Authors: Willem Nesse, Frank Abbas, Ids van der Ploeg...

BACKGROUND

Currently, a large variety of classifications is used for periodontitis as a risk factor for other diseases. None of these classifications quantifies the amount of inflamed periodontal tissue, while this information is needed to assess the inflammatory burden posed by periodontitis.

AIM

To develop a classification of periodontitis that quantifies the amount of inflamed periodontal tissue, which can be easily and broadly applied.

MATERIAL AND METHODS

A literature search was conducted to look for a classification of periodontitis that quantified the amount of inflamed periodontal tissue. A classification that quantified the root surface area affected by attachment loss was found. This classification did not quantify the surface area of inflamed periodontal tissue, however. Therefore, an Excel spreadsheet was developed in which the periodontal inflamed surface area (PISA) is calculated using clinical Attachment Level (CAL), recessions and bleeding on probing (BOP).

RESULTS

The PISA reflects the surface area of bleeding pocket epithelium in square millimetres. The surface area of bleeding pocket epithelium quantifies the amount of inflamed periodontal tissue. A freely downloadable spreadsheet is available to calculate the PISA.

CONCLUSION

PISA quantifies the inflammatory burden posed by periodontitis and can be easily and broadly applied.

Topics: Epithelial Attachment; Gingival Hemorrhage; Gingival Recession; Humans; Inflammation; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Periodontitis; Periodontium; Tooth Root

PubMed: 18564145
DOI: 10.1111/j.1600-051X.2008.01249.x

Comparative Study

Authors: W Marcenes, N J Kassebaum, E Bernabé...

The Global Burden of Disease (GBD) 2010 Study produced comparable estimates of the burden of 291 diseases and injuries in 1990, 2005, and 2010. This article reports on the global burden of untreated caries, severe periodontitis, and severe tooth loss in 2010 and compares those figures with new estimates for 1990. We used disability-adjusted life-years (DALYs) and years lived with disability (YLDs) metrics to quantify burden. Oral conditions affected 3.9 billion people, and untreated caries in permanent teeth was the most prevalent condition evaluated for the entire GBD 2010 Study (global prevalence of 35% for all ages combined). Oral conditions combined accounted for 15 million DALYs globally (1.9% of all YLDs; 0.6% of all DALYs), implying an average health loss of 224 years per 100,000 population. DALYs due to oral conditions increased 20.8% between 1990 and 2010, mainly due to population growth and aging. While DALYs due to severe periodontitis and untreated caries increased, those due to severe tooth loss decreased. DALYs differed by age groups and regions, but not by genders. The findings highlight the challenge in responding to the diversity of urgent oral health needs worldwide, particularly in developing communities.

Topics: Activities of Daily Living; Adult; Age Factors; Cost of Illness; Dental Caries; Developing Countries; Eating; Female; Gingival Hemorrhage; Gingival Pocket; Global Health; Halitosis; Health Services Needs and Demand; Humans; Male; Mastication; Middle Aged; Periodontal Attachment Loss; Periodontal Diseases; Periodontitis; Population Dynamics; Population Growth; Prevalence; Quality-Adjusted Life Years; Tooth Diseases; Tooth Loss; Toothache

PubMed: 23720570
DOI: 10.1177/0022034513490168

Review

Authors: Wojciech Niemczyk, Katarzyna Janik, Jacek Żurek...

The gold standard in the non-surgical treatment of periodontitis is scaling and root planing (SRP). In recent years, the use of autogenous platelet concentrates has spread over many specialties in dentistry and, thus, has also been gaining popularity in periodontal treatment. Its two main fractions are platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), which, since 2014, can also be used via injection as injectable platelet-rich fibrin (i-PRF). The authors conducted a comprehensive systematic review in accordance with the PRISMA 2020 guidelines. It involved searching PubMed, Embase, Scopus, and Google Scholar databases using the phrases ("Root Planing" OR "Subgingival Curettage" OR "Periodontal Debridement") AND ("Platelet-Rich Plasma"). Based on the authors' inclusion and exclusion criteria, 12 results were included in the review, out of 1170 total results. The objective of this review was to ascertain the impact of utilizing PRP and i-PRF in SRP. The results revealed that both the incorporation of PRP and i-PRF were found to be significantly associated with are duction in gingival pocket depth and again in clinical attachment level; however, i-PRF demonstrated superiority in improving clinical parameters. Furthermore, i-PRF demonstrated notable bactericidal efficacy against . On the other hand, PRP proved inferior to an Nd:YAG laser in clinical parameter improvement; however, it demonstrated significant efficiency as well. This literature review led the authors to the conclusion that autologous platelet concentrates might be competent agents for improving the therapeutic outcomes of SRP.

Topics: Humans; Platelet-Rich Plasma; Platelet-Rich Fibrin; Periodontitis; Root Planing; Injections

PubMed: 38928026
DOI: 10.3390/ijms25126319

Comparative Study Randomized Controlled Trial

Authors: Wim Teughels, Andaç Durukan, Onur Ozcelik...

AIM

The aim of this randomized placebo-controlled clinical trial was to evaluate the effects of Lactobacillus reuteri-containing probiotic lozenges as an adjunct to scaling and root planing (SRP).

