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The Journal of Evidence-based Dental... Sep 2012This review aimed to update the current evidence on the efficacy of the adjunctive use of local and systemic antimicrobials in the treatment of periodontitis and to... (Review)
Review
CONTEXT
This review aimed to update the current evidence on the efficacy of the adjunctive use of local and systemic antimicrobials in the treatment of periodontitis and to assess whether it might improve the clinical limitations and shortcomings of standard nonsurgical treatment in the management of periodontitis.
EVIDENCE ACQUISITION
Relevant randomized clinical trials (RCT) with more than 3 months of follow-up, published from 2010 to 2012 for systemic antimicrobials and from 2008 to 2012 for local antimicrobials, were searched in Medline and critically analyzed. Scientific evidence evaluated in different systematic reviews and reviews presented at European and World Workshops were also included. Only adjunctive therapies were considered in the present review: articles comparing debridement alone or plus placebo, versus debridement plus systemic or local antimicrobials were included.
EVIDENCE SYNTHESIS
Adjunctive systemic antimicrobials have been evaluated both in aggressive and chronic periodontitis: in aggressive periodontitis, amoxicillin and metronidazole have been extensively studied, reporting clinical and microbiological benefits; in chronic periodontitis, different products are under scrutiny, such as azithromycin. The clinical efficacy of local antimicrobials, although extensively demonstrated, is still surrounded by a constant debate on the cost-effectiveness evaluation and on its adequate indications.
CONCLUSIONS
Despite the clinical efficacy of the adjunctive use of local and systemic antimicrobials, demonstrated in RCTs and in systematic reviews, there is a lack of evidence to support well-defined clinical protocols, including products and dosages.
Topics: Anti-Infective Agents; Combined Modality Therapy; Cost-Benefit Analysis; Dental Plaque; Dental Scaling; Disease Management; Humans; Periodontal Debridement; Periodontitis; Root Planing
PubMed: 23040339
DOI: 10.1016/S1532-3382(12)70013-1 -
Journal of Periodontology Apr 2022The British Society of Periodontology (BSP) implemented a simplified version of the 2017 World Workshop Classification (WWC) on staging and grading of periodontitis, for...
Prognostic performance of the 2017 World Workshop classification on staging and grading of periodontitis compared with the British Society of Periodontology's implementation.
BACKGROUND
The British Society of Periodontology (BSP) implemented a simplified version of the 2017 World Workshop Classification (WWC) on staging and grading of periodontitis, for use in UK clinical practice. The aim of this study was to assess the long-term (>10 years) prognostic capability of BSP's implementation (BSP-i) compared with the 2017 WWC, using periodontal-related tooth loss (TLP) as a disease outcome.
METHODS
Data on medical history, smoking status, and clinical periodontal parameters were retrieved from 270 patients who received non-surgical and surgical periodontal therapy from 1966 to 2007. Each patient received a baseline diagnosis according to the 2017 WWC and the BSP-i guidelines for implementation. Univariate multilevel Cox regression frailty models were performed to analyze the association between variables with TLP. A post-hoc comparison with Bonferroni correction was performed to analyze interclass comparisons. The prognostic performance of both systems was analyzed using Harrell C index.
RESULTS
The prognostic performance of both systems was very similar (0.922 for the 2017 WWC and 0.925 for the BSP-i). The singular prognostic performance of BSP stage was slightly higher than that of 2017 WWC stage (0.9212 versus 0.9188), while the 2017 WWC grade showed a slightly better performance than BSP grade (0.9175 versus 0.9155). BSP-i's extent performed better than the 2017 WWC extent (0.9203 versus 0.9098); however, in the 2017 WWC extent, the class "localized" was associated with a better prognosis than "generalized."
CONCLUSION
The overall prognostic performance of the two systems was excellent, with both systems having a Harrell C index score of >0.92.
Topics: Humans; Periodontics; Periodontitis; Prognosis; Tooth Loss
PubMed: 34314515
DOI: 10.1002/JPER.21-0296 -
Journal of Periodontology Dec 2014Only a few studies have examined the association between periodontitis and glycated hemoglobin (HbA1c) levels in individuals without diabetes. The aim of this study is... (Comparative Study)
Comparative Study
BACKGROUND
Only a few studies have examined the association between periodontitis and glycated hemoglobin (HbA1c) levels in individuals without diabetes. The aim of this study is to compare HbA1c levels in individuals without diabetes and with and without periodontitis before and after non-surgical periodontal therapy.
