-
BMC Oral Health Apr 2021Beta-tricalcium phosphate in regenerative surgery has shown promising results in terms of bone gain and new vital bone formation; however, several studies have... (Meta-Analysis)
Meta-Analysis
Effectiveness of beta-tricalcium phosphate in comparison with other materials in treating periodontal infra-bony defects around natural teeth: a systematic review and meta-analysis.
BACKGROUND
Beta-tricalcium phosphate in regenerative surgery has shown promising results in terms of bone gain and new vital bone formation; however, several studies have contradicted this finding. The aim of this study was to evaluate the effectiveness of beta-tricalcium phosphate compared to other grafting materials in the regeneration of periodontal infra-bony defects.
METHODS
Electronic database (Cochrane, MEDLINE, PubMed, Embase, Science Citation Index Expanded) and manual searches for related data were performed up until March 2020. The outcomes were pocket depth reduction, clinical attachment level gain, and amount of bone fill.
RESULTS
Five studies were selected based on the inclusion criteria. Bone regeneration with beta-tricalcium phosphate was observed to be superior to that with debridement alone but showed comparable results to other bone graft materials in terms of pocket depth reduction, clinical attachment level gain, and bone fill. Regenerative procedures for periodontal infra-bony defects that used beta-tricalcium phosphate in combination with other growth factors yielded superior outcomes. The meta-analysis revealed that for cases with two-wall defects, the use of beta-tricalcium phosphate yielded statistically significant differences in pocket depth reduction and clinical attachment level gain, but not in bone fill.
CONCLUSIONS
Beta-tricalcium phosphate appears to be a promising material for use in periodontal infra-bony defect regeneration around natural teeth. However, randomized clinical trials with larger sample sizes and more controlled study designs are needed to support these findings.
Topics: Alveolar Bone Loss; Bone Regeneration; Bone Substitutes; Calcium Phosphates; Guided Tissue Regeneration, Periodontal; Humans; Periodontal Attachment Loss; Treatment Outcome
PubMed: 33926447
DOI: 10.1186/s12903-021-01570-8 -
Clinical Oral Investigations Jun 2021To explore the evidence of periodontal manifestations and treatment modalities in patients with Langerhans cell histiocytosis (LCH). (Review)
Review
OBJECTIVES
To explore the evidence of periodontal manifestations and treatment modalities in patients with Langerhans cell histiocytosis (LCH).
MATERIAL AND METHODS
A systematic literature search was performed and the criteria for PRISMA and risk of bias assessment were applied. Human clinical studies (≥10 patients) presenting patients with LCH and periodontal findings were considered for inclusion.
RESULTS
From 298 titles identified, six case series with a total of 1278 patients suffering from LCH were included. In these studies, oral symptoms were reported in a frequency ranging from 10 to 100%. Overall, in 216 patients (17%), oral symptoms were observed. Out of these patients, 49-100% demonstrated periodontal symptoms. The most common oral findings were pain, swelling, tooth loss/mobility, and bone lesions. Specific periodontal findings comprised varying frequencies of gingival ulcerations, increased pocket depths, and gingival bleeding. Treatment measures constituted of surgical curettage of bone lesions, soft tissue excision and/or tooth extractions, radiotherapy, systemic chemotherapy, or a combination of these approaches. Healing without recurrence of oral lesions was reported in most of the cases.
CONCLUSIONS
The available evidence on periodontal manifestations in LCH patients is heterogeneous. Several oral and periodontal findings were reported and may occur as initial symptoms and/or at later stages of the disease.
CLINICAL RELEVANCE
The dentist should be aware of possible oral involvement of systemic diseases such as LCH, and these manifestations may mimic periodontal disease.
Topics: Gingivitis; Histiocytosis, Langerhans-Cell; Humans; Oral Ulcer; Pain; Periodontal Diseases
PubMed: 33751219
DOI: 10.1007/s00784-021-03873-0 -
Clinical Oral Investigations Oct 2021The aim of this systematic review and meta-analysis was to evaluate the efficacy of indocyanine green-mediated photodynamic therapy (ICG-PDT) as an adjunct to... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The aim of this systematic review and meta-analysis was to evaluate the efficacy of indocyanine green-mediated photodynamic therapy (ICG-PDT) as an adjunct to non-surgical periodontal therapy (NSPT), in the management of chronic periodontitis.
