-
Brazilian Oral Research 2021There are several studies that evaluate the use of lasers in periodontal treatment in non-surgical or surgical therapy. However, while several studies showed clinically... (Review)
Review
There are several studies that evaluate the use of lasers in periodontal treatment in non-surgical or surgical therapy. However, while several studies showed clinically beneficial effects of some lasers in periodontal treatment, there are few clinical reports of additional advantages of lasers as adjunctive treatments in periodontology. The aim of this paper is to demonstrate and critically analyze the level of scientific evidence of effects of low-level lasers and high-power lasers in periodontology. A narrative review of the studies was carried out in each topic and type of laser or periodontal treatment. In nonsurgical periodontal therapy the results showed that there is an additional clinical benefit when using a diode laser (DL) associated with scaling and root planing (SRP) in patients with moderate to severe periodontitis. The Er:YAG laser seems to be the most suitable for nonsurgical periodontal therapy and promotes the same clinical effects as conventional therapy. In periodontal surgery vaporization of the gingival or mucosal tissue can be carried out with DL, CO2, Nd:YAG, Er:YAG and Er,Cr:YSGG lasers. Photobiomodulation (PBM), mediated by low-level lasers associated with non-surgical periodontal therapy, promotes additional benefits in the short term and accelerates the bone and gingival tissue repair process and also reduces postoperative symptoms of periodontal surgery. The effect of antimicrobial Photodynamic Therapy is relevant in the initial reevaluation periods. Studies have shown controversial results of the use of lasers in periodontics, and this fact may be due to the lack of standard parameters of irradiation in each clinical application.
Topics: Chronic Periodontitis; Dental Scaling; Humans; Laser Therapy; Lasers, Semiconductor; Lasers, Solid-State; Periodontitis; Root Planing
PubMed: 34586213
DOI: 10.1590/1807-3107bor-2021.vol35.0099 -
TheScientificWorldJournal 2020Periodontal disease is a public health problem and is strongly associated with systemic diseases; however, its worldwide distribution is not fully understood.
BACKGROUND
Periodontal disease is a public health problem and is strongly associated with systemic diseases; however, its worldwide distribution is not fully understood.
OBJECTIVE
To evaluate global data of periodontal disease: (1) among adolescents, adults, and older population and (2) in low-, middle-, and high-income countries.
METHODS
This ecological study included data of periodontal disease from the World Health Organization's data bank which are based on the Community Periodontal Index of Treatment Needs (CPITN code: 0 = no disease; 1 = bleeding on probing; 2 = calculus; 3 = periodontal pocket (PD) 4-5 mm; 4 = PD (6+ mm). Age- and income-related periodontal disease inequalities were evaluated across the globe.
RESULTS
Compared with 9.3% of adults and 9.7% of older persons, 21.2% of adolescents had no periodontal disease ( = 0.005). Nearly 18.8% of adolescents compared with 8.9% of adults and 5% of older persons had bleeding on probing ( ≤ 0.001). Similarly, 50.3% of adolescents, 44.6% of adults, and 31.9% older persons demonstrated the occurrence of calculus ( = 0.01). On the other hand, older persons had the highest prevalence of PD 4-5 mm and PD 6+ mm than adults and adolescents ( ≤ 0.001). The distribution of periodontitis (CPITN code 3 + 4) in adults differed significantly in low- (28.7%), lower-middle- (10%), upper-middle- (42.5%), and high-income countries (43.7%) ( = 0.04). However, no significant differences in periodontitis (CPITN code 3 + 4) were observed in adolescents and older persons in low- to high-income countries.
CONCLUSIONS
Within the limitations of data, this study found that the distribution of periodontal disease increases with age. Periodontitis was the most common in older persons and in population from high-income countries.
Topics: Adolescent; Adult; Age Factors; Aged; Female; Geography; Global Health; Health Services Needs and Demand; Humans; Male; Periodontal Diseases; Periodontal Index; Periodontitis; Population Surveillance; Prevalence; Socioeconomic Factors; Young Adult
PubMed: 32549797
DOI: 10.1155/2020/2146160 -
Periodontology 2000 Jun 2023In this review, typical clinical complications involving periodontal tissues are illustrated that can be encountered in conjunction with orthodontic therapy (OT).... (Review)
Review
In this review, typical clinical complications involving periodontal tissues are illustrated that can be encountered in conjunction with orthodontic therapy (OT). Special considerations are given for various clinical scenarios, such as the patient presenting in periodontal health, with periodontitis, or with mucogingival conditions. While some of the complications are seen as common side effects of OT, other, more severe, problems that could have been avoided may be viewed as treatment errors. Recommendations are made on how to prevent these complications, based on the currently available evidence, on clinical practice guidelines, and on expert opinion. In conclusion, while there are several areas in which OT can have unwanted adverse effects on periodontal/mucogingival conditions, there is also great potential for synergies, offering opportunities for close cooperation between the two specialties (periodontics and orthodontics) for the benefit of patients affected by tooth malpositioning and/or periodontal or mucogingival problems.
