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The International Journal of Esthetic... 2014The primary goal of nonsurgical periodontal therapy is to control microbial periodontal infection by removing bacterial biofilm, calculus, and toxins from periodontally... (Review)
Review
The primary goal of nonsurgical periodontal therapy is to control microbial periodontal infection by removing bacterial biofilm, calculus, and toxins from periodontally involved root surfaces. A review of the scientific literature indicates that mechanical nonsurgical periodontal treatment predictably reduces the levels of inflammation and probing pocket depths, increases the clinical attachment level and results in an apical shift of the gingival margin. Another parameter to be considered, in spite of the lack of scientific evidence, is the reduction in the degree of tooth mobility, as clinically experienced. It is important to point out that nonsurgical periodontal treatment presents limitations such as the long-term maintainability of deep periodontal pockets, the risk of disease recurrence, and the skill of the operator. A high number of posttreatment residual pockets exhibiting bleeding on probing and > 5 mm deep are related to lower clinical stability. The successful treatment of plaque-induced periodontitis will restore periodontal health, but with reduced periodontium. In such cases, anatomical damage from previous periodontal disease will persist and inverse architecture of soft tissue may impair home plaque removal. The clinician can select one of the following therapeutic options according to the individual patient's needs: - Quadrant/sextant wise instrumentation (conventional staged debridement, CSD). - Instrumentation of all pockets within a 24-hour period with (full mouth disinfection [FMD]) or without (full mouth scaling and root planing [FMSRP]) local antiseptics. Both procedures can be associated with systemic antimicrobials. -CSD or FMD in combination with laser or photodynamic therapy. Patients with aggressive periodontitis constitute a challenge to the clinician. To date there are no established protocols for controlling the disease. However, data from the literature on the application of the FMD protocol combined with amoxicillin-metronidazole systemic administration are promising. A new classification in supra- and subcrestal nonsurgical periodontal therapy will be proposed. The supracrestal therapy includes the treatment of gingivitis, nonsurgical coverage of recession-type defects, treatment of suprabony defects and papilla reconstruction techniques. Within subcrestal periodontal therapy, it is of paramount importance to preserve both marginal tissues and connective fibers inserted in the root cementum at the apical part of the bony defects.
Topics: Anti-Infective Agents; Anti-Infective Agents, Local; Combined Modality Therapy; Humans; Periodontal Attachment Loss; Periodontal Debridement; Periodontal Diseases; Periodontal Pocket; Periodontitis
PubMed: 24765632
DOI: No ID Found -
Periodontology 2000 Jun 2023In this review, typical clinical complications involving periodontal tissues are illustrated that can be encountered in conjunction with orthodontic therapy (OT).... (Review)
Review
In this review, typical clinical complications involving periodontal tissues are illustrated that can be encountered in conjunction with orthodontic therapy (OT). Special considerations are given for various clinical scenarios, such as the patient presenting in periodontal health, with periodontitis, or with mucogingival conditions. While some of the complications are seen as common side effects of OT, other, more severe, problems that could have been avoided may be viewed as treatment errors. Recommendations are made on how to prevent these complications, based on the currently available evidence, on clinical practice guidelines, and on expert opinion. In conclusion, while there are several areas in which OT can have unwanted adverse effects on periodontal/mucogingival conditions, there is also great potential for synergies, offering opportunities for close cooperation between the two specialties (periodontics and orthodontics) for the benefit of patients affected by tooth malpositioning and/or periodontal or mucogingival problems.
Topics: Humans; Periodontium; Periodontal Diseases; Periodontitis; Periodontics
PubMed: 36920050
DOI: 10.1111/prd.12484 -
Tissue Engineering. Part C, Methods Aug 2022Periodontitis is a chronic infectious oral disease with a high prevalence rate in the world, and is a major cause of tooth loss. Nowadays, people have realized that the... (Review)
Review
Periodontitis is a chronic infectious oral disease with a high prevalence rate in the world, and is a major cause of tooth loss. Nowadays, people have realized that the local microenvironment that includes proteins, cytokines, and extracellular matrix has a key influence on the functions of host immune cells and periodontal ligament (PDL) stem cells during a chronic infectious disease such as periodontitis. The above pathological process of periodontitis will lead to a defect of periodontal tissues. Through the application of biomaterials, biological agents, and stem cell therapy, guided tissue regeneration (GTR) makes it possible to reconstruct healthy PDL tissue after local inflammation control. To date, substantial advances have been made in periodontal GTR. However, the process of periodontal remodeling experiences complex microenvironment changes, and currently periodontium regeneration still remains to be a challenging feat. In this review, we summarized the main challenges in each stage of periodontal regeneration, and try to put forward appropriate biomaterial treatment mechanisms or potential tissue engineering strategies that provide a theoretical basis for periodontal tissue engineering regeneration research.
