multi-level regression analysis, and Cox Proportional-Hazards Models were also analyzed. RESULTS One hundred and eighty-four molars were included with an average follow-up of 7.52 years. At the 3- to 6-month re-evaluation 1.39 ± 0.99 mm pocket depth reduction, 0.88 ± 1.29 mm clinical attachment gain, and a 0.51 ± 1.13 mm increase in recession was observed. The 5- and 10-year survival rates were 88.3% and 61.3%, respectively. The horizontal and vertical extent of furcation involvement, baseline probing depth, mucoperiosteal flap elevation, and the frequency of supportive periodontal therapy influenced the clinical outcomes and tooth survival. CONCLUSION Non-surgical and surgical mechanical root debridement is a viable treatment for the management of furcation involved molars with shallow horizontal and vertical components.
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Affiliation(s)
- Jad Majzoub
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
| | - Ali Salami
- Department of Mathematics, Faculty of Sciences, Lebanese University, Nabatieh, Lebanon
| | - Shayan Barootchi
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
| | - Lorenzo Tavelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI.,Department of Oral Medicine, Infection and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, MA
| | - Hom-Lay Wang
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
| | - Hsun-Liang Chan
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
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Rahim-Wöstefeld S, Kronsteiner D, ElSayed S, ElSayed N, Eickholz P, Pretzl B. Development of a prognostic tool: based on risk factors for tooth loss after active periodontal therapy. Clin Oral Investig 2021; 26:813-822. [PMID: 34435251 PMCID: PMC8791882 DOI: 10.1007/s00784-021-04060-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/27/2021] [Indexed: 11/30/2022]
Abstract
Objectives The aim of this study was to develop a prognostic tool to estimate long-term tooth retention in periodontitis patients at the beginning of active periodontal therapy (APT). Material and methods Tooth-related factors (type, location, bone loss (BL), infrabony defects, furcation involvement (FI), abutment status), and patient-related factors (age, gender, smoking, diabetes, plaque control record) were investigated in patients who had completed APT 10 years before. Descriptive analysis was performed, and a generalized linear-mixed model-tree was used to identify predictors for the main outcome variable tooth loss. To evaluate goodness-of-fit, the area under the curve (AUC) was calculated using cross-validation. A bootstrap approach was used to robustly identify risk factors while avoiding overfitting. Results Only a small percentage of teeth was lost during 10 years of supportive periodontal therapy (SPT; 0.15/year/patient). The risk factors abutment function, diabetes, and the risk indicator BL, FI, and age (≤ 61 vs. > 61) were identified to predict tooth loss. The prediction model reached an AUC of 0.77. Conclusion This quantitative prognostic model supports data-driven decision-making while establishing a treatment plan in periodontitis patients. In light of this, the presented prognostic tool may be of supporting value. Clinical relevance In daily clinical practice, a quantitative prognostic tool may support dentists with data-based decision-making. However, it should be stressed that treatment planning is strongly associated with the patient’s wishes and adherence. The tool described here may support establishment of an individual treatment plan for periodontally compromised patients.
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Affiliation(s)
- Sonja Rahim-Wöstefeld
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, 69120, Heidelberg, Germany.
- Private Practice, 68159, Mannheim, Germany.
| | - Dorothea Kronsteiner
- Institute of Medical Biometry and Informatics (IMBI), University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Shirin ElSayed
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Nihad ElSayed
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Peter Eickholz
- Department of Periodontology, Center of Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, 60596, Frankfurt, Germany
| | - Bernadette Pretzl
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, 69120, Heidelberg, Germany
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14
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Association, prediction, generalizability: Cross-center validity of predicting tooth loss in periodontitis patients. J Dent 2021; 109:103662. [PMID: 33857544 DOI: 10.1016/j.jdent.2021.103662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/24/2021] [Accepted: 04/09/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To predict patients' tooth loss during supportive periodontal therapy across four German university centers. METHODS Tooth loss in 897 patients in four centers (Kiel (KI) n = 391; Greifswald (GW) n = 282; Heidelberg (HD) n = 175; Frankfurt/Main (F) n = 49) during supportive periodontal therapy (SPT) was assessed. Our outcome was annualized tooth loss per patient. Multivariable linear regression models were built on data of 75 % of patients from one center and used for predictions on the remaining 25 % of this center and 100 % of data from the other three centers. The prediction error was assessed as root-mean-squared-error (RMSE), i.e., the deviation of predicted from actually lost teeth per patient and year. RESULTS Annualized tooth loss/patient differed significantly between centers (between median 0.00 (interquartile interval: 0.00, 0.17) in GW and 0.09 (0.00, 0.19) in F, p = 0.001). Age, smoking status and number of teeth before SPT were significantly associated with tooth loss (p < 0.03). Prediction within centers showed RMSE of 0.14-0.30, and cross-center RMSE was 0.15-0.31. Predictions were more accurate in F and KI than in HD and GW, while the center on which the model was trained had a less consistent impact. No model showed useful predictive values. CONCLUSION While covariates were significantly associated with tooth loss in linear regression models, a clinically useful prediction was not possible with any of the models and generalizability was not given. Predictions were more accurate for certain centers. CLINICAL RELEVANCE Association should not be confused with predictive value: Despite significant associations of covariates with tooth loss, none of our models was useful for prediction. Usually, model accuracy was even lower when tested across centers, indicating low generalizability.
