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Chen Z, Lin CY, Wang HL. Patient-reported outcome measures and health economics in regenerative periodontal therapy: A systematic review and meta-analysis. Periodontol 2000 2024. [PMID: 39118280 DOI: 10.1111/prd.12601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 07/08/2024] [Accepted: 07/26/2024] [Indexed: 08/10/2024]
Abstract
Understanding patient responses to periodontal regeneration is crucial. This systematic review and meta-analysis addressed two key questions: (a) the impact of periodontal regeneration on patient-reported outcome measures (PROMs) for intrabony and furcation involvement and (b) the cost-effectiveness of periodontal regeneration for treating periodontal defects. Twenty-four studies were included, with 20 randomized clinical trials (RCTs) reporting patient-reported outcomes and five (three RCTs and two economic model-based studies) reporting cost-effectiveness outcomes. Results favored regeneration therapy over conventional flap surgery for intrabony defects, showing improvements in qualitative (i.e., amount of regenerated attachment apparatus) and quantitative parameters (i.e., probing and radiographic parameters). In terms of PROMs, regenerative treatments involving barrier membranes resulted in longer chair times and higher rates of complications (such as membrane exposure or edema) compared to flap with biologic agents or access flap alone. Despite this, oral health-related quality of life improved after both regenerative and extraction procedures. Economically, regeneration remained favorable compared to extraction and replacement or open flap debridement alone for periodontal defects. Single-flap variants in open flap debridement yielded similar outcomes to regenerative treatment, offering a potentially cost-effective option. Nevertheless, further discussion on the benefits of less-invasive flap designs is needed due to the lack of histological evaluation.
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Affiliation(s)
- Zhaozhao Chen
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Cho-Ying Lin
- Department of Periodontics, Chang Gung Memorial Hospital, Taipei, Taiwan
- Chang Gung University, Taoyuan city, Taiwan
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Esteve-Pardo G, De-Larriva E, Sanchez-Suarez LM, Sanchez-Nicolas JA, Bernabeu-Esclapez A, Esteve-Colomina L. How do implant patients experience complications? A cross-sectional multicentre pilot study. Clin Oral Implants Res 2023; 34:987-998. [PMID: 37416986 DOI: 10.1111/clr.14125] [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: 01/09/2023] [Revised: 05/29/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND This cross-sectional study aimed to quantify the impact of implant-related complications on perceived pain, functional impairment, concern, quality of life (QoL) and confidence which were the study's primary outcomes. MATERIALS AND METHODS Patients were recruited in five centres over 19 months. They completed a structured ad hoc questionnaire scoring pain, chewing ability, concern, QoL and confidence in future implant treatment. Some potential independent variables were also recorded. The data were analysed descriptively and with a multiple-stepwise regression model for correlations of the five primary variables with the other data. RESULTS The sample consisted of 408 patients, with prosthesis mobility being the most common complication (40.7%). Most patients (79.2%) consulted because of a complication, while 20.8% were asymptomatic and consulted regularly. Pain was correlated with symptoms at consultation and in biological/mixed complications (p < .001; R2 = 44.8%). Chewing impairment with implant loss, prosthesis fracture and removable implant-supported or total prostheses (p < .001; R2 = 42.8%); patient concern was correlated with the clinical symptoms and removable implant-supported prostheses (p < .001; R2 = 36.1%); impact on QoL was correlated with implant loss, prosthesis fracture and removable implant-supported prostheses (p < .001; R2 = 41.1%). Patient confidence was relatively independent and only impact on quality of life significantly influenced it (r = 0.73). CONCLUSIONS Implant-related complications moderately impaired patients' perceptions of pain, chewing ability, concern and QoL. Nevertheless, complications only slightly reduced their confidence in future implant treatment.
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Chambrone L, Zucchelli G. Why is there a lack of evidence regarding errors and complications in periodontal and implant therapy? Periodontol 2000 2023; 92:13-20. [PMID: 35916780 DOI: 10.1111/prd.12445] [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: 04/01/2022] [Revised: 05/23/2022] [Accepted: 05/26/2022] [Indexed: 01/09/2023]
Abstract
The occurrence of errors, complications, and adverse effects may occur as a consequence of single or multiple events related to the clinician and/or patient. Apparently, the amount of dental literature on these undesirable outcomes has not been as prolific as that obtained for conventional primary periodontal outcome measures. This review explores the potential reasons for the lack of studies reporting on errors and complications in periodontal and implant therapy, as well as other noteworthy methodological aspects, to enlighten their impact on the selection of the best (or most appropriate) "gold standard" periodontal/implant-related treatment options, and on the overall decision-making process. The following points were addressed: (a) the importance of reporting errors and complications in clinical research; (b) the adequate reporting of errors and complications in periodontology and dental implantology; and (c) efficacy trials vs effectiveness studies and their impact on the assessment and report of periodontal and implant treatment-related risks and complications.