Topics: Humans; Periodontium; Periodontal Diseases; Periodontitis; Periodontics
PubMed: 36920050
DOI: 10.1111/prd.12484 -
Periodontology 2000 Jun 2023Regenerative periodontal surgical procedures are an important component in the treatment of advanced periodontitis. They aim to improve the long-term prognosis of teeth... (Review)
Review
Regenerative periodontal surgical procedures are an important component in the treatment of advanced periodontitis. They aim to improve the long-term prognosis of teeth that are periodontally compromised by the presence of intrabony and/or furcation defects, resulting biologically in formation of root cementum, periodontal ligament, and alveolar bone and evidenced clinically by reduction of deep pockets to maintainable probing depths and/or improvements of vertical and horizontal furcation depth. Over the last 25 years, substantial clinical evidence has been accumulated to support the value of regenerative procedures in periodontally compromised dentitions. However, treatment success requires close attention to certain factors on the level of the patient, the tooth/defect, and the operator. Ignoring these factors in case selection, treatment planning, and treatment execution will increase the risk of complications that may jeopardize clinical success and may even be considered as treatment errors. Based on the currently available evidence from clinical practice guidelines, treatment algorithms, and on expert opinion, the present article provides an overview on the main factors, which influence the outcomes of regenerative periodontal surgery and gives recommendations on how to prevent complications and treatment errors.
Topics: Humans; Guided Tissue Regeneration, Periodontal; Oral Surgical Procedures; Treatment Outcome; Periodontitis; Prognosis; Alveolar Bone Loss; Furcation Defects
PubMed: 37435999
DOI: 10.1111/prd.12504 -
BMC Oral Health Dec 2021The aetiology of oral cancer is multifactorial, as various risk factors (genetics, socioeconomic and lifestyle factors) contribute to its development. Data in the...
BACKGROUND
The aetiology of oral cancer is multifactorial, as various risk factors (genetics, socioeconomic and lifestyle factors) contribute to its development. Data in the literature suggest that people with periodontal disease have an increased risk of developing oral cancer, and the severity of periodontitis correlates with the appearance of oral squamous cell carcinoma. The aim of this study was to revise the non-genetic risk factors that may influence the development of OC, while focusing on the dental and periodontal status and OH.
METHODS
Two hundred patients (hundred diagnosed with oral cancer and hundred without oral cancer) were enrolled in our case-control study, to evaluate the association between oral cancer and the presence and severity of periodontitis, while examining several risk factors that might be responsible for oral cancer formation. A questionnaire customised for oral cancer patients was used to obtain the socioeconomic and lifestyle risk factors that may influence the development of oral squamous cell carcinoma. The dental and periodontal status along with the level of oral hygiene was recorded quantitatively. The chi-square and Mann-Whitney tests and logistic regression were used for the statistical analysis.
RESULTS
By considering both the case and the control groups, a significant correlation was found between the incidence of oral cancer and some socioeconomic factors and lifestyle habits, such as the sex, age, education and alcohol consumption of an individual. The mean value of the Silness-Löe plaque index was significantly higher in the case population. The number of completely edentulous patients was higher among the oral cancer population. The incidence of oral cancer was 57.1% in patients with periodontal disease. In comparison, the incidence of oral squamous cell carcinoma was only 28.6% among the patients without periodontitis. Most of the oral cancer patients (72.1%) had stage 4 periodontitis. On the other hand, the vast majority of the control group (51.6%) had stage 2 periodontitis.
CONCLUSION
Periodontitis can be an individual risk factor for oral cancer development. Periodontally compromised individuals should be strictly monitored, especially those with severe periodontitis and coexisting lifestyle risk factors. Maintaining their periodontal health in at-risk patients can minimize cancer risks.
Topics: Carcinoma, Squamous Cell; Case-Control Studies; Humans; Mouth Neoplasms; Periodontal Index; Periodontitis; Risk Factors
PubMed: 34911520
DOI: 10.1186/s12903-021-01998-y -
The Angle Orthodontist May 2022To evaluate the effect of fixed orthodontic treatment on periodontal parameters in periodontally compromised adult orthodontic patients. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To evaluate the effect of fixed orthodontic treatment on periodontal parameters in periodontally compromised adult orthodontic patients.
