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Paternò Holtzman L, Valente NA, Vittorini Orgeas G, Copes L, Discepoli N, Clementini M. Change in clinical parameters after subgingival instrumentation for the treatment of periodontitis and timing of periodontal re-evaluation: A systematic review and meta-analysis. J Clin Periodontol 2025; 52:137-158. [PMID: 38706227 DOI: 10.1111/jcpe.13985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 02/21/2024] [Accepted: 03/21/2024] [Indexed: 05/07/2024]
Abstract
AIM To evaluate the changes in periodontal parameters (reduction in probing pocket depth [PPD], gain in clinical attachment level [CAL] and reduction in full-mouth bleeding on probing [BoP]) after subgingival instrumentation of periodontal pockets at different time points in systemically healthy patients suffering from periodontitis. MATERIALS AND METHODS Four databases were searched for RCTs that carried out subgingival instrumentation in periodontal pockets and evaluated PPD at a minimum of two consecutive time points other than baseline. The analysis was conducted for both all pocket depths and stratified for initially shallow (4-5 mm) and deep (≥6 mm) pockets and data were extracted for various time points, 1-2, 3-4 and 5-6 months. Weighted mean effects (WMEs) were calculated with 95% confidence interval (CI) and predictive intervals were calculated. RESULTS Twenty-nine RCTs were identified, and all of them were included in the meta-analysis. The results showed that for both shallow and deep pockets there was a small though clinically meaningful change between 1- to 2-month and 3- to 4-month time points and between these and 5-6 months. CONCLUSIONS In systemically healthy patients, the greater part of reduction in PPD and gain in CAL occurs within the first 1-2 months after subgingival instrumentation. However, additional benefits in terms of pocket depth reduction occur beyond these early time points.
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Affiliation(s)
- Lucrezia Paternò Holtzman
- Department of Periodontology and Prosthodontics, George Eastman Dental Hospital, Policlinico Universitario Umberto I, Rome, Italy
| | - Nicola Alberto Valente
- Division of Periodontology, School of Dental Medicine, Department of Surgical Sciences, Faculty of Medicine, Università degli Studi di Cagliari, Cagliari, Italy
| | | | - Luca Copes
- Department of Periodontology, Vita-Salute San Raffaele University, Milan, Italy
| | - Nicola Discepoli
- Department of Medical Biotechnologies, Unit of Periodontology, University of Siena, Siena, Italy
| | - Marco Clementini
- UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
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Raittio E, Leite FRM, Machado V, Botelho J, Nascimento GG. Do all individuals benefit equally from non-surgical periodontal therapy? Secondary analyses of systematic review data. J Periodontal Res 2024. [PMID: 39319628 DOI: 10.1111/jre.13347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 08/23/2024] [Accepted: 08/27/2024] [Indexed: 09/26/2024]
Abstract
AIMS This study aimed to assess the variability and treatment effect heterogeneity in response to non-surgical periodontal therapy (NSPT). METHODS Data from randomized controlled trials included in two recent systematic reviews on the effect of NSPT on mean clinical attachment loss (CAL), mean probing pocket depth (PPD), percentage of sites with bleeding on probing (%BOP), PPD ≤3 mm (%PD ≤3 mm), and C-reactive protein levels (CRP) at 3-12-month follow-up among adults with systemic diseases or conditions were used. In these trials, the control arms received no treatment, hygiene advice, or supragingival scaling. The Bayesian meta-regression models were utilized to assess the variability ratios between NSPT and control groups. RESULTS Data from 36 trials on mean PPD, 32 trials on mean CAL, eight trials on %PD ≤3 mm, 31 trials on %BOP and 19 trials on CRP were used. Variability in mean CAL and CRP was approximately 10% higher in the NSPT arms than in the control arms, hinting that there may be room for treatment effect heterogeneity. Instead, variability in mean PPD, %BOP, and %PD ≤3 mm was lower in the NSPT arms than in the control arms. CONCLUSION Potential treatment effect heterogeneity in response to NSPT was observed for CRP and mean CAL. However, substantial measurement error in CAL and natural variation in CRP may contribute to these findings. Conversely, treatment effect heterogeneity appears less pronounced for mean PPD, %BOP, and %PD ≤3 mm, potentially due to greater treatment effects in patients with more severe periodontitis and reduced measurement error in these parameters.
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Affiliation(s)
- Eero Raittio
- Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - Fabio R M Leite
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore City, Singapore
- Oral Health Academic Clinical Programme, Duke-NUS Medical School, Singapore City, Singapore
| | - Vanessa Machado
- Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Caparica, Portugal
| | - João Botelho
- Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Caparica, Portugal
| | - Gustavo G Nascimento
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore City, Singapore
- Oral Health Academic Clinical Programme, Duke-NUS Medical School, Singapore City, Singapore
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Guo Y, Huang Y, Huang C, Sun X, Luan Q, Zhang L. Non-invasive assessment of periodontal inflammation by continuum-removal hemodynamic spectral indices. Eur J Med Res 2024; 29:193. [PMID: 38528571 DOI: 10.1186/s40001-024-01748-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/26/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Hyperspectral techniques have aroused great interest in non-invasively measuring periodontal tissue hemodynamics. However, current studies mainly focused on three typical inflammation stages (healthy, gingivitis and periodontitis) and practical approaches for using optical spectroscopy for early and precisely detection of periodontal inflammation at finer disease stages have not been well studied. METHODS This study provided novel spectroscopic insights into periodontitis at different stages of disease, and developed six simple but physically meaning hemodynamic spectral indices (HSIs) including four spectral absorption depths of oxyhemoglobin ( D HbO 2 ), deoxyhemoglobin ( D Hb ), total hemoglobin ( t Hb ) and tissue water ( D water ), and two normalized difference indices of oxyhemoglobin( N D HbO 2 I ) and deoxyhemoglobin ( N D Hb I ) from continuum-removal spectra (400-1700 nm) of periodontal tissue collected from 47 systemically healthy subjects over different severities from healthy, gingivitis, slight, moderate to severe periodontitis for early and precision diagnostics of periodontitis. Typical statistical analyses were conducted to explore the effectiveness of the proposed HSIs. RESULTS D Hb and t Hb exerted significant increasing trends as inflammation progressed, whereas D HbO 2 exhibited significant difference (P < 0.05) from the healthy sites only at moderate and severe periodontitis and D water presented unstable sensitives to disease severity. By contrast, N D HbO 2 I and N D Hb I showed more steadily downward trends as severity increased, and demonstrated the highest correlations with clinical gold standard parameters. Particularly, the proposed normalized HSIs ( N D HbO 2 I and N D Hb I ) yielded high correlations of - 0.49 and - 0.44 with probing depth, respectively, far outperforming results achieved by previous studies. The performances of the HSIs were also confirmed using the periodontal therapy group. CONCLUSIONS These results indicated great potentials of combination optical spectroscopy and smart devices to non-invasively probe periodontitis at earlier stages using the simple and practical HSIs. Trial registration This study was retrospectively registered in the Chinese Clinical Trial Registry on October 24, 2021, and the clinical registration number is ChiCTR2100052306.
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Affiliation(s)
- Yuan Guo
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, China
- Second Dental Center, School and Hospital of Stomatology, Peking University, Beijing, 100081, China
| | - Yixiang Huang
- Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing, 100094, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Changping Huang
- Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing, 100094, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Xuejian Sun
- Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing, 100094, China
| | - Qingxian Luan
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, China.
| | - Lifu Zhang
- Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing, 100094, China.
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Ferrarotti F, Baima G, Rendinelli M, Citterio F, Mariani GM, Mussano F, Romano F, Romandini M, Aimetti M. Pocket closure after repeated subgingival instrumentation: a stress test to the EFP guideline for stage III-IV periodontitis. Clin Oral Investig 2023; 27:6701-6708. [PMID: 37773418 PMCID: PMC10630226 DOI: 10.1007/s00784-023-05279-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/23/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVES To study the effects of one or two repeated subgingival instrumentations (RSI) in achieving the endpoints of therapy (EoT) in open pockets [residual probing pocket depth (PPD) ≥ 6 mm and PPD 4-5 mm with bleeding on probing (BoP)] after steps I-II of therapy. MATERIALS AND METHODS Twenty-five patients (3,552 total sites; 1,450 open pockets) with stage III-IV periodontitis received steps I-II of periodontal therapy and were re-evaluated after 4-6 weeks (T1). Residual pockets received RSI at T1 and at 3 months (T2). EoT (PPD < 4 or PPD < 6 BoP-) rate at T1, T2 and 6 months (T3) was computed. The number of needed surgeries and treatment costs were calculated. RESULTS At T1, 67.6% of open pockets achieved EoT. At residual PPD ≥ 6 mm at T1 (n = 172), one and two RSI resulted in 33.1% and 45.9% of EoT at T2 and T3, respectively. At residual PPD 4-5 mm with BoP at T1 (n = 298), one and two RSI resulted in 66.8% and 72.1% of EoT at T2 and T3, respectively. PPD at T1 predicted EoT after RSI in both cases, while tooth type only in residual PPD 4-5 mm BoP + . At T1, mean number of surgeries per patient and associated costs were significantly higher than after one/two RSI. CONCLUSIONS RSI may achieve EoT in residual PPD 4-5 mm BoP + and PPD ≥ 6 mm in a considerable number of cases. CLINICAL RELEVANCE These findings may support the administration of one/two cycles of RSI prior to surgical approach. PROTOCOL REGISTRATION ClinicalTrials.gov identification number: NCT04826926.
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Affiliation(s)
- Francesco Ferrarotti
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, Via Nizza 230, Turin, Italy
| | - Giacomo Baima
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, Via Nizza 230, Turin, Italy.