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Affiliation(s)
- Leandro Chambrone
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz, CRL, Monte de Caparica, Portugal
- Unit of Basic Oral Investigation (UIBO), School of Dentistry, Universidad El Bosque, Bogota, Colombia
- Department of Periodontics, School of Dentistry, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Giovanni Zucchelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
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Chambrone L, Garcia-Valenzuela FS, Avila-Ortiz G. Errors and complications in clinical periodontal practice due to methodologic bias and bad interpretation of the evidence. Periodontol 2000 2023; 92:373-381. [PMID: 36604793 DOI: 10.1111/prd.12475] [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: 04/01/2022] [Revised: 08/01/2022] [Accepted: 08/21/2022] [Indexed: 01/07/2023]
Abstract
Different types of errors and complications may arise during and after the execution of periodontal or implant-related procedures. Some of the most relevant, although also controversial, and less commented, causative agents of errors and complications are methodological biases and bad interpretation of the evidence. Proper assessment of the literature requires of solid clinical knowledge combined with a systematic approach built on the recognition of common methodological biases and the avoidance of interpretive errors to critically retrieve, dissect, and judiciously apply available information for the promotion of periodontal and peri-implant health. This review addresses common types of methodological bias and interpretive errors that can alter the reader's perceptions on the real effect and potential ramifications of the reported outcomes of a given therapeutic approach due to bad interpretation of the available evidence: (1) types of methodological biases; (2) spin and interpretive bias; (3) interpretation pitfalls when assessing the evidence (4) choice of relevant endpoints to answer the question(s) of interest; and (5) balance between statistical significance and clinical relevance.
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Affiliation(s)
- Leandro Chambrone
- Evidence-Based Hub, Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz, CRL, Monte de Caparica, Portugal
- Unit of Basic Oral Investigation (UIBO), School of Dentistry, Universidad El Bosque, Bogota, Colombia
- Department of Periodontics, School of Dental Medicine, The University of Pennsylvania, Pennsylvania, Philadelphia, USA
| | | | - Gustavo Avila-Ortiz
- Private Practice, Atelier Dental, Madrid, Spain
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Massachusetts, Boston, USA
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5
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Needleman I, Almond N, Leow N, Phillips J. Outcomes of periodontal therapy: Strengthening the relevance of research to patients. A co-created review. Periodontol 2000 2023. [PMID: 36786482 DOI: 10.1111/prd.12483] [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: 07/11/2022] [Revised: 12/09/2022] [Accepted: 01/03/2023] [Indexed: 02/15/2023]
Abstract
Periodontitis is a long-term condition affecting up to half of the population globally and causing significant impacts on life quality. Successful management depends on taking life-long ownership of the condition by those affected. There is a wealth of research to inform on management options. However, most of the research has been designed by professional experts with outcomes to gauge benefits and harms based on parameters that inform on the disease process but which might not be informative to support decision-making in people with lived experience (PWLE) of periodontal ill-health (including both patients and carers). The importance of relevant outcomes is highlighted in the concept of the "expert patient" which aims to strengthen the capacity of PWLE to make health-care choices that are important for them, elements of which are likely to be already familiar to many clinicians delivering periodontal health care. Therefore, the voice and collaboration of PWLE in research are recognised as crucial to developing high quality, relevant evidence especially for long-term conditions. In this paper, we review what is known about the relevance of treatment outcomes to PWLE. We also examine the degree to which PWLE have been involved in identifying outcomes that are important to them as well as the diversity and therefore representativeness of PWLE recruited for studies. We consider why having more relevant outcomes could enhance the expertise of PWLE in managing their periodontitis. We then conclude with key learnings from our review which we hope will encourage more rapid development of these initiatives in periodontology for the benefit of global health and wellbeing.
