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Journal of Clinical Periodontology 2002To systematically review the evidence of effectiveness of surgical vs. non-surgical therapy for the treatment of chronic periodontal disease. (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVE
To systematically review the evidence of effectiveness of surgical vs. non-surgical therapy for the treatment of chronic periodontal disease.
METHODS
A search was conducted for randomized controlled trials of at least 12 months duration comparing surgical with non-surgical treatment of chronic periodontal disease. Data sources included the National Library of Medicine computerised bibliographic database MEDLINE, and the Cochrane Oral Health Group (COHG) Specialist Trials Register. Screening, data abstraction and quality assessment were conducted independently by multiple reviewers (L.H., F.H., L.T.). The primary outcome measures evaluated were gain in clinical attachment level (CAL) and reduction in probing pocket depth (PPD).
RESULTS
The search provided 589 abstracts of which six randomized controlled trials were included. Meta-analysis evaluation of these studies indicated that 12 months following treatment, surgical therapy resulted in 0.6 mm more PPD reduction (WMD 0.58 mm; 95% CI 0.38, 0.79) and 0.2 mm more CAL gain (WMD 0.19 mm; 95% CI 0.04, 0.35) than non-surgical therapy in deep pockets (>6 mm). In 4-6 mm pockets scaling and root planing resulted in 0.4 mm more attachment gain (WMD -0.37 mm; 95% CI -0.49, -0.26) and 0.4 mm less probing depth reduction (WMD 0.35 mm; 95% CI 0.23, 0.47) than surgical therapy. In shallow pockets (1-3 mm) non-surgical therapy resulted in 0.5 mm less attachment loss (WMD -0.51 mm; 95% CI -0.74, -0.29) than surgical therapy.
CONCLUSIONS
Both scaling and root planing alone and scaling and root planing combined with flap procedure are effective methods for the treatment of chronic periodontitis in terms of attachment level gain and reduction in gingival inflammation. In the treatment of deep pockets open flap debridement results in greater PPD reduction and clinical attachment gain.
Topics: Chronic Disease; Dental Scaling; Humans; Outcome Assessment, Health Care; Periodontal Attachment Loss; Periodontal Index; Periodontitis; Randomized Controlled Trials as Topic; Subgingival Curettage; Surgical Flaps
PubMed: 12787211
DOI: 10.1034/j.1600-051x.29.s3.5.x -
Journal of Clinical Periodontology Jul 2020To evaluate the benefit of resective surgical periodontal therapy (root amputation or resection, root separation, tunnelling) in periodontitis patients exhibiting class...
OBJECTIVE
To evaluate the benefit of resective surgical periodontal therapy (root amputation or resection, root separation, tunnelling) in periodontitis patients exhibiting class II and III furcation involvement (FI) compared with non-surgical treatment (SRP) or open flap debridement (OFD).
MATERIAL
Outcomes were tooth survival (primary), vertical probing attachment gain, and reduction in probing pocket depth (secondary) evidenced by randomized clinical trials, prospective and retrospective cohort studies and case series with ≥ 12 months of follow-up. Search was performed on 3 electronic databases from January 1998 to December 2018.
RESULTS
From a total of 683 articles, 66 studies were identified for full-text analysis and 7 studies finally included. Six hundred sixty-seven patients contributed 2,021 teeth with class II or III FI. Data were very heterogeneous regarding follow-up and distribution of FI. A total of 1,515 teeth survived 4 to 30.8 years after therapy. Survival ranged from 38%-94.4% (root amputation or resection, root separation), 62%-67% (tunnelling), 63%-85% (OFD) and 68%-80% (SRP). Overall, treatment provided better results for class II FI than class III.
CONCLUSION
Within their limits, the data indicate that in class II and III FI, SRP and OFD may result in similar survival rates as root amputation/resection, root separation or tunnelling.