MATERIAL AND METHODS

Thirty chronic periodontitis patients were recruited and monitored clinically and microbiologically at baseline, 3, 6, 9 and 12 weeks after therapy. All patients received one-stage full-mouth disinfection and randomly assigned over a test (SRP + probiotic, n = 15) or control (SRP + placebo, n = 15) group. The lozenges were used two times a day for 12 weeks.

RESULTS

At week 12, all clinical parameters were significantly reduced in both groups, while there was significantly more pocket depth reduction (p < 0.05) and attachment gain (p < 0.05) in moderate and deep pockets; more Porphyromonas gingivalis reduction was observed in the SRP + probiotic group.

CONCLUSIONS

The results indicate that oral administration of L. reuteri lozenges could be a useful adjunct to SRP in chronic periodontitis.

Topics: Adult; Aggregatibacter actinomycetemcomitans; Bacterial Load; Bacteroides; Chronic Periodontitis; Combined Modality Therapy; Dental Plaque; Dental Scaling; Disinfection; Double-Blind Method; Female; Follow-Up Studies; Fusobacterium nucleatum; Gingival Hemorrhage; Gingival Recession; Humans; Limosilactobacillus reuteri; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Pocket; Placebos; Porphyromonas gingivalis; Prevotella intermedia; Probiotics; Root Planing; Tablets

PubMed: 24164569
DOI: 10.1111/jcpe.12155

Authors: Swati Mittal, Maki Komiyama, Yuka Ozaki...

BACKGROUND

Smoking is associated with the deteriorating health of the gingiva and periodontium. The long-term beneficial effects of smoking cessation on oral health are well known. However, the effects of short-term smoking cessation on gingival bleeding and periodontal pocket depth are unknown. The purpose of the present study was to determine the effects of short-term smoking cessation on gingival bleeding and periodontal pocket depth.

METHODS

Dentate smokers with a mean age of 56.9 ± 14.4 years at an outpatient smoking cessation clinic participated in this study. A professional dentist checked the periodontal pocket depth and gingival bleeding. Patients visited the smoking cessation clinic on their first visit and 2, 4, 8, and 12 weeks (three months). The gingival assessment was re-performed in those who succeeded in smoking cessation 3 months after the baseline.

RESULTS

The baseline data of 83 patients showed that an increase in pocket depth was associated with increasing age and the amount of smoking. A significant increase in gingival bleeding ( = .031) and increase in pocket depth ( = .046) were observed 3 months after the baseline in patients who successfully quit smoking ( = 14).

CONCLUSION

Short-term smoking cessation increased periodontal pocket depth and gingival bleeding. These findings may reflect healing processes that occur in the healthy gingiva.

IMPLICATIONS

Study findings will be useful to advise patients during smoking cessation programs. Dentists can inform patients that an initial increase in gingival bleeding and pocket depth could be associated with smoking cessation. Such advice will prevent patients from any apprehension that may cause them to recommence smoking.

Topics: Adult; Aged; Dental Plaque Index; Gingival Hemorrhage; Humans; Middle Aged; Periodontal Attachment Loss; Periodontal Pocket; Smokers; Smoking; Smoking Cessation

PubMed: 34893003
DOI: 10.1080/00016357.2021.1995040

Authors: Gioia Michelotti, Philipp Sahrmann, Tobias T Tauböck...

The shearing off of a cement fragment can cause localised periodontal attachment loss. Typical signs are an isolated periodontal pocket, possibly with gingival swelling, a positive CO2 test and a radiographically detectable radio-opaque fragment parallel to the root surface. We use two cases to show how the treatment of cementum shearing can look.

Topics: Dental Cementum; Tooth Root

PubMed: 33789419
DOI: 10.61872/sdj-2021-04-05

Authors: Anootpal Gogoi

This case report describes Clark's technique of vestibuloplasty to treat shallow vestibule and, in addition, the use of free gingival autograft to augment attached gingiva to treat Miller's recession. Vestibuloplasty is performed to deepen a shallow vestibule. Different vestibuloplasty techniques are used to deepen the shallow vestibule by modifying the soft tissue attachment. A 29-year-old male presented to the Department of Periodontics and Oral Implantology, Regional Dental College, Guwahati, India with the chief complaint of bleeding from the lower anterior along with the gingival recession. Maintenance of regular oral hygiene was an added hindrance. The combined technique of vestibuloplasty and use of free gingival graft was performed to achieve dual benefits of increasing the vestibular depth and attainment of a thick gingival phenotype.