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Affiliation(s)
- Ian Needleman
- Unit of Periodontology, UCL Eastman Dental Institute, London, UK
| | | | - Natalie Leow
- Unit of Periodontology, UCL Eastman Dental Institute, London, UK
| | - Jim Phillips
- Centre for Empowering Patients and Communities (CEMPAC), Cirencester, UK
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Brodzikowska A, Górski B, Szerszeń M, Sanz M. Efficacy of Guided Tissue Regeneration Using Frozen Radiation-Sterilized Allogenic Bone Graft as Bone Replacement Graft Compared with Deproteinized Bovine Bone Mineral in the Treatment of Periodontal Intra-Bony Defects: Randomized Controlled Trial. J Clin Med 2023; 12:jcm12041396. [PMID: 36835930 PMCID: PMC9964170 DOI: 10.3390/jcm12041396] [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: 01/15/2023] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023] Open
Abstract
(1) Background: The aim of this study was to compare the clinical and radiographic outcomes of guided tissue regeneration (GTR) using two biomaterials as bone replacement grafts in the treatment of periodontal intra-bony defects. (2) Methods: Using a split-mouth design, 30 periodontal intra-bony defects were treated with either frozen radiation-sterilized allogenic bone grafts (FRSABG tests) or deproteinized bovine bone mineral (DBBM, controls) combined with a bioabsorbable collagen membrane in 15 patients. Clinical attachment level gains (CAL-G), probing pocket depth reductions (PPD-R), and radiographic changes in linear defect fill (LDF) were evaluated 12 months postoperatively. (3) Results: The CAL, PPD, and LDF values improved significantly in both groups 12 months after the surgery. However, in the test group, the PPD-R and LDF values were significantly higher compared to the controls (PPD-R 4.66 mm versus 3.57 mm, p = 0.0429; LDF 5.22 mm versus 4.33, p = 0.0478, respectively). Regression analysis showed that baseline CAL was a significant predictor for PPD-R (p = 0.0434), while the baseline radiographic angle was a predictor for CAL-G (p = 0.0026) and LDF (p = 0.064). (4) Conclusions: Both replacement grafts when used for GTR with a bioabsorbable collagen membrane yielded successful clinical benefits in teeth with deep intra-bony defects 12 months postoperatively. The use of FRSABG significantly enhanced PPD reduction and LDF.
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Affiliation(s)
- Aniela Brodzikowska
- Department of Conservative Dentistry, Medical University of Warsaw, 02-097 Warsaw, Poland
- Correspondence: ; Tel.: +48-501019990
| | - Bartłomiej Górski
- Department of Periodontal and Oral Mucosa Diseases, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Marcin Szerszeń
- Department of Prosthodontics, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Mariano Sanz
- ETEP Research Group, Department of Dental Clinical Specialties, Faculty of Odontology, University Complutense of Madrid, 28040 Madrid, Spain
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Thoma DS, Strauss FJ, Mancini L, Gasser TJW, Jung RE. Minimal invasiveness in soft tissue augmentation at dental implants: A systematic review and meta-analysis of patient-reported outcome measures. Periodontol 2000 2022; 91:182-198. [PMID: 35950734 DOI: 10.1111/prd.12465] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/10/2022] [Accepted: 06/23/2022] [Indexed: 11/29/2022]
Abstract
The aim of this study was to compare patient-reported outcome measures (PROMs) of soft tissue substitutes versus autogenous grafts for soft tissue augmentation procedures at implant sites. Comprehensive and systematic literature searches were performed until December 2021. A focused question was formulated based on the Population, Intervention, Comparison and Outcome criteria (PICO): In patients with dental implants undergoing soft tissue augmentation (P), do soft tissue substitutes (I) compared to autogenous soft tissue graft (SCTG [subepithelial connective tissue graft]) (C) limit the post-operative morbidity and other patient reported-outcomes measures (O). Randomized controlled clinical trials, prospective-, retrospective- and case-series studies were included. Meta-analyses were performed whenever possible and the results were expressed as weighted mean differences (WMD). A total of 29 clinical studies were included. For mucosal thickness gain, soft tissue substitutes significantly