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The Cochrane Database of Systematic... Jan 2018Periodontitis is a bacterially-induced, chronic inflammatory disease that destroys the connective tissues and bone that support teeth. Active periodontal treatment aims... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Periodontitis is a bacterially-induced, chronic inflammatory disease that destroys the connective tissues and bone that support teeth. Active periodontal treatment aims to reduce the inflammatory response, primarily through eradication of bacterial deposits. Following completion of treatment and arrest of inflammation, supportive periodontal therapy (SPT) is employed to reduce the probability of re-infection and progression of the disease; to maintain teeth without pain, excessive mobility or persistent infection in the long term, and to prevent related oral diseases.According to the American Academy of Periodontology, SPT should include all components of a typical dental recall examination, and importantly should also include periodontal re-evaluation and risk assessment, supragingival and subgingival removal of bacterial plaque and calculus, and re-treatment of any sites showing recurrent or persistent disease. While the first four points might be expected to form part of the routine examination appointment for periodontally healthy patients, the inclusion of thorough periodontal evaluation, risk assessment and subsequent treatment - normally including mechanical debridement of any plaque or calculus deposits - differentiates SPT from routine care.Success of SPT has been reported in a number of long-term, retrospective studies. This review aimed to assess the evidence available from randomised controlled trials (RCTs).
OBJECTIVES
To determine the effects of supportive periodontal therapy (SPT) in the maintenance of the dentition of adults treated for periodontitis.
SEARCH METHODS
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 8 May 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 5), MEDLINE Ovid (1946 to 8 May 2017), and Embase Ovid (1980 to 8 May 2017). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.
SELECTION CRITERIA
Randomised controlled trials (RCTs) evaluating SPT versus monitoring only or alternative approaches to mechanical debridement; SPT alone versus SPT with adjunctive interventions; different approaches to or providers of SPT; and different time intervals for SPT delivery.We excluded split-mouth studies where we considered there could be a risk of contamination.Participants must have completed active periodontal therapy at least six months prior to randomisation and be enrolled in an SPT programme. Trials must have had a minimum follow-up period of 12 months.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened search results to identify studies for inclusion, assessed the risk of bias in included studies and extracted study data. When possible, we calculated mean differences (MDs) and 95% confidence intervals (CIs) for continuous variables. Two review authors assessed the quality of evidence for each comparison and outcome using GRADE criteria.
MAIN RESULTS
We included four trials involving 307 participants aged 31 to 85 years, who had been previously treated for moderate to severe chronic periodontitis. Three studies compared adjuncts to mechanical debridement in SPT versus debridement only. The adjuncts were local antibiotics in two studies (one at high risk of bias and one at low risk) and photodynamic therapy in one study (at unclear risk of bias). One study at high risk of bias compared provision of SPT by a specialist versus general practitioner. We did not identify any RCTs evaluating the effects of SPT versus monitoring only, or of providing SPT at different time intervals, or that compared the effects of mechanical debridement using different approaches or technologies.No included trials measured our primary outcome 'tooth loss'; however, studies evaluated signs of inflammation and potential periodontal disease progression, including bleeding on probing (BoP), clinical attachment level (CAL) and probing pocket depth (PPD).There was no evidence of a difference between SPT delivered by a specialist versus a general practitioner for BoP or PPD at 12 months (very low-quality evidence). This study did not measure CAL or adverse events.Due to heterogeneous outcome reporting, it was not possible to combine data from the two studies comparing mechanical debridement with or without the use of adjunctive local antibiotics. Both studies found no evidence of a difference between groups at 12 months (low to very low-quality evidence). There were no adverse events in either study.The use of adjunctive photodynamic therapy did not demonstrate evidence of benefit compared to mechanical debridement only (very low-quality evidence). Adverse events were not measured.The quality of the evidence is low to very low for these comparisons. Future research is likely to change the findings, therefore the results should be interpreted with caution.
AUTHORS' CONCLUSIONS
Overall, there is insufficient evidence to determine the superiority of different protocols or adjunctive strategies to improve tooth maintenance during SPT. No trials evaluated SPT versus monitoring only. The evidence available for the comparisons evaluated is of low to very low quality, and hampered by dissimilarities in outcome reporting. More trials using uniform definitions and outcomes are required to address the objectives of this review.
Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Chronic Periodontitis; Dental Plaque; Humans; Middle Aged; Periodontal Debridement; Periodontics; Photochemotherapy; Randomized Controlled Trials as Topic; Tooth Loss
PubMed: 29291254
DOI: 10.1002/14651858.CD009376.pub2 -
Trials Jul 2019Periodontal intrabony defects are usually treated surgically with the aim of increasing attachment and bone levels and reducing risk of progression. However, recent...
BACKGROUND
Periodontal intrabony defects are usually treated surgically with the aim of increasing attachment and bone levels and reducing risk of progression. However, recent studies have suggested that a minimally invasive non-surgical therapy (MINST) leads to considerable clinical and radiographic defect depth reductions in intrabony defects. The aim of this study is to compare the efficacy of a modified MINST approach with a surgical approach (modified minimally invasive surgical therapy, M-MIST) for the treatment of intrabony defects.
METHODS
This is a parallel-group, single-centre, examiner-blind non-inferiority randomised controlled trial with a sample size of 66 patients. Inclusion criteria are age 25-70, diagnosis of periodontitis stage III or IV (grades A to C), presence of ≥ 1 'intrabony defect' with probing pocket depth (PPD) > 5 mm and intrabony defect depth ≥ 3 mm. Smokers and patients who received previous periodontal treatment to the study site within the last 12 months will be excluded. Patients will be randomly assigned to either the modified MINST or the M-MIST protocol and will be assessed up to 15 months following initial therapy. The primary outcome of the study is radiographic intrabony defect depth change at 15 months follow-up. Secondary outcomes are PPD and clinical attachment level change, inflammatory markers and growth factors in gingival crevicular fluid, bacterial detection, gingival inflammation and healing (as measured by geometric thermal camera imaging in a subset of 10 test and 10 control patients) and patient-reported outcomes.
DISCUSSION
This study will produce evidence about the clinical efficacy and potential applicability of a modified MINST protocol for the treatment of periodontal intrabony defects, as a less invasive alternative to the use of surgical procedures.
TRIAL REGISTRATION
ClinicalTrials.gov, NCT03797807. Registered on 9 January 2019.
Topics: Adult; Aged; Alveolar Bone Loss; Dental Scaling; Equivalence Trials as Topic; Female; Guided Tissue Regeneration, Periodontal; Humans; London; Male; Middle Aged; Minimally Invasive Surgical Procedures; Periodontal Debridement; Periodontitis; Root Planing; Severity of Illness Index; Surgical Flaps; Time Factors; Treatment Outcome; Young Adult
PubMed: 31351492
DOI: 10.1186/s13063-019-3544-8 -
Periodontology 2000 Jun 2020Cardiovascular diseases are the worldwide leading cause of mortality. Cardiovascular diseases are noncommunicable conditions with a complex pathogenesis, and their... (Review)
Review
Cardiovascular diseases are the worldwide leading cause of mortality. Cardiovascular diseases are noncommunicable conditions with a complex pathogenesis, and their clinical manifestations include major cardiovascular events such as myocardial infarction and stroke. Epidemiologic evidence suggests a consistent association between periodontitis and increased risk of cardiovascular diseases. Some evidence supports a beneficial effect of the treatment of periodontitis on both surrogate and hard cardiovascular outcomes. This narrative review has been conducted as an update of the most recent evidence on the effects of periodontitis treatment on cardiovascular outcomes since the last commissioned review of the European Federation of Periodontology-American Academy of Periodontology World Workshop in 2012. Newer evidence originating from published randomized controlled trials confirms a positive effect of periodontal treatment on surrogate measures of cardiovascular diseases, whereas there have been no randomized controlled trials investigating the effect of periodontal treatment on the incidence of cardiovascular disease events such as myocardial infarction and stroke. In conclusion, there is sufficient evidence from observational and experimental studies on surrogate cardiovascular measures to justify the design and conduct of appropriately powered randomized controlled trials investigating the effect of effective periodontal interventions on cardiovascular disease outcomes (ie, myocardial infarction and stroke) with adequate control of traditional cardiovascular risk factors.