- Politecnico di Torino, Turin, Italy.
| | - Martina Rendinelli
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, Via Nizza 230, Turin, Italy
| | - Filippo Citterio
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, Via Nizza 230, Turin, Italy
| | - Giulia Maria Mariani
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, Via Nizza 230, Turin, Italy
| | - Federico Mussano
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, Via Nizza 230, Turin, Italy
| | - Federica Romano
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, Via Nizza 230, Turin, Italy
| | - Mario Romandini
- Department of Periodontology, Faculty of Dentistry, University of Oslo, Geitmyrsveien, 69, 0455, Oslo, Norway.
| | - Mario Aimetti
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, Via Nizza 230, Turin, Italy
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D'Elia G, Floris W, Marini L, Corridore D, Rojas MA, Ottolenghi L, Pilloni A. Methods for Evaluating the Effectiveness of Home Oral Hygiene Measures-A Narrative Review of Dental Biofilm Indices. Dent J (Basel) 2023; 11:172. [PMID: 37504238 PMCID: PMC10378657 DOI: 10.3390/dj11070172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/09/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
Dental plaque is a biofilm structured in an extracellular matrix of polymers of host and microbial origin; the microorganisms can coexist in harmony with the host, thus guarantying oral health. Environmental modifications can lead to dysbiosis and onset of oral diseases; in fact, plaque is the etiological agent both of periodontal disease and dental decay. The use of an effective oral hygiene index should be considered as a relevant goal for the clinicians and the researchers, and consequently, numerous plaque indices have been proposed during the years. The present literature review aims primarily to obtain a complete summary of these scores to assess plaque deposits. It is useful because the clinician/researcher will select the right scoring method for the specific situation only if he knows the available options and if he is aware of both their strengths and weaknesses. This review applies a basic classification of plaque indices that distinguishes the ones that use non-quantitative methods from the ones that use quantitative methods. Non-quantitative methods are more subjective because they are based on the ability of the clinician to point out the presence or the entity of deposits, while quantitative methods introduce objectifiable means to measure plaque deposits.
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Affiliation(s)
- Gerarda D'Elia
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, #6 Via Caserta, 00161 Rome, Italy
| | - William Floris
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, #6 Via Caserta, 00161 Rome, Italy
| | - Lorenzo Marini
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, #6 Via Caserta, 00161 Rome, Italy
| | - Denise Corridore
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, #6 Via Caserta, 00161 Rome, Italy
| | - Mariana Andrea Rojas
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, #6 Via Caserta, 00161 Rome, Italy
| | - Livia Ottolenghi
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, #6 Via Caserta, 00161 Rome, Italy
| | - Andrea Pilloni
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, #6 Via Caserta, 00161 Rome, Italy
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Vivek B, Ramesh KSV, Gautami PS, Sruthima GNVS, Dwarakanath C, Anudeep M. Effect of periodontal treatment on oral health-related quality of life - A randomised controlled trial. J Taibah Univ Med Sci 2021; 16:856-863. [PMID: 34899130 PMCID: PMC8626792 DOI: 10.1016/j.jtumed.2021.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/18/2021] [Accepted: 07/06/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives Periodontal disease is a chronic, infectious gum disease, which eventually leads to tooth loss, adversely affecting quality of life (QoL). Most of the research in this area focuses on evaluating clinical parameters rather than patient-based outcomes. Currently, these parameters are gaining importance along with treatment outcomes of chronic diseases and QoL. This study evaluates the impact of periodontal disease and its treatment on oral health-related quality of life (OHRQoL). Methods We recruited 90 participants who were divided into two groups. One was the test group (n = 45) that underwent non-surgical periodontal therapy (NSPT) followed by periodontal flap surgery (SurgPT). Second was the control group (n = 45) that underwent only NSPT. Clinical parameters, plaque index, gingival index, periodontal/probing pocket depth (PPD), clinical attachment level (CAL), and mobility were recorded. An OHRQoL questionnaire was used to assess the functional, physical, social, and psychological domains at baseline, three, and six months. Results The mean PPD in the test group was 6.9 ± 0.38, 3.2 ± 0.36, 3.5 ± 0.5, and 5.8 ± 0.67, 3.13 ± 0.21, 3.73 ± 0.45 in the NSPT group at baseline, 3, and 6 months, respectively. The mean CAL in the SurgPT group was 7.07 ± 0.41, 3.56 ± 0.27, 3.74 ± 0.30, and 6.08 ± 0.16, 4.02 ± 0.17, 4.16 ± 0.19 in the NSPT group at baseline, 3, and 6 months, respectively. Both treatments resulted in reduction in all clinical parameters and were statistically significant in the SurgPT group (p < 0.001). Oral Health Impact Profile scores substantially decreased in the SurgPT group (mean difference-25.0) compared to the NSPT group (mean difference-5.0) (p-0.001). Conclusions In this study, NSPT and SurgPT had a positive impact on OHRQoL by improving clinical parameters, but SurgPT had substantially better outcomes in terms of improved QoL.
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Affiliation(s)
- Bypalli Vivek
- Department of Periodontics, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
| | - Konathala S V Ramesh
- Department of Periodontics, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
| | - Penmetsa S Gautami
- Department of Periodontics, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
| | | | | | - Mopidevi Anudeep
- Department of Periodontics, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
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Ng E, Tay JRH, Ong MMA. Minimally Invasive Periodontology: A Treatment Philosophy and Suggested Approach. Int J Dent 2021; 2021:2810264. [PMID: 34257659 PMCID: PMC8245214 DOI: 10.1155/2021/2810264] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 01/20/2023] Open
Abstract
Severe periodontitis is a highly prevalent dental disease. With the advent of implant dentistry, teeth are often extracted and replaced. Periodontal surgery, where indicated, could also result in increased trauma to the patient. This literature review discusses different treatment modalities for periodontitis and proposes a treatment approach emphasizing maximum preservation of teeth while minimizing morbidity to the patient. Scientific articles were retrieved from the MEDLINE/PubMed database up to January 2021 to identify appropriate articles that addressed the objectives of this review. This was supplemented with hand searching using reference lists from relevant articles. As tooth prognostication does not have a high predictive value, a more conservative approach in extracting teeth should be abided by. This may involve repeated rounds of nonsurgical periodontal therapy, and adjuncts such as locally delivered statin gels and subantimicrobial-dose doxycycline appear to be effective. Periodontal surgery should not be carried out at an early phase in therapy as improvements in nonsurgical therapy may be observed up to 12 months from initial treatment. Periodontal surgery, where indicated, should also be minimally invasive, with periodontal regeneration being shown to be effective over 20 years of follow-up. Biomarkers provide an opportunity for early detection of disease activity and personalised treatment. Quality of life is proposed as an alternative end point to the traditional biomedical paradigm focused on the disease state and clinical outcomes. In summary, minimally invasive therapy aims to preserve health and function of the natural dentition, thus improving the quality of life for patients with periodontitis.
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Affiliation(s)
- Ethan Ng
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore 168938, Singapore
| | - John Rong Hao Tay
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore 168938, Singapore
| | - Marianne Meng Ann Ong
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore 168938, Singapore
- Oral Health Academic Clinical Programme, Duke-NUS Medical School, Singapore 169857, Singapore
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8
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Makabenta JMV, Nabawy A, Li CH, Schmidt-Malan S, Patel R, Rotello VM. Nanomaterial-based therapeutics for antibiotic-resistant bacterial infections. Nat Rev Microbiol 2021; 19:23-36. [PMID: 32814862 PMCID: PMC8559572 DOI: 10.1038/s41579-020-0420-1] [Citation(s) in RCA: 654] [Impact Index Per Article: 163.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2020] [Indexed: 12/22/2022]
Abstract
Antibiotic-resistant bacterial infections arising from acquired resistance and/or through biofilm formation necessitate the development of innovative 'outside of the box' therapeutics. Nanomaterial-based therapies are promising tools to combat bacterial infections that are difficult to treat, featuring the capacity to evade existing mechanisms associated with acquired drug resistance. In addition, the unique size and physical properties of nanomaterials give them the capability to target biofilms, overcoming recalcitrant infections. In this Review, we highlight the general mechanisms by which nanomaterials can be used to target bacterial infections associated with acquired antibiotic resistance and biofilms. We emphasize design elements and properties of nanomaterials that can be engineered to enhance potency. Lastly, we present recent progress and remaining challenges for widespread clinical implementation of nanomaterials as antimicrobial therapeutics.
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Affiliation(s)
| | - Ahmed Nabawy
- Department of Chemistry, University of Massachusetts Amherst, Amherst, MA, USA
| | - Cheng-Hsuan Li
- Department of Chemistry, University of Massachusetts Amherst, Amherst, MA, USA
| | - Suzannah Schmidt-Malan
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Vincent M Rotello
- Department of Chemistry, University of Massachusetts Amherst, Amherst, MA, USA.
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9
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Ferrarotti F, Giraudi M, Citterio F, Fratini A, Gualini G, Piccoli GM, Mariani GM, Romano F, Aimetti M. Pocket elimination after osseous resective surgery: A systematic review and meta-analysis. J Clin Periodontol 2020; 47:756-767. [PMID: 32145035 DOI: 10.1111/jcpe.13281] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 01/17/2020] [Accepted: 03/02/2020] [Indexed: 11/28/2022]
Abstract
AIM To systemically review the available evidence on the clinical performance of osseous resective surgery (ORS) in the treatment of residual periodontal defects in terms of pocket elimination and biological costs in patients with chronic periodontitis. MATERIALS AND METHODS Three databases (PubMed, EMBASE and Cochrane) were searched up to January 2019. Clinical trials with a follow-up duration of at least 12 months after ORS with or without fibre retention technique were included. Quantitative synthesis was conducted with random-effect meta-analysis. RESULTS Overall, 1,765 studies were retrieved, of which 53 full-text articles were screened by two reviewers. Finally, a total of three RCTs were included in the meta-analysis. Random-effect meta-analysis showed a weighted mean percentage of pocket elimination (final PD ≤ 4 mm) at 12 months of 98.3% (95% CI: 96.8; 99.7) with I2 of 26%. The weighted mean amount of resected bone was 0.87 mm (95% CI: 0.49; 1.25), and the weighted mean increase in gingival recession was 2.13 mm (95% CI: 1.49; 2.78) at 12 months. CONCLUSIONS ORS represents an effective surgical approach for the elimination of residual periodontal pockets in the short to medium term. Additional randomized controlled clinical trials with data on pocket elimination are warranted.