reduced the pain perception compared to SCTG (n = 4; WMD = 14.91 Visual Analog Scale [VAS] units; 95% confidence interval [CI] 6.42-23.40; P < .0006) based on a 0-100 VAS scale. Based on a 0-10 VAS scale, a borderline significance of pain reduction was found when soft tissue substitutes were applied (n = 4; WMD = 1.62 VAS units; 95% CI 0.01-3.23; P = .05). For keratinized tissue gain, soft tissue substitutes significantly reduced the pain perception after keratinized tissue augmentation compared to SCTG based on a 0-100 VAS scale (n = 2; WMD = 21.43 VAS units; 95% CI 12.58-30.28; P < .0001). Based on the 0-10 VAS scale, soft tissue substitutes significantly reduced the pain as compared to SCTG (n = 4; WMD = 1.65 VAS units; 95% CI 0.66-2.64; P = .001). Regarding pain medication, soft tissue substitutes required less painkillers (n = 6; WMD = 1.56 tablets; 95% CI 1.22-1.91; P < .00001) after soft tissue augmentation. The surgery time was significantly reduced when soft tissue substitutes were used (n = 5; WMD = 10.9 minutes; 95% CI 4.60-17.19; P < .00001). There were no significant differences in satisfaction, aesthetics, and quality of life (OHIP-14) between soft tissue substitutes and autogenous grafts following soft tissue augmentation at implants sites. Soft tissue substitutes, compared to autogenous grafts, significantly improve PROMs following soft tissue augmentation at implant sites. Soft tissue substitutes can reduce pain perception, amounts of painkillers and surgery time while achieving similar levels of patient´s satisfaction as autogenous grafts without impairing the clinical outcomes. The current evidence indicates that they constitute a valid and reliable alternative to minimize the invasiveness in soft tissue augmentation procedures at implant sites.
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Affiliation(s)
- Daniel S Thoma
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zürich, Switzerland
| | - Franz J Strauss
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zürich, Switzerland
| | - Leonardo Mancini
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zürich, Switzerland
| | - Thomas J W Gasser
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zürich, Switzerland
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zürich, Switzerland
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Cirelli JA, Fiorini T, Moreira CHC, Molon RSD, Dutra TP, Sallum EA. Periodontal regeneration: is it still a goal in clinical periodontology? Braz Oral Res 2021; 35:e09. [PMID: 34586211 DOI: 10.1590/1807-3107bor-2021.vol35.0097] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/31/2021] [Indexed: 11/22/2022] Open
Abstract
In the last decades, Periodontal Regeneration has been one of the most discussed topics in Periodontics, attracting the attention of researchers and clinicians. This can be justified by the evident and continuous progress observed in the field, characterized by a better understanding of the biological mechanisms involved, significant improvement of operative and technical principles, and the emergence of a wide range of biomaterials available for this purpose. Together, these aspects put the theme much in evidence in the search for functional and esthetic therapeutic solutions for periodontal tissue destruction. Despite the evident evolution, periodontal regeneration may be challenging and require the clinician to carefully evaluate each case before making a therapeutic decision. With a critical reassessment of the clinical and preclinical literature, the present study aimed to discuss the topic to answer whether Periodontal Regeneration is still a goal in clinical periodontology. The main aspects involved in the probability of success or failure of regenerative approaches were considered. A greater focus was given to intrabony and furcation defects, clinical conditions with greater therapeutic predictability. Aspects such as more appropriate materials/approaches, long-term benefits and their justification for a higher initial cost were discussed for each condition. In general, deep intrabony defects associated with residual pockets and buccal/lingual class II furcation lesions have predictable and clinically relevant results. Careful selection of the case (based on patient and defect characteristics) and excellent maintenance are essential conditions to ensure initial and long-term success.