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15
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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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16
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Declassifying Mobility Classification. J Endod 2020; 46:1539-1544. [PMID: 32768419 DOI: 10.1016/j.joen.2020.07.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Tooth mobility is often discussed among dental health care providers according to a numerical scale (ie, 1, 2, or 3) without a clear understanding of the definition of each category. Thus, a comprehensive review to examine and discuss the various classifications is needed. The aim of this comprehensive review was to discuss the main clinical classifications of tooth mobility. METHODS The authors conducted electronic searches in MEDLINE, Scopus, and PubMed. Additionally, the authors manually searched the textbooks, gray literature, and bibliographies of all relevant articles. RESULTS The most commonly referenced clinical index for mobility was the Miller index; yet, many other mobility classifications exist as well as modifications of those indexes. The literature has been very inconsistent and at times inaccurate when classifying mobility; using various stages of mobility using grades, classes, and scores interchangeably and not defining the meaning of the actual numerical scores/terminologies are common problems. CONCLUSIONS In order to avoid ambiguity and provide clarity regarding the impact of degrees of mobility when used clinically, this review comprehensively discusses different classifications and definitions of tooth mobility with attention to the importance of using them consistently and accurately. There is a need to standardize 1 classification for mobility.
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17
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Cui Q, Chen Q, Liu P, Liu D, Wen Z. Clinical decision support model for tooth extraction therapy derived from electronic dental records. J Prosthet Dent 2020; 126:83-90. [PMID: 32703604 DOI: 10.1016/j.prosdent.2020.04.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/11/2020] [Accepted: 04/13/2020] [Indexed: 01/16/2023]
Abstract
STATEMENT OF PROBLEM Tooth extraction therapy serves as a key initial step in many prosthodontic treatment plans. Dentists must make an appropriate decision on the tooth extraction therapy considering multiple determinants and whether a clinical decision support (CDS) model might help. PURPOSE The purpose of this retrospective records study was to construct a CDS model to predict tooth extraction therapy in clinical situations by using electronic dental records (EDRs). MATERIAL AND METHODS The cohort involved 4135 deidentified EDRs of 3559 patients from the database of a prosthodontics department. Knowledge-based algorithms were first proposed to convert raw data from EDRs into structured data for feature extraction. Redundant features were filtered by a recursive feature-elimination method. The tooth extraction problem was then modeled alternatively as a binary or triple classification problem to be solved by 5 machine learning algorithms. Five machine learning algorithms within each model were compared, as well as the efficiency between 2 models. In addition, the proposed CDS was verified by 2 prosthodontists. RESULTS The triple classification model outperformed the binary model with the F1 score of the Extreme Gradient Boost (XGBoost) algorithm as 0.856 and 0.847, respectively. The XGBoost outperformed the other 4 algorithms. The accuracy, precision, and recall of the XGBoost algorithm were 0.962, 0.865, and 0.830 in the binary classification and 0.924, 0.879, and 0.836 in the triple classification, respectively. The performance of the 2 prosthodontists was inferior to the models. CONCLUSIONS The CDS model for tooth extraction therapy achieved high performance in terms of decision-making derived from EDRs.