Topics: Furcation Defects; Guided Tissue Regeneration, Periodontal; Humans; Periodontitis; Prospective Studies; Retrospective Studies
PubMed: 31912534
DOI: 10.1111/jcpe.13241 -
BMC Oral Health Jul 2023Periodontitis is a common and chronic inflammatory disease characterized by irreversible destruction of the tooth surrounding tissues, especially intrabony defects,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Periodontitis is a common and chronic inflammatory disease characterized by irreversible destruction of the tooth surrounding tissues, especially intrabony defects, which eventually lead to tooth loss. In recent years, stem cell-based therapy for periodontitis has been gradually applied to the clinic, but whether stem cell-based therapy plays a positive role in periodontal regeneration is unclear at present.
METHODS
The clinical studies related to the evaluation of mesenchymal stem cells for periodontal regeneration in PubMed, Cochrane Central Register of Controlled trials (CENTRAL), Web of Science (WOS), Embase, Scopus, Wanfang and China national knowledge infrastructure (CNKI) databases were searched in June 2023. The inclusion criteria required the studies to compare the efficacy of stem cell-based therapy with stem cell free therapy for the treatment periodontitis, and to have a follow-up for at least six months. Two evaluators searched, screened, and assessed the quality and the risk of bias in the included studies independently. Review Manager 5.4 software was used to perform the meta-analysis, and GRADEpro GDT was used to evaluate the level of the evidence.
RESULTS
Five randomized controlled trials (RCTs) including 118 patients were analyzed. The results of this meta-analysis demonstrated that stem cell-based therapy showed better therapeutic effects on clinical attachment level (CAL) (MD = - 1.18, 95% CI = - 1.55, - 0.80, P < 0.00001), pocket probing depth (PPD) (MD = - 0.75, 95% CI = - 1.35, - 0.14, P = 0.020), and linear distance from bone crest to bottom of defect (BC-BD)( MD = - 0.95, 95% CI = - 1.67, - 0.23, P = 0.010) compared with cell-free group. However, stem cell-based therapy presented insignificant effects on gingival recession (P = 0.14), linear distance from cementoenamel junction to bottom of defect (P = 0.05).
CONCLUSION
The results demonstrate that stem cell-based therapy may be beneficial for CAL, PPD and BC-BD. Due to the limited number of studies included, the strength of the results in this analysis was affected to a certain extent. The high-quality RCTs with large sample size, multi-blind, multi-centric are still required, and the methodological and normative clinical study protocol should be established and executed in the future.
Topics: Humans; Guided Tissue Regeneration, Periodontal; Alveolar Bone Loss; Periodontitis; Tooth Loss; Chronic Disease; Randomized Controlled Trials as Topic
PubMed: 37454056
DOI: 10.1186/s12903-023-03186-6 -
Surgery For Obesity and Related... Oct 2018To review and analyze periodontal clinical parameters after bariatric surgery. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To review and analyze periodontal clinical parameters after bariatric surgery.
BACKGROUND
Periodontitis, a dysbiotic inflammatory disease, has been associated with obesity. The purpose of bariatric surgery is to reduce weight and systemic inflammation. Consequently, it is of interest to systematically review the impact of bariatric surgery on periodontal status.
METHODS
Electronic searches were conducted in MEDLINE, EMBASE, Thesis database, and the Cochrane Library databases. Gray literature and the main journals of both specialties were also reviewed. Only cross-sectional and prospective studies focusing on bleeding on probing, pocket depth, and clinical attachment levels were selected.
RESULTS
After a thorough screening of 651 studies, 10 studies were selected by 2 independent reviewers. Four (n = 250) and 3 studies (n = 191) were included in the meta-analysis at 6- and 12-month follow-up, respectively. At 6-month follow-up increased periodontal inflammation (P = .03) and periodontal destruction were observed. However, 12 months after baseline, the difference between bariatric patients and control was no longer significant.
CONCLUSION
The present systematic review and meta-analysis suggests that deterioration of periodontal status may be observed in the first 6 months after surgery. Consequently, periodontal screening and management of the patient's request for bariatric surgery should be recommended to avoid further deterioration of periodontal status after bariatric surgery.