Topics: Cardiovascular Diseases; Humans; Myocardial Infarction; Periodontics; Periodontitis; Risk Factors
PubMed: 32385887
DOI: 10.1111/prd.12299 -
Periodontology 2000 Feb 2019Periodontology has evolved from a predominantly mechanical to a sophisticated infectious disease-based discipline. Research has paved the way for a greater understanding... (Review)
Review
Periodontology has evolved from a predominantly mechanical to a sophisticated infectious disease-based discipline. Research has paved the way for a greater understanding of the periodontal microbiome, improvement in periodontal diagnostics and therapies, and the recognition of periodontitis being associated with more than 50 systemic diseases. The etiopathology of progressive periodontitis includes active herpesviruses, specific bacterial pathogens, and proinflammatory immune responses. This article points to a role of periodontal herpesviruses in the development of systemic diseases and proposes treatment of severe periodontitis not only to avoid tooth loss, but also to reduce the risk for systemic diseases. An efficient, safe, and reliable anti-infective treatment of severe periodontitis is presented, which targets both herpesviruses and bacterial pathogens and which can be carried out in minimal time with minimal cost.
Topics: Focal Infection; Herpesviridae; Humans; Periodontics; Periodontitis
PubMed: 30892771
DOI: 10.1111/prd.12258 -
Oral Diseases Apr 2024The possible association between hypertension and periodontitis and the effect of hypertension on periodontal treatment were investigated by evaluating salivary and...
OBJECTIVE
The possible association between hypertension and periodontitis and the effect of hypertension on periodontal treatment were investigated by evaluating salivary and gingival crevicular fluid (GCF) interleukin (IL)-6 and C reactive protein (CRP) levels.
METHODS
Forty-two healthy individuals without any previously diagnosed systemic disease [10 periodontally healthy (control) and 10 periodontitis (CP)] and subjects with hypertension [13 periodontally healthy (HP) and 9 with periodontitis (CP + HP)] participated in the study. GCF and saliva samples were obtained at baseline and 4 weeks after Phase I periodontal treatment. Biochemical parameters were analyzed using ELISA.
RESULTS
Before the periodontal treatment, significantly higher GCF IL-6 and CRP levels were detected in CP + HP and CP groups compared to HP and control groups (p < 0.01). Salivary CRP level in CP + HP group was found to be higher than the control group (p < 0.05). Statistically significant gingival and plaque index measurements (p < 0.01) might suggest a possible effect of hypertension on periodontal status. Periodontal treatment significantly improved the clinical indices; however, biochemical parameters did not change after the treatment.
CONCLUSION
The association of hypertension with periodontitis through local salivary and GCF inflammatory mediators might be possible in disease process.
Topics: Humans; Hypertension; C-Reactive Protein; Gingival Crevicular Fluid; Saliva; Interleukin-6; Male; Female; Adult; Periodontitis; Middle Aged; Periodontal Index; Case-Control Studies; Dental Plaque Index; Dental Scaling; Inflammation Mediators
PubMed: 36798972
DOI: 10.1111/odi.14543 -
British Dental Journal Jan 2019The 2017 World Workshop Classification system for periodontal and peri-implant diseases and conditions was developed in order to accommodate advances in knowledge...
The 2017 World Workshop Classification system for periodontal and peri-implant diseases and conditions was developed in order to accommodate advances in knowledge derived from both biological and clinical research, that have emerged since the 1999 International Classification of Periodontal Diseases. Importantly, it defines clinical health for the first time, and distinguishes an intact and a reduced periodontium throughout. The term 'aggressive periodontitis' was removed, creating a staging and grading system for periodontitis that is based primarily upon attachment and bone loss and classifies the disease into four stages based on severity (I, II, III or IV) and three grades based on disease susceptibility (A, B or C). The British Society of Periodontology (BSP) convened an implementation group to develop guidance on how the new classification system should be implemented in clinical practice. A particular focus was to describe how the new classification system integrates with established diagnostic parameters and pathways, such as the basic periodontal examination (BPE). This implementation plan focuses on clinical practice; for research, readers are advised to follow the international classification system. In this paper we describe a diagnostic pathway for plaque-induced periodontal diseases that is consistent with established guidance and accommodates the novel 2017 classification system, as recommended by the BSP implementation group. Subsequent case reports will provide examples of the application of this guidance in clinical practice.