Topics: Biocompatible Materials; Guided Tissue Regeneration, Periodontal; Humans; Periodontal Ligament; Periodontitis; Periodontium; Tissue Engineering
PubMed: 35838120
DOI: 10.1089/ten.TEC.2022.0106 -
Photobiomodulation, Photomedicine, and... Jul 2022In the last few decades, lasers in dentistry have encompassed all branches in dentistry, with more focus in periodontology. In recent years, the use of lasers against... (Review)
Review
In the last few decades, lasers in dentistry have encompassed all branches in dentistry, with more focus in periodontology. In recent years, the use of lasers against periodontitis and peri-implantitis has undergone a decisive development that has involved various operational areas. The broadest applications were probably found in the clinical approach to soft tissues. Laser therapy is a novel technique that may provide further beneficial effects to conventional periodontal and peri-implant therapies. However, clinical evidence for the improvement of periodontal wound healing and tissue regeneration through laser treatment is still limited. This review is aimed at assessing the advantages and disadvantages of the use of lasers in dental procedures and pathologies, focusing more on protocols for the management of periodontal and peri-implant diseases. The adjuvant action of laser therapy, in addition to conventional therapies for the management of periodontal and peri-implant disease, could induce benefits, but further investigation would be necessary to standardize better the protocols applied and to understand the actual tissue response to laser therapy.
Topics: Humans; Laser Therapy; Low-Level Light Therapy; Peri-Implantitis; Periodontics; Periodontitis
PubMed: 35763842
DOI: 10.1089/photob.2021.0191 -
Journal of Clinical Periodontology May 2023The aim of the study was to evaluate the prevalence of periodontitis in dentate people between 2011 and 2020. (Meta-Analysis)
Meta-Analysis Review
AIM
The aim of the study was to evaluate the prevalence of periodontitis in dentate people between 2011 and 2020.
MATERIALS AND METHODS
PUBMED, Web of Science, and LILACS were searched up to and including December 2021. Epidemiological studies reporting the prevalence of periodontitis conducted between 2011 and 2020 were eligible for inclusion in this review. Studies were grouped according to the case definition of confidence as confident (Centers for Disease Control [CDC] AAP 2012; CDC/AAP 2007; and Armitage 1999) and non-confident (community periodontal index of 3 or 4, periodontal pocket depth >4 mm, and clinical attachment level ≥1 mm). Random effects meta-analyses with double arcsine transformation were conducted. Sensitivity subgroup and meta-regression analyses explored the effect of confounding variables on the overall estimates.
RESULTS
A total 55 studies were included. The results showed a significant difference, with confident case definitions (61.6%) reporting nearly twice the prevalence as non-confident classifications (38.5%). Estimates using confident periodontal case definitions showed a pooled prevalence of periodontitis of 61.6%, comprising 17 different countries. Estimates reporting using the CDC/AAP 2012 case definition presented the highest estimate (68.1%) and the CDC/AAP 2007 presented the lowest (48.8%). Age was a relevant confounding variable, as older participants (≥65 years) had the highest pooled estimate (79.3%).
CONCLUSION
Between 2011 and 2020, periodontitis in dentate adults was estimated to be around 62% and severe periodontitis 23.6%. These results show an unusually high prevalence of periodontitis compared to the previous estimates from 1990 to 2010.
Topics: Adult; Humans; Aged; Prevalence; Periodontitis; Epidemiologic Studies; Periodontal Index; Periodontal Pocket
PubMed: 36631982
DOI: 10.1111/jcpe.13769 -
BMC Oral Health Dec 2021The aetiology of oral cancer is multifactorial, as various risk factors (genetics, socioeconomic and lifestyle factors) contribute to its development. Data in the...
BACKGROUND
The aetiology of oral cancer is multifactorial, as various risk factors (genetics, socioeconomic and lifestyle factors) contribute to its development. Data in the literature suggest that people with periodontal disease have an increased risk of developing oral cancer, and the severity of periodontitis correlates with the appearance of oral squamous cell carcinoma. The aim of this study was to revise the non-genetic risk factors that may influence the development of OC, while focusing on the dental and periodontal status and OH.