Topics: Bariatric Surgery; Female; Humans; Male; Middle Aged; Obesity, Morbid; Periodontitis; Treatment Outcome
PubMed: 30154031
DOI: 10.1016/j.soard.2018.07.017 -
Oral Health & Preventive Dentistry Nov 2022To critically evaluate the periodontal parameters of patients receiving fixed labial and lingual orthodontic therapy. (Meta-Analysis)
Meta-Analysis
PURPOSE
To critically evaluate the periodontal parameters of patients receiving fixed labial and lingual orthodontic therapy.
MATERIALS AND METHODS
The current systematic review was registered at PROSPERO. Clinical studies comparing the periodontal parameters between fixed labial and lingual orthodontic treatment were searched up to June 2022 in four electronic databases, and unpublished literature was searched at ClinicalTrial.gov. The risk of bias of randomised controlled clinical trials (RCTs) and non-randomised clinical trials (n-RCTs) was assessed using the Cochrane risk-of-bias tool 2.0 and the Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) assessment tool, respectively. The pooled periodontal parameters were calculated in random-effect meta-analyses. The confidence of evidence was assessed via the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
RESULTS
Eight studies involving 223 patients were included in the current study. The risk of bias was high for 2 RCTs and 3 n-RCTs, and moderate for 3 n-RCTs. Patients receiving fixed lingual orthodontic treatment showed a lower plaque index (MD = -0.14; 95%CI -0.27 to -0.02). No statistically significant difference was found in the bleeding on probing index (MD = 0.11; 95%CI -0.03 to 0.25), gingival index (MD = 0.02; 95%CI -0.06 to 0.11), and periodontal pocket depth ( MD = 0.06; 95%CI -0.16 to 0.27) between the two groups. The overall quality of the evidence was very low to low.
CONCLUSION
The present study indicates no obvious difference in periodontal parameters between the fixed labial and lingual orthodontic systems, although the overall quality was very low to low. Further RCTs with standardised outcome measures are needed.
Topics: Humans; Dental Plaque Index; Periodontal Index; Tongue; Dental Care; Periodontal Pocket
PubMed: 36416605
DOI: 10.3290/j.ohpd.b3601703 -
European Journal of Rheumatology Jul 2021A close association between periodontal disease (PD) and ankylosing spondylitis (AS) has long been speculated. Both diseases are characterized by dysregulation of the...
A close association between periodontal disease (PD) and ankylosing spondylitis (AS) has long been speculated. Both diseases are characterized by dysregulation of the host inflammatory response, leading to further destruction of the soft and hard connective tissue. There is evidence of increased levels of tumor necrosis factor-alpha and various interleukins in both patients of AS and periodontitis. This study aimed to conduct a systematic review exploring the relationship between AS and PD. We searched MEDLINE - Embase databases (from their inception till October 2019) using appropriate combinations of the following search items with limits '(English, Human)': Ankylosing spondylitis, spondyloarthritis, spondyloarthropathies, spondyloarthritides, spinal disease, musculoskeletal disease, rheumatic disease and periodontitis, PD, periodontoses, parodontoses, chronic periodontitis, gum disease, gingivitis, oral health, dental health, plaque index (PI), bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment loss (CAL). This search was supplemented by the manual search of bibliographies of the selected articles and conference proceedings of the European League against Rheumatism. Only the reviews and observational studies of cross-sectional, cohort, or case-control type on adult patients with AS were selected. Data were extracted from a predesigned PROforma. A total of 984 articles were identified, and 12 were selected for a detailed appraisal. All the identified studies were of the case-control type. The prevalence of periodontitis ranged from 38% to 88% in patients with AS and 26% to 71% in the control group. Of the 12 studies, 2 showed significant changes in PI, 2 showed altered PPD, 3 showed significantly increased CAL, and 2 showed increased BOP. In 7 studies, periodontitis was seen in a significant number of patients with AS (p<0.05). All the studies reported that the prevalence of PD in patients with AS was higher than that in patients without AS. Our systematic review found an association between AS and PD. Patients with AS show a higher prevalence of periodontitis and poor oral hygiene than the healthy controls.