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Affiliation(s)
- Joni Augusto Cirelli
- Universidade Estadual Paulista - Unesp, School of Dentistry at Araraquara, Department of Diagnosis and Surgery, Araraquara, SP, Brazil
| | - Tiago Fiorini
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Department of Conservative Dentistry, Porto Alegre, RS, Brazil
| | - Carlos Heitor Cunha Moreira
- Universidade Federal de Santa Maria - UFSM, School of Dentistry, Department of Stomatology, Santa Maria, RS, Brazil
| | - Rafael Scaf de Molon
- Universidade Estadual Paulista - Unesp, School of Dentistry at Araraquara, Department of Diagnosis and Surgery, Araraquara, SP, Brazil
| | - Tamires Pereira Dutra
- Universidade Estadual de Campinas - Unicamp, Piracicaba Dental School - Department of Prosthodontics and Periodontics, Piracicaba, SP, Brazil
| | - Enílson Antonio Sallum
- Universidade Estadual de Campinas - Unicamp, Piracicaba Dental School - Department of Prosthodontics and Periodontics, Piracicaba, SP, Brazil
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Tellez M, Meraner M, Lim S, Brandon R, Ismail A. An innovative approach to assess comprehensive care: Temple University's patient wellness report. J Dent Educ 2020; 85:652-659. [PMID: 33368251 DOI: 10.1002/jdd.12521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/12/2002] [Accepted: 12/01/2002] [Indexed: 11/11/2022]
Abstract
PURPOSE The transition from a paper-based to an all-electronic patient health record took a major step forward in 2018, with the implementation of an electronic health record that supports the School's patient-centered comprehensive care model and facilitates outcomes assessment. The Patient Wellness Report (PWR) summarizes findings of the patient assessment, and it does so automatically by locating data already entered in axiUm forms. This study aimed to describe the PWR implementation procedures and to examine outcomes and characteristics among patients with completed treatment plans during an 18-month period. METHODS Outcome data were extracted from axiUm for patients aged ≥16 years who completed comprehensive care treatment plans. Each PWR contained 14 metrics related to "dimensions" of wellness (quality of life, general health factors, oral hygiene, caries risk, and degree of periodontal inflammation and pocketing), each of which is rated on a 3-point scale based on best available scientific evidence. RESULTS A total of 2074 patients completed planned procedures between July 2018 and January 2020, and met the study eligibility criteria. Improvement of several conditions was observed between baseline and follow-up in caries lesions (21%), blood pressure (9%), and periodontal pocket (3.2%). A majority of patients rated in good condition at baseline had their scores unchanged at follow-up in the following areas: dental anxiety (92%), speaking (88%), smoking (87%), and alcohol consumption (79%). CONCLUSION Improvements in dental caries and blood pressure metrics were easily monitored using the PWR. In addition, disparities exist in improvement of patient outcomes by race/ethnicity.
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Affiliation(s)
- Marisol Tellez
- Department of Oral Health Sciences, Maurice H. Kornberg School of Dentistry, Temple University, Philadelphia, Pennsylvania, USA
| | - Mark Meraner
- Department of Restorative Dentistry, Maurice H. Kornberg School of Dentistry, Temple University, Philadelphia, Pennsylvania, USA
| | - Sungwoo Lim
- Maurice H. Kornberg School of Dentistry, Temple University, Philadelphia, Pennsylvania, USA
| | - Ryan Brandon
- Maurice H. Kornberg School of Dentistry, Temple University, Philadelphia, Pennsylvania, USA
| | - Amid Ismail
- Department of Restorative Dentistry, Maurice H. Kornberg School of Dentistry, Temple University, Philadelphia, Pennsylvania, USA
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Schinini G, Sales D, Gómez MV, Romanelli HJ, Chambrone L. Healing of donor sites of connective tissue grafts harvested by the single incision technique: A randomized clinical trial evaluating the use of collagen hemostatic sponge with or without sutures. J Periodontol 2020; 92:629-636. [PMID: 33140428 DOI: 10.1002/jper.20-0645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the effect of suturing on the early wound healing of donor sites of subepithelial connective tissue grafts (SCTG), harvested by the single incision technique (SIT), following the application of a collagen sponge. METHODS Thirty-six patients were randomized to receive a collagen sponge with or without sutures in the palatal donor sites following connective tissue grafting via the SIT. Outcome variables were early healing index (EHI) at 7, 14, and 30 days, self-reported pain using a visual analogue scale (VAS) recorded on the 0 to 100 scale at 7 and 14 days, and immediate and delayed bleeding. RESULTS No significant differences were found between groups at baseline. EHI index showed no differences between groups in all-time intervals. Eight subjects from suture group (SG) and 10 from no suture group (nSG) showed complete wound closure at day 14 (P >0.05) and at 30 days, complete closure was observed in 35 out of 36 patients. Four subjects from the SG and three from the nSG had immediate bleeding (P >0.05), while delayed bleeding was observed in two subjects from the SG and three from the nSG during the first week of healing (P >0.05). No differences were found in VAS scale between groups (SG, 36.2 ± 24.8; nSG, 21.5 ± 24.2, P >0.05). CONCLUSION It can be concluded that when a collagen sponge is placed in palatal donor areas of SCTG harvest by means of the SIT (incision length of ≈15 mm), sutured and non-sutured sites display similar early wound healing outcomes and patient-reported outcomes.