METHODS
Two hundred patients (hundred diagnosed with oral cancer and hundred without oral cancer) were enrolled in our case-control study, to evaluate the association between oral cancer and the presence and severity of periodontitis, while examining several risk factors that might be responsible for oral cancer formation. A questionnaire customised for oral cancer patients was used to obtain the socioeconomic and lifestyle risk factors that may influence the development of oral squamous cell carcinoma. The dental and periodontal status along with the level of oral hygiene was recorded quantitatively. The chi-square and Mann-Whitney tests and logistic regression were used for the statistical analysis.
RESULTS
By considering both the case and the control groups, a significant correlation was found between the incidence of oral cancer and some socioeconomic factors and lifestyle habits, such as the sex, age, education and alcohol consumption of an individual. The mean value of the Silness-Löe plaque index was significantly higher in the case population. The number of completely edentulous patients was higher among the oral cancer population. The incidence of oral cancer was 57.1% in patients with periodontal disease. In comparison, the incidence of oral squamous cell carcinoma was only 28.6% among the patients without periodontitis. Most of the oral cancer patients (72.1%) had stage 4 periodontitis. On the other hand, the vast majority of the control group (51.6%) had stage 2 periodontitis.
CONCLUSION
Periodontitis can be an individual risk factor for oral cancer development. Periodontally compromised individuals should be strictly monitored, especially those with severe periodontitis and coexisting lifestyle risk factors. Maintaining their periodontal health in at-risk patients can minimize cancer risks.
Topics: Carcinoma, Squamous Cell; Case-Control Studies; Humans; Mouth Neoplasms; Periodontal Index; Periodontitis; Risk Factors
PubMed: 34911520
DOI: 10.1186/s12903-021-01998-y -
Periodontology 2000 Jun 2023Regenerative periodontal surgical procedures are an important component in the treatment of advanced periodontitis. They aim to improve the long-term prognosis of teeth... (Review)
Review
Regenerative periodontal surgical procedures are an important component in the treatment of advanced periodontitis. They aim to improve the long-term prognosis of teeth that are periodontally compromised by the presence of intrabony and/or furcation defects, resulting biologically in formation of root cementum, periodontal ligament, and alveolar bone and evidenced clinically by reduction of deep pockets to maintainable probing depths and/or improvements of vertical and horizontal furcation depth. Over the last 25 years, substantial clinical evidence has been accumulated to support the value of regenerative procedures in periodontally compromised dentitions. However, treatment success requires close attention to certain factors on the level of the patient, the tooth/defect, and the operator. Ignoring these factors in case selection, treatment planning, and treatment execution will increase the risk of complications that may jeopardize clinical success and may even be considered as treatment errors. Based on the currently available evidence from clinical practice guidelines, treatment algorithms, and on expert opinion, the present article provides an overview on the main factors, which influence the outcomes of regenerative periodontal surgery and gives recommendations on how to prevent complications and treatment errors.
Topics: Humans; Guided Tissue Regeneration, Periodontal; Oral Surgical Procedures; Treatment Outcome; Periodontitis; Prognosis; Alveolar Bone Loss; Furcation Defects
PubMed: 37435999
DOI: 10.1111/prd.12504 -
The Angle Orthodontist May 2022To evaluate the effect of fixed orthodontic treatment on periodontal parameters in periodontally compromised adult orthodontic patients. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To evaluate the effect of fixed orthodontic treatment on periodontal parameters in periodontally compromised adult orthodontic patients.
MATERIALS AND METHODS
This was a prospective, randomized, controlled clinical trial. Thirty-six periodontally compromised adult patients (mean age: 29.67 ± 4.8 years) were randomly allocated to either test (perio-ortho) or control group (perio). After periodontal stabilization in both groups, orthodontic treatment was started in the test group, whereas the control group remained on periodontal maintenance only. Evaluation and comparison of clinical parameters (plaque index [PI]; gingival index [GI]; bleeding on probing [BOP]; probing depth [PD]; clinical attachment level [CAL]) of both groups was assessed at three time intervals: T0 (base line), T1 (at start of orthodontic treatment), and T2 (1 year after start of orthodontic treatment). Radiological parameters (alveolar bone levels [ABL]) were recorded using CBCT at T1 and T2.