METHODS
This comparative study was done on individuals without diabetes who were 35 to 65 years old. Group A consisted of 30 individuals without periodontitis, and group B consisted of 30 individuals with periodontitis. Body mass indices and clinical parameters, including oral hygiene index-simplified (OHI-S) score, gingival index (GI), probing depth (PD), clinical attachment level (CAL), and HbA1c level, of all participants were recorded. All participants received non-surgical periodontal therapy (scaling and root planing). After 3 months, all participants were reexamined, and clinical parameters and HbA1c levels were evaluated and compared to baseline values.
RESULTS
There were significant differences between group A and group B in regard to baseline OHI-S, GI, PD, and HbA1c (P <0.05). There was no clinical attachment loss in group A, either at baseline or after 3 months. At the end of 3 months, group B showed improvement in all clinical parameters (P <0.05) and their HbA1c levels also significantly decreased (P <0.05), although the values never reached those of group A.
CONCLUSION
The HbA1c levels of individuals without diabetes and with periodontitis (group B) were significantly reduced 3 months after non-surgical periodontal therapy, although they never reached the same levels as those of the individuals without diabetes or periodontitis (group A).
Topics: Adult; Aged; Body Mass Index; Dental Scaling; Female; Follow-Up Studies; Glycated Hemoglobin; Humans; Male; Middle Aged; Oral Hygiene Index; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Periodontitis; Root Planing
PubMed: 24968250
DOI: 10.1902/jop.2014.130661 -
Zhonghua Kou Qiang Yi Xue Za Zhi =... Dec 2022The S3 level clinical practice guideline for the treatment of stage Ⅳperiodontitis, developed by the European Federation of Periodontology, was published in April 22,...
The S3 level clinical practice guideline for the treatment of stage Ⅳperiodontitis, developed by the European Federation of Periodontology, was published in April 22, 2022 (DOI: 10.1111/jcpe.13639). According to the severity and complexity, stage Ⅳ periodontitis was grouped into four case types, and comprehensive treatment plans were formulated correspondingly in the guideline, including tooth splinting, occlusal adjustment, orthodontic therapy, restorative therapy, and personalized supportive periodontal care as well. The aim of present work is to intensively interpret the key points of the guideline and help the clinicians to understand this guideline better, in order to improve the treatment level of stage Ⅳ periodontitis in China.
Topics: Humans; Periodontitis; Periodontics; Tooth; Occlusal Adjustment; China
PubMed: 36509518
DOI: 10.3760/cma.j.cn112144-20220803-00437 -
Australian Dental Journal Sep 2009Periodontitis is a biofilm infection with a mixed microbial aetiology. Periodontitis is generally treated by non-surgical mechanical debridement and regular periodontal... (Review)
Review
Periodontitis is a biofilm infection with a mixed microbial aetiology. Periodontitis is generally treated by non-surgical mechanical debridement and regular periodontal maintenance care. Periodontal surgery may be indicated for some patients to improve access to the root surface for mechanical debridement. A range of systemic antibiotics for treatment of periodontitis has been documented, with some studies showing superior clinical outcomes following adjunctive antibiotics while others do not. This has resulted in controversy as to the role of systemic antibiotics in the treatment of periodontal diseases. Recent systematic reviews have provided an evidence-based assessment of the possible benefits of adjunctive antibiotics in periodontal therapy. This review aims to provide an update on clinical issues of when and how to prescribe systemic antibiotics in periodontal therapy.
Topics: Anti-Bacterial Agents; Biofilms; Combined Modality Therapy; Dental Scaling; Humans; Periodontitis; Subgingival Curettage
PubMed: 19737272
DOI: 10.1111/j.1834-7819.2009.01147.x -
Oral Diseases Mar 2024To investigate the clinical management of stage IV periodontitis patients among clinicians within the Italian Society of Periodontology and Implantology.
OBJECTIVE
To investigate the clinical management of stage IV periodontitis patients among clinicians within the Italian Society of Periodontology and Implantology.