PubMed: 33284102
DOI: 10.5152/eurjrheum.2020.20177 -
Annals of Anatomy = Anatomischer... Feb 2022Alveolar bone loss and mobility of teeth is commonly observed in periodontitis patients. Regeneration of periodontal intrabony defects is indicated to restore the lost... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Alveolar bone loss and mobility of teeth is commonly observed in periodontitis patients. Regeneration of periodontal intrabony defects is indicated to restore the lost bone and periodontal tissues. The aim of the present study was to evaluate the clinical outcomes of periodontal intrabony lesions by using nanocrystalline hydroxyapatite (NHA) graft and comparing it with open flap debridement (OFD) alone.
MATERIALS AND METHODS
The eligibility criteria encompassed randomized (RCTs) and controlled clinical trials (CCTs). Weighted mean differences were calculated for clinical attachment level (CAL) gain, probing pocket depth (PPD) reduction and gingival recession (REC) change, demonstrated as forest plots. The revised Cochrane Risk of Bias tool for randomized trials (RoB2) and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool were used for quality assessment of RCTs and non-randomized trials respectively.
RESULTS
From 22 full-text articles identified, three RCTs, one CCT and one retrospective follow-up of RCT were included. All the five papers comprised the quantitative evaluation. The use of NHA graft provided additional CAL gain of 0.96 mm (p = 0.0009) and PPD reduction of 0.97 mm (p < 0.00001) when compared to OFD alone. However, in terms of REC changes, no considerable benefits of NHA graft were demonstrated than OFD alone (p = 0.48).
CONCLUSIONS
The bioactive NHA graft showed promising results clinically in regenerative periodontology and can be considered for the management of periodontal intrabony defects. The use of NHA graft considerably provided better clinical outcomes in intrabony defects compared to using the OFD alone. Future research investigating NHA graft against other regenerative materials including specific BGs, at longer follow-up periods and bigger sample sizes and in furcation defects warranted.
Topics: Alveolar Bone Loss; Bone Transplantation; Durapatite; Follow-Up Studies; Guided Tissue Regeneration, Periodontal; Humans; Retrospective Studies; Treatment Outcome
PubMed: 34864225
DOI: 10.1016/j.aanat.2021.151877 -
Journal of Parkinson's Disease 2023Multiple observational studies have yielded controversial results regarding the association between Parkinson's disease (PD) and periodontitis. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Multiple observational studies have yielded controversial results regarding the association between Parkinson's disease (PD) and periodontitis.
OBJECTIVE
This systematic review and meta-analysis was conducted to ascertain their bidirectional relationship.
METHODS
A literature search for relevant studies was performed in PubMed, EMBASE, the Cochrane Library, and Web of Science databases from inception to December 19, 2022. Effect sizes (ES) with 95% confidence intervals were pooled under the random-effects model. Then, leave-one-out sensitivity analysis and contour-enhanced funnel plot were applied to assess the stability of the results.
RESULTS
A total of 34 studies and 24 studies were included for systematic review and quantitative meta-analysis, respectively. Pooled ES indicated that periodontitis was not significantly associated with PD risk (HR = 1.13, 95% CI 0.88-1.45, n = 3; OR = 1.94, 95% CI 0.55-6.90, n = 7), while the Mendelian randomization study revealed no association between PD and periodontitis risk (coefficient [B] = -0.0001, standard error = 0.0001, p = 0.19). Furthermore, PD patients exhibited higher levels of periodontal pocket depth (SMD = 1.10, 95% CI 0.53-1.67), clinical attachment level (SMD = 1.40, 95% CI 0.55-2.26), plaque index (SMD = 0.81, 95% CI 0.22-1.39), and Oral Health Impact Profile-14 score (SMD = 0.91, 95% CI 0.33-1.49) compared to healthy controls.
CONCLUSIONS
Our meta-analysis identified no bidirectional association between PD risk and periodontitis risk, though the prevalence of periodontitis and poorer oral status was higher in PD patients.