Topics: Dental Plaque; Humans; Periodontal Diseases; Periodontics; Periodontitis; Periodontium
PubMed: 30631188
DOI: 10.1038/sj.bdj.2019.3 -
Dental Clinics of North America Jan 2022The ultimate goal in periodontal therapy is the complete re-establishment of the lost tissues. Dental researchers and clinicians are continuously working to develop... (Review)
Review
The ultimate goal in periodontal therapy is the complete re-establishment of the lost tissues. Dental researchers and clinicians are continuously working to develop current therapeutic techniques and technologies that can regenerate damaged periodontal tissues. Predicting the outcome of the treatment is a challenging endeavor, because a variety of local and systemic variables can affect the success of the applied regenerative therapy. To real-time monitor the biological changes during periodontitis or after periodontal treatment, various biomarkers have been studied in periodontology. This article discusses the available evidence on the use of biomarkers in the detection of periodontal regeneration.
Topics: Biomarkers; Guided Tissue Regeneration, Periodontal; Humans; Periodontal Ligament; Periodontics; Periodontitis; Periodontium; Regeneration
PubMed: 34794552
DOI: 10.1016/j.cden.2021.06.006 -
Swiss Dental Journal Feb 2018
Review
Topics: Decision Trees; Dental Prophylaxis; Follow-Up Studies; Long-Term Care; Periodontal Pocket; Periodontitis; Risk Factors
PubMed: 29533057
DOI: 10.61872/sdj-2018-02-02 -
Annals of African Medicine 2023Periodontitis is the sixth most prevalent chronic disease. Literature suggests a relationship between diabetes and periodontitis and when coexist may aggravate each... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Periodontitis is the sixth most prevalent chronic disease. Literature suggests a relationship between diabetes and periodontitis and when coexist may aggravate each other deleterious consequences. Therefore, we aimed to assess the effects of periodontitis treatment on glycemic control.
MATERIALS AND METHODS
A systematic literature search was conducted in PubMed, Cochrane Library, and the first 100 articles in Google Scholar from January 2011 to October 2021. The terms periodontitis, periodontal treatment, diabetes mellitus, nonsurgical treatment, glycated hemoglobin (HbA1c) were used, with the Protean "AND" and "OR." The titles, abstracts, and references of the included studies were screened. Any discrepancy was solved by an agreement between researchers. Out of 1059 studies retrieved, 320 stands after the removal of duplication, from them, 31 full texts were screened and only 11 studies were included in the final meta-analysis.
RESULTS
In the present meta-analysis, 11 studies (1469 patients included) were pooled, and the overall effect showed that periodontitis treatment improved the HbA1c, odd ratio, -0.024, 95% confidence interval, -0.42-.06, P value, 0.009, Chi-square, 52.99. However, substantial heterogeneity was observed, P value, < 0.001, I for heterogeneity 81%.
CONCLUSION
Periodontitis treatment improved the HbA1c among patients with diabetes and poor glycemic control. Screening of this common disease is important in diabetes holistic care.
Topics: Humans; Glycated Hemoglobin; Diabetes Mellitus, Type 2; Periodontitis; Root Planing
PubMed: 37026192
DOI: 10.4103/aam.aam_53_22 -
Advances in Experimental Medicine and... 2022Scaling and root planing is the gold standard for the treatment of periodontitis, but administration of systemic antibiotics may be needed especially for sites with deep... (Review)
Review
Scaling and root planing is the gold standard for the treatment of periodontitis, but administration of systemic antibiotics may be needed especially for sites with deep probing depths, or in the presence of comorbidities. However, treated sites are subject to recolonization with a microbiota similar to that present before therapy, and supportive periodontal therapy is employed after the treatment of active disease. The use of beneficial organisms, known as probiotics, seems an attractive proposal to promote a healthy associated subgingival microbiome and to control inflammation for the management of periodontitis. The mechanisms underlying the benefits promoted by probiotics involve interference on periodontopathogens, modulation of the exacerbated immune host response and the ability to restore the integrity of the epithelial barrier on mucosa surfaces. This review examines the scientific data related to the effects of probiotics on the treatment of periodontal diseases and addresses the future approaches necessary for their implementation.
Topics: Anti-Bacterial Agents; Humans; Periodontitis; Probiotics; Root Planing
PubMed: 35612808
DOI: 10.1007/978-3-030-96881-6_19