MATERIALS AND METHODS
This was a prospective, randomized, controlled clinical trial. Thirty-six periodontally compromised adult patients (mean age: 29.67 ± 4.8 years) were randomly allocated to either test (perio-ortho) or control group (perio). After periodontal stabilization in both groups, orthodontic treatment was started in the test group, whereas the control group remained on periodontal maintenance only. Evaluation and comparison of clinical parameters (plaque index [PI]; gingival index [GI]; bleeding on probing [BOP]; probing depth [PD]; clinical attachment level [CAL]) of both groups was assessed at three time intervals: T0 (base line), T1 (at start of orthodontic treatment), and T2 (1 year after start of orthodontic treatment). Radiological parameters (alveolar bone levels [ABL]) were recorded using CBCT at T1 and T2.
RESULTS
Intragroup analysis showed statistically significant improvement in all clinical and radiological periodontal parameters in both groups (P ≤ .05). Intergroup comparison revealed improvement in the periodontal parameters was not statistically significant between the groups (P ≥ .05). Subgroup analysis showed reduction in the number of moderate and severe periodontitis sites in both groups with significant more gains in ABL in the test group compared to the control group.
CONCLUSIONS
Orthodontic treatment after periodontal stabilization does not have any detrimental effect on periodontal health in adult periodontally compromised orthodontic patients and may add to the benefits achieved by periodontal treatment alone.
Topics: Adult; Dental Care; Dental Plaque Index; Humans; Periodontal Attachment Loss; Periodontal Index; Periodontitis; Prospective Studies; Young Adult
PubMed: 34882193
DOI: 10.2319/022521-156.1 -
Journal of Clinical Periodontology Aug 2008Currently, a large variety of classifications is used for periodontitis as a risk factor for other diseases. None of these classifications quantifies the amount of...
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 -
Journal of Clinical Periodontology Jul 2020To compare the adjunctive effects of lasers or antimicrobial photodynamic therapy (aPDT) to non-surgical mechanical instrumentation alone in untreated periodontitis... (Meta-Analysis)
Meta-Analysis Review
Adjunctive laser or antimicrobial photodynamic therapy to non-surgical mechanical instrumentation in patients with untreated periodontitis: A systematic review and meta-analysis.
AIM
To compare the adjunctive effects of lasers or antimicrobial photodynamic therapy (aPDT) to non-surgical mechanical instrumentation alone in untreated periodontitis patients.
MATERIALS AND METHODS
Two focused questions were addressed using the Population, Intervention, Comparison and Outcome criteria as follows: in patients with untreated periodontitis, (a) does laser application provide adjunctive effects on probing pocket depth (PPD) changes compared with non-surgical instrumentation alone? and (b) does application of aPDT provide adjunctive effects on PPD changes compared with non-surgical instrumentation alone? Both randomized controlled clinical trials (RCTs) and controlled clinical trials (CCTs) were included. Results of the meta-analysis are expressed as weighted mean differences (WMD) and reported according to the PRISMA guidelines.
RESULTS
Out of 1,202 records, 10 articles for adjunctive laser and 8 for adjunctive aPDT were included. With respect to PPD changes, 1 meta-analysis including 2 articles (total n = 42; split-mouth design) failed to identify a statistically significant difference (WMD = 0.35 mm; 95%CI: -0.04/0.73; p = .08) in favour of adjunctive aPDT (wavelength range 650-700 nm). In terms of adjunctive laser application, a high variability of clinical outcomes at 6 months was noted. Two articles included patient-reported outcomes and 10 reported on the presence/absence of harms/adverse effects.
CONCLUSIONS
Available evidence on adjunctive therapy with lasers and aPDT is limited by (a) the low number of controlled studies and (b) the heterogeneity of study designs. Patient-reported benefits remain to be demonstrated.
Topics: Anti-Infective Agents; Chronic Periodontitis; Dental Scaling; Humans; Lasers; Photochemotherapy; Root Planing
PubMed: 31859395
DOI: 10.1111/jcpe.13236 -
Journal of Periodontal Research Feb 2017Although low-level laser therapy (LLLT) has been demonstrated to have a biomodulatory effect on periodontal tissue, no systematic review has exclusively addressed its... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND OBJECTIVES
Although low-level laser therapy (LLLT) has been demonstrated to have a biomodulatory effect on periodontal tissue, no systematic review has exclusively addressed its effectiveness as an adjunct to non-surgical periodontal treatment. This study aimed to evaluate whether an additional benefit exists for the application of LLLT compared with scaling and root planing (SRP) alone.