METHODS
A cross-sectional study was designed on a web-based anonymous survey. Comparison between ordinary members (OMs) versus active and certified members (ACMs) and comparison between members with at least 10 years of experience in periodontology (Ov10) and members with less than 10 years of experience in periodontology (Un10) were performed.
RESULTS
A total of 324 out of 1362 members (response rate of 24%) responded to the questionnaire. ACMs and Ov10 more often reported their teams hold adequate skills to manage cases. Step I and II periodontal therapy took more time in the ACMs and Ov10 groups. ACMs used different strategies to perform step I-II therapy, and antibiotics were used less frequently than OMs. Unresponsive sites were treated more often with surgery by ACMs compared to OMs. ACMs adopted different treatment sequences compared to OMs. Ov10 group used more often CBCT, lateral cephalogram, and wax-up while Un10 group tend to avoid orthodontic therapy.
CONCLUSIONS
More experienced members spent more time in step I and II of periodontal therapy, used more diagnostic tools, and performed more often surgery and orthodontics in the treatment of stage IV periodontitis patients.
Topics: Humans; Cross-Sectional Studies; Periodontitis; Periodontics; Surveys and Questionnaires; Clinical Decision-Making
PubMed: 36055972
DOI: 10.1111/odi.14366 -
The Journal of Contemporary Dental... Apr 2020The aim of this article was to determine the effect of nonsurgical periodontal therapy on clinical parameters and also to evaluate serum level of interleukin (IL)-6 and...
AIM
The aim of this article was to determine the effect of nonsurgical periodontal therapy on clinical parameters and also to evaluate serum level of interleukin (IL)-6 and tumor necrosis factor (TNF)-α in chronic periodontitis patients with and without hypothyroidism.
MATERIALS AND METHODS
Subjects were 40 female patients (20 systemically healthy subjects with chronic periodontitis and 20 subjects with hypothyroidism and chronic periodontitis). Clinical parameters like plaque score, gingival score, gingival recession, probing pocket depth, and clinical attachment level were recorded at baseline and 4 weeks after nonsurgical periodontal therapy. Nonsurgical periodontal therapy included oral hygiene instructions and full-mouth scaling and root planing. A total of 5 mL of venous blood sample was collected from each subject at baseline and 4 weeks after nonsurgical periodontal therapy.
RESULTS
The clinical parameters and biochemical parameters like IL-6 and TNF-α in both groups showed pronounced reduction at the end of 4 weeks following nonsurgical periodontal therapy. However, simultaneous comparison of clinical and biochemical parameters between the two groups was not statistically significant.
CONCLUSION
This study provides evidence that nonsurgical periodontal therapy contributes to reduction in serum level of IL-6 and TNF-α in systemically healthy subjects with chronic periodontitis and subjects with hypothyroidism and chronic periodontitis.
CLINICAL SIGNIFICANCE
The prevalence of periodontitis as well as hypothyroidism is increasing nowadays. Interleukin-6 and TNF-α are found to play a significant role in pathobiology of both periodontitis and hypothyroidism. With the treatment of periodontitis, it is found that there is improvement in periodontal and thyroid status of the patients. So, it is an alert to health professionals about the relation of hypothyroidism and periodontitis so that they consider a multidisciplinary approach.
Topics: Chronic Periodontitis; Dental Plaque Index; Dental Scaling; Female; Gingival Crevicular Fluid; Humans; Hypothyroidism; Interleukin-6; Periodontal Attachment Loss; Periodontal Pocket; Root Planing; Tumor Necrosis Factor-alpha
PubMed: 32584278
DOI: No ID Found -
The Journal of Contemporary Dental... Dec 2023This split-mouth randomized trial (RCT) aimed to assess the effect of diode laser on the clinical parameters in patients with periodontitis, compare the results with... (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
This split-mouth randomized trial (RCT) aimed to assess the effect of diode laser on the clinical parameters in patients with periodontitis, compare the results with scaling and root planing (SRP) alone, and assess the implications of diode laser (DL) on plaque bacteria.