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Affiliation(s)
- Guillermo Schinini
- Department of Postgraduate Periodontics, Maimónides University, Buenos Aires, Argentina
| | - Diego Sales
- Department of Postgraduate Periodontics, Maimónides University, Buenos Aires, Argentina
| | - Mariel V Gómez
- Department of Postgraduate Periodontics, Maimónides University, Buenos Aires, Argentina
| | - Hugo J Romanelli
- Department of Postgraduate Periodontics, Maimónides University, Buenos Aires, Argentina
| | - Leandro Chambrone
- School of Dentistry, Ibirapuera University, São Paulo, Brazil.,Evidence-Based Hub, Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal.,Unit of Basic Oral Investigation (UIBO), Universidad El Bosque, Bogota, Colombia
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Palaiologou A, Kotsakis GA. Dentist-Patient Communication of Treatment Outcomes in Periodontal Practice: A Need for Dental Patient-Reported Outcomes. J Evid Based Dent Pract 2020; 20:101443. [PMID: 32473794 DOI: 10.1016/j.jebdp.2020.101443] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/08/2020] [Accepted: 04/10/2020] [Indexed: 11/18/2022]
Abstract
Periodontal practice has made tremendous progress toward evidence-based treatment over the past decade. Importantly, a new classification scheme for periodontal and peri-implant treatments has recently been devised that is incorporating current evidence and enabling patient-specific periodontal care. However, this important progress can be further accelerated with the availability of patient-perceived outcomes of periodontal and implant interventions. The majority of existing clinical studies assess treatment effects based on clinician-measured surrogate outcomes, such as probing depth and attachment levels which are easily communicated to or perceived by dental patients. As dental patient-reported outcomes (dPROs) gain momentum in dental practice, our understanding of the true outcome of dental therapies is vastly increasing. In periodontal research in particular, the utilization of dPROs has clearly demonstrated that periodontal disease contributes to an individual's burden of disease in a substantial manner. Correspondingly, disease treatment interventions seem to lead to varying levels of patient-perceived improvements. The present editorial aims to highlight the importance of patient communication of treatment outcomes in periodontal and implant research and to review the information on available measures for capturing dPROs.
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Sezgin Y, İnönü E. Serbest Dişeti Grefti Uygulamalarının Uzun Dönemde Yaşam Kalitesine Etkisinin Değerlendirilmesi. ACTA MEDICA ALANYA 2019. [DOI: 10.30565/medalanya.530329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Hu ML, Zheng G, Han JM, Yang M, Zhang YD, Lin H. Effect of Lasers on Dentine Hypersensitivity: Evidence From a Meta-analysis. J Evid Based Dent Pract 2019; 19:115-130. [DOI: 10.1016/j.jebdp.2018.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/22/2018] [Accepted: 12/23/2018] [Indexed: 02/08/2023]
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Treatment of intrabony defects with modified perforated membranes in aggressive periodontitis: subtraction radiography outcomes, prognostic variables, and patient morbidity. Clin Oral Investig 2018; 23:3005-3020. [PMID: 30374832 PMCID: PMC7398389 DOI: 10.1007/s00784-018-2712-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 10/17/2018] [Indexed: 12/12/2022]
Abstract
Objectives The main objectives of this study were (1) to evaluate bone/graft density alterations by digital subtraction radiography; (2) to determine factors associated with favorable clinical and radiographic outcomes, and (3) to report on patient morbidity after guided tissue regeneration (GTR) in aggressive periodontitis (AgP) patients. Materials and methods Adapting a split-mouth design, 30 comparative intrabony defects in 15 patients were randomly treated with xenogenic graft plus modified perforated membranes (MPM, tests) or xenogenic graft plus standard collagen membranes (CM, controls). The time period of observation was 12 months. Results There were significant improvements in clinical and radiographic parameters within each group, without intergroup differences. However, higher PPD reduction for three-wall defects was noted in MPM sites (5.22 versus 3.62 mm; p = 0.033). Moreover, a significant gain in bone/graft density of 4.9% from 6 to 12 months post-operatively was observed in test sites. Multivariate analysis demonstrated that morphology of intrabony defects was a predictor of CAL gain (p = 0.06), while independent prognostic variables effecting changes in bone/graft density were radiographic defect depth (p = 0.025) and radiographic angle (p = 0.033). The majority of patients reported some discomfort, pain, and edema with mild intensity without any significant differences between treatment modalities. Conclusions This study demonstrated enhanced bone/graft density gain after GTR with MPM, which may indicate greater area of new bone formation. Independent variables effecting treatment outcomes were intrabony defect morphology, radiographic defect depth, and radiographic angle. Clinical relevance This study supports the regenerative treatment of intrabony defects in AgP patients and identifies some variables with prognostic value.
