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Journal of Periodontal Research Aug 2023Growth factors have been used with success in periodontal regeneration, especially in intrabony defects. Among those, the recombined form of fibroblast growth factor-2...
BACKGROUND
Growth factors have been used with success in periodontal regeneration, especially in intrabony defects. Among those, the recombined form of fibroblast growth factor-2 (rhFGF-2) has been also examined.
OBJECTIVE
To address the outcomes of periodontal regeneration using rhFGF-2 alone or in combination with bone substitutes primarily in terms of Radiographic Bone Fill (RBF%) and secondary Probing Pocket Depth (PPD), and Probing Attachment Levels (PAL).
MATERIAL AND METHODS
A search in MEDLINE and EMBASE using the Ovid interface was conducted from 2000 up to and including the 12th of November 2022. Starting from the initially identified 1289 articles, 34 studies were selected for further analysis. Following the full-text screening, 7 of the 34 studies met the inclusion criteria and thus were included in the systematic review after assessing their quality according to the Newcastle-Ottawa scale (NOS). Clinical and radiographic results (bone gain, pocket depth, and clinical attachment level) after the application of FGF-2 alone or in combination with different carriers were studied in patients with intrabony defects of at least one wall and pocket depth greater than 4 mm.
RESULTS
Primary outcomes: RBF% was higher in studies using a combination of rhFGF-2 and bone substitutes (74.6 ± 20.0%) compared to others using the specific growth factor alone or negative controls (22.7 ± 20.7%). In terms of secondary outcomes, the analysis failed to show an additional benefit from the use of the rhFGF-2 alone or in combination with bone substitutes.
CONCLUSION
rhFGF-2 can improve RBF% in the treatment of periodontal defects, especially when it is used in combination with a bone substitute.
Topics: Humans; Fibroblast Growth Factor 2; Bone Substitutes; Alveolar Bone Loss; Guided Tissue Regeneration, Periodontal; Periodontal Attachment Loss; Treatment Outcome
PubMed: 37130815
DOI: 10.1111/jre.13131 -
Complementary Therapies in Clinical... Nov 2021Periodontal disease (PD) is the second most prevalent buccal infectious condition in adults. Owing to its multifactorial etiology, treatment and maintenance are... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Periodontal disease (PD) is the second most prevalent buccal infectious condition in adults. Owing to its multifactorial etiology, treatment and maintenance are challenging. Scaling and root planing, associated with adequate plaque control, are considered the gold standard treatments for this disease. However, the instrumentation techniques can fail to completely eliminate calculus, particularly in higher grade and progression rated PD cases, and the continuing efficient removal of the biofilm by the patient can limit the long-term response of this treatment. Anti-infective herbal products, such as Curcuma, have been added as adjuvant therapy to prolong periodontal treatment outcomes.
OBJECTIVE
This systematic review aimed to summarize and evaluate whether Curcuma can contribute to PD treatment when applied as an adjunct to the standard scaling and root planing therapy.
DATA SOURCES
We searched databases using specific keywords and Boolean operators and systematically conducted the extraction and analysis according to the PROSPERO (CRD42019145691) database. The main eligibility criteria were randomized clinical trials in humans published in the English language.
RESULTS
Twelve studies were included in the review and 11 in the meta-analysis. Quantitative analysis of different clinical parameters was described. In comparison with the control group, Curcuma was associated with a reduction in pocket depth after 90 days of treatment (mean deviation: 0.48; 95% confidence interval: 0.89-0.08).
CONCLUSION
This systematic review and meta-analysis indicated that Curcuma is an effective product when applied as adjunct therapy for PD treatment. This improved the clinical and microbiological parameters.
Topics: Adult; Chronic Periodontitis; Combined Modality Therapy; Curcuma; Dental Scaling; Humans; Periodontal Diseases; Root Planing
PubMed: 34662850
DOI: 10.1016/j.ctcp.2021.101493 -
International Journal of Dental Hygiene Feb 2022This systematic review aimed to analyse available evidence to answer two focused questions about the efficacy of erythritol powder air-polishing (EPAP) (i) as an... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This systematic review aimed to analyse available evidence to answer two focused questions about the efficacy of erythritol powder air-polishing (EPAP) (i) as an adjunctive during active periodontal therapy (APT) and (ii) as an alternative to hand/ultrasonic instrumentation during supportive periodontal therapy (SPT). Additionally, microbiological outcomes and patient's comfort/perceptions were assessed as secondary outcomes.