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Affiliation(s)
- Qiwen Cui
- Graduate student, Graduate Mathematics, School of Mathematical Sciences, Peking University, Beijing, PR China
| | - Qingxiao Chen
- Resident, Graduate Prosthodontics, Center of Digital Dentistry, Peking University School and Hospital of Stomatology, Beijing, PR China; Resident, Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, PR China; Resident, National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University, Beijing, PR China; Resident, NHC Key Laboratory of Digital Technology of Stomatology, Peking University, Beijing, PR China; Resident, Beijing Key Laboratory of Digital Stomatology, Peking University, Beijing, PR China; Resident, National Clinical Research Center for Oral Diseases, Peking University, Beijing, PR China.
| | - Pufan Liu
- Graduate student, Graduate Mathematics, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, PR China
| | - Debin Liu
- Graduate student, Graduate Mathematics, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, PR China
| | - Zaiwen Wen
- Professor, Beijing International Center for Mathematical Research, Peking University, Beijing, PR China
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18
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Pelekos G, Acharya A, Eiji N, Hong G, Leung WK, McGrath C. Effects of adjunctive probiotic L. reuteri lozenges on S/RSD outcomes at molar sites with deep pockets. J Clin Periodontol 2020; 47:1098-1107. [PMID: 32511775 DOI: 10.1111/jcpe.13329] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 12/20/2022]
Abstract
AIM To evaluate effects of probiotic Lactobacillus reuteri (L. reuteri) lozenges as an S/RSD adjunct on site-level changes at molars with deep pockets. MATERIALS AND METHODS 447 molar sites with pockets ≥ 5 mm from a previous randomized clinical trial of adjunctive L. reuteri lozenges for 28 days were analyzed. Multilevel mixed-effect models (MLM) were constructed to analyze site-level outcomes "change in CAL" and "pocket closure" (residual PPD < 5 mm) in placebo and probiotic groups at 90 and 180 days. Possible patient-, tooth-, and site-level predictors were analyzed as fixed-effects. RESULTS Estimated change in CAL in probiotic (90 day: 0.87 mm, 180 day: 0.68 mm) was greater than placebo treated molar sites (90 day: 0.73 mm, 180 day: 0.66 mm) and the relative risk (RR) of pocket closure in the probiotic group (90 day: 1.7, 180 day: 1.6) was higher as compared to placebo. Furcation involvement and BOP at site predicted significantly worse treatment outcomes. CONCLUSION As compared to S/RSD with placebo, a 28-day course of adjunctive probiotic L. reuteri lozenges improved CAL change at molar sites with ≥ 5 mm deep pockets and conferred a higher probability of shallow residual pocket depth. Presence of furcation-involvement and bleeding on probing worsened treatment outcomes.
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Affiliation(s)
- Georgios Pelekos
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Aneesha Acharya
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.,Dr. D.Y. Patil Dental College and Hospital, D.Y Patil Vidyapeeth, Pune, India
| | - Nemoto Eiji
- Department of Periodontology and Endodontology, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Guang Hong
- Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Wai Keung Leung
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Colman McGrath
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
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19
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Nagy U, Guédat C, Giannopoulou C, Schimmel M, Müller F, Srinivasan M. Microbiological evaluation of LOCATOR® Legacy attachments: A cross-sectional clinical study. Clin Exp Dent Res 2019; 5:476-484. [PMID: 31687180 PMCID: PMC6820581 DOI: 10.1002/cre2.209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/24/2019] [Accepted: 05/27/2019] [Indexed: 11/19/2022] Open
Abstract
Objective This retrospective cross‐sectional study aimed to evaluate quantitatively the oral microbiome in the tri‐lobe central cavity of Locator Legacy attachment and verify whether it harbors a different, potentially more pathogenic, bacterial spectrum than the adjacent edentulous ridge. Materials and Methods Edentulous patients rehabilitated with implant overdentures using Locator Legacy attachments were recruited for this study. The clinical examination comprised probing depths, mobility, peri‐implant, and periodontal health along with intraoral swabs for microbiological evaluation, polymerase chain reaction (PCR) testing, and candida culture. The swabs were collected from the trilobed cavity of the attachment and the adjacent edentulous ridge. PCR was performed to detect six specific bacteria, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Tannerella forsythia, Treponema denticola, Prevotella intermedia, and Parvimonas micra. Statistical analyses were performed using McNemar's test and Wilcoxon's rank sum test with the significance set to p < .05. Results A total of 50 participants with a mean age of 71.5 ± 9.6 years participated in the study. No significant differences in the microbiome were found between samples from the ridge and the attachment. No significantly different numbers in the candida cultures were identified, and the presence of a removable prostheses did not demonstrate a significant association with the prevalence of candida. Conclusions Within the limits of this study and the investigated bacterial species, the trilobed cavity of the attachment does not seem to increase the bacterial load.
