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Journal of Dentistry Aug 2008A systematic review of clinical trials has been performed to evaluate the reproducibility of manual (MP) and electronic probes (EP) in the measurement of clinical... (Review)
Review
OBJECTIVE
A systematic review of clinical trials has been performed to evaluate the reproducibility of manual (MP) and electronic probes (EP) in the measurement of clinical periodontal attachment level (AL) in untreated periodontitis subjects.
METHODS
Systematic electronic (PubMed Medline and Latin American and Caribbean Health Science--LILACS literature databases) and hand searches (English, Spanish and Portuguese languages; search terms "periodontitis diagnosis", "clinical attachment level measurements", "clinical attachment level detection", "clinical diagnosis of periodontitis", "manual probe", "electronic probe", "periodontitis or periodontal disease or attachment level or clinical attachment level") were performed to identify clinical trials involving CAL measurements, MP and EP in untreated periodontitis subjects. Quality and external validity were determined for selected studies.
RESULTS
The initial search identified 37 articles. Ten studies met the initial eligibility, but eight were excluded after thorough analysis. The results from those two selected studies showed that the average variance and the absolute mean difference of CAL measurements for both types of probes cannot be considered different.
CONCLUSION
"Based on this systematic review, MP and EP probes showed a tendency to have similar reliability in the measurement of CAL in untreated periodontitis subjects when used by a calibrated examiner. However, this finding is not supported by strong evidence.
Topics: Clinical Trials as Topic; Electronics; Humans; Periodontal Attachment Loss; Periodontics; Periodontitis; Reproducibility of Results
PubMed: 18534736
DOI: 10.1016/j.jdent.2008.04.015 -
Photodiagnosis and Photodynamic Therapy Sep 2017To determine whether treatment with antimicrobial photodynamic therapy (aPDT) as an adjunct to scaling and root planing (SRP) yield better clinical periodontal outcomes... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
To determine whether treatment with antimicrobial photodynamic therapy (aPDT) as an adjunct to scaling and root planing (SRP) yield better clinical periodontal outcomes than antibiotics (AB) as adjunct to SRP in periodontitis.
METHODS
Electronic searches were conducted in databases (MEDLINE, PubMed, EMBASE, SCOPUS, Cochrane Central Register of Controlled Trials and Cochrane Oral Health Group Trials Register databases) up to and including April 2017.
RESULTS
Five randomized trials were included. All studies used the combined approach aPDT+SRP and AB+SRP in the test and control group respectively. The follow up period ranged from 12 to 48 weeks. All studies used diode lasers. The wavelengths, power density and duration of irradiation used were 670 nanometre, 75 milliwatts per square centimeters and 60s respectively. None of the studies showed additional benefits of aPDT at follow up. Considering the effects of adjunctive aPDT as compared to AB, a high degree of heterogeneity for periodontal probing depth (PPD) (p<0.0001, I=87.47%) was noticed among both the groups. Meta-analysis showed significant clinical attachment level (CAL) gain (WMD=0.60, 95% CI=0.25 to 0.95, p=0.001), and not PPD reduction (WMD=0.67, 95% CI=-0.36 to 1.71, p=0.204) for aPDT as compared to AB at follow up.
CONCLUSION
It remains debatable whether aPDT is more effective as compared to adjunctive AB in the treatment of periodontitis, given that the scientific evidence is weak. Precautions must be exercised when interpreting the results of this study due to the small sample size and high heterogeneity among studies.
Topics: Anti-Bacterial Agents; Combined Modality Therapy; Dental Scaling; Humans; Periodontitis; Photochemotherapy; Randomized Controlled Trials as Topic; Root Planing
PubMed: 28502875
DOI: 10.1016/j.pdpdt.2017.05.007 -
Journal of Clinical Periodontology Sep 2008The aim was to answer three relevant questions: can systemic antimicrobials be efficacious if the biofilm is not disrupted? Can the type of debridement of the... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The aim was to answer three relevant questions: can systemic antimicrobials be efficacious if the biofilm is not disrupted? Can the type of debridement of the subgingival biofilm impact upon the clinical outcomes of the adjunctive antimicrobial therapy? Is the efficacy of the adjunctive systemic antimicrobial therapy dependent on the quality of the debridement of the subgingival biofilm and the sequence debridement-antibiotic usage?
MATERIAL AND METHODS
Relevant papers were searched, critically analysed and their data were extracted.