MATERIALS AND METHODS
Four electronic databases (PubMed, Cochrane Central Register of Controlled Trials, Embase via OVID, Web of Science) were searched for randomised controlled trials comparing NSPT with ICG-PDT to NSPT without laser therapy. Primary outcome measures were changes in probing pocket depth (PPD) and clinical attachment level (CAL). Clinical outcomes were extracted and pooled from 7 eligible trials and meta-analyses conducted using mean difference with standard deviations.
RESULTS
For PPD, adjunctive ICG-PDT resulted in a mean additional reduction of 1.17 mm (95% CI: 0.67-1.66 mm) at 3 months and a mean additional reduction of 1.06 mm (95% CI: 0.54-1.57 mm) at 6 months. For CAL, adjunctive ICG-PDT resulted in a mean additional gain of 0.70 mm (95% CI: 0.17-1.23 mm) at 3 months and a mean additional gain of 1.03 mm (95% CI: 0.83-1.24 mm) at 6 months. No adverse events were reported in any studies.
CONCLUSIONS
The adjunctive use of ICG-PDT in NSPT results in improved treatment outcomes at 3 and 6 months post-therapy. Further investigation is needed to evaluate variables such as different photosensitiser concentrations and adjusting parameters associated with the light source.
CLINICAL RELEVANCE
Indocyanine green-based photosensitisers may be a novel, clinically efficacious agent for use in the management of periodontitis.
Topics: Anti-Bacterial Agents; Chronic Periodontitis; Dental Scaling; Humans; Indocyanine Green; Photochemotherapy; Root Planing
PubMed: 33710461
DOI: 10.1007/s00784-021-03871-2 -
Antioxidants (Basel, Switzerland) Feb 2021In recent times, the use of natural products has gained momentum, either as a treatment or as adjuvants for other drugs in the treatment of different conditions.... (Review)
Review
In recent times, the use of natural products has gained momentum, either as a treatment or as adjuvants for other drugs in the treatment of different conditions. Propolis is a natural substance produced by bees which has proven useful for treating periodontal disease. This systematic review and meta-analysis gather evidence of the effectiveness of propolis in this kind of condition. The MEDLINE, CENTRAL, PubMed, EMBASE and Web of Science databases were searched for scientific articles to identify the findings published up to October 2020. The MeSH phrases used in the search were: "periodontal diseases AND propolis treatment"; "gingivitis AND propolis treatment"; "periodontitis AND propolis treatment"; "propolis treatment AND oral health"; "propolis AND oxidative stress AND periodontitis". The Boolean operator "AND" was used to combine the searches. Randomized trials where propolis was used in the treatment of different periodontal conditions were included. Non-randomized clinical studies were systematically reviewed and 224 studies were detected, eight of which met the criteria for inclusion in the meta-analysis. Only three of these were selected for quantitative synthesis. In conclusion, propolis is safe to use and can improve the results of periodontal disease treatment, reducing probing pocket depth compared with treatment with a placebo (difference in means, fixed effects -0.67 [95% CI: -0.84, -0.50]).
PubMed: 33578659
DOI: 10.3390/antiox10020269 -
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 -
Journal of Oral Biology and... 2021Previous systematic reviews showed additional benefit of adjuvant bisphosphonates (BP) in the treatment of periodontitis. In contrast, it is unclear the effect of BP in... (Review)
Review
BACKGROUND
Previous systematic reviews showed additional benefit of adjuvant bisphosphonates (BP) in the treatment of periodontitis. In contrast, it is unclear the effect of BP in patients with diabetes and smokers, its pooled effect when administered locally or systemically is also unknown.
OBJECTIVES
This study aimed to systematically review the literature about the use of BP as adjuvant to nonsurgical scaling and root planning (SRP).
METHODOLOGY
This study followed the PRISMA guideline. This study included randomized clinical trials that administered locally or systemically BPs as adjuvant for periodontal treatment. Five databases were used. Meta-analyses were performed, using the pooled mean differences (MD) for clinical attachment level (CAL) and probing pocket depth (PPD). Standard mean difference (SMD) was used for radiographic assessment (RADIO). Subgroup analyses were performed for locally delivered meta-analyses, considering diabetes and smoking exposure.
RESULTS
Thirteen studies were included. It was showed MD of 1.52 mm (95%CI: 0.97-2.07) and 1.44 mm (95%CI: 1.08-1.79) for PPD reduction and CAL gain, respectively, for locally delivered BP. BP was not able to provide significant improvements in smokers (subgroup analysis) when considering CAL (MD: 1.37; 95%CI: -0.17-2.91) and PPD (MD: 1.35; 95%CI: -0.13-2.83). Locally delivered BP also improved significantly the RADIO assessments (SMD: 4.34; 95%CI: 2.94-5.74). MD for systemically administered BP was 0.40 mm (95%CI: 0.21-0.60), 0.51 mm (95%CI: 0.19-0.83) and 1.05 (95%CI: 0.80-1.31) for PPD, CAL and RADIO, respectively.