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Affiliation(s)
- Ursina Nagy
- Division of Removable Prosthodontics, University Clinics of Dental Medicine University of Geneva Geneva Switzerland
| | - Christophe Guédat
- Division of Removable Prosthodontics, University Clinics of Dental Medicine University of Geneva Geneva Switzerland.,Division of Orthodontics, University Clinics of Dental Medicine University of Geneva Geneva Switzerland
| | - Catherine Giannopoulou
- Division of Periodontology, University Clinics of Dental Medicine University of Geneva Geneva Switzerland
| | - Martin Schimmel
- Division of Removable Prosthodontics, University Clinics of Dental Medicine University of Geneva Geneva Switzerland.,Division of Gerodontology, School for Dental Medicine University of Bern Bern Switzerland
| | - Frauke Müller
- Division of Removable Prosthodontics, University Clinics of Dental Medicine University of Geneva Geneva Switzerland.,Service of Geriatrics, Department of Internal Medicine, Rehabilitation and Geriatrics Geneva University Hospitals Geneva Switzerland
| | - Murali Srinivasan
- Division of Removable Prosthodontics, University Clinics of Dental Medicine University of Geneva Geneva Switzerland.,Clinic of General-, Special Care-, and Geriatric Dentistry (KABS), Center of Dental Medicine University of Zurich Zurich Switzerland
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20
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Pei X, Ouyang X, Luan Q, Suda R, Cao C. Natural 4‐year periodontal progression of mandibular first molars in Chinese villagers based on radiographic records. J Periodontol 2019; 90:1390-1398. [PMID: 31257589 DOI: 10.1002/jper.18-0194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 01/14/2019] [Accepted: 03/01/2019] [Indexed: 01/22/2023]
Affiliation(s)
- Xiyan Pei
- Department of PeriodontologyPeking University School and Hospital of Stomatology Beijing P. R. China
- First Clinic DivisionPeking University School and Hospital of Stomatology Beijing P. R. China
| | - Xiangying Ouyang
- Department of PeriodontologyPeking University School and Hospital of Stomatology Beijing P. R. China
| | - Qingxian Luan
- Department of PeriodontologyPeking University School and Hospital of Stomatology Beijing P. R. China
| | - Reiko Suda
- Departments of PeriodonticsShowa University School of Dentistry Tokyo Japan
| | - Caifang Cao
- Department of PeriodontologyPeking University School and Hospital of Stomatology Beijing P. R. China
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21
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Kumar S. Evidence-Based Update on Diagnosis and Management of Gingivitis and Periodontitis. Dent Clin North Am 2018; 63:69-81. [PMID: 30447793 DOI: 10.1016/j.cden.2018.08.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This article is an overview to update the practicing general dental practitioner about clinically relevant evidence-based topics published in the recent past in the diagnosis, etiopathogenesis, and management of gingivitis and periodontitis.
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Affiliation(s)
- Satish Kumar
- A.T. Still University, Arizona School of Dentistry and Oral Health, 5855 E Still Circle, Mesa, AZ 85296, USA.
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Gopalakrishnan D, Miller PD, Mahuli AV, Sangamithra S, Phantumvanit P, Buranawat B. Evaluation of periodontally diseased molars in diabetics with Miller-McEntire Periodontal Prognostic Index. J Indian Soc Periodontol 2018; 22:401-405. [PMID: 30210188 PMCID: PMC6128126 DOI: 10.4103/jisp.jisp_271_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Aim and Objective: The aim of this study was to prospectively determine and establish the periodontal prognosis of diseased molars in diabetic patients using the Miller–McEntire Periodontal Prognostic Index (MMPPI) with an additional criterion for diabetes (changes in glycosylated hemoglobin levels), at 2-year postperiodontal therapy. Materials and Methods: A sample of 200 molars in 25 patients with diabetes mellitus (DM) and chronic periodontitis were evaluated. The prognostic parameters evaluated include age, probing depth (PD), mobility, furcation involvement, diabetes, and molar type. The total score calculated from all parameters was used considered prognosis score for each molar. All patients were evaluated at baseline and 2-year posttreatment. Results: The results of this study suggest that following prognostic factors, DM (hazard ratio [HR] =5.2), age (HR = 0.4), and molar type (HR = 0.6) were clinically significant at the end of the 2-year posttherapy from baseline. A total of 4 (2%) teeth were extracted from the 200 teeth with a mean of 0.02 for the tooth lost during 2-year posttreatment. Significant improvements (P < 0.05) in the frequency PD, furcation, and mobility scores were noted at 2 years. Conclusions: These findings demonstrate that score for DM as prognostic criterion is a valid addition to MMPPI. The factors such as DM, age, and molar type can impact the prognosis of molar survival. Studies with a larger sample size and longer follow-up are required to affirm the findings of this preliminary study.