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Rocha dos Santos M, Sangiorgio JPM, Neves FLDS, França-Grohmann IL, Nociti FH, Silverio Ruiz KG, Santamaria MP, Sallum EA. Xenogenous Collagen Matrix and/or Enamel Matrix Derivative for Treatment of Localized Gingival Recessions: A Randomized Clinical Trial. Part II: Patient-Reported Outcomes. J Periodontol 2017; 88:1319-1328. [DOI: 10.1902/jop.2017.170127] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Manuela Rocha dos Santos
- Department of Prosthesis and Periodontology, Division of Periodontics, Piracicaba Dental School, State University of Campinas, Campinas, Brazil
| | - João Paulo Menck Sangiorgio
- Department of Prosthesis and Periodontology, Division of Periodontics, Piracicaba Dental School, State University of Campinas, Campinas, Brazil
| | - Felipe Lucas da Silva Neves
- Department of Diagnosis and Surgery, Division of Periodontics, State University of São Paulo Campus, São José dos Campos, Brazil
| | - Isabela Lima França-Grohmann
- Department of Prosthesis and Periodontology, Division of Periodontics, Piracicaba Dental School, State University of Campinas, Campinas, Brazil
| | - Francisco Humberto Nociti
- Department of Prosthesis and Periodontology, Division of Periodontics, Piracicaba Dental School, State University of Campinas, Campinas, Brazil
| | - Karina Gonzales Silverio Ruiz
- Department of Prosthesis and Periodontology, Division of Periodontics, Piracicaba Dental School, State University of Campinas, Campinas, Brazil
| | - Mauro Pedrine Santamaria
- Department of Diagnosis and Surgery, Division of Periodontics, State University of São Paulo Campus, São José dos Campos, Brazil
| | - Enilson Antonio Sallum
- Department of Prosthesis and Periodontology, Division of Periodontics, Piracicaba Dental School, State University of Campinas, Campinas, Brazil
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16
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Insua A, Monje A, Wang HL, Inglehart M. Patient-Centered Perspectives and Understanding of Peri-Implantitis. J Periodontol 2017; 88:1153-1162. [DOI: 10.1902/jop.2017.160796] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Angel Insua
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
| | - Alberto Monje
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
- Department of Oral Surgery and Stomatology, ZMK Bern, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
| | - Marita Inglehart
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
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17
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Baiju R, Peter E, Varghese N, Anju P. Patient Reported Outcome Assessment of Periodontal Therapy: A Systematic Review. J Clin Diagn Res 2017; 11:ZC14-ZC19. [PMID: 28969266 PMCID: PMC5620913 DOI: 10.7860/jcdr/2017/28505.10343] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 07/15/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Patient Reported Outcomes (PROs) are now regarded as a fundamental measure of therapeutic success. Patient's opinion regarding the impact of disease and its treatment is assessed using scales such as Oral Health Related Quality Of Life (OHRQoL) tools. Patient centred outcome assessment is now being considered as a primary outcome measure in clinical trials. AIM To evaluate whether treatment of periodontal disease could influence OHRQoL based on available literature. MATERIALS AND METHODS An electronic search was done in Google, Google Scholar and Pubmed for articles in English language using the terms Quality of Life or ORHQoL or PROs or patient centered outcome and periodontal therapy. The search commenced on 1st September 2016 and ended on 15th December 2016. Studies that employed one or more than one multi-item OHRQoL instrument to assess PROs related to either non-surgical or surgical periodontal therapy were reviewed. RESULTS Initially 423 relevant articles were obtained, from which based on screening titles and abstracts 396 were excluded. Full text of remaining 27 articles were retrieved. Nineteen clinical studies with 1345 participants and 2 systematic reviews were included after the full text review. CONCLUSION Both surgical and Non-surgical Periodontal Therapy (NSPT) significantly influenced the OHRQoL scores. However the change in scores after surgical therapy when compared to nonsurgical therapy was not statistically significant. There is a need for a specific PROs scale that could potentially tap the entire dimension of the change in patients' perception brought about by periodontal therapy.