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Affiliation(s)
- Francesco Ferrarotti
- Section of Periodontology, Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Marta Giraudi
- Section of Periodontology, Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Filippo Citterio
- Section of Periodontology, Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Adriano Fratini
- Section of Periodontology, Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Giacomo Gualini
- Section of Periodontology, Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Gian Marco Piccoli
- Section of Periodontology, Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Giulia Maria Mariani
- Section of Periodontology, Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Federica Romano
- Section of Periodontology, Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Mario Aimetti
- Section of Periodontology, Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
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Luthra S, Grover HS, Singh A, Lall A, Masamatti SS. Comparative evaluation of C-reactive protein and complete blood count in chronic periodontitis patients following Phase I therapy: A serological and hematological study. J Indian Soc Periodontol 2019; 23:525-533. [PMID: 31849397 PMCID: PMC6906908 DOI: 10.4103/jisp.jisp_639_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Periodontitis is an example of persistent low-grade disease. The primary cause for the disease is anaerobic gram-negative bacteria thriving in a protective biofilm in subgingival periodontal pockets. The treatment of this infection is removal of these deposits by mechanical instrumentation (Phase I therapy). This can help achieve reduction of the bacterial load thus suppressing localized inflammation. Phase I therapy or mechanical debridement of the subgingival area causes a severe transient bacteremia along with some damage to the surrounding soft tissue, resulting in a systemic inflammatory response being elicited. The objective of the current study was to comparatively assess periodontal parameters, serum C-reactive protein (CRP) levels, and transitory alterations in hematological parameters; in 30-systemically healthy patients having chronic periodontitis, before and after Phase I therapy. Materials and Method The individuals underwent an intensive session of mechanotherapy with ultrasonic scalers. Blood samples were taken before treatment and at 1, 7, and 30 days after treatment to assess the parameters. Results There was a clear recuperation in periodontal parameters as well as marked improvement in the values of CRP and complete blood count (CBC) by 30 days after transient alterations occurring initially. Conclusion Phase I (mechanotherapy) - the first step in treatment of periodontitis leads to transient bacteremia by systemic dispersal of bacteria harbored in dental plaque. This produces an acute-phase response resulting in variations in the levels of CRP and the CBC counts. After a month, both periodontal and hematological parameters show marked improvement, thus establishing periodontal health and decreasing the risk of inadvertent cardiovascular or thromboembolic episode.
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Affiliation(s)
| | - Harpreet Singh Grover
- Department of Periodontics & Oral Implantology, SGT Dental College, Gurugram, Haryana, India
| | - Alka Singh
- Department of Biochemistry, SGT Medical College, Gurugram, Haryana, India
| | - Adosh Lall
- Department of Periodontics & Oral Implantology, SGT Dental College, Gurugram, Haryana, India
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Lai YC, Chiu CH, Cai ZQ, Lin JY, Yao CY, Lyu DY, Lee SY, Chen KW, Chen IY. OCT-Based Periodontal Inspection Framework. SENSORS (BASEL, SWITZERLAND) 2019; 19:E5496. [PMID: 31842494 PMCID: PMC6960521 DOI: 10.3390/s19245496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/07/2019] [Accepted: 12/09/2019] [Indexed: 11/23/2022]
Abstract
Periodontal diagnosis requires discovery of the relations among teeth, gingiva (i.e., gums), and alveolar bones, but alveolar bones are inside gingiva and not visible for inspection. Traditional probe examination causes pain, and X-ray based examination is not suited for frequent inspection. This work develops an automatic non-invasive periodontal inspection framework based on gum penetrative Optical Coherence Tomography (OCT), which can be frequently applied without high radiation. We sum up interference responses of all penetration depths for all shooting directions respectively to form the shooting amplitude projection. Because the reaching interference strength decays exponentially with tissues' penetration depth, this projection mainly reveals the responses of the top most gingiva or teeth. Since gingiva and teeth have different air-tissue responses, the gumline, revealing itself as an obvious boundary between teeth and gingiva, is the basis line for periodontal inspection. Our system can also automatically identify regions of gingiva, teeth, and alveolar bones from slices of the cross-sectional volume. Although deep networks can successfully and possibly segment noisy maps, reducing the number of manually labeled maps for training is critical for our framework. In order to enhance the effectiveness and efficiency of training and classification, we adjust Snake segmentation to consider neighboring slices in order to locate those regions possibly containing gingiva-teeth and gingiva-alveolar boundaries. Additionally, we also adapt a truncated direct logarithm based on the Snake-segmented region for intensity quantization to emphasize these boundaries for easier identification. Later, the alveolar-gingiva boundary point directly under the gumline is the desired alveolar sample, and we can measure the distance between the gumline and alveolar line for visualization and direct periodontal inspection. At the end, we experimentally verify our choice in intensity quantization and boundary identification against several other algorithms while applying the framework to locate gumline and alveolar line in vivo data successfully.
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Affiliation(s)
- Yu-Chi Lai
- Department of Computer Science and Information Engineering, National Taiwan University of Science and Technology, Taipei 106, Taiwan; (Y.-C.L.); (C.-H.C.); (Z.-Q.C.); (J.-Y.L.); (K.-W.C.); (I.-Y.C.)
| | - Chia-Hsing Chiu
- Department of Computer Science and Information Engineering, National Taiwan University of Science and Technology, Taipei 106, Taiwan; (Y.-C.L.); (C.-H.C.); (Z.-Q.C.); (J.-Y.L.); (K.-W.C.); (I.-Y.C.)
| | - Zhong-Qi Cai
- Department of Computer Science and Information Engineering, National Taiwan University of Science and Technology, Taipei 106, Taiwan; (Y.-C.L.); (C.-H.C.); (Z.-Q.C.); (J.-Y.L.); (K.-W.C.); (I.-Y.C.)
| | - Jin-Yang Lin
- Department of Computer Science and Information Engineering, National Taiwan University of Science and Technology, Taipei 106, Taiwan; (Y.-C.L.); (C.-H.C.); (Z.-Q.C.); (J.-Y.L.); (K.-W.C.); (I.-Y.C.)
| | - Chih-Yuan Yao
- Department of Computer Science and Information Engineering, National Taiwan University of Science and Technology, Taipei 106, Taiwan; (Y.-C.L.); (C.-H.C.); (Z.-Q.C.); (J.-Y.L.); (K.-W.C.); (I.-Y.C.)
| | - Dong-Yuan Lyu
- Department of Dentistry, National Yang-Ming University, Taipei 112, Taiwan; (D.-Y.L.)
| | - Shyh-Yuan Lee
- Department of Dentistry, National Yang-Ming University, Taipei 112, Taiwan; (D.-Y.L.)
- Department of Stomatology, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Department of Dentistry, Taipei City Hospital, Taipei 103, Taiwan
| | - Kuo-Wei Chen
- Department of Computer Science and Information Engineering, National Taiwan University of Science and Technology, Taipei 106, Taiwan; (Y.-C.L.); (C.-H.C.); (Z.-Q.C.); (J.-Y.L.); (K.-W.C.); (I.-Y.C.)
| | - I-Yu Chen
- Department of Computer Science and Information Engineering, National Taiwan University of Science and Technology, Taipei 106, Taiwan; (Y.-C.L.); (C.-H.C.); (Z.-Q.C.); (J.-Y.L.); (K.-W.C.); (I.-Y.C.)
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12
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Preus HR, AL‐Lami Q, Baelum V. Oral hygiene revisited. The clinical effect of a prolonged oral hygiene phase prior to periodontal therapy in periodontitis patients. A randomized clinical study. J Clin Periodontol 2019; 47:36-42. [DOI: 10.1111/jcpe.13207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/19/2019] [Accepted: 09/26/2019] [Indexed: 01/31/2023]
Affiliation(s)
- Hans R. Preus
- Department of Periodontology Institute of Clinical Odontology Faculty of Dentistry University of Oslo Oslo Norway
| | - Qamar AL‐Lami
- Department of Periodontology Institute of Clinical Odontology Faculty of Dentistry University of Oslo Oslo Norway
| | - Vibeke Baelum
- Department of Dentistry Health Aarhus University Aarhus Denmark
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Profili F, Sparabombe S, Tawse Smith A, D'Isidoro O, Quaranta A. The effect of miniaturized manual versus mechanical instruments on calculus removal and root surface characteristics: An in vitro light microscopic study. Clin Exp Dent Res 2019; 5:519-527. [PMID: 31687186 PMCID: PMC6820583 DOI: 10.1002/cre2.218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/06/2019] [Accepted: 06/12/2019] [Indexed: 11/29/2022] Open
Abstract
Objectives The aim of this study was to evaluate by light microscopy analysis the effect of the use of miniaturised piezoelectric tips versus mini‐five area specific curets on calculus removal and postoperative root surface alterations. Methods A total of 20 extracted teeth were used. Two square surfaces (5×5 mm) were marked on each root surface with a diamond bur mounted on a high‐speed handpiece. Before and after instrumentation, a series of magnified images (4.2×) of each experimental surface were taken with a standardized approach. According to a randomization list, the two surfaces on each sample were instrumented in a standardised fashion either with a mine‐five curet or a slim piezoelectric tip. The images were processed using an imaging software. Data were summarised as means and standard deviations for the two outcomes (calculus and alterations.) at each time (pre and post) for both of the groups (manual and mechanical). Results Both manual and mechanical instrumentation significantly reduced the calculus deposits (p < .001) without significant differences between the two groups. Both manual and mechanical treatments significantly increased alterations (p < .01). There was a statistically significant evidence of a greater increase in alterations from mechanical treatment. Conclusions Slim mechanical piezoelectric tips and manual mini‐five area‐specific curets have similar effects on calculus removal. Manual instrumentation results in a more homogeneous postoperative root surface with less root alterations.
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Affiliation(s)
| | - Scilla Sparabombe
- School of Dental Hygiene Università Politecnica delle Marche Ancona Italy
| | - Andrew Tawse Smith
- Department of Oral Sciences, Faculty of Dentistry University of Otago Dunedin New Zealand
| | | | - Alessandro Quaranta
- Discipline of Periodontics and Implantology, School of Dentistry and Oral Health Griffith University Gold Coast QLD Australia
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14
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Sambunjak D, Nickerson JW, Poklepovic Pericic T, Johnson TM, Imai P, Tugwell P, Worthington HV. WITHDRAWN: Flossing for the management of periodontal diseases and dental caries in adults. Cochrane Database Syst Rev 2019; 4:CD008829. [PMID: 31013348 PMCID: PMC6478368 DOI: 10.1002/14651858.cd008829.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Good oral hygiene is thought to be important for oral health. This review is to determine the effectiveness of flossing in addition to toothbrushing for preventing gum disease and dental caries in adults. OBJECTIVES To assess the effects of flossing in addition to toothbrushing, as compared with toothbrushing alone, in the management of periodontal diseases and dental caries in adults. SEARCH METHODS We searched the following electronic databases: the Cochrane Oral Health Group Trials Register (to 17 October 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 4), MEDLINE via OVID (1950 to 17 October 2011), EMBASE via OVID (1980 to 17 October 2011), CINAHL via EBSCO (1980 to 17 October 2011), LILACS via BIREME (1982 to 17 October 2011), ZETOC Conference Proceedings (1980 to 17 October 2011), Web of Science Conference Proceedings (1990 to 17 October 2011), Clinicaltrials.gov (to 17 October 2011) and the metaRegister of Controlled Clinical Trials (to 17 October 2011). We imposed no restrictions regarding language or date of publication. We contacted manufacturers of dental floss to identify trials. SELECTION CRITERIA We included randomised controlled trials conducted comparing toothbrushing and flossing with only toothbrushing, in adults. DATA COLLECTION AND ANALYSIS Two review authors independently assessed risk of bias for the included studies and extracted data. We contacted trial authors for further details where these were unclear. The effect measure for each meta-analysis was the standardised mean difference (SMD) with 95% confidence intervals (CI) using random-effects models. We examined potential sources of heterogeneity, along with sensitivity analyses omitting trials at high risk of bias. MAIN RESULTS Twelve trials were included in this review, with a total of 582 participants in flossing plus toothbrushing (intervention) groups and 501 participants in toothbrushing (control) groups. All included trials reported the outcomes of plaque and gingivitis. Seven of the included trials were assessed as at unclear risk of bias and five were at high risk of bias.Flossing plus toothbrushing showed a statistically significant benefit compared to toothbrushing in reducing gingivitis at the three time points studied, the SMD being -0.36 (95% CI -0.66 to -0.05) at 1 month, SMD -0.41 (95% CI -0.68 to -0.14) at 3 months and SMD -0.72 (95% CI -1.09 to -0.35) at 6 months. The 1-month estimate translates to a 0.13 point reduction on a 0 to 3 point scale for Loe-Silness gingivitis index, and the 3 and 6 month results translate to 0.20 and 0.09 reductions on the same scale.Overall there is weak, very unreliable evidence which suggests that flossing plus toothbrushing may be associated with a small reduction in plaque at 1 or 3 months.None of the included trials reported data for the outcomes of caries, calculus, clinical attachment loss, or quality of life. There was some inconsistent reporting of adverse effects. AUTHORS' CONCLUSIONS There is some evidence from twelve studies that flossing in addition to toothbrushing reduces gingivitis compared to toothbrushing alone. There is weak, very unreliable evidence from 10 studies that flossing plus toothbrushing may be associated with a small reduction in plaque at 1 and 3 months. No studies reported the effectiveness of flossing plus toothbrushing for preventing dental caries.