RESULTS
For the first question, studies assessing susceptibility of bacteria in biofilms, and clinical studies evaluating systemic antimicrobials as monotherapy, were reviewed. For the second question, clinical studies comparing systemic antimicrobials as adjuncts to non-surgical debridement or to periodontal surgery and clinical trials using systemic antibiotics with periodontal surgery were evaluated. For the third question, a previous systematic review was updated.
CONCLUSION
If systemic antimicrobials are indicated in periodontal therapy, they should be adjunctive to mechanical debridement. There is not enough evidence to support their use with periodontal surgery. Indirect evidence suggests that antibiotic intake should start on the day of debridement completion, debridement should be completed within a short time (preferably <1 week) and with an adequate quality, to optimize the results.
Topics: Anti-Bacterial Agents; Biofilms; Combined Modality Therapy; Debridement; Dental Scaling; Drug Combinations; Drug Resistance, Bacterial; Humans; Periodontitis; Root Planing; Treatment Outcome
PubMed: 18724841
DOI: 10.1111/j.1600-051X.2008.01260.x -
Journal of Periodontology Dec 1997This paper is one of three in a series prepared by the Research, Science and Therapy Committee of The American Academy of Periodontology and is intended for the... (Review)
Review
This paper is one of three in a series prepared by the Research, Science and Therapy Committee of The American Academy of Periodontology and is intended for the information of the dental profession. It represents the position of the Academy regarding the current state of knowledge about treatment of gingivitis and periodontitis. The other papers are entitled The Etiology and Pathogenesis of Periodontal Diseases and Diagnosis of Periodontal Diseases.
Topics: Acute Disease; Chronic Disease; Dental Scaling; Gingival Overgrowth; Gingivitis; Gingivitis, Necrotizing Ulcerative; Guided Tissue Regeneration, Periodontal; Humans; Periodontitis; Root Planing
PubMed: 9444602
DOI: No ID Found -
Clinical Oral Investigations Jun 2023To date, scarce evidence exists around the application of subgingival air-polishing during treatment of severe periodontitis. The aim of this study was to evaluate the... (Randomized Controlled Trial)
Randomized Controlled Trial
Efficacy of the additional use of subgingival air-polishing with erythritol powder in the treatment of periodontitis patients: a randomized controlled clinical trial. Part II: effect on sub-gingival microbiome.
OBJECTIVES
To date, scarce evidence exists around the application of subgingival air-polishing during treatment of severe periodontitis. The aim of this study was to evaluate the effect on the health-related and periodontitis-related subgingival microbiome of air-polishing during non-surgical treatment of deep bleeding pockets in stage III-IV periodontitis patients.
MATERIALS AND METHODS
Forty patients with stage III-IV periodontitis were selected, and pockets with probing depth (PD) 5-9 mm and bleeding on probing were selected as experimental sites. All patients underwent a full-mouth session of erythritol powder supragingival air-polishing and ultrasonic instrumentation. Test group received additional subgingival air-polishing at experimental sites. Subgingival microbial samples were taken from the maxillary experimental site showing the deepest PD at baseline. Primary outcome of the first part of the present study was the 3-month change in the number of experimental sites. Additional analysis of periodontal pathogens and other sub-gingival plaque bacteria sampled at one experimental site at baseline and 3 months following treatment was performed through a real-time quantitative PCR microarray.
RESULTS
In the test group, a statistical increase of some health-related species was observed (Abiotropha defectiva, Capnocytophaga sputigena, and Lautropia mirabilis), together with the decrease of pathogens such as of Actinomyces israelii, Catonella morbi, Filifactor alocis, Porphyromonas endodontalis, Sele-nomonas sputigena, Tannerella forsythia, Treponema denticola, and Treponema socranskii. In the control group, statistical significance was found only in the decrease of Filifactor alocis, Tannerella forsythia, and Treponema socranskii.
CONCLUSIONS
The addition of erythritol-chlorhexidine powder seems to cause a shift of the periodontal micro-biome toward a more eubiotic condition compared to a conventional treatment. The study was registered on Clinical Trials.gov (NCT04264624).
CLINICAL RELEVANCE
Subgingival air-polishing could help re-establishing a eubiotic microbioma in deep bleeding periodontal pockets after initial non-surgical treatment.