CONCLUSION
The administration of BP in adjunct to SRP may result in additional clinical effects.
PubMed: 33537188
DOI: 10.1016/j.jobcr.2021.01.008 -
Annals of Palliative Medicine Jan 2021Periodontal disease is a chronic inflammatory disease that includes primarily gingivitis and periodontitis, caused by bacterial infection of the supporting structures of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Periodontal disease is a chronic inflammatory disease that includes primarily gingivitis and periodontitis, caused by bacterial infection of the supporting structures of the teeth. For years, much attention has been diverted to periodontal disease among the elderly, not enough attention is paid to adolescents. The purpose of this meta-analysis is to evaluate the epidemic trend of periodontal disease in adolescents in mainland China.
METHODS
We conducted a comprehensive literature search through PubMed, Embase, CNKI, Chongqing VIP database, Chinese Wan Fang Database, and CBM. A series of subgroup analyses were done to explore the epidemiological characteristics of periodontal disease (gender, location, age, survey year, and geographical distribution) with the help of related software.
RESULTS
Thirty studies were included in this study. The data extraction and analysis were from three indexes, including bleeding on probing (BOP), pocket depth (PD), and dental calculus (DC). The detection rates of BOP(+), PD ≥4 mm and DC(+) were 48.8% (95% CI: 36.2-61.4%), 1.0% (0.0-2.0%), and 49.8% (41.0-58.6%), respectively. There were significant differences for the prevalence of gingivitis both in gender and area: the prevalence was higher in males than that in females, and risk ratio was 1.04 (95% CI, 1.01-1.06); a lower prevalence in urban areas compared with rural areas, and the risk ratio was 0.90 (95% CI, 0.85-0.96).
CONCLUSIONS
This study shows a high prevalence of gingivitis among adolescents in China. Higher-quality epidemiological surveys with standard examination criteria are needed.
Topics: Adolescent; China; Female; Humans; Male; Periodontal Diseases; Prevalence; Surveys and Questionnaires
PubMed: 33474964
DOI: 10.21037/apm-20-1919 -
The Saudi Dental Journal Jan 2021This systematic review aims to assess the efficacy chlorhexidine chip as an adjunctive therapy of scaling and root planning on periodontal disease treatment. (Review)
Review
OBJECTIVE
This systematic review aims to assess the efficacy chlorhexidine chip as an adjunctive therapy of scaling and root planning on periodontal disease treatment.
MATERIAL AND METHODS
This study follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA) and was registered in the PROSPERO database (CRD42019148221). The search was performed in PubMed/MEDLINE, Scopus, and Cochrane databases until April 2020. The PICO question was: "Is the chlorhexidine chip (CHX) effective as an adjunctive therapy of scaling and root planning on periodontal disease treatment?". Inclusion criteria involved: randomized controlled clinical trials, with a minimum of 15 patients included on the sample and each patient has two sites of probing depth of ≥5 mm; The minimum follow up was at least 1 months of follow-up and the outcomes present in the studies probing depth (PD), plaque index (PI) and clinical attachment level (CAL) after scaling and root planning (SRP).
RESULTS
After searching the databases, 13 articles were selected for qualitative and 8 for quantitative analysis. Were included 427 patients, with a mean age of 45.6 years. The results shown that the association of chlorhexidine chips to scaling and root planning reduce periodontal pocket depths ( < 0.00001; MD -0.77 [CI -1.0 to -0.55]; I = 23%, = 0.24), gain on the clinical attachment level ( < 0.0001; MD -0.57 [CI -0.86 to -0.27]; I = 33%, P = 0.18P < 0.0001) and reduction on plaque index (P = 0.04; MD -0.23 [CI -0.45 to -0.01]; I = 91%, P < 0.00001).
CONCLUSIONS
Thus, we can conclude that chlorhexidine chip when used associated to scaling and root planning promoted a significant improvement the reduction of periodontal diseases.
PubMed: 33473236
DOI: 10.1016/j.sdentj.2020.11.002 -
Systematic Reviews Jan 2021The antioxidant potential of vitamin C is useful in reducing oxidative stress, free radicals, and reactive oxygen species, which may assist in the improved outcomes of... (Review)
Review
BACKGROUND AND OBJECTIVE
The antioxidant potential of vitamin C is useful in reducing oxidative stress, free radicals, and reactive oxygen species, which may assist in the improved outcomes of periodontal therapy. This systematic review was aimed to evaluate the effectiveness of vitamin C supplementation as an adjunct to non-surgical periodontal therapy, in the management of periodontitis.