RESULTS
Intragroup analysis showed statistically significant improvement in all clinical and radiological periodontal parameters in both groups (P ≤ .05). Intergroup comparison revealed improvement in the periodontal parameters was not statistically significant between the groups (P ≥ .05). Subgroup analysis showed reduction in the number of moderate and severe periodontitis sites in both groups with significant more gains in ABL in the test group compared to the control group.
CONCLUSIONS
Orthodontic treatment after periodontal stabilization does not have any detrimental effect on periodontal health in adult periodontally compromised orthodontic patients and may add to the benefits achieved by periodontal treatment alone.
Topics: Adult; Dental Care; Dental Plaque Index; Humans; Periodontal Attachment Loss; Periodontal Index; Periodontitis; Prospective Studies; Young Adult
PubMed: 34882193
DOI: 10.2319/022521-156.1 -
Journal of Periodontal Research Oct 2022Deep learning (DL) has been employed for a wide range of tasks in dentistry. We aimed to systematically review studies employing DL for periodontal and implantological... (Review)
Review
Deep learning (DL) has been employed for a wide range of tasks in dentistry. We aimed to systematically review studies employing DL for periodontal and implantological purposes. A systematic electronic search was conducted on four databases (Medline via PubMed, Google Scholar, Scopus, and Embase) and a repository (ArXiv) for publications after 2010, without any limitation on language. In the present review, we included studies that reported deep learning models' performance on periodontal or oral implantological tasks. Given the heterogeneities in the included studies, no meta-analysis was performed. The risk of bias was assessed using the QUADAS-2 tool. We included 47 studies: focusing on imaging data (n = 20) and non-imaging data in periodontology (n = 12), or dental implantology (n = 15). The detection of periodontitis and gingivitis or periodontal bone loss, the classification of dental implant systems, or the prediction of treatment outcomes in periodontology and implantology were major use cases. The performance of the models was generally high. However, it varied given the employed methods (which includes various types of convolutional neural networks (CNN) and multi-layered perceptron (MLP)), the variety in specific modeling tasks, as well as the chosen and reported outcomes, outcome measures and outcome level. Only a few studies (n = 7) showed a low risk of bias across all assessed domains. A growing number of studies evaluated DL for periodontal or implantological objectives. Heterogeneity in study design, poor reporting and a high risk of bias severely limit the comparability of studies and the robustness of the overall evidence.
Topics: Alveolar Bone Loss; Deep Learning; Gingivitis; Humans; Periodontics; Periodontitis
PubMed: 35856183
DOI: 10.1111/jre.13037 -
Periodontology 2000 Feb 2018The aim of this paper was to evaluate strategies for periodontal therapy from the perspective of periodontal disease being a consequence of microbial colonization of the... (Review)
Review
The aim of this paper was to evaluate strategies for periodontal therapy from the perspective of periodontal disease being a consequence of microbial colonization of the periodontal pocket environment. In classic bacterial infections the diversity of the microbiota decreases as the disease develops. In most cases of periodontitis, however, the diversity of the flora increases. Most incriminating bacteria are thought to harm tissues significantly only if present in high numbers over prolonged periods of time. Clinical trials have repeatedly demonstrated that scaling and root planing, a procedure that aims to remove subgingival bacterial deposits by scraping on the tooth surface within the periodontal pocket, is effective. At present, for the therapy of any form of periodontal disease, there exists no protocol with proven superiority, in terms of efficiency or effectiveness, over scaling and root planing plus systemic amoxicillin and metronidazole. Some exponents advocate rationing these drugs for patients with a specific microbial profile. However, the evidence for any benefit of bacteriology-assisted clinical protocols is unsatisfactory. Treated sites are subject to recolonization with a microbiota similar to that present before therapy. The degree and speed of recolonization depends on the treatment protocol, the distribution patterns of periodontal microorganisms elsewhere in the oral cavity and the quality of the patient's oral hygiene. To limit the use of antibiotics and to avoid accumulation of harmful effects by repeated therapy, further efforts must be made to optimize procedures addressing the microbial colonization and recolonization of the periodontal pocket.
Topics: Amoxicillin; Anti-Bacterial Agents; Bacteria; Bacterial Physiological Phenomena; Biodiversity; Dental Scaling; Humans; Metronidazole; Microbiota; Oral Hygiene; Periodontal Diseases; Periodontal Pocket; Periodontitis; Root Planing
PubMed: 29193304
DOI: 10.1111/prd.12147