METHODS
PubMed, Cochrane and Medline were searched for relevant articles published before February 2021 following PRISMA guidelines. The search was conducted by three independent reviewers, and the agreement was measured by Cohen's kappa score. Out of 1043 articles, eight randomized clinical trials were selected for systematic review and quantitative synthesis. Only periodontal parameters, such as clinical attachment level (CAL), probing pocket depth (PPD) and bleeding on probing (BoP), showed homogeneity and, thus, were selected for meta-analysis.
RESULTS
The improvement in PPD and BoP scores after using EPAP was comparable with hand/ultrasonic instrumentation during both APT and SPT. Significant CAL gain was achieved with EPAP during APT (0.16 mm, p < 0.02) compared with hand/ultrasonic instrumentation at the end point, whereas non-significant CAL gain was achieved during SPT. No differences were observed regarding microbiological outcomes between the two treatment modalities. However, EPAP inflicted less pain and was better perceived by the patients.
CONCLUSION
Erythritol powder air-polishing can substitute hand/ultrasonic instrumentation for SPT, and CAL gain is significantly improved when EPAP is used as an adjunct during APT. For microbiological outcomes, no significant differences were observed between the two approaches; however, EPAP was better tolerated by the patients than hand/ultrasonic instrumentation.
CLINICAL RELEVANCE
Erythritol powder air-polishing can be used as an adjunct during APT and as an alternative to conventional mechanical debridement during SPT.
Topics: Dental Scaling; Erythritol; Humans; Powders; Ultrasonics
PubMed: 34318577
DOI: 10.1111/idh.12539 -
European Journal of Orthodontics Sep 2023Maxillary incisor and canine teeth are commonly impacted and require multidisciplinary treatment to accommodate them in the dental arch. (Meta-Analysis)
Meta-Analysis
Periodontal outcomes associated with impacted maxillary central incisor and canine teeth following surgical exposure and orthodontic alignment: a systematic review and meta-analysis.
BACKGROUND
Maxillary incisor and canine teeth are commonly impacted and require multidisciplinary treatment to accommodate them in the dental arch.
OBJECTIVES
To assess the periodontal outcomes of impacted maxillary central incisor and canine teeth, which have been successfully aligned in the arch following surgical exposure and orthodontic traction with fixed appliance therapy.
SEARCH METHODS
Systematic literature searches without restrictions were undertaken in eight databases.
SELECTION CRITERIA
Studies reporting surgical interventions in combination with orthodontic traction with fixed appliance therapy to align impacted maxillary incisors or canines published up to January 2023.
DATA COLLECTION
Duplicate independent study selection, data extraction, and risk of bias assessment.
ANALYSIS
Random-effects meta-analyses of aggregate data.
RESULTS
Twenty-three studies (21 retrospective and 2 prospective) were included in the final analysis. Three studies reported outcomes for maxillary central incisors and 20 reported outcomes for maxillary canines. For maxillary central incisors, all three studies were rated as being at moderate risk of bias. For maxillary canines, 17 studies and 1 study were rated at moderate and high risk of bias, respectively. Both prospective studies were rated at a low risk of bias. Meta-analyses comparing aligned impacted maxillary canines to their non-impacted contralateral counterparts found the former had increased Plaque Index scores (mean difference [MD] 0.19; 95% confidence interval [CI] 0.03, 0.35; P = 0.03), increased clinical attachment loss (MD 0.40 mm; 95% CI 0.17, 0.63; P = 0.01), increased pocket probing depth (MD 0.18 mm; 95% CI 0.07, 0.28; P = 0.001), increased bone loss (MD 0.51 mm; 95% CI 0.31, 0.72; P < 0.001), and reduced keratinized gingival width (MD -0.31 mm; 95% CI -0.61, -0.01; P = 0.04).