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Affiliation(s)
- Dario Sambunjak
- Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, Ilica 242, Zagreb, Croatia, 10000
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15
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Preus HR, Maharajasingam N, Rosic J, Baelum V. Oral hygiene phase revisited: How different study designs have affected results in intervention studies. J Clin Periodontol 2019; 46:548-551. [PMID: 30974490 DOI: 10.1111/jcpe.13109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/21/2019] [Accepted: 03/31/2019] [Indexed: 11/28/2022]
Abstract
Every periodontal researcher have been taught, and every textbook in periodontics have advocated, that a phase in which the patient is meticulously motivated and instructed in proper oral hygiene-the oral hygiene phase-must be included in any periodontal intervention. However, how is this oral hygiene phase actually portrayed in periodontal intervention studies, and how much space have this important phase received in the planning and carry-through of intervention studies? The purpose of this letter to the editor was to review current literature in the period 1975/01/01-2017/12/31 on periodontal, mechanical intervention studies in order to see what focus the oral hygiene phase had received in these articles. The result showed that the oral hygiene phase is variable in length and content, variable in claimed result, insufficiently described, and invariably amalgamated with the scaling and root planing which is the intervention or part of an intervention. The consequences of these findings are discussed and suggestions proposed for more harmonized and calibrated oral hygiene phase introduced to avoid biased and inflated results of interventions.
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Affiliation(s)
- Hans R Preus
- Department of Periodontology, Institute of Clinical Odontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Nisha Maharajasingam
- Department of Periodontology, Institute of Clinical Odontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Jovana Rosic
- Department of Periodontology, Institute of Clinical Odontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Vibeke Baelum
- Section for Oral Epidemiology and Public Health, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
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16
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Graziani F, Karapetsa D, Alonso B, Herrera D. Nonsurgical and surgical treatment of periodontitis: how many options for one disease? Periodontol 2000 2018; 75:152-188. [PMID: 28758300 DOI: 10.1111/prd.12201] [Citation(s) in RCA: 288] [Impact Index Per Article: 41.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Treatment of periodontitis aims at preventing further disease progression with the intentions to reduce the risk of tooth loss, minimize symptoms and perception of the disease, possibly restore lost periodontal tissue and provide information on maintaining a healthy periodontium. Therapeutic intervention includes introduction of techniques to change behavior, such as: individually tailored oral-hygiene instructions; a smoking-cessation program; dietary adjustment; subgingival instrumentation to remove plaque and calculus; local and systemic pharmacotherapy; and various types of surgery. No single treatment option has shown superiority, and virtually all types of mechanical periodontal treatment benefit from adjunctive antimicrobial chemotherapy. Periodontal treatment, because of the chronic nature of periodontitis, is a lifelong commitment to intricate oral-hygiene techniques, which, when properly implemented, will minimize the risk of disease initiation and progression.
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17
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Kozlovsky A, Rapaport A, Artzi Z. Influence of operator skill level on the clinical outcome of non-surgical periodontal treatment: a retrospective study. Clin Oral Investig 2018; 22:2927-2932. [DOI: 10.1007/s00784-018-2380-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 02/06/2018] [Indexed: 12/16/2022]
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18
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Preus HR, Gjermo P, Baelum V. A double-masked Randomized Clinical Trial (RCT) comparing four periodontitis treatment strategies: 5-year clinical results. J Clin Periodontol 2017; 44:1029-1038. [DOI: 10.1111/jcpe.12793] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2017] [Indexed: 01/21/2023]
Affiliation(s)
- Hans R. Preus
- Department of Periodontology; Institute of Clinical Odontology; Faculty of Dentistry; University of Oslo; Oslo Norway
| | - Per Gjermo
- Department of Periodontology; Institute of Clinical Odontology; Faculty of Dentistry; University of Oslo; Oslo Norway
| | - Vibeke Baelum
- Department of Dentistry and Oral Health; Aarhus University; Aarhus Denmark
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19
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Rosenauer T, Wagenschwanz C, Kuhn M, Kensche A, Stiehl S, Hannig C. The Bleeding on Brushing Index: a novel index in preventive dentistry. Int Dent J 2017; 67:299-307. [PMID: 28503739 DOI: 10.1111/idj.12300] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the suitability of a dichotomous index, based on a special interdental brushing tool, to detect initial pathological processes in interproximal areas. Furthermore, different techniques of interdental hygiene were compared. METHODS Participants (n = 108) were instructed to clean their teeth using the Bass technique and were randomly assigned to three groups according to the type of interdental cleaning used: group A, use of interdental brushes; group B, no interdental hygiene (the control group); and group C, use of dental floss. Approximal Plaque Index (API), Plaque Index (PI), modified Sulcus Bleeding Index (mSBI) and the Bleeding on Brushing Index (BOB) were measured at baseline, and after 2 (t1) and 4 (t2) weeks. Statistical analysis was performed using the Wilcoxon test and the Mann-Whitney U-test. RESULTS One-hundred and six participants completed the study. The BOB decreased significantly in all groups (P < 0.001) with the most pronounced reduction being recorded for group A (baseline: 49.3 ± 23.0%; 4 weeks: 5.1 ± 6.9%). Also, the mSBI (P < 0.001) decreased significantly in all groups during the study. The API appeared to be less affected by the oral hygiene than other indices. The highest correlation was observed between BOB and mSBI (r = 0.785, P < 0.001). CONCLUSION The BOB is a valuable complement for the existing array of indices in preventive dentistry, and is able to detect potential pathological processes in interproximal spaces. Additionally, this study suggests that interdental hygiene with individually selected brushes is superior to flossing. CLINICAL RELEVANCE With the BOB, gingival inflammation can be demonstrated to patients, which could increase compliance.
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Affiliation(s)
- Tobias Rosenauer
- Clinic of Operative Dentistry, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Constanze Wagenschwanz
- Clinic of Operative Dentistry, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Matthias Kuhn
- Institute for Medical Informatics and Biometry (IMB), Carl Gustav Carus Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Anna Kensche
- Clinic of Operative Dentistry, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Sandra Stiehl
- Clinic of Operative Dentistry, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Christian Hannig
- Clinic of Operative Dentistry, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
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Joseph R, Sasikumar M, Mammen J, Joseraj MG, Radhakrishnan C. Nonsurgical periodontal-therapy improves glycosylated hemoglobin levels in pre-diabetic patients with chronic periodontitis. World J Diabetes 2017; 8:213-221. [PMID: 28572882 PMCID: PMC5437619 DOI: 10.4239/wjd.v8.i5.213] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 01/22/2017] [Accepted: 03/13/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the effect of nonsurgical periodontal therapy on glycosylated haemoglobin levels in pre-diabetic patients with chronic periodontitis (CHP).
METHODS Sixty pre-diabetic patients with CHP were selected and equally allocated to case and control group. All subjects were evaluated at base line for periodontal parameters (plaque index, oral hygiene index, modified gingival index, probing pocket depth, clinical attachment level) and systemic parameters [glycosylated hemoglobin (HbA1c), fasting lipid profile, and fasting blood glucose]. The case group received non-surgical periodontal therapy. Subjects were re-evaluated for periodontal and systemic parameters after three months.
RESULTS Both groups were comparable at baseline. Three months after non surgical periodontal therapy (NSPT), there was significant improvement in periodontal parameters in case group. The mean difference in systemic parameters like HbA1c and fasting plasma glucose from baseline to fourth month for case group was 0.22 ± 0.11 and 3.90 ± 8.48 respectively and control group was -0.056 ± 0.10 and -1.66 ± 6.04 respectively, which was significant between case and control group (P < 0.05). In the case group there was a significant decrease in HbA1c from baseline to three months following NSPT (P < 0.05).
CONCLUSION This study showed that periodontal inflammation could affect the glycemic control in otherwise systemically healthy individuals. Periodontal therapy improved periodontal health status and decreased glycosylated haemoglobin levels, thus reducing the probability of occurrence of inflammation induced prediabetes in patients with CHP.