MATERIALS AND METHODS
Seventeen periodontitis patients were randomly assigned into two equal groups based on the therapy delivered. Group I (control site) received just SRP at baseline, while group II (test site) received both SRP and DL irradiation. For both groups, the clinical periodontal parameters probing pocket depth (PPD), and clinical attachment level (CAL) were measured at baseline, 30 days, and 90 days. Microbiological amount was also measured at baseline, 30, and 90 days after periodontal treatment. The amounts of (), (), and () were determined using real-time PCR probing with specific bacterial primers.
RESULTS
In both groups, PPD and CAL showed statistically significant reductions at different time intervals ( < 0.05). No significant difference were observed in CAL values after 1 and 3 months in both test and control groups ( > 0.05). The mean values of the concentration of and were lower in the case group as compared to the control group and the difference was statistically significant after 1 month (* = 0.001).
CLINICAL SIGNIFICANCE
According to this study, non-invasive laser treatment has the potential to improve clinical outcomes by lowering the quantity of and .
CONCLUSION
In both groups, a considerable decrease in the periodontal pathogens and were discovered; however, the intergroup comparison was insignificant in relation to PD and CAL. The adjunctive treatment with diode laser showed better efficacy in ensuring a better periodontal treatment than SRP alone. How to cite this article: Abdullah LA, Hashim N, Rehman MM, . Effectiveness of Diode (810 nm) Laser in Periodontal Parameters and Reduction of Subgingival Bacterial Load in Periodontitis Patients. J Contemp Dent Pract 2023;24(12):1008-1015.
Topics: Humans; Bacterial Load; Periodontitis; Dental Scaling; Root Planing; Periodontal Pocket; Lasers, Semiconductor; Chronic Periodontitis; Periodontal Attachment Loss; Follow-Up Studies
PubMed: 38317400
DOI: 10.5005/jp-journals-10024-3603 -
Journal of Periodontology Jan 2019Recently, brain-derived neurotrophic factor (BDNF)/high molecular weight hyaluronic acid (HMW-HA) complex with flap surgery has been shown to promote periodontal tissue...
BACKGROUND
Recently, brain-derived neurotrophic factor (BDNF)/high molecular weight hyaluronic acid (HMW-HA) complex with flap surgery has been shown to promote periodontal tissue regeneration. The objective of this study was to evaluate the effects of local subgingival application of BDNF/HMW-HA complex adjunctive to scaling and root planning (SRP) on ligature-induced periodontitis in dogs.
METHODS
The dogs were divided into four treatment groups: no treatment (control), SRP alone, SRP followed by local application of HMW-HA (SRP+HMW-HA), and SRP followed by local application of BDNF (500 μg/ml)/ HMW-HA complex (SRP+BDNF/HMW-HA). HMW-HA or BDNF/HMW-HA complex was topically applied to periodontal pockets using a syringe without surgery. Two weeks after treatment, clinical parameters (gingival index, clinical attachment level, periodontal pocket depth and bleeding on probing) were recorded and specimens were collected from anesthetized animals for histological analysis.
RESULTS
The SRP+BDNF/HMW-HA group showed significant improvement in all clinical parameters compared to other treatment groups. Histologic analysis showed greater suppression of apical migration of epithelial tissue and milder inflammatory cell infiltration in the SRP+BDNF/HMW-HA group than in the other treatment groups. Furthermore, new cementum and alveolar bone were regenerated, and collagen fibers were inserted into them in the SRP+BDNF/HMW-HA group.
CONCLUSION
BDNF/HMW-HA complex as an adjunct to nonsurgical periodontal treatment has the potential to reduce excess inflammation. Further investigation will be needed to clarify periodontal tissue regenerative effects of BDNF/HMW-HA complex in a nonsurgical setting.
Topics: Animals; Brain-Derived Neurotrophic Factor; Dental Scaling; Dogs; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Root Planing
PubMed: 30030840
DOI: 10.1002/JPER.18-0070 -
Zhonghua Kou Qiang Yi Xue Za Zhi =... Feb 2012
Topics: China; Chronic Periodontitis; Dental Restoration, Permanent; Genotype; Humans; Periodontal Diseases; Periodontics; Periodontitis; Porphyromonas gingivalis
PubMed: 22490240
DOI: 10.3760/cma.j.issn.1002-0098.2012.02.001