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Affiliation(s)
- R.M. Baiju
- Associate Professor, Department of Periodontics, Government Dental College Thrissur, Kerala University of Health Sciences, Kerala, India
| | - Elbe Peter
- Associate Professor, Department of Orthodontics, Government Dental College Alleppey, Kerala University of Health Sciences, Kerala, India
| | - N.O. Varghese
- Principal, Department of Conservative Dentistry and Endodontics, Pms College of Dental Sciences, Trivandrum, Kerala, India
| | - P Anju
- Senior Resident, Department of Periodontics, Government Dental College Kottayam, Kerala University of Health Sciences, Kerala, India
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18
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Stefanini M, Jepsen K, de Sanctis M, Baldini N, Greven B, Heinz B, Wennström J, Cassel B, Vignoletti F, Sanz M, Jepsen S, Zucchelli G. Patient-reported outcomes and aesthetic evaluation of root coverage procedures: a 12-month follow-up of a randomized controlled clinical trial. J Clin Periodontol 2016; 43:1132-1141. [DOI: 10.1111/jcpe.12626] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Martina Stefanini
- Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
| | - Karin Jepsen
- Department of Periodontology; University of Bonn; Bonn Germany
| | - Massimo de Sanctis
- Department of Periodontology; Vita Salute San Raffaele University of Milan; Milan Italy
| | - Nicola Baldini
- Department of Periodontology; University of Siena; Siena Italy
| | | | | | - Jan Wennström
- Department of Periodontology; the Sahlgrenska Academy University of Gothenburg; Gothenburg Sweden
| | - Björn Cassel
- Department of Periodontology; the Sahlgrenska Academy University of Gothenburg; Gothenburg Sweden
| | - Fabio Vignoletti
- Department of Periodontology; University of Madrid; Madrid Spain
| | - Mariano Sanz
- Department of Periodontology; University of Madrid; Madrid Spain
| | - Søren Jepsen
- Department of Periodontology; University of Bonn; Bonn Germany
| | - Giovanni Zucchelli
- Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
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Minimally Invasive Treatment of Infrabony Periodontal Defects Using Dual-Wavelength Laser Therapy. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2016; 2016:7175919. [PMID: 27366790 PMCID: PMC4912985 DOI: 10.1155/2016/7175919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 04/15/2016] [Accepted: 04/26/2016] [Indexed: 01/08/2023]
Abstract
Introduction. Surgical management of infrabony defects is an invasive procedure, frequently requiring the use of adjunctive material such as grafts or biologics, which is time-consuming and associated with expense and morbidity to the patient. Lasers in periodontal regeneration have been reported in the literature, with each wavelength having potential benefits through different laser-tissue interactions. The purpose of this case series was to assess the efficacy of a new dual-wavelength protocol in the management of infrabony defects. Materials and Methods. 32 defects (one in each patient) were treated using ultrasonic debridement, followed by flapless application of Erbium, Chromium:Yttrium, Scandium, Gallium, Garnet (Er,Cr:YSGG) laser (wavelength 2780 nm), and final application of diode laser (wavelength 940 nm). Pocket depths (PD) were measured after 6 months and repeat radiographs taken after one year. Results. The mean baseline PD was 8.8 mm (range 6–15 mm) and 6 months later was 2.4 mm (range 2–4 mm), with mean PD reduction being 6.4 ± 1.7 mm (range 3–12 mm). There was a significant gain in relative linear bone height (apical extent of bone), with mean percentage bone fill of 39.7 ± 41.2% and 53% of sites showing at least 40% infill of bone. Conclusion. The results compare favourably with traditional surgery and require further validation through randomised clinical controlled trials.
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20
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Rosen EB, Donoff RB, Riedy CA. U.S. Dental School Deans’ Views on the Value of Patient-Reported Outcome Measures in Dentistry. J Dent Educ 2016. [DOI: 10.1002/j.0022-0337.2016.80.6.tb06134.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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