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Journal of Dentistry Mar 2021To adapt the supranational European Federation for Periodontology (EFP) S3-Level Clinical Practice Guideline for treatment of periodontitis (stage I-III) to a UK...
OBJECTIVES
To adapt the supranational European Federation for Periodontology (EFP) S3-Level Clinical Practice Guideline for treatment of periodontitis (stage I-III) to a UK healthcare environment, taking into account the views of a broad range of stakeholders, and patients.
SOURCES
This UK version is based on the supranational EFP guideline (Sanz et al., 2020) published in the Journal of Clinical Periodontology. The source guideline was developed using the S3-level methodology, which combined the assessment of formal evidence from 15 systematic reviews with a moderated consensus process of a representative group of stakeholders, and accounts for health equality, environmental factors and clinical effectiveness. It encompasses 62 clinical recommendations for the treatment of stage I-III periodontitis, based on a step-wise process mapped to the 2017 classification system.
METHODOLOGY
The UK version was developed from the source guideline using a formal process called the GRADE ADOLOPMENT framework. This framework allows for the adoption (unmodified acceptance), adaptation (acceptance with modifications) and the de novo development of clinical recommendations. Using this framework and following the S3-process, the underlying systematic reviews were updated and a representative guideline group of 75 delegates from 17 stakeholder organisations was assembled into three working groups. Following the formal S3-process, all clinical recommendations were formally assessed for their applicability to the UK and adoloped accordingly.
RESULTS AND CONCLUSION
Using the ADOLOPMENT protocol, a UK version of the EFP S3-level clinical practice guideline was developed. This guideline delivers evidence- and consensus-based clinical recommendations of direct relevance to the dental community in the UK.
CLINICAL SIGNIFICANCE
The aim of S3-level guidelines is to combine the evaluation of formal evidence, grading and synthesis with the clinical expertise of a broad range of stakeholders to form clinical recommendations. Herein, the first major international S3-level guideline in dentistry, the EFP guideline, was implemented for direct clinical applicability in the UK healthcare system.
Topics: Delivery of Health Care; Humans; Periodontics; Periodontitis; Systematic Reviews as Topic; United Kingdom
PubMed: 33573801
DOI: 10.1016/j.jdent.2020.103562 -
Clinical Oral Investigations Feb 2021To 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
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 benefits of subgingival air polishing during non-surgical treatment of deep bleeding pockets in stages III-IV periodontitis patients MATERIALS AND METHODS: Forty patients with stages III-IV periodontitis were selected, and pockets with probing depth (PD) 5-9 mm and bleeding on probing (BoP) 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. The proportion of experimental sites shifting to PD ≤ 4 mm and no BoP at 3 months (i.e., non-bleeding closed pockets, NBCPs) was regarded as the primary outcome variable.
RESULTS
The proportion of NBCP was comparable between test and control group (47.9 and 44.7%, respectively). Baseline PD of 7-9 mm, multi-rooted teeth and the presence of plaque negatively influenced the probability of obtaining NBCP.
CONCLUSIONS
The additional application of subgingival air polishing does not seem to provide any significant clinical advantage in achieving closure at moderate to deep bleeding pockets in treatment of stages III-IV periodontitis patients. The study was registered on Clinical Trials.gov (NCT04264624).
CLINICAL RELEVANCE
While air polishing can play a role in biofilm removal at supragingival and shallow sites, ultrasonic root surface debridement alone is still the choice for initial treatment of deep bleeding periodontal pockets.
Topics: Dental Polishing; Dental Scaling; Erythritol; Humans; Periodontitis; Powders
PubMed: 33404760
DOI: 10.1007/s00784-020-03648-z -
Annals of Periodontology Nov 1996
Comparative Study Review
Topics: Dental Scaling; Disease Progression; Gingivitis; Humans; Outcome Assessment, Health Care; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Periodontitis; Root Planing
PubMed: 9118268
DOI: 10.1902/annals.1996.1.1.443 -
The Alpha Omegan Dec 2000
Review
Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Chronic Disease; Drug Delivery Systems; Humans; Periodontitis; Root Planing; Subgingival Curettage; Therapeutic Irrigation; Ultrasonics
PubMed: 11212409
DOI: No ID Found -
Journal of Clinical Periodontology Dec 2021To evaluate the clinical efficacy of full-mouth scaling (FMS), full-mouth disinfection (FMD), and FMD with adjuvant erythritol air-polishing (FMDAP) compared to... (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
To evaluate the clinical efficacy of full-mouth scaling (FMS), full-mouth disinfection (FMD), and FMD with adjuvant erythritol air-polishing (FMDAP) compared to quadrant-wise debridement (Q-SRP) in patients with periodontitis stage III/IV.