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Affiliation(s)
- Dharmarajan Gopalakrishnan
- Department of Periodontics and Implant Dentistry, Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand.,Department of Periodontology and Oral Implantology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Preston Dallas Miller
- Department of Stomatology, Division of Periodontics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Amit Vasant Mahuli
- Department of Public Health Dentistry, NIMS University Dental College, Jaipur, Rajasthan, India
| | - Sidharthan Sangamithra
- Department of Periodontology and Oral Implantology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Prathip Phantumvanit
- Department of Community Dentistry, Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand
| | - Borvornwut Buranawat
- Department of Periodontics and Implant Dentistry, Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand
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Gopalakrishnan D, Miller PD, Mahuli AV, Sangamithra S, Phantumvanit P, Buranawat B. Prospective evaluation of periodontally diseased molars in smokers using the Miller-McEntire Periodontal Prognostic Index. J Indian Soc Periodontol 2018; 22:304-309. [PMID: 30131621 PMCID: PMC6077974 DOI: 10.4103/jisp.jisp_272_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 05/24/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The purpose of this 2-year prospective survival analysis study is to determine a statistically validated periodontal prognostic score for diseased molars in smokers using the Miller-McEntire Periodontal Prognostic Index (MMPPI). MATERIALS AND METHODS Two hundred molars were evaluated from 25 patients who were smokers with moderate-to-severe chronic periodontitis. The factors evaluated included age, probing depth, mobility, furcation involvement, smoking, and molar type. A modified, 5 level, scoring criterion for smoking based on smoking-dose was adopted. MMPPI was computed as the sum of scores for all six prognostic factors. Appropriate periodontal treatment and supportive periodontal therapy were provided. All patients were evaluated at baseline and 2 years posttreatment. Hazard risk ratio (HR) was computed for each prognostic factor. RESULTS A total of 3 (1.5%) teeth of the 200 molars were extracted over the 2-year follow-up duration, with a mean of 0.015 teeth lost. The HR was found as significantly higher for three individual prognostic factors: mobility (HR = 5.57, P = 0.02), smoking (HR = 3.35, P = 0.04), and furcation involvement (HR = 7.30, P = 0.01). Significant and positive HR (HR = 1.70, P = 0.01) was noted for the total MMPPI score, validating its prognostic value for molar survival at 2 years prospectively. CONCLUSIONS The findings of the current study demonstrate the prognostic validity of MMPPI incorporating a more detailed smoking score criterion. The factors smoking, furcation involvement, and mobility significantly impacted the likelihood of survival of periodontally diseased molars. Further studies with a larger sample size and longer follow-up are required to confirm these findings.
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Affiliation(s)
- Dharmarajan Gopalakrishnan
- Department of Periodontics & Implant Dentistry, Thammasat University, Rangsit Campus, Phatum Thani, Thailand
- Department of Periodontology and Oral Implantology, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Preston Dallas Miller
- Department of Stomatology, Division of Periodontics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Amit Vasant Mahuli
- Department of Public Health Dentistry, NIMS University Dental College, Jaipur, Rajasthan, India
| | - Sidharthan Sangamithra
- Department of Periodontology and Oral Implantology, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Prathip Phantumvanit
- Department of Community Dentistry, Faculty of Dentistry, Thammasat University, Rangsit Campus, Phatum Thani, Thailand
| | - Borvornwut Buranawat
- Department of Periodontics & Implant Dentistry, Thammasat University, Rangsit Campus, Phatum Thani, Thailand
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Martinez‐Canut P, Alcaraz J, Alcaraz J, Alvarez‐Novoa P, Alvarez‐Novoa C, Marcos A, Noguerol B, Noguerol F, Zabalegui I. Introduction of a prediction model to assigning periodontal prognosis based on survival time. J Clin Periodontol 2018; 45:46-55. [PMID: 28871596 PMCID: PMC5767737 DOI: 10.1111/jcpe.12810] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 12/17/2022]
Abstract
AIMS To develop a prediction model for tooth loss due to periodontal disease (TLPD) in patients following periodontal maintenance (PM), and assess its performance using a multicentre approach. MATERIAL AND METHODS A multilevel analysis of eleven predictors of TLPD in 500 patients following PM was carried out to calculate the probability of TLPD. This algorithm was applied to three different TLPD samples (369 teeth) gathered retrospectively by nine periodontist, associating several intervals of probability with the corresponding survival time, based on significant differences in the mean survival time. The reproducibility of these associations was assessed in each sample (One-way ANOVA and pairwise comparison with Bonferroni corrections). RESULTS The model presented high specificity and moderate sensitivity, with optimal calibration and discrimination measurements. Seven intervals of probability were associated with seven survival time and these associations contained close to 80% of the cases: the probability predicted the survival time at this percentage. The model performed well in the three samples, as the mean survival time of each association were significantly different within each sample, while no significant differences between the samples were found in pairwise comparisons of means. CONCLUSIONS This model might be useful for predicting survival time in different TLPD samples.