CONCLUSIONS
Limited evidence suggests that surgical exposure and orthodontic alignment of impacted maxillary central incisor or canine teeth, results in modest adverse effects in the periodontium. These findings should be viewed with caution as our certainty for these outcomes is very low to low due to the bias and heterogeneity. Further well-conducted studies reporting patient centred outcomes are required.
REGISTRATION
PROSPERO (CRD42020225639).
Topics: Humans; Cuspid; Incisor; Prospective Studies; Retrospective Studies; Tooth, Impacted
PubMed: 37643750
DOI: 10.1093/ejo/cjad039 -
Journal of Clinical Periodontology Oct 2022"Host modulatory therapy" (HMT) with ω-3 fatty acids aims at reducing inflammation. With HMT as an adjunct, a better result of periodontal therapy is expected. The aim... (Meta-Analysis)
Meta-Analysis Review
AIM
"Host modulatory therapy" (HMT) with ω-3 fatty acids aims at reducing inflammation. With HMT as an adjunct, a better result of periodontal therapy is expected. The aim of this systematic review and meta-analysis (MA) was to examine the additional effect of ω-3 fatty acids to non-surgical periodontal therapy (SRP) on the probing pocket depth (PPD) and the clinical attachment level (CAL).
MATERIALS AND METHODS
MEDLINE-PubMed and Cochrane-CENTRAL libraries were searched up to January 2021 for randomized controlled trials in patients with chronic periodontitis, treated with SRP/placebo as controls and SRP/ω-3 fatty acids as the test group.
RESULTS
The search identified 173 unique abstracts, and screening resulted in 10 eligible publications. Descriptive analysis showed a significant effect on the PPD and CAL in favour of the groups with ω-3 fatty acids in the majority of comparisons. MA revealed that adjunctive use of ω-3 fatty acids to SRP resulted in 0.39 mm more PPD reduction (95% CI: -0.58; -0.21) and 0.41 mm more CAL gain (95% CI: -0.63; -0.19) than SRP alone.
CONCLUSIONS
In patients with periodontitis, dietary supplementation with ω-3 fatty acids as an adjunct to SRP is more effective in reducing the PPD and improving the CAL than SRP alone. If SRP is indicated, the use of ω-3 fatty acids can be considered for a moderate extra added effect on PPD reduction and CAL gain. The strength of this recommendation is moderate.
Topics: Chronic Periodontitis; Dental Scaling; Fatty Acids, Omega-3; Humans; Root Planing
PubMed: 35713248
DOI: 10.1111/jcpe.13680 -
Journal of Clinical Periodontology Jun 2020To systemically review the available evidence on the clinical performance of osseous resective surgery (ORS) in the treatment of residual periodontal defects in terms of... (Meta-Analysis)
Meta-Analysis
AIM
To systemically review the available evidence on the clinical performance of osseous resective surgery (ORS) in the treatment of residual periodontal defects in terms of pocket elimination and biological costs in patients with chronic periodontitis.
MATERIALS AND METHODS
Three databases (PubMed, EMBASE and Cochrane) were searched up to January 2019. Clinical trials with a follow-up duration of at least 12 months after ORS with or without fibre retention technique were included. Quantitative synthesis was conducted with random-effect meta-analysis.
RESULTS
Overall, 1,765 studies were retrieved, of which 53 full-text articles were screened by two reviewers. Finally, a total of three RCTs were included in the meta-analysis. Random-effect meta-analysis showed a weighted mean percentage of pocket elimination (final PD ≤ 4 mm) at 12 months of 98.3% (95% CI: 96.8; 99.7) with I of 26%. The weighted mean amount of resected bone was 0.87 mm (95% CI: 0.49; 1.25), and the weighted mean increase in gingival recession was 2.13 mm (95% CI: 1.49; 2.78) at 12 months.
CONCLUSIONS
ORS represents an effective surgical approach for the elimination of residual periodontal pockets in the short to medium term. Additional randomized controlled clinical trials with data on pocket elimination are warranted.