Topics: Humans; Parkinson Disease; Periodontitis; Prevalence
PubMed: 37899063
DOI: 10.3233/JPD-230059 -
Clinical Oral Investigations Mar 2018This study aimed to systematically review clinical trials about the effect of statins as adjunct to mechanical periodontal therapy, on probing pocket depth, clinical... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This study aimed to systematically review clinical trials about the effect of statins as adjunct to mechanical periodontal therapy, on probing pocket depth, clinical attachment level, and intrabony defects, in comparison to mechanical periodontal therapy alone or in association with placebo.
MATERIAL AND METHODS
Three databases were searched for controlled clinical trials that used any locally delivered or systemically statin as a sole adjunctive therapy to mechanical periodontal treatment. Weighted mean differences between baseline and 6 months after periodontal treatment for clinical attachment level (CAL), probing pocket depth (PPD), and intrabony defect (IBD) were calculated. A high heterogeneity was detected. Therefore, a meta-regression adjusted for type of statin and year of publication was performed.
RESULTS
Fifteen studies were included in the systematic review, and ten studies were included in the meta-analysis. In the meta-regression, the adjunct use of simvastatin, rosuvastatin, and atorvastatin additionally reduced PPD in comparison to mechanical periodontal therapy and a placebo gel (2.90 ± 0.35, 3.90 ± 0.77, 3.06 ± 0.71 mm, respectively; p < 0.05). Regarding the resolution of IBD, simvastatin and rosuvastatin significantly improved in comparison to control group (0.89 ± 0.35 and 1.93 ± 0.77 mm, respectively; p < 0.05). No statistically significant difference was found between the statins for both PPD and IBD (p < 0.05). Regarding CAL gain, simvastatin provided a statistically significant improvement as compared to the control group (2.02 ± 0.79 mm; p = 0.043).
CONCLUSIONS
The use of statins, used as sole adjuncts to mechanical periodontal treatment, improved the periodontal parameters. In the quantitative analyses, simvastatin was the only drug that showed additional benefits in all evaluated parameters.
CLINICAL RELEVANCE
Statins promote significantly clinical periodontal improvements when administered in association with non-surgical scaling and root planning (SRP), when compared to SRP alone or in association with a placebo.
Topics: Dental Scaling; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Periodontal Attachment Loss; Periodontal Diseases; Periodontal Index; Periodontal Pocket; Root Planing
PubMed: 29396642
DOI: 10.1007/s00784-018-2354-9 -
Acta Odontologica Scandinavica Mar 2022To comprehensively investigate the efficacy of adjunctive probiotics compared to placebo, using conventional and novel treatment outcomes. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To comprehensively investigate the efficacy of adjunctive probiotics compared to placebo, using conventional and novel treatment outcomes.
MATERIALS AND METHODS
Three databases (MEDLINE, EMBASE, and CENTRAL) were searched. Outcomes included percent change in the total number of deep sites before and after therapy, change in mean probing pocket depth (mm), percentage patients requiring additional therapy, risk for disease progression, and microbiological and immunological results. Meta-analysis was conducted to evaluate treatment effects wherever appropriate.
RESULTS
Ten studies were selected from 818 records. Meta-analysis showed that adjunctive probiotics had no additional benefit for percentage change of the total number of deeper sites (≥5 mm, ≥6 mm, ≥7 mm) before and after therapy. No significant difference was observed for mean probing pocket depth reduction at 3 and 6 months. Statistically significant beneficial odds ratios for need for additional therapy (OR = 0.19, 95% CI [0.07-0.56]) and risk of disease progression (OR = 0.32, 95% CI [0.14-0.73]) were observed with probiotic administration. Immunological rather than microbiological outcomes correlated more consistently with clinical findings. No adverse events were reported.
CONCLUSIONS
Adjunctive probiotics are safe in systemically healthy individuals and could offer additional patient-level benefits compared to placebo, hence its use can sometimes be justified.
Topics: Dental Care; Dental Scaling; Humans; Periodontal Debridement; Probiotics
PubMed: 34197264
DOI: 10.1080/00016357.2021.1942193