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Affiliation(s)
- Pedro Martinez‐Canut
- Private PracticeValenciaSpain
- Division of PeriodonticsFacultad de Medicina y OdontologíaU. ValenciaValenciaSpain
| | - Jaime Alcaraz
- Assistant professor Postgraduate Program in PeriodonticsFacultad de Medicina y OdontologíaU. ValenciaValenciaSpain
- Private PracticeAlicanteSpain
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McGowan T, McGowan K, Ivanovski S. A Novel Evidence-Based Periodontal Prognosis Model. J Evid Based Dent Pract 2017; 17:350-360. [DOI: 10.1016/j.jebdp.2017.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 05/12/2017] [Accepted: 05/12/2017] [Indexed: 11/28/2022]
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Nibali L, Krajewski A, Donos N, Völzke H, Pink C, Kocher T, Holtfreter B. The effect of furcation involvement on tooth loss in a population without regular periodontal therapy. J Clin Periodontol 2017; 44:813-821. [DOI: 10.1111/jcpe.12756] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Luigi Nibali
- Centre for Oral Clinical Research; Institute of Dentistry; Barts and The London School of Medicine and Dentistry; Queen Mary University London (QMUL); London UK
| | - Anna Krajewski
- Centre for Oral Clinical Research; Institute of Dentistry; Barts and The London School of Medicine and Dentistry; Queen Mary University London (QMUL); London UK
| | - Nikos Donos
- Centre for Oral Clinical Research; Institute of Dentistry; Barts and The London School of Medicine and Dentistry; Queen Mary University London (QMUL); London UK
| | - Henry Völzke
- Institute for Community Medicine; University Medicine Greifswald; Greifswald Germany
| | - Christiane Pink
- Unit of Periodontology; Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry; University Medicine Greifswald; Greifswald Germany
| | - Thomas Kocher
- Institute for Community Medicine; University Medicine Greifswald; Greifswald Germany
| | - Birte Holtfreter
- Institute for Community Medicine; University Medicine Greifswald; Greifswald Germany
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Oshita K, Saeki N, Kubo T, Abekura H, Tanaka N, Kawamoto M. A novel mouthpiece prevents bite injuries caused by intraoperative transcranial electric motor-evoked potential monitoring. J Anesth 2016; 30:850-4. [PMID: 27468733 DOI: 10.1007/s00540-016-2220-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 07/14/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Intraoperative transcranial motor-evoked potential monitoring causes contraction of the masseter muscles, which may cause injuries to the oral cavity and damage to the orotracheal tube. We developed a mouthpiece made from vinyl-silicone impression material to prevent these injuries. The purpose of this study was to examine its efficacy and safety. METHODS Twenty-two patients undergoing spinal surgery under transcranial motor-evoked potential monitoring were fitted with bespoke vinyl-silicone mouthpieces by dentists before surgery. On induction of general anesthesia and orotracheal intubation, the mouthpiece was attached to the upper and lower dental arches. A lateral cervical X-ray was taken at the end of surgery to examine the condition of the orotracheal tube. The incidence of endotracheal tube deformation was compared with an historic control group of 20 patients in whom a conventional gauze bite block had been previously used before induction of the mouthpiece. The oral cavity was examined by a dentist the day before surgery and 3 days postoperatively, and intraoral injuries were recorded. RESULTS No endotracheal tube deformation was found in 22 patients fitted with the new mouthpiece. The incidence of tube deformation (none of 22 patients, 0 %) was significantly lower than in those who had been fitted with the gauze bite block (9 of 20 patients, 45.0 %; p < 0.001). Application of the mouthpiece resulted in no tongue or tooth injuries. CONCLUSION A novel mouthpiece reduced the incidence of damage to the endotracheal tube caused by intraoperative transcranial motor-evoked potential monitoring.