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Gartenmann SJ, Dörig I, Sahrmann P, Held U, Walter C, Schmidlin PR. Influence of different post-interventional maintenance concepts on periodontal outcomes: an evaluation of three systematic reviews. BMC Oral Health 2016; 17:19. [PMID: 27431672 PMCID: PMC4949770 DOI: 10.1186/s12903-016-0244-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 07/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To selectively review the existing literature on post-interventional maintenance protocols in patients with periodontal disease receiving either non-surgical or surgical periodontal treatment. METHODS Three systematic reviews with different periodontal interventions, i.e. scaling and root planing (SRP), SRP with adjunctive antibiotics or regenerative periodontal surgery were evaluated focusing on their post-interventional maintenance care. Due to the early publication of one review an additional literature search update was undertaken. The search was executed for studies published from January 2001 till March 2015 through an electronic database to ensure the inclusion of resent studies on SRP. Two reviewers guided the study selection and assessed the validity of the three reviews found. RESULTS Within the group of scaling and root planing alone there have been nine studies with more than three appointments for maintenance care and five studies with more than two appointments in the first 2 months after the intervention. Chlorhexidine was the most frequently used antiseptic agent used for 2 weeks after non-surgical intervention. Scaling and root planing with adjunctive antibiotics showed a similar number of visits with professional biofilm debridement, whereas regenerative studies displayed more studies with more than three visits in the intervention group. In addition, the use of antiseptics was longer and lasted 4 to 8 weeks after the regenerative intervention. The latter studies also showed more stringent maintenance protocols. CONCLUSIONS With increased interventional effort there was a greater tendency to increase frequency and duration of the maintenance care program and antiseptic agents.
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Affiliation(s)
- Stefanie J Gartenmann
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland
| | - Iris Dörig
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland
| | - Philipp Sahrmann
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland
| | - Ulrike Held
- Horten Centre for Patient-Oriented Research and Knowledge Transfer, Department of Internal Medicine, University of Zurich, Zurich, Switzerland
| | - Clemens Walter
- Department of Periodontology, Endodontology and Cariology University Center for Dental Medicine (UZB), Basel, Switzerland
| | - Patrick R Schmidlin
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland.
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22
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Armitage GC, Xenoudi P. Post-treatment supportive care for the natural dentition and dental implants. Periodontol 2000 2016; 71:164-84. [DOI: 10.1111/prd.12122] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2015] [Indexed: 12/11/2022]
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O'Malley L, Adair P, Bonetti DL, Preshaw PM, Jervøe‐Storm P, Cochrane Oral Health Group. WITHDRAWN: Psychological interventions to improve adherence to oral hygiene instructions in adults with periodontal diseases. Cochrane Database Syst Rev 2016; 2:CD005097. [PMID: 26928225 PMCID: PMC10641657 DOI: 10.1002/14651858.cd005097.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
As this review is 10 years old, it has been withdrawn and will be superseded. A new protocol has been written and published: O'Malley L, Bonetti DL, Adair P, Jervøe‐Storm PM, Preshaw PM. Psychological interventions for improving adherence to oral hygiene instructions in adults with periodontal diseases (Protocol). Cochrane Database of Systematic Reviews 2016, Issue 1. Art. No.: CD012049. DOI: 10.1002/14651858.CD012049. The full review will be published in 2017. The editorial group responsible for this previously published document have withdrawn it from publication.
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Affiliation(s)
- Lucy O'Malley
- School of Dentistry, The University of ManchesterJR Moore BuildingOxford RoadManchesterGreater ManchesterUKM13 9PL
| | - Pauline Adair
- University of StrathclydeSchool of Psychological Sciences and Health40 George StreetGlasgowUKG1 1QE
| | - Debbie L Bonetti
- University of DundeeSchool of DentistryFrankland Building, Small's WyndDundeeScotlandUKDD1 4HN
| | - Philip M Preshaw
- Newcastle UniversitySchool of Dental SciencesFramlington PlaceNewcastle upon TyneUKNE2 4BW
| | - Pia‐Merete Jervøe‐Storm
- University Hospital BonnDepartment of Periodontology, Operative and Preventive DentistryWelschnonnenstrasse 17BonnGermany53111
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Annaji S, Sarkar I, Rajan P, Pai J, Malagi S, Bharmappa R, Kamath V. Efficacy of Photodynamic Therapy and Lasers as an Adjunct to Scaling and Root Planing in the Treatment of Aggressive Periodontitis - A Clinical and Microbiologic Short Term Study. J Clin Diagn Res 2016; 10:ZC08-12. [PMID: 27042576 DOI: 10.7860/jcdr/2016/13844.7165] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 08/05/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Aggressive periodontitis comprises a group of rare, severe, rapidly progressive form of periodontitis. Conventional treatment includes mechanical debridement augmented with adjunctive antimicrobial therapy. Development of antibiotic resistance has led to use of lasers. Photodynamic therapy (PDT) is a novel non-invasive therapeutic approach with increased site and pathogen specificity. This study compares PDT and Lasers as an adjunct to conventional Scaling in the treatment of patients with aggressive periodontitis. MATERIALS AND METHODS Fifteen untreated aggressive periodo-ntitis patients were randomly assigned in a split mouth design for one of the following treatment modalities: 1) SRP alone; (2) SRP + Diode Laser irradiation with 810 nm at 1W, continuous mode for 30 sec per tooth; (3) SRP + PDT on "0" day; (4) SRP + PDT on "0", 7(th) and 21(st) day. The clinical parameters included PI, BOP, PPD, CAL recorded at the baseline & 3(rd) month. The site with greatest probing pocket depth (PPD) was selected from each quadrant for bacterial sampling and cultured for Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis & Prevotella intermedia. RESULTS Statistically significant reduction in clinical & microbial parameters was seen. Sites 4 showed a greater reduction compared to other groups. CONCLUSION Photodynamic therapy is a valuable treatment modality adjunctive to conventional scaling and root planing.
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Affiliation(s)
- Sreedhar Annaji
- Reader, Department of Periodontics, Coorg Institute of Dental Sciences , Virajpet, India
| | - Indranil Sarkar
- Post Graduate Student, Department of Periodontics, Coorg institute of Dental Sciences , Virajpet, India
| | - Padma Rajan
- Professor and Head of Department, Department of Periodontics, Coorg institute of Dental Sciences , Virajpet, India
| | - Jagdish Pai
- Professor, Department of Periodontics, Coorg institute of Dental Sciences , Virajpet, India
| | - Sachin Malagi
- Reader, Department of Periodontics, Coorg institute of Dental Sciences , Virajpet, India
| | - Radhika Bharmappa
- Senior Lecturer, Department of Periodontics, Coorg institute of Dental Sciences , Virajpet, India
| | - Vinesh Kamath
- Senior Lecturer, Department of Periodontics, Coorg institute of Dental Sciences , Virajpet, India
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Gonzalez S, Cohen CL, Galván M, Alonaizan FA, Rich SK, Slots J. Gingival bleeding on probing: relationship to change in periodontal pocket depth and effect of sodium hypochlorite oral rinse. J Periodontal Res 2014; 50:397-402. [DOI: 10.1111/jre.12219] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2014] [Indexed: 12/15/2022]
Affiliation(s)
- S. Gonzalez
- Graduate Periodontology Clinic; Ostrow School of Dentistry of USC; Los Angeles CA USA
| | - C. L. Cohen
- Graduate Periodontology Clinic; Ostrow School of Dentistry of USC; Los Angeles CA USA
| | - M. Galván
- Graduate Periodontology Clinic; Ostrow School of Dentistry of USC; Los Angeles CA USA
| | - F. A. Alonaizan
- Graduate Endodontic Clinic; Ostrow School of Dentistry of USC; Los Angeles CA USA
| | - S. K. Rich
- Graduate Periodontology Clinic; Ostrow School of Dentistry of USC; Los Angeles CA USA
| | - J. Slots
- Graduate Periodontology Clinic; Ostrow School of Dentistry of USC; Los Angeles CA USA
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Ribeiro EDP, Bittencourt S, Nociti-Júnior FH, Sallum EA, Sallum AW, Casati MZ. The effect of one session of supragingival plaque control on clinical and biochemical parameters of chronic periodontitis. J Appl Oral Sci 2012; 13:275-9. [PMID: 20878030 DOI: 10.1590/s1678-77572005000300014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2004] [Accepted: 03/11/2005] [Indexed: 11/22/2022] Open
Abstract
Supragingival plaque control is a requisite for the success of any periodontal procedure. However, little is know about the effect of this procedure alone on periodontitis. The aim of this study was to determine the effect of supragingival plaque control on clinical and biochemical parameters of chronic periodontitis. Twenty-five subjects exhibiting at least 4 pockets > 5mm, non-smokers and with no relevant systemic diseases, were selected for the study. The clinical and biochemical assessments were done before and 21 days after removal of plaque retentive factors, extraction of affected teeth and instruction in oral hygiene. The statistical analysis was done with the Student paired t-test (p<0,05) and demonstrated a reduction on the percentage of sites with bleeding on probing from 42.72 ± 15.83 to 35.87 ± 13.30 (p=0.002). Reduction in probing depth was detected on anterior teeth (initial/final mean: 2.88 mm/2.78 mm; p=0.01) and interproximal sites (initial/final mean: 3.80 mm/3.65 mm; p=0.001). There was an increase from 66.81% to 68.65% in the number of sites with probing depth of 1 to 3mm and a decrease from 26.21% to 24.17% in those with probing depth of 4 to 6mm. The BAPNA results showed a decrease from 51.44 ± 20.78 to 38.64 ± 12.34 (p=0.04). This study demonstrated that supragingival plaque control provides a reduction in gingival inflammation and alterations in the subgingival microflora detected by the BAPNA test.