Topics: Chronic Periodontitis; Gingival Recession; Humans; Periodontal Index; Periodontal Pocket
PubMed: 32145035
DOI: 10.1111/jcpe.13281 -
Journal of Periodontal Research Apr 2023The objective of this systematic review and meta-analysis was to evaluate the effect of periodontal surgery on the subgingival microbiome. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The objective of this systematic review and meta-analysis was to evaluate the effect of periodontal surgery on the subgingival microbiome.
BACKGROUND
Periodontitis is a chronic inflammation of the tooth supporting tissues caused by the dysbiosis of the subgingival biofilm. It is managed through different non-surgical and surgical treatment modalities. Recent EFP S3 guidelines recommended performing periodontal surgery as part of Step 3 periodontitis treatment after Step 1 and Step 2 periodontal therapy, with the aim to achieve pocket closure of persisting sites. Changes in the sub-gingival microbiome may explain the treatment outcomes observed at different time points. Various microbiological detection techniques for disease-associated pathogens have been evolved over time and have been described in the literature. However, the impact of different types of periodontal surgery on the subgingival microbiome remains unclear.
METHODS
A systematic literature search was conducted in Medline, Embase, LILACS and Cochrane Library supplemented by manual search (23DEC2019, updated 21APR2022).
RESULTS
From an initial search of 3046 studies, 28 were included according to our specific inclusion criteria. Seven microbiological detection techniques were used to analyse disease-associated species in subgingival plaque samples: optical microscope, culture, polymerase chain reaction (PCR), checkerboard, enzymatic reactions, immunofluorescence and 16S gene sequencing. The included studies exhibited differences in various aspects of their methodologies such as subgingival plaque sample collection or treatment modalities. Clinical data showed a significant decrease in probing pocket depths (PPD) and clinical attachment loss (CAL) after periodontal surgery. Microbiological findings were overall heterogeneous. Meta-analysis was performed on a sub-cohort of studies all using checkerboard as a microbiological detection technique. Random effect models for Treponema denticola (T. denticola), Porphyromonas gingivalis (P. gingivalis) and Tannerella forsythia (T. forsythia) did not show a significant effect on mean counts 3 months after periodontal surgery. Notably, Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) showed a significant increase 3 months after periodontal surgery. 16S gene sequencing was used in one included study and reported a decrease in disease-associated species with an increase in health-associated species after periodontal surgery at 3 and 6 months.
CONCLUSION
This systematic review has shown that the effect of periodontal surgery on the changes in subgingival microbiome is heterogeneous and may not always be associated with a decrease in disease-associated species. The variability could be attributed to the microbiological techniques employed for the analysis. Therefore, there is a need for well-designed and adequately powered studies to understand how periodontal surgery influences the subgingival microbiome and how the individual's microbiome affects treatment outcomes after periodontal surgery.
Topics: Humans; Periodontal Pocket; Periodontitis; Porphyromonas gingivalis; Tannerella forsythia; Microbiota; Aggregatibacter actinomycetemcomitans; Treponema denticola
PubMed: 36597817
DOI: 10.1111/jre.13092 -
Clinical and Experimental Dental... Dec 2022To assess the Candida species occurrence rate and concentration in periodontal pockets in chronic periodontitis (CP) by meta-analysis. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To assess the Candida species occurrence rate and concentration in periodontal pockets in chronic periodontitis (CP) by meta-analysis.
MATERIALS AND METHODS
A search was performed of articles published between January 1, 2010, and October 1, 2020, in English and in Russian, in the electronic databases MEDLINE-PubMed, Google Scholar, The Cochrane Library, ClinicalTrials.gov, Research Gate, eLIBRARY, and Cyberleninka (PROSPEROCRD42021234831). The odds ratio (OR), standardized mean difference (SMD), and 95% confidence interval (CI) were calculated using Review Manager 5.4.1 to compare the risk of CP when Candida spp. were detected in the gingival sulcus or periodontal pocket and to compare Candida spp. density counts in patients with CP and periodontally healthy patients.