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Affiliation(s)
- Kyoko Oshita
- Department of Anesthesiology and Critical Care, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, Japan.
| | - Noboru Saeki
- Department of Anesthesiology and Critical Care, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, Japan
| | - Takayasu Kubo
- Department of Advanced Prosthodontics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hitoshi Abekura
- Department of Advanced Prosthodontics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuhiro Tanaka
- Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masashi Kawamoto
- Department of Anesthesiology and Critical Care, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, Japan
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Fardal Ø, Grytten J, Martin J, Houlihan C, Heasman P. Using prognostic factors from case series and cohort studies to identify individuals with poor long-term outcomes during periodontal maintenance. J Clin Periodontol 2016; 43:789-96. [PMID: 27140725 DOI: 10.1111/jcpe.12573] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The accuracy of applying prognostic factors to individual patients is uncertain. AIM/METHOD The aim was to apply prognostic factors from several outcome studies (case series and cohort) to identify: (1) patients who lost a tooth/teeth during periodontal maintenance; (2) patients who were non-responding to treatment; (3) patients needing re-treatment during periodontal maintenance. In addition, tooth loss was related to initial prognosis and it was determined which of the prognostic factors were also risk factors. Chi squared analysis was carried out for the outcomes of patients with-, and without prognostic factors. Significance level was set at p ≤ 0.05. Sensitivity and specificity was calculated for patients with and without prognostic factors. RESULTS The prognostic factors only identified a small proportion of patients who lost teeth (34-38%). Combining the prognostic factors resulted in a lower accuracy. A higher proportion of patients with no prognostic factors lost teeth (53.8-96.2%). The chance of identifying a non-responding patient based on family history was 5.9%, for stress 32.4%, and for heavy smoking 8.7%. Significantly more patients (29/40 , χ² = 16.2 p < 0.05) with initial uncertain/poor prognosis and significantly fewer patients (11/40, χ² = 16.2, p < 0.05) with erratic/no compliance needing re-treatment were identified. 21 of 40 patients (52.5%) (p = 0.655) with family history needing retreatment were identified. Combining the prognostic factors identified 5-22% out of a total of 40% of patients needing re-treatment. six out of nine (67%) teeth with an initial hopeless prognosis were lost, 10/109 (9%) teeth with a poor prognosis were lost, 11/346 (3%) teeth with a moderate prognosis were lost and 9/1972 (0.46%) of teeth with a good prognosis were lost. None of the prognostic factors was found also to be a risk factor for developing periodontal diseases. CONCLUSION Applying prognostic factors to identify individual patients with poor long-term outcomes is associated with low accuracy.
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Affiliation(s)
| | - Jostein Grytten
- Institute of Community Dentistry, University of Oslo, Oslo, Norway
| | - John Martin
- Private Practice, State College, PA, USA.,PreViser Corporation, Mount Vernon, WA, USA
| | | | - Peter Heasman
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
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29
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Nibali L, Zavattini A, Nagata K, Di Iorio A, Lin GH, Needleman I, Donos N. Tooth loss in molars with and without furcation involvement - a systematic review and meta-analysis. J Clin Periodontol 2016; 43:156-66. [DOI: 10.1111/jcpe.12497] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2015] [Indexed: 12/24/2022]
Affiliation(s)
- Luigi Nibali
- Periodontology Unit and Department of Clinical Research; UCL Eastman Dental Institute; London UK
- Clinical Oral Research Centre; Institute of Dentistry; Queen Mary University London (QMUL); London UK
| | - Angelo Zavattini
- Periodontology Unit and Department of Clinical Research; UCL Eastman Dental Institute; London UK
| | - Kohji Nagata
- Periodontology Unit and Department of Clinical Research; UCL Eastman Dental Institute; London UK
- Department of Biomaterials Science and Turku Clinical Biomaterials Centre - TCBC; Institute of Dentistry; University of Turku; Turku Finland
- Department of Removable Partial Prosthodontics Rehabilitation; Tokyo Medical and Dental University; Tokyo Japan
| | - Anna Di Iorio
- Library Services; UCL Eastman Dental Institute; London UK
| | - Guo-Hao Lin
- Department of Periodontics and Oral Medicine; University of Michigan School of Dentistry; Ann Arbor MI USA
| | - Ian Needleman
- Periodontology Unit and Department of Clinical Research; UCL Eastman Dental Institute; London UK
| | - Nikos Donos
- Clinical Oral Research Centre; Institute of Dentistry; Queen Mary University London (QMUL); London UK
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30
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Donovan TE, Marzola R, Becker W, Cagna DR, Eichmiller F, McKee JR, Metz JE, Albouy JP. Annual review of selected scientific literature: Report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2015; 114:756-809. [PMID: 26611624 DOI: 10.1016/j.prosdent.2015.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 10/13/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Terence E Donovan
- Chair, Committee on Scientific Investigation, American Academy of Restorative Dentistry (AARD); and Professor and Chair for Biomaterials, Department of Operative Dentistry, University of North Carolina School of Dentistry at Chapel Hill, NC.