DATA SOURCES
PubMed, EMBASE, Cochrane Library, and Web of Science.
STUDY ELIGIBILITY CRITERIA
Randomized controlled trials published between January 1990 and March 2020.
PARTICIPANTS
People 18 years and older with periodontitis.
STUDY APPRAISAL AND SYNTHESIS METHODS
The Critical Appraisal Skills Programme (CASP) quality appraisal tool.
RESULTS
The initial search yielded 441 articles out of which six studies fulfilled the inclusion criteria. Vitamin C supplementation helped improve bleeding indices in gingivitis but did not significantly lead to reduction of probing depths or clinical attachment gain for periodontitis.
CONCLUSION
Administration of vitamin C as an adjunct to non-surgical periodontal therapy did not result in clinically significant improvements in pocket probing depths at 3 months in periodontitis patients. With the limited evidence available, no recommendation can be made for supplementation of vitamin C in conjunction with initial periodontal therapy for subjects with periodontitis to improve primary treatment outcome measures.
Topics: Ascorbic Acid; Dietary Supplements; Humans; Periodontitis; Vitamins
PubMed: 33397446
DOI: 10.1186/s13643-020-01554-9 -
Journal of Clinical Periodontology Mar 2021Systematic reviews have established the short-term improvements of periodontal regenerative/reconstructive procedures compared to conventional surgical treatment in... (Meta-Analysis)
Meta-Analysis
Medium- and long-term clinical benefits of periodontal regenerative/reconstructive procedures in intrabony defects: Systematic review and network meta-analysis of randomized controlled clinical studies.
BACKGROUND
Systematic reviews have established the short-term improvements of periodontal regenerative/reconstructive procedures compared to conventional surgical treatment in intrabony defects. However, a hierarchy of periodontal regenerative/reconstructive procedures regarding the medium- to long-term results of treatment does not exist.
AIM
To systematically assess the literature to answer the focused question "In periodontitis patients with intrabony defects, what are the medium- and long-term benefits of periodontal regenerative/reconstructive procedures compared with open flap debridement (OFD), in terms of clinical and/or radiographic outcome parameters and tooth retention?".
MATERIAL & METHODS
Randomized controlled clinical trials (RCTs), reporting on clinical and/or radiographic outcome parameters of periodontal regenerative/reconstructive procedures ≥3 years post-operatively, were systematically assessed. Clinical [residual probing pocket depth (PD) and clinical attachment level (CAL) gain, tooth loss] and radiographic [residual defect depth (RDD), bone gain (RBL)] outcome parameters were assessed. Descriptive statistics were calculated, and Bayesian random-effects network meta-analyses (NMA) were performed where possible.
RESULTS
Thirty RCTs, presenting data 3 to 20 years after treatment with grafting, GTR, EMD, as monotherapies, combinations thereof, and/or adjunctive use of blood-derived growth factor constructs or with OFD only, were included. NMA based on 21 RCTs showed that OFD was clearly the least efficacious treatment; regenerative/reconstructive treatments resulted in significantly shallower residual PD in 4 out 8 comparisons [range of mean differences (MD): -2.37 to -0.60 mm] and larger CAL gain in 6 out 8 comparisons (range of MD: 1.26 to 2.66 mm), and combination approaches appeared as the most efficacious. Tooth loss after regenerative/reconstructive treatment was less frequent (0.4%) compared to OFD (2.8%), but the evidence was sparse. There were only sparse radiographic data not allowing any relevant comparisons.
CONCLUSION
Periodontal regenerative/reconstructive therapy in intrabony defects results, in general, in shallower residual PD and larger CAL gain compared with OFD, translating in high rates of tooth survival, on a medium (3-5 years) to long-term basis (5-20 years). Combination approaches appear, in general, more efficacious compared to monotherapy in terms of shallower residual PD and larger CAL gain. A clear hierarchy could, however, not be established due to limited evidence.
Topics: Alveolar Bone Loss; Bone Transplantation; Dental Enamel Proteins; Follow-Up Studies; Guided Tissue Regeneration, Periodontal; Humans; Network Meta-Analysis; Periodontal Attachment Loss; Plastic Surgery Procedures; Treatment Outcome
PubMed: 33289191
DOI: 10.1111/jcpe.13409