RESULTS
Twenty-six studies were included in the systematic review and 11 were included in the meta-analysis. The results showed that Candida spp. may increase the chance of CP development by 1.76 times (OR = 1.76; 95% CI = 1.04-2.99; Z = 2.10; p = .04; I = 61%). More Candida spp. were found in patients with CP than in periodontally healthy patients (SMD = 1.58; 95% CI = 0.15-3.02; p = .03; I = 98%). No data were found relating to the statistically significant influence of Candida glabrata, Candida krusei and Candida tropicalis on CP development.
CONCLUSION
We found that Candida albicans insignificantly increased the risk of CP development but, due to the heterogeneity of the included studies, further research is necessary to determine the exact role of Candida spp. in the development and course of the inflammatory periodontal diseases.
Topics: Humans; Chronic Periodontitis; Candida; Periodontal Pocket; Candida albicans; Gingiva
PubMed: 35903878
DOI: 10.1002/cre2.635 -
Journal of Clinical Medicine Jun 2020Polycystic ovary syndrome (PCOS) has reproductive and metabolic properties that may be linked to periodontitis (PD). This study aimed to update and render a robust... (Review)
Review
Polycystic ovary syndrome (PCOS) has reproductive and metabolic properties that may be linked to periodontitis (PD). This study aimed to update and render a robust critical assessment on all evidence linking PCOS and PD, and appraising a hypothetical bidirectional association. Five databases (PubMed, Scholar, EMBASE, Web of Science and CENTRAL) were searched up to May 2020. Case-control and cohort studies on the association of PCOS and PD were included. The risk of bias of observational studies was assessed through the Newcastle-Ottawa Scale (NOS). Random effects meta-analyses of standardized mean difference (SMD) and risk ratio (RR) were performed. We followed Strength of Recommendation Taxonomy (SORT) to appraise the strength and quality of the evidence. Twelve case-controls fulfilled the inclusion criteria (876 with PCOS and 48170 healthy controls), all scored as having a low risk of bias. Meta-analysis revealed that PCOS females have 28% more risk towards PD, and PD females have 46% more risk to have PCOS. PCOS females with PD had higher gum bleeding, periodontal pocket depth and clinical attachment loss than non-PCOS females with PD. Populations with undefined periodontal status contribute to underestimated results. On the basis of the available evidence, it is possible to assume a bidirectional link between PCOS and PD. That is, PCOS increases by 28% the risk of having PD and in the same fashion, PD increases by 46% the risk of having PCOS. Furthermore, women with PCOS were associated with worsening clinical characteristics and inflammation of PD. These findings suggest that PCOS and PD may be linked. Hence, further prospective and clinical trial studies with nonsurgical periodontal therapy are necessary to clarify the existence of an increased risk of PCOS in women with PD and vice-versa.
PubMed: 32585861
DOI: 10.3390/jcm9061961 -
The Saudi Dental Journal Feb 2021Platelet concentrates have been shown to enhance periodontal regeneration when used as a treatment on their own or in conjunction with bone grafting materials. This... (Review)
Review
OBJECTIVES
Platelet concentrates have been shown to enhance periodontal regeneration when used as a treatment on their own or in conjunction with bone grafting materials. This systematic review aims to assess the effects of using platelet-rich fibrin (PRF), both alone and in combination with other conventionally used materials, on periodontal regeneration in clinical trials.
MATERIALS AND METHODS
A systematic electronic search was performed in the electronic databases MEDLINE (PubMed), Scopus, and Web of Science. Specifically, we searched for English language articles published between 2009 and 2019 that conducted in-human studies and included a summary of the results. Our primary search yielded 220 articles, and of these, 110 were clinical studies. Forty-four articles were then selected for a full reading.
RESULTS
Twenty-six randomized control trials (RCTs) met the inclusion criteria and were included in this review. Despite the differences between the reviewed studies, most revealed the ability of PRF to promote periodontal wound healing. The positive effects of PRF were observed in clinical criteria, such as reductions in pocket probing depth (PD) and increases in clinical attachment level (CAL), as well as in the degree of defect bone fill, which was determined either radiographically or by surgical re-entry.
CONCLUSIONS
Additional studies are needed to compare the clinical outcomes of various PRF application procedures and establish standardized protocols for treating periodontal disease with PRF.
PubMed: 33551617
DOI: 10.1016/j.sdentj.2020.12.002