METHODS
In this four-arm parallel, prospective, randomized, controlled multi-centre study, changes of pocket probing depths (PPDs), clinical attachment level (CAL), bleeding on probing (BOP), and proportion of closed pockets (PPD ≤4 mm without BOP) were evaluated at baseline and after 3 and 6 months.
RESULTS
From 190 randomly participating patients, 172 were included in the final analysis. All groups showed significant (p < .05) improvements in all clinical parameters over 3 and 6 months. During the study period, FMDAP showed significantly higher reductions of mean PPD in teeth with moderate (PPD 4-6 mm) and deep (PPD > 6 mm) pockets and significantly increased proportions of pocket closure than Q-SRP. Patients treated with FMD had significantly greater PPD reduction in deep pockets and a higher percentage of pocket closure after 3 months but not after 6 months compared to Q-SRP. CAL and BOP changes did not significantly differ among all groups. Efficiency of treatment (time effort to gain one closed pocket) was significantly higher for FMDAP, FMD, and FMS compared to Q-SRP (6.3, 8.5, 9.5 vs. 17.8 min per closed pocket; p < .05).
CONCLUSIONS
All treatment modalities were effective, without significant differences between full-mouth approaches. FMDAP showed improved clinical outcomes over Q-SRP for moderate and deep pockets after 6 months. Full-mouth protocols were more time-efficient than conventional Q-SRP.
CLINICAL SIGNIFICANCE
The trial was registered in a clinical trial database (ClinicalTrials.gov: NCT03509233).
Topics: Chronic Periodontitis; Dental Scaling; Humans; Periodontal Index; Periodontitis; Prospective Studies; Root Planing; Treatment Outcome
PubMed: 34517434
DOI: 10.1111/jcpe.13548 -
Advances in Dental Research Dec 1991This paper reviews current (Fall, 1990) information related to the diagnosis of periodontal diseases. As background, principles of diagnostic decision-making and... (Review)
Review
This paper reviews current (Fall, 1990) information related to the diagnosis of periodontal diseases. As background, principles of diagnostic decision-making and conceptual shifts during the 1970's and 1980's are reviewed in brief. "Diseases" that appeared in many classification schemes for periodontal diseases in the early 1970's--for example, "periodontosis" and "occlusal trauma"--do not appear in most current classifications. A recent (1989a) classification recommended by the American Academy of Periodontology holds that "periodontitis" includes several different diseases. There is, indeed, evidence for several different forms of periodontitis, but the AAP's classification does not conform to the principles of diagnostic decision-making because of the significant overlap between and heterogeneities within its suggested "diseases". An alternative classification is suggested, based on a concept that the periodontal diseases are mixed infections whose outcome is modified by relative effectiveness of host response. This view suggests that the most usual forms, gingivitis and adult periodontitis, normally occur in persons with essentially normal defense systems. Variation in extent or severity of disease can be understood as a function of the local infection in hosts with various degrees of compromised resistance to the infection. Early-onset periodontitis (EOP) cases could be accounted for by those where host response is abnormal to some significant degree. The greater the abnormality, the greater the extent and severity of disease might be. Localized EOP cases would be those where a relatively effective specific response intervenes to ameliorate progress of disease after the initially rapid progression. Other issues are detection of disease activity and assessment of risk for disease progression. Non-cultural bacteriological tests are available, but have not yet been shown to detect or predict activity or risk. One difficulty in reaching such proof for those or other tests has been the lack of an appropriate "gold standard" for disease activity or progression. This is being remedied by development of improved automated probes and imaging technologies. Considerable effort is being devoted to determining whether factors in gingival crevicular fluid may have diagnostic utility. More evidence is needed before clinical utility is known, but several enzymes and cytokines have potential for aiding diagnostic decisions.