| | - Riccardo Marzola
- Adjunct Professor, Fixed Implant Prosthodontics, University of Bologna; and Private practice, Ferrara, Italy
| | - William Becker
- Clinical Professor, Advanced Education in Prosthodontics, Herman Ostrow School of Dentistry, Los Angeles, Calif
| | - David R Cagna
- Associate Dean, Professor and Director, Advanced Prosthodontics, University of Tennessee Health Sciences Center, Memphis, Tenn
| | - Frederick Eichmiller
- Vice President and Dental Director, Delta Dental of Wisconsin, Stevens Point, Wisc
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Nunn ME, Carney WG, McNally SJ. The Miller-McEntire Score for Molars Provides an Evidence-based Approach to Assigning Periodontal Prognosis for Molar Teeth. J Evid Based Dent Pract 2015; 15:73-6. [PMID: 25987389 DOI: 10.1016/j.jebdp.2015.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Martha E Nunn
- Director, Center for Oral Health Research, Associate Professor, Department of Periodontics, School of Dentistry, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA.
| | - William G Carney
- Assistant Professor, Department of Diagnostic Sciences, School of Dentistry, Creighton University, Omaha, NE 68178, USA.
| | - Stuart J McNally
- Assistant Professor, Department of General Dentistry, School of Dentistry, Creighton University, Omaha, NE 68178, USA.
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Martin JA. Re: An evidenced-based scoring index to determine the periodontal prognosis on molars. Miller PD Jr., McEntire ML, Marlow NM, Gellin RG. (J Periodontol 2014;85:214-225.). J Periodontol 2014; 85:1158. [PMID: 25168258 DOI: 10.1902/jop.2014.130743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- John A Martin
- private practice, State College, PA and PreViser Corporation, Mount Vernon, WA
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Miller PD, McEntire ML, Marlow NM, Gellin RG. Authors' response. J Periodontol 2014; 85:1159-60. [PMID: 25168259 DOI: 10.1902/jop.2014.140060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Preston D Miller
- Department of Stomatology, Division of Periodontics, Medical University of South Carolina, Charleston, SC, on behalf of coauthors Mark L. McEntire, Nicole M. Marlow, and Robert G. Gellin
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Harrel SK, Abraham CM, Rivera-Hidalgo F, Shulman JD, Nunn ME. Videoscope-assisted minimally invasive periodontal surgery (V-MIS). J Clin Periodontol 2014; 41:900-7. [PMID: 25039580 DOI: 10.1111/jcpe.12294] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2014] [Indexed: 11/28/2022]
Abstract
AIM Small incision surgery has become routine in many areas of medicine but has not been widely accepted in periodontal therapy. A videoscope to assist minimally invasive surgery (MIS) has been developed. The clinical outcomes from MIS performed using this videoscope (V-MIS) are reported. MATERIALS AND METHODS Patients were evaluated for residual defects following non-surgical therapy consisting of root planing with local anaesthetic. Thirty patients having 110 sites with residual pocket probing depth (PPD) of at least 5 mm, 2 mm loss of clinical attachment level (CAL), and radiographic evidence of bone loss were surgically treated. V-MIS was performed utilizing the videoscope for surgical visualization. RESULTS At re-evaluation 6 months post surgery, there was a statistically significant improvement (p < .001) in mean PPD and CAL (PPD 3.88 ± 1.02 mm, CAL 4.04 ± 1.38 mm) in 1, 2, and 3 wall defects. All PPD at re-evaluation were 3 mm or less. There was a mean post-surgical increase in soft tissue height (0.13 ± 0.61 mm, p = 0.168) with a decrease in recession. CONCLUSIONS The improvement in PPD and CAL from V-MIS, in the authors' opinion, appears to be favourable when compared to previously reported results of periodontal regenerative surgery. The lack of post-surgical recession following V-MIS has not been reported with traditional regenerative surgery.
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Affiliation(s)
- Stephen K Harrel
- Texas A&M University, Baylor College of Dentistry, Dallas, TX, USA
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