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Affiliation(s)
- Erica Del Peloso Ribeiro
- Department of Prosthodontics and Periodontics, School of Dentistry at Piracicaba, University of Campinas
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Sambunjak D, Nickerson JW, Poklepovic T, Johnson TM, Imai P, Tugwell P, Worthington HV. Flossing for the management of periodontal diseases and dental caries in adults. Cochrane Database Syst Rev 2011:CD008829. [PMID: 22161438 DOI: 10.1002/14651858.cd008829.pub2] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Good oral hygiene is thought to be important for oral health. This review is to determine the effectiveness of flossing in addition to toothbrushing for preventing gum disease and dental caries in adults. OBJECTIVES To assess the effects of flossing in addition to toothbrushing, as compared with toothbrushing alone, in the management of periodontal diseases and dental caries in adults. SEARCH METHODS We searched the following electronic databases: the Cochrane Oral Health Group Trials Register (to 17 October 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 4), MEDLINE via OVID (1950 to 17 October 2011), EMBASE via OVID (1980 to 17 October 2011), CINAHL via EBSCO (1980 to 17 October 2011), LILACS via BIREME (1982 to 17 October 2011), ZETOC Conference Proceedings (1980 to 17 October 2011), Web of Science Conference Proceedings (1990 to 17 October 2011), Clinicaltrials.gov (to 17 October 2011) and the metaRegister of Controlled Clinical Trials (to 17 October 2011). We imposed no restrictions regarding language or date of publication. We contacted manufacturers of dental floss to identify trials. SELECTION CRITERIA We included randomised controlled trials conducted comparing toothbrushing and flossing with only toothbrushing, in adults. DATA COLLECTION AND ANALYSIS Two review authors independently assessed risk of bias for the included studies and extracted data. We contacted trial authors for further details where these were unclear. The effect measure for each meta-analysis was the standardised mean difference (SMD) with 95% confidence intervals (CI) using random-effects models. We examined potential sources of heterogeneity, along with sensitivity analyses omitting trials at high risk of bias. MAIN RESULTS Twelve trials were included in this review, with a total of 582 participants in flossing plus toothbrushing (intervention) groups and 501 participants in toothbrushing (control) groups. All included trials reported the outcomes of plaque and gingivitis. Seven of the included trials were assessed as at unclear risk of bias and five were at high risk of bias.Flossing plus toothbrushing showed a statistically significant benefit compared to toothbrushing in reducing gingivitis at the three time points studied, the SMD being -0.36 (95% CI -0.66 to -0.05) at 1 month, SMD -0.41 (95% CI -0.68 to -0.14) at 3 months and SMD -0.72 (95% CI -1.09 to -0.35) at 6 months. The 1-month estimate translates to a 0.13 point reduction on a 0 to 3 point scale for Loe-Silness gingivitis index, and the 3 and 6 month results translate to 0.20 and 0.09 reductions on the same scale.Overall there is weak, very unreliable evidence which suggests that flossing plus toothbrushing may be associated with a small reduction in plaque at 1 or 3 months.None of the included trials reported data for the outcomes of caries, calculus, clinical attachment loss, or quality of life. There was some inconsistent reporting of adverse effects. AUTHORS' CONCLUSIONS There is some evidence from twelve studies that flossing in addition to toothbrushing reduces gingivitis compared to toothbrushing alone. There is weak, very unreliable evidence from 10 studies that flossing plus toothbrushing may be associated with a small reduction in plaque at 1 and 3 months. No studies reported the effectiveness of flossing plus toothbrushing for preventing dental caries.
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Affiliation(s)
- Dario Sambunjak
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Soltanska 2, Split, Croatia, 21 000
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Tashiro K, Katoh T, Yoshinari N, Hirai K, Andoh N, Makii K, Matsuo K, Ogasawara T. The short-term effects of various oral care methods in dependent elderly: comparison between toothbrushing, tongue cleaning with sponge brush and wiping on oral mucous membrane by chlorhexidine. Gerodontology 2011; 29:e870-82. [PMID: 22126396 DOI: 10.1111/j.1741-2358.2011.00577.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To explore the short-term effects from toothbrushing, tongue cleaning with sponge brush and wiping on oral mucous membrane by chlorhexidine. BACKGROUND Numerous reports have been seen in recent years proving the effectiveness of mouth cleaning with a toothbrush for the prevention of respiratory infections among the dependent elderly. However, the short-term effects from each oral care method have not yet been clarified. Hence, an investigation was conducted by having each subject independently perform various oral care methods for five consecutive days. MATERIALS AND METHODS The subjects consisted of 12 assistance-dependent elderly who have difficulties with tooth brushing by themselves, have 10 or more residual teeth and are not yet using plate dentures. After the pre-intervention examination, each of the following oral care methods were performed on the same subject on an approximately three week basis: 1) Tooth brushing 2) Tongue cleaning with sponge brush 3) Wiping on oral mucous with sponge brush by chlorhexidine. Each method was performed independently, once a day for 5 consecutive days and the subjects were reexamined on the sixth day for comparative verification. RESULTS Consequently, toothbrushing decreased the plaque index and gingival index significantly and an improvement of oral malodour was also acknowledged (p < 0.01). Tongue cleaning with a sponge brush decreased the tongue coat score significantly (p < 0.05) and oral malodour was also improved (p < 0.01). Wiping on oral mucous with a sponge brush soaked in chlorhexidine significantly decreased opportunistic infections in the pharynx region (p < 0.05). CONCLUSIONS It was suggested that the use of not only a toothbrush but also chlorhexidine gluconate may be indicated for dependent elderly people in whom pathogens of opportunistic infection are detected.
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Affiliation(s)
- Kazuhisa Tashiro
- Department of Oral Health Promotion, Graduate School of Oral Medicine, Matsumoto Dental University, Nagano, Japan.
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Martins Júnior W, De Rossi A, Samih Georges Abi Rached R, Rossi MA. A scanning electron microscopy study of diseased root surfaces conditioned with EDTA gel plus Cetavlon after scaling and root planing. JOURNAL OF ELECTRON MICROSCOPY 2011; 60:167-175. [PMID: 21228022 DOI: 10.1093/jmicro/dfq083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In the present investigation, a scanning electron microscopy analysis was performed to evaluate the effects of the topical application of ethylenediaminetetraacetic acid (EDTA) gel associated with Cetavlon (EDTAC) in removing the smear layer and exposing collagen fibers following root surface instrumentation. Twenty-eight teeth from adult humans, single rooted and scheduled for extraction due to periodontal reasons, were selected. Each tooth was submitted to manual (scaling and root planing) instrumentation alone or combined with ultrasonic instruments, with or without etching using a 24% EDTAC gel. Following extraction, specimens were processed and examined under a scanning electron microscope. A comparative morphological semi-quantitative analysis was performed; the intensity of the smear layer and the decalcification of cementum and dentinal surfaces were graded in 12 sets using an arbitrary scale ranging from 1 (area covered by a smear layer) to 4 (no smear layer). Root debridement with hand instruments alone or combined with ultrasonic instruments resulted in a similar smear layer covering the root surfaces. The smear layer was successfully removed from the surfaces treated with EDTAC, which exhibited numerous exposed dentinal tubules and collagen fibers. This study supports the hypothesis that manual instrumentation alone or instrumentation combined with ultrasonic instrumentation is unable to remove the smear layer, whereas the subsequent topical application of EDTAC gel effectively removes the smear layer, uncovers dentinal openings and exposes collagen fibers.
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Affiliation(s)
- Walter Martins Júnior
- Department of Periodontics, Dentistry School, University of Ribeirão Preto, Sao Paulo, Brazil
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31
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Xiang X, Sowa MG, Iacopino AM, Maev RG, Hewko MD, Man A, Liu KZ. An update on novel non-invasive approaches for periodontal diagnosis. J Periodontol 2010; 81:186-98. [PMID: 20151796 DOI: 10.1902/jop.2009.090419] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
For decades there has been an ongoing search for clinically acceptable methods for the accurate, non-invasive diagnosis and prognosis of periodontitis. There are several well-known inherent drawbacks with current clinical procedures. The purpose of this review is to summarize some of the newly emerging diagnostic approaches, namely, infrared spectroscopy, optical coherence tomography (OCT), and ultrasound. The history and attractive features of these new approaches are briefly illustrated, and the interesting and significant inventions related to dental applications are discussed. The particularly attractive aspects for the dental community are that some of these methods are totally non-invasive, do not impose any discomforts to the patients during the procedure, and require no tissue to be extracted. For instance, multiple inflammatory indices withdrawn from near infrared spectra have the potential to identify early signs of inflammation leading to tissue breakdown. Morphologically, some other non-invasive imaging modalities, such as OCT and ultrasound, could be employed to accurately measure probing depths and assess the status of periodontal attachment, the front-line of disease progression. Given that these methods reflect a completely different assessment of periodontal inflammation, if clinically validated, these methods could either replace traditional clinical examinations for the diagnosis of periodontitis or at least serve as attractive complementary diagnostic tools. However, the potential of these techniques should be interpreted more cautiously given the multifactorial character of periodontal disease. In addition to these novel tools in the field of periodontal inflammatory diseases, other alternative modalities like microbiologic and genetic approaches are only briefly mentioned in this review because they have been thoroughly discussed in other comprehensive reviews.
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Affiliation(s)
- Xiaoming Xiang
- Institute for Biodiagnostics, National Research Council of Canada, Winnipeg, MB
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Lai S, Zee KY, Lai M, Corbet E. Clinical and Radiographic Investigation of the Adjunctive Effects of a Low-Power He-Ne Laser in the Treatment of Moderate to Advanced Periodontal Disease: A Pilot Study. Photomed Laser Surg 2009; 27:287-93. [DOI: 10.1089/pho.2007.2206] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S.M.L. Lai
- Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - K.-Y. Zee
- Faculty of Dentistry, The University of Sydney, Westmead, New South Wales, Australia
| | - M.K. Lai
- Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - E.F. Corbet
- Faculty of Dentistry, The University of Hong Kong, Hong Kong
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Radvar M, Mardani N, Mellati E, Habibi M. Improvement of Periodontal Parameters in Untreated Quadrants After Surgical Periodontal Therapy at Adjacent Quadrants. J Periodontol 2009; 80:565-71. [DOI: 10.1902/jop.2009.080417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Park SY, Shin SY, Yang SM, Kye SB. Factors Influencing the Outcome of Root-Resection Therapy in Molars: A 10-Year Retrospective Study. J Periodontol 2009; 80:32-40. [DOI: 10.1902/jop.2009.080316] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Beuchat M, Busslinger A, Schmidlin PR, Michel B, Lehmann B, Lutz F. Clinical comparison of the effectiveness of novel sonic instruments and curettes for periodontal debridement after 2 months. J Clin Periodontol 2008. [DOI: 10.1111/j.1600-051x.2001.281209.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kaner D, Bernimoulin JP, Hopfenmüller W, Kleber BM, Friedmann A. Controlled-delivery chlorhexidine chip versus amoxicillin/metronidazole as adjunctive antimicrobial therapy for generalized aggressive periodontitis: a randomized controlled clinical trial. J Clin Periodontol 2007; 34:880-91. [PMID: 17850607 DOI: 10.1111/j.1600-051x.2007.01122.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Subgingival application of chlorhexidine via a controlled-delivery device (CHX chip) improves the clinical outcome of scaling/root planing (SRP) in therapy for chronic periodontitis. Generalized aggressive periodontitis (GAP) is commonly treated with SRP and adjunctive antimicrobial medication. To date, the efficacy of CHX chips in GAP therapy has not been evaluated. AIM To compare SRP plus adjunctive CHX chip placement with SRP plus adjunctive systemic amoxicillin/metronidazole with regard to clinical efficacy in first-line therapy for GAP. MATERIAL AND METHODS Thirty-six GAP patients were treated with SRP and randomly with either placement of CHX chips or systemic amoxicillin/metronidazole. Clinical attachment level (CAL), probing depth (PD), bleeding on probing (BoP) and suppuration (Pus) were measured at baseline, 3 and 6 months after therapy. RESULTS CAL, PD, BoP and Pus were significantly reduced in both groups after 3 months. In the CHX chip group, PD significantly increased again between 3 and 6 months. Finally, amoxicillin/metronidazole patients presented significantly more CAL "gain", PD reduction and less remaining deep sites after 6 months. Pus remained detectable in CHX chip patients only. CONCLUSIONS In first-line non-surgical therapy for GAP, SRP plus adjunctive systemic amoxicillin/metronidazole was more efficacious in clinically relevant measures of outcome than SRP plus adjunctive placement of CHX chips.