MATERIAL AND METHODS
An extensive search was conducted in the Cochrane Library (Issue 8, 2015), PubMed (1997) and EMBASE (1947) before August 2015 for randomized controlled trials (RCTs). The bias risk was assessed with the Cochrane tool for risk of bias evaluation. A meta-analysis was performed using REVMAN 5.3.
RESULTS
After independent screening of 354 initial records, eight publications (seven RCTs) were included. However, six were rated as 'having a high risk of bias' as a result of major methodological weakness in 'allocation concealment' and 'blinding of key personnel'. Meta-analysis showed that LLLT-mediated SRP demonstrated significant short-term benefits over SRP monotherapy in the improvement of the probing pocket depth (p = 0.0009 at 1 mo; p = 0.03 at 2 mo) and the level of interleukin-1β in the gingival crevicular fluid (p = 0.01 at 1 mo). Nevertheless, LLLT failed to show significant additional intermediate-term (3 and 6 mo) effects in terms of clinical parameters and alveolar bone density.
CONCLUSION
These findings indicated that LLLT showed only short-term additional benefits after conventional SRP. Its long-term effects remain unclear due to substantial methodological weaknesses and an insufficient number of current studies. Future RCTs with better designs and longer follow-up periods are required to assess the effectiveness of LLLT as an adjunctive treatment strategy in patients with periodontal disease.
Topics: Combined Modality Therapy; Dental Scaling; Humans; Low-Level Light Therapy; Periodontitis; Root Planing
PubMed: 26932392
DOI: 10.1111/jre.12361 -
Trials Jan 2020Periodontal diseases are regarded as the most common diseases of mankind. The prevalence rate of periodontal disease assumes a clear growth tendency, increasing by 57.3%...
Clinical evaluation of ultrasonic subgingival debridement versus ultrasonic subgingival scaling combined with manual root planing in the treatment of periodontitis: study protocol for a randomized controlled trial.
BACKGROUND
Periodontal diseases are regarded as the most common diseases of mankind. The prevalence rate of periodontal disease assumes a clear growth tendency, increasing by 57.3% from 1990 to 2010. Thereby, effective periodontal therapy is still a long-term task and a difficult problem. The goals of periodontal therapy are to eliminate the infectious and inflammatory processes of periodontal diseases. Root planing, in order to eliminate the "infected cementum," has been an important step in the treatment of periodontitis since the 1970s. However, along with the understanding of the effects of endotoxin on the root surface, the necessity of manual root planing has been gradually queried. Ultrasonic instruments, which are more recent innovations, would not remove the cementum excessively, and are also more time-saving and labor-saving compared to using hand instruments. Hence, an increasing number of dentists prefer to do scaling with ultrasonic instruments only. However, the necessity of root planing remains emphasized in the international mainstream views of periodontal mechanical treatment. Therefore, this study is devoted to compare the clinical effect of ultrasonic subgingival debridement and ultrasonic subgingival scaling combined with manual root planing, which takes the implementation of root planing as the only variable and is more in line with the current clinical situation, thus hoping to provide some valuable reference to dentists.
METHODS/DESIGN
Forty adult patients who fit the inclusion criteria are being recruited from the Peking University Hospital of Stomatology (Beijing, China). By means of randomization tables, one quadrant of the upper and lower teeth is the test group and the other is the control group. Test group: ultrasonic subgingival scaling combined with manual root planing.
CONTROL GROUP
ultrasonic subgingival debridement. In a 24-week follow-up period, plaque index, probing depth, clinical attachment loss, bleeding index, furcation involvement, mobility, and patient-reported outcome (Visual Analog Scale for pain and sensitivity) will be observed and documented.
DISCUSSION
This study evaluates the effectiveness of ultrasonic subgingival scaling combined with manual root planing and ultrasonic subgingival debridement alone in the nonsurgical treatment of periodontitis with a split-mouth design after 1, 3 and 6 months. The result of the trial should potentially contribute to an advanced treatment strategy for periodontitis with an ideal clinical outcome.
TRIAL REGISTRATION
International Clinical Trials Registry Platform (ICTRP), ID: ChiCTR1800017122. Registered on 12 July 2018.
Topics: Combined Modality Therapy; Dental Scaling; Humans; Periodontal Debridement; Periodontitis; Root Planing; Ultrasonic Therapy; Randomized Controlled Trials as Topic
PubMed: 31992331
DOI: 10.1186/s13063-019-4031-y