Topics: Adolescent; Adult; Aggressive Periodontitis; Gingival Crevicular Fluid; Gingivitis; Humans; Periodontal Diseases; Periodontics; Periodontitis; Predictive Value of Tests; Risk Factors; Sensitivity and Specificity
PubMed: 1819278
DOI: 10.1177/08959374910050010201 -
Current Opinion in Dentistry Feb 1991An increasing emphasis is being placed on the phase following active therapy for inflammatory periodontal diseases. This phase of therapy, once termed maintenance, is... (Review)
Review
An increasing emphasis is being placed on the phase following active therapy for inflammatory periodontal diseases. This phase of therapy, once termed maintenance, is now called supportive periodontal therapy (SPT) (American Academy of Periodontology, Current Procedural Terminology for Periodontics. 5th American Academy of Periodontology, 1986). Supportive periodontal therapy has been shown to have an important role in controlling periodontal problems. However, most patients do not comply with suggested SPT intervals.
Topics: Continuity of Patient Care; Dental Implants; Dental Prophylaxis; Humans; Oral Hygiene; Periodontal Diseases; Periodontitis; Recurrence
PubMed: 1912627
DOI: No ID Found -
Schweizer Monatsschrift Fur Zahnmedizin... 1994Clinical data characterizing the results of non-surgical, conservative versus surgical modalities of periodontal treatment are presented and summarized, as they appeared... (Comparative Study)
Comparative Study Review
Clinical data characterizing the results of non-surgical, conservative versus surgical modalities of periodontal treatment are presented and summarized, as they appeared in the international literature. Primarily, the clinical disease status prior to treatment is discussed. Thereafter, the therapeutic success of either modality was measured on the basis of the following parameters: reduction of probing depth, changes in attachment levels, cleanliness of root surfaces, elimination of inflammation, and longlasting tooth survival. The literature review revealed that the choice of either treatment modality influences the therapeutic success only indirectly. More important is that the diseased root surface is meticulously cleaned from all bacterial debris. In the presence of shallow (1 to 3 mm) and medium-sized (4 to 6 mm) pockets, surgical and non-surgical treatment provides equally good results. Deep pockets (7 mm or deeper) and, in particular, crater-like bony pockets as well as furcation involvement respond with better results, if surgical treatment is assigned. In the long run, however, therapeutic success can be secured only by means of a consequent periodical recall and with support of the patient's willingness to perform optimal oral hygiene.
Topics: Dental Scaling; Follow-Up Studies; Gingivectomy; Humans; Periodontal Pocket; Periodontitis; Remission Induction
PubMed: 7973551
DOI: No ID Found -
British Dental Journal Apr 2014
Topics: Humans; Periodontal Diseases; Periodontal Index; Periodontics; Periodontitis
PubMed: 24762871
DOI: 10.1038/sj.bdj.2014.300 -
Clinical Oral Investigations Dec 2020The aim of this article was to perform a systematic review on the effectiveness of local adjuvant therapies in the treatment of aggressive periodontitis (AgP), now...
OBJECTIVES
The aim of this article was to perform a systematic review on the effectiveness of local adjuvant therapies in the treatment of aggressive periodontitis (AgP), now reported as periodontitis grade C.
MATERIALS AND METHODS
The authors selected randomized clinical trials of AgP patients who received local therapy as adjuvants to non-surgical periodontal with a duration of at least 90 days. Seven databases were searched up to January 2020. The gain in clinical attachment level (CAL) and reduction of probing depth (PD) were the outcomes of interest.
RESULTS
Of the 3583 studies found, only five articles were included in the qualitative analysis. Among the substances analyzed, only 1.2 mg of simvastatin gel (SMV) (1.2 mg/0.1 ml), 1% of alendronate gel (ALN) (10 mg/ml), and 25% metronidazole gel (MTZ) (Elyzol) showed a significant decrease in the probing depth when compared with their respective control groups. The gain CAL was shown using 1.2 mg SMV gel (1.2 mg/0.1 ml) and 1% ALN gel (10 mg/ml).
CONCLUSION
Although 1.2 mg SMV gel (1.2 mg/0.1 ml), 1% ALN gel (10 mg/ml), and 25% MTZ gel (Elyzol) have shown better results, local therapies adjuvant to SRP the data found were limited. Future clinical studies with appreciable methodological quality should be conducted.
CLINICAL RELEVANCE
Despite some benefits of local delivery therapy, up to now, it has not been possible to prove the efficacy of local therapy as an adjunct to standard treatment of AgP (periodontitis grade C).
Topics: Aggressive Periodontitis; Alendronate; Chronic Periodontitis; Dental Scaling; Humans; Periodontal Index; Root Planing
PubMed: 33070281
DOI: 10.1007/s00784-020-03631-8