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Affiliation(s)
- Doğan Kaner
- Institute for Periodontology and Synoptic Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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38
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Renz A, Ide M, Newton T, Robinson PG, Smith D. Psychological interventions to improve adherence to oral hygiene instructions in adults with periodontal diseases. Cochrane Database Syst Rev 2007:CD005097. [PMID: 17443571 DOI: 10.1002/14651858.cd005097.pub2] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Adherence to oral hygiene is an important aspect of the treatment of periodontal disease. Traditional educational interventions have been shown to be of little value in achieving long term behaviour change. OBJECTIVES The aim of this review was to determine the impact of interventions aimed to increase adherence to oral hygiene instructions in adult periodontal patients based on psychological models and theoretical frameworks. This review considered the following outcomes: Observational measures of oral health related behaviour Self reported oral health related behaviours, beliefs and attitudes towards oral health related behaviour Clinical markers of periodontal disease. SEARCH STRATEGY The Cochrane Oral Health Group's Trials Register (2005), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2004, Issue 4), MEDLINE (from 1966 to December 2004), EMBASE (from 1980 to December 2004), PSYCHINFO (from 1966 to December 2004), Ingenta (from 1998 to December 2004) and CINAHL (from 1966 to December 2004). Reference lists from relevant articles were searched and the authors of eligible trials were contacted to identify trials and obtain additional information. No language restriction was applied. SELECTION CRITERIA Randomised controlled trials testing the effectiveness of interventions based on psychological models compared with educational, attention or no active intervention controls to improve adherence to oral hygiene in adults with either gingivitis or periodontitis. DATA COLLECTION AND ANALYSIS Titles and abstracts of studies that were potentially relevant to the review were independently screened by two review authors. Those that were clearly ineligible were rejected. For the remaining studies, the full paper was reviewed by two review authors and where necessary further information was sought from the author to verify eligibility. Included studies were assessed on their quality using standard criteria. MAIN RESULTS The review identified four studies (including 344 participants) in which a psychological model or theory had been explicitly used as the basis for the design of the intervention. The overall quality of trials was low. Due to the hetereogeneity between studies, both in terms of outcome measures and psychological models adopted, a meta-analysis was not possible. The four studies adopted four different theoretical frameworks, though there was some overlap in that three of the studies incorporated elements of Operant and Classical Conditioning. Psychological interventions resulted in improved plaque scores in comparison to no intervention groups, and in one study in comparison to an attention control group. One study found decreased gingival bleeding in the active intervention group but no change in pocket depth or attachment loss after 4 months. Psychological interventions were associated with improved self reported brushing and flossing in both studies which assessed these behaviours. Only one study explored the impact of psychological interventions on beliefs and attitudes, the psychological intervention, in comparison to educational and no intervention controls, showed improved self efficacy beliefs in relation to flossing, but no effect on dental knowledge or self efficacy beliefs in relation to tooth brushing. AUTHORS' CONCLUSIONS There is tentative evidence from low quality studies that psychological approaches to behaviour management can improve oral hygiene related behaviours. However, the overall quality of the included trials was low. Furthermore, the design of the interventions was weak and limited, ignoring key aspects of the theories. Thus, there is a need for greater methodological rigour in the design of trials in this area.
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Affiliation(s)
- A Renz
- GKT Dental Institute, Oral Health Services Research & Dental Public Health, Caldecot Road, Denmark Hill Campus, London, UK SE5 9RW.
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Kahl M, Haase E, Kocher T, Rühling A. Clinical effects after subgingival polishing with a non-aggressive ultrasonic device in initial therapy. J Clin Periodontol 2007; 34:318-24. [PMID: 17378888 DOI: 10.1111/j.1600-051x.2007.01056.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The Vector ultrasonic system provides root debridement supported by different abrasive irrigation fluids. The aim of this study was to investigate the clinical outcome of initial therapy with subgingival low-abrasive debridement. MATERIAL AND METHODS Twenty patients, who had at least two teeth with pocket depths >5 mm in each quadrant, took part in this prospective randomized clinical study. Patients were treated in a split-mouth design as one test quadrant (1) subgingivally with Vector fluid polish (VU-H) and as three control quadrants, (2) with only supragingival polishing (PO-H), (3) with hand instruments (HI-H) performed by a hygienist and (4) with hand instruments (HI-D) performed by a dentist. At baseline, 3 and 6 months after treatment, pocket depths and attachment levels (ALs) were measured and bleeding on probing (BOP) was recorded. RESULTS At 6-month evaluation, all groups showed an improvement in clinical parameters. No statistically significant differences in any of the investigated parameters could be observed between the Vector group and the hand scaling groups, or when comparing the results of the two different operators. CONCLUSION This study demonstrates that Vector treatment with polishing fluid was able to reduce pocket depths and the prevalence of BOP and improve clinical AL in a similar way as scaling with curettes.
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Affiliation(s)
- Maren Kahl
- Department of Periodontology, School of Dentistry, University of Kiel, Kiel, Germany.
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Rhemrev GE, Timmerman MF, Veldkamp I, Van Winkelhoff AJ, Van der Velden U. Immediate effect of instrumentation on the subgingival microflora in deep inflamed pockets under strict plaque control. J Clin Periodontol 2006; 33:42-8. [PMID: 16367855 DOI: 10.1111/j.1600-051x.2005.00871.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate (1) reduction in the number of microorganisms obtained directly after subgingival instrumentation, (2) rate of bacterial re-colonization during 2 weeks, under supragingival plaque-free conditions. MATERIALS AND METHODS Effects of subgingival instrumentation were measured at one deep pocket in 22 patients (11 smokers and 11 non-smokers). Immediately after initial therapy, experimental sites, under strict plaque control, were instrumented subgingivally. Microbiological evaluation was performed at pre-instrumentation, immediate post-instrumentation and 1 and 2 weeks post-instrumentation. RESULTS Mean total anaerobic colony forming units (CFUs) dropped from 3.9 x 10(6) before to 0.09 x 10(6) immediately following instrumentation. Significant reductions were found for Tannerella forsythia, Micromonas micros, Fusobacterium nucleatum and spirochetes. Significant reductions were not observed for Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia and Campylobacter rectus. Except for spirochetes, no reduction in prevalence of specific periodontal bacteria was found immediately after instrumentation. During follow-up, mean total CFU tended to increase. Prevalence of periodontal bacteria further reduced. No effect of smoking was found. CONCLUSION Results indicate that subgingival mechanical cleaning in itself, has a limited effect, in actually removing bacteria. The subsequent reduction in prevalence of specific periodontal bacteria shows that it is apparently difficult for these species to survive in treated pockets.
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Affiliation(s)
- G E Rhemrev
- Department of Periodontology, Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
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41
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Needleman I, Suvan J, Moles DR, Pimlott J. A systematic review of professional mechanical plaque removal for prevention of periodontal diseases. J Clin Periodontol 2005; 32 Suppl 6:229-82. [PMID: 16128841 DOI: 10.1111/j.1600-051x.2005.00804.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To investigate the effect of professional mechanical plaque removal (PMPR) on the prevention of periodontal diseases. METHODS We searched for randomized controlled trials, controlled clinical trials and cohort studies from 1950 to October 2004. Screening and data abstraction were conducted independently and in duplicate. Critical appraisal of studies was based on objective criteria and evidence tables were constructed. RESULTS From 2179 titles and abstracts, 132 full-text articles were screened and 32 studies were relevant. Evidence exists that PMPR in adults, particularly in combination with oral hygiene instruction (OHI), may be more effective than no treatment judged by surrogate measures. The evidence for a benefit of PMPR+OHI over OHI alone is less clear. The optimum frequency of PMPR has not been investigated although more frequent PMPR is associated with improved markers of health. The strength of evidence for these results ranges from weak to moderate due to risk of bias, inconsistent results, lack of appropriate statistics and small sample size. CONCLUSIONS There appears to be little value in providing PMPR without OHI. In fact, repeated OHI might have a similar effect as PMPR. Some forms of PMPR might achieve greater patient satisfaction. There is little difference in beneficial or adverse effects of different methods of PMPR.
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Affiliation(s)
- Ian Needleman
- International Centre for Evidence-Based Oral Health, Eastman Dental Institute, UCL, London, UK.
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Chapper A, Catão VV, Oppermann RV. Hand and ultrasonic instrumentation in the treatment of chronic periodontitis after supragingival plaque control. Braz Oral Res 2005; 19:41-6. [PMID: 16229355 DOI: 10.1590/s1806-83242005000100008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This study compared the clinical effects of hand or ultrasonic scaling and root planing on the treatment of chronic periodontitis. After supragingival plaque control, twenty patients were examined by a blinded and calibrated examiner for probing pocket depth (PPD), clinical attachment level (CAL) and bleeding on probing (BOP). Experimental teeth were allocated to the following subgingival treatment groups according to PPD: 1) hand instrumentation; 2) hand instrumentation with irrigation; 3) ultrasonic instrumentation; 4) ultrasonic followed by hand instrumentation. Time used in the procedures was recorded. Follow-up examinations were performed at 30 and 90 days after treatment. Each patient's individual BOP, PPD and CAL means were analyzed with repeated-measures ANOVA. Differences in the instrumentation time were analyzed with 1-way ANOVA. Significance level was established at 5%. All treatments produced significant changes in the clinical parameters. BOP reduced, in proximal surfaces, from 67.21-79.17% at baseline to 45.75-51.54% at 90 days. Significant reductions were also found for PPD and CAL in all groups, both in proximal and free surfaces. Reductions in mean PPD at 90 days ranged from 0.92 to 1.14 mm for the free surfaces and from 1.01 to 1.35 mm for proximal surfaces, whereas reductions in CAL ranged from 0.43 to 0.82 mm and from 0.60 to 0.73 mm for free and proximal surfaces, respectively. Mean instrumentation time ranged from 4.77 to 5.30 minutes. No statistically significant differences were found among the four study groups. It can be concluded that the four methods of subgingival instrumentation were equally efficacious in the improvement of the studied clinical parameters.