PubMed: 35510014
DOI: 10.7759/cureus.23642

Review

Authors: Amina Basic, Gunnar Dahlén

The purpose of this narrative review is to highlight the importance of microbial metabolites in the pathogenesis of periodontal diseases. These diseases, involving gingivitis and periodontitis are inflammatory conditions initiated and maintained by the polymicrobial dental plaque/biofilm. Gingivitis is a reversible inflammatory condition while periodontitis involves also irreversible destruction of the periodontal tissues including the alveolar bone. The inflammatory response of the host is a natural reaction to the formation of plaque and the continuous release of metabolic waste products. The microorganisms grow in a nutritious and shielded niche in the periodontal pocket, protected from natural cleaning forces such as saliva. It is a paradox that the consequences of the enhanced inflammatory reaction also enable more slow-growing, fastidious, anaerobic bacteria, with often complex metabolic pathways, to colonize and thrive. Based on complex food chains, nutrient networks and bacterial interactions, a diverse microbial community is formed and established in the gingival pocket. This microbiota is dominated by anaerobic, often motile, Gram-negatives with proteolytic metabolism. Although this alternation in bacterial composition often is considered pathologic, it is a natural development that is promoted by ecological factors and not necessarily a true "dysbiosis". Normal commensals are adapting to the gingival crevice when tooth cleaning procedures are absent. The proteolytic metabolism is highly complex and involves a number of metabolic pathways with production of a cascade of metabolites in an unspecific manner. The metabolites involve short chain fatty acids (SCFAs; formic, acetic, propionic, butyric, and valeric acid), amines (indole, scatole, cadaverine, putrescine, spermine, spermidine) and gases (NH, CO, NO, HS, H). A homeostatic condition is often present between the colonizers and the host response, where continuous metabolic fluctuations are balanced by the inflammatory response. While it is well established that the effect of the dental biofilm on the host response and tissue repair is mediated by microbial metabolites, the mechanisms behind the tissue destruction (loss of clinical attachment and bone) are still poorly understood. Studies addressing the functions of the microbiota, the metabolites, and how they interplay with host tissues and cells, are therefore warranted.

PubMed: 37388417
DOI: 10.3389/froh.2023.1210200

Review

Authors: Fábio Trindade, Frank G Oppenheim, Eva J Helmerhorst...

Periodontitis is a complex immune-inflammatory disease that results from a preestablished infection in gingiva, mainly due to Gram-negative bacteria that colonize deeper in gingival sulcus and latter periodontal pocket. Host inflammatory and immune responses have both protective and destructive roles. Although cytokines, prostaglandins, and proteases struggle against microbial burden, these molecules promote connective tissue loss and alveolar bone resorption, leading to several histopathological changes, namely destruction of periodontal ligament, deepening of periodontal pocket, and bone loss, which can converge to attain tooth loss. Despite the efforts of genomics, transcriptomics, proteomics/peptidomics, and metabolomics, there is no available biomarker for periodontitis diagnosis, prognosis, and treatment evaluation, which could assist on the established clinical evaluation. Nevertheless, some genes, transcripts, proteins and metabolites have already shown a different expression in healthy subjects and in patients. Though, so far, 'omics approaches only disclosed the host inflammatory response as a consequence of microbial invasion in periodontitis and the diagnosis in periodontitis still relies on clinical parameters, thus a molecular tool for assessing periodontitis lacks in current dental medicine paradigm. Saliva and gingival crevicular fluid have been attracting researchers due to their diagnostic potential, ease, and noninvasive nature of collection. Each one of these fluids has some advantages and disadvantages that are discussed in this review.

Topics: Humans; Periodontitis

PubMed: 24828325
DOI: 10.1002/prca.201400028

Soft Tissue Augmentation Using De-Epithelialized Free Gingival Graft Compared to Single-line Incision Subepithelial Connective Tissue Graft in the Management of Miller Class I and II Gingival Recession: A Randomized Controlled Clinical Trial.

Authors: Mohamed Mashaly, Noha A Ghallab, Weam Elbattawy...

AIMS

The purpose of this randomized controlled clinical trial was to clinically assess soft tissue augmentation and compare patients' morbidity and root coverage outcomes of coronally advanced flap (CAF) with subepithelial connective tissue graft (SCTG) versus de-epithelialized free gingival graft (DFGG) in the management of Miller Class I and II gingival recession.

MATERIALS AND METHODS

Twenty-eight patients with Miller's Class I or II gingival recession (GR) defects were randomly assigned into two equal parallel groups treated with either CAF + SCTG, harvested using single-line incision technique (control), or CAF + DFGG (test). Gingival thickness (GT), recession depth, recession width, percentage of root coverage, keratinized tissue width, pocket depth, and clinical attachment level were measured at baseline and 3 and 6 months postoperatively. Patient-reported outcomes were assessed postoperatively, including pain, stress, bleeding, and inability to chew. Patients' overall satisfaction and root coverage esthetic scores were recorded at 6 months.

RESULTS

Both groups demonstrated a statistically significant improvement in all clinical outcomes after 3 and 6 months compared to baseline. DFGG showed a statistically significant increase in GT after 6 months. No statistically significant difference was detected in other clinical outcomes between both groups at different time intervals. Both treatments achieved 92.9% complete root coverage. Patients treated with CAF + DFGG reported significantly higher stress and inability to chew scores after 2 weeks than those treated with SCTG. There were no significant differences in patient satisfaction between both groups.

CONCLUSIONS

CAF + SCTG and CAF + DFGG were both effective and can be applied safely in treating Miller Class I and II GRs.

PubMed: 36213850
DOI: 10.4103/ccd.ccd_763_20