Topics: Humans; Powders; Erythritol; Dental Scaling; Periodontitis
PubMed: 36538094
DOI: 10.1007/s00784-022-04811-4 -
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 -
Periodontology 2000 Oct 1996
Review
Topics: Anti-Infective Agents; Dental Calculus; Dental Instruments; Dental Scaling; Equipment Design; Humans; Periodontal Diseases; Periodontitis; Recurrence; Retreatment; Root Planing; Ultrasonic Therapy
PubMed: 9567998
DOI: 10.1111/j.1600-0757.1996.tb00085.x -
Journal of Clinical Periodontology 2002The purpose of this study was to perform a systematic review of the literature and to evaluate, in patients with chronic periodontitis, what the effect is of subgingival... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The purpose of this study was to perform a systematic review of the literature and to evaluate, in patients with chronic periodontitis, what the effect is of subgingival debridement (SGD), in terms of bleeding on probing, pocket depth and probing attachment level.
MATERIAL AND METHODS
An electronic search of the Cochrane Oral Health Group specialized register and MEDLINE were performed using specific search terms to identify studies assessing in patients with chronic periodontitis the effect of subgingival debridement with regard to clinical outcomes. This was performed on titles registered up to 2001. The only papers included were those which utilized data based on the patient as unit of observation.
RESULTS
The searches identified 702 abstracts. Titles and abstracts were independently screened by two reviewers (G.A.W. & M.F.T.) to identify publications that met specific inclusion criteria. The agreement between the two reviewers was assessed. The kappa score for agreement was 0.80. Review of these abstracts resulted in 114 publications for detailed review. Finally, 26 papers which met the criteria of eligibility were independently selected by the two reviewers. The kappa score for agreement on this decision was 0.92. Disagreement regarding inclusion of both abstracts and full papers was resolved by discussion between the reviewers. No randomized controlled trials (RCT) could be retrieved that were specifically designed to answer the question formulated at the outset of this systematic review. From the 10 controlled studies, four provide a definitive 'yes' that SGD is effective with regard to clinical outcomes. In the one study where subgingival debridement was not supported by oral hygiene instruction, the paper provided a definitive 'no'. The weighted mean of attachment gain of SGD in pockets initially >or=5 mm was 0.64 mm as compared with 0.37 mm for supragingival plaque control only (SPC). The reduction of pocket depth was 0.59 mm and 1.18 mm for SPC and SGD, respectively. Of the 18 papers that provided only information on the effect of treatment as compared with the baseline values, eight showed SGD to be beneficial with regard to clinical attachment level change while the remaining 10 provided no such an analysis. The weighted mean of this effect was a 0.74-mm gain of attachment as a result of treatment in pockets initially >or= 4 mm.
CONCLUSIONS
In patients with chronic periodontitis, subgingival debridement (in conjunction with supragingival plaque control) is an effective treatment in reducing probing pocket depth and improving the clinical attachment level. In fact it is more effective than supragingival plaque control alone.
Topics: Adult; Chronic Disease; Dental Scaling; Humans; Periodontal Index; Periodontitis; Subgingival Curettage
PubMed: 12787207
DOI: 10.1034/j.1600-051x.29.s3.3.x -
Medicina (Kaunas, Lithuania) Mar 2021Periodontitis is among the most common health conditions and represents a major public health issue related to increasing prevalence and seriously negative socioeconomic... (Review)
Review
Periodontitis is among the most common health conditions and represents a major public health issue related to increasing prevalence and seriously negative socioeconomic impacts. Periodontitis-associated low-grade systemic inflammation and its pathological interplay with systemic conditions additionally raises awareness on the necessity for highly performant strategies for the prevention and management of periodontitis. Periodontal diagnosis is the backbone of a successful periodontal strategy, since prevention and treatment plans depend on the accuracy and precision of the respective diagnostics. Periodontal diagnostics is still founded on clinical and radiological parameters that provide limited therapeutic guidance due to the multifactorial complexity of periodontal pathology, which is why biomarkers have been introduced for the first time in the new classification of periodontal and peri-implant conditions as a first step towards precision periodontics. Since the driving forces of precision medicine are represented by biomarkers and machine learning algorithms, with the lack of periodontal markers validated for diagnostic use, the implementation of a precision medicine approach in periodontology remains in the very initial stage. This narrative review elaborates the unmet diagnostic needs in periodontal diagnostics, the concept of precision periodontics, periodontal biomarkers, and a roadmap toward the implementation of a precision medicine approach in periodontal practice.
Topics: Dental Care; Humans; Periodontal Diseases; Periodontics; Periodontitis; Precision Medicine
PubMed: 33802358
DOI: 10.3390/medicina57030233 -
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