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Affiliation(s)
- Noel Claffey
- Dublin Dental School and Hospital, Trinity College, Ireland
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Abstract
The most fundamental premise in the current view of periodontal disease is that not all individuals are at equal risk for disease and disease progression. Studies reveal that about 5-20% of the population is at risk for severe disease progression. The purpose of this paper is to define at-risk patients, review risk factors and indicators of disease progression, and outline an evidence-based strategy that includes both self-care and professional care for maintaining periodontal health. Risk factors/risk indicators considered include history of previous disease, increased pocket depth and loss of clinical attachment, frequency of dental care, specific bacterial pathogens, and systemic/environmental host factors such as smoking, diabetes mellitus, genetics, and stress. Because host factors may have more influence on disease progression than periodontal pathogens, personal and professional maintenance care must include the role of the host in periodontal disease progression. By examining the evidence surrounding these complex issues, dentists and dental hygienists are able to determine the extent to which evidence supports available approaches to maintain periodontal health and control disease progression.
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Affiliation(s)
- M Darby
- School of Dental Hygiene, Old Dominion University, Norfolk, VA 23529-0499, USA.
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Lewis MW, Holder-Ballard C, Selders RJ, Scarbecz M, Johnson HG, Turner EW. Comparison of the Use of a Toothpick Holder to Dental Floss in Improvement of Gingival Health in Humans. J Periodontol 2004; 75:551-6. [PMID: 15152819 DOI: 10.1902/jop.2004.75.4.551] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although advances have been made in modulation of host inflammatory response in periodontal therapy, it is important to control the bacterial challenge to the host immune system through conventional therapy and improvement of personal oral hygiene. Although toothbrushing is generally performed, interdental cleaning is not as common. This study compared the use of dental floss to a toothpick holder in the improvement of gingival health. METHODS Participants were examined and those with clinical gingivitis or slight chronic periodontitis were included in the study. O'Leary plaque, interproximal plaque index (IPI), and Eastman interdental bleeding index scores (EIBI) were recorded at baseline and following appointments. Forty-two females and 13 males ranging from 18 to 50 years in age were randomly divided into either a dental flossing group or toothpick holder using group. Each was given instructions in the use of the oral hygiene device and examined 2, 6, and 12 weeks following baseline. At 12 weeks, 27 floss users and 20 toothpick-holder users completed the study. RESULTS Plaque scores were reduced in both groups as the study progressed. Mean O'Leary plaque scores decreased significantly for both methods from baseline to week 12 (P < 0.05). The EIBI and IPI scores decreased in mean scores over time for each method (P < 0.05). A correlation was found between the O'Leary plaque index and the IPI scores (P < 0.05). CONCLUSION The results of this study found that the use of dental floss or toothpick holder resulted in no significantly different effect in the improvement of gingival health.
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Affiliation(s)
- Maurice W Lewis
- Department of Restorative Dentistry, Division of Operative Dentistry, University of Tennessee College of Dentistry, Memphis, TN 38163, USA
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Müller HP, Heinecke A. Clinical effects of scaling and root planing in adults infected with Actinobacillus actinomycetemcomitans. Clin Oral Investig 2004; 8:63-9. [PMID: 14986069 DOI: 10.1007/s00784-003-0251-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2003] [Accepted: 12/09/2003] [Indexed: 10/26/2022]
Abstract
The periodontal pathogen Actinobacillus actinomycetemcomitans can frequently be isolated from subgingival plaque of adults with chronic inflammatory periodontal disease and individuals with plaque-induced gingivitis. Problems with the persistence of the organism after thorough debridement of root surfaces have been reported. In the present study clinical effects of the hygienic phase of periodontal therapy in ten adult patients with moderate or advanced periodontitis harbouring A. actinomycetemcomitans were analysed. Since proper analysis of highly correlated data within a given patient is crucial for appropriate interpretation, a major objective of this study was to compare the results of different models derived from logistic regression of clinical and microbiological factors on gain or loss of clinical attachment under different assumptions. Subgingival samples from every tooth present were obtained before and 6 weeks after thorough subgingival scaling, and selectively cultivated for the organism. A relevant gain of clinical attachment of 2 mm or more was observed at a total of 36% of periodontitis sites after scaling. Overall, loss of attachment of 2 mm or more was observed at 8% sites. Most loss occurred at sites with gingival enlargement (15%), whereas 3% periodontitis sites lost 2 mm or more. In multivariate analyses erroneously assuming either independence of data or correctly considering the correlated structure of observations attachment gain was mainly associated with deep probing depths at the outset. Presence or absence of A. actinomycetemcomitans before or after therapy was not included into the periodontitis models. Also, loss of attachment of 2 mm or more after subgingival scaling was not influenced by the organism. A direct comparison of the results obtained with both approaches of logistic regression may be helpful in the assessment of the influence of the magnitude of correlation of the data on the regression coefficients.
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Affiliation(s)
- Hans-Peter Müller
- Faculty of Dentistry, Kuwait University, P.O. Box 24923, 13110 Safat, Kuwait.
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Tan BTK, Mordan NJ, Embleton J, Pratten J, Galgut PN. Study of Bacterial Viability within Human Supragingival Dental Calculus. J Periodontol 2004; 75:23-9. [PMID: 15025213 DOI: 10.1902/jop.2004.75.1.23] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is evidence that supragingival calculus contains unmineralized channels and lacunae. The purpose of this study was to investigate the viability of bacteria within these areas. METHODS Supragingival calculus harvested from patients with moderate to severe chronic periodontitis was immediately frozen to -70 degrees C. Six samples were cryosectioned, stained with a bacterial viability kit, and examined with fluorescence microscopy. Controls comprised heat treatment of cryosections prior to staining. Four additional samples were stained and examined whole in a confocal laser scanning microscope (CLSM). Nine additional samples were prepared for bacterial culture, after initial irradiation with ultraviolet light to kill viable organisms on the covering plaque layer. Test samples were crushed to expose internal bacteria, while two controls were used without crushing. RESULTS Viable bacteria, as identified using the bacterial viability stain, were found within cavities/lacunae in supragingival calculus cryosections. Similar results were obtained from whole calculus samples using CLSM. Of the nine experimental samples where bacterial culture was attempted, five provided positive bacterial culture under both aerobic and anaerobic conditions; one showed positive growth under aerobic conditions only; while one showed no bacterial growth. The controls showed no bacterial growth. CONCLUSIONS From this study, it appears that viable aerobic and anaerobic bacteria may be present within supragingival calculus, specifically within the internal channels and lacunae. Clinically, this may be important, since incomplete removal of supragingival calculus may expose these reservoirs of possible pathogenic bacteria and be a factor in the recurrence of periodontal diseases after treatment.
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Affiliation(s)
- Benjamin T K Tan
- Department of Periodontology, Eastman Dental Institute for Oral Health Care Sciences, University College London, UK
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Hallmon WW, Rees TD. Local Anti-Infective Therapy: Mechanical and Physical Approaches. A Systematic Review. ACTA ACUST UNITED AC 2003; 8:99-114. [PMID: 14971251 DOI: 10.1902/annals.2003.8.1.99] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although mechanical non-surgical therapy (scaling and root planing) is the most common means of initial treatment of periodontal diseases, the relative clinical efficacy of various methods, including manual versus machine-driven, with or without adjunctive agents, has not been determined. RATIONALE This systematic review analyzes the literature in an effort to identify the most effective therapies, based on both clinical and patient-centered outcomes. FOCUSED QUESTION In patients with periodontitis, what is the effect of mechanically-driven instrumentation (e.g., power-driven) and/or subgingival irrigation with and without manual instrumentation compared to manual instrumentation alone? SEARCH PROTOCOL Two investigators examined MEDLINE and the Cochrane Oral Health Group specialized registry for clinical trials published in English. Hand searches were performed of the International Journal of Periodontics & Restorative Dentistry, Journal of Clinical Periodontology, Journal of Periodontology, and Journal of Periodontal Research. Searches were performed for articles published through April 2002. Editors of these journals were asked to provide information on articles currently under review. In addition, an electronic discussion group on periodontal diseases and treatment was contacted, as were manufacturers of manual and mechanical instruments and of adjunctive agents. SELECTION CRITERIA INCLUSION CRITERIA Only randomized clinical trials, cohort studies, or case-control studies at least 3 months long were included. All studies had to compare manual instrumentation (MI; scaling and root planing [SRP]) alone with some other form of non-surgical therapy. These included MI versus mechanically-driven instruments (MDI) alone; MI versus MI plus MDI; MI versus MDI plus an agent (e.g., chlorhexidine); and MI versus subgingival irrigation (SGI) delivered in conjunction with MI or MDI. EXCLUSION CRITERIA Studies not meeting the inclusion criteria or those treating periodontal diseases as a manifestation or complication of some other disease or disorder were not included. DATA COLLECTION AND ANALYSIS Probing depth, clinical attachment level, bleeding on probing, and gingival recession were the primary outcomes. Because of the heterogeneity of the patient populations, treatments, and outcome measures, meta-analysis was not appropriate. Only in-study data were compared. Four of the studies required extrapolating data from figures and graphs, resulting in questionable accuracy. MAIN RESULTS 1. Nine studies, representing a study population of 129, were included in the review. 2. Five studies compared MI with MDI alone. The other 4 compared MI alone to MI plus SGI or subgingival tissue treatment. 3. There was comparable efficacy between MI and MDI when treating single-rooted teeth. 4. The use of SGI or subgingival tissue treatment as an adjunct to MI provided no additional benefit compared to MI alone. 5. Findings reported in the review must be interpreted with considerable caution, as lack of study heterogeneity made meta-analysis unfeasible and the need to extrapolate outcomes values from graphs and figures may have resulted in some inaccuracy. REVIEWERS' CONCLUSIONS 1. Manual and mechanically-driven instrumentation appears comparable in affecting improved clinical outcomes. 2. Instrumentation time for MI and MDI were similar, except for 1 study in which MDI was significantly shorter. 3. Adjunctive SGI plus MI and subgingival tissue treatment result in similar clinical outcomes when compared to MI alone. 4. If study data are to be effectively and analytically combined to facilitate meaningful comparisons of treatment outcomes, detailed and standardized study designs must be developed and used consistently in clinical trials.
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Affiliation(s)
- William W Hallmon
- Department of Periodontics, Texas A&M University System Health Science Center-Baylor College of Dentistry, Dallas, Texas, USA.
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Abstract
The purpose of this paper is to provide an overview of the role of periodontal maintenance procedures in the treatment of periodontal diseases. Reliance on this position paper in patient management will not guarantee a successful outcome, as periodontal diseases typically involve complex causes and symptoms. Ultimately, decisions regarding the diagnosis, treatment, and management of disease, as well as subsequent preventive therapy, must be made by the treating practitioner based on specific circumstances presented by the patient.
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