Factors associated with the performance and achieving goals of specialized periodontal procedures in Brazilian dental specialties centers.

BACKGROUND: The Brazilian Dental Specialty Centers (CEO, in Portuguese) represent the strategy of the National Oral Health Policy to provide secondary-level dental care. They offer more complex procedures, such as the treatment of periodontitis. This study aims to investigate the factors associated with the performance and the achievement goals of specialized procedures and the achievement gols of periodontics in CEO. METHODOLOGY: Analytical and cross-sectional study using secondary data. The database of the second cycle of the External Evaluation of the National Program for Improving Access and Quality in CEO (PMAQ-CEO, in Portuguese), was utilized, which assessed 1,042 CEO on-site in 2018. The data were analyzed using multiple Poisson regression, estimating the prevalence ratio (PR) (p < 0.05). RESULTS: A third of the CEO (n = 305) performed all specialized procedures, with a higher prevalence observed in those with more than one bicarbonate jet prophylaxis unit (RP = 2.12; 95% CI: 1.160-3.881; p = 0.015) and when they had a higher percentage of specialist professionals (RP = 1.004; 95% CI: 1.002-1.006; p < 0.001). The periodontics goal was achieved by 617 (59.2%) CEO, with a higher prevalence among those who had a manager with supplementary training (PR = 1.21; 95% CI: 1.100-1.335; p < 0.001) and with a higher workload for the periodontist dentist (PR = 1.15; 95% CI: 1.103-1.201; p < 0,001). CONCLUSION: Although most CEOs do not perform allspecialized periodontics procedures, more than half achieved the established goals. The provision of specialized periodontics services in CEO and the achievement of goals are influenced by the quantity and professional qualifications, as well as the availability of equipment.

Importance of periodontal phenotype in periodontics and restorative dentistry: a systematic review.

BACKGROUND: Periodontal phenotype is regarded to be one of the key factors influencing the efficacy of restorative therapies in dental practice. The objective of the systematic review was to explore the importance of thin and thick periodontal phenotypes and how they affect the outcome of periodontal and restorative therapies by looking at a number of academic publications from various online databases. METHODS: Following the PRISMA guidelines (Preferred Reporting Items for Systematic Review standards), relevant data will be searched and retrieved from three significant scientific databases, including PubMed, EBSCO, and Scopus. The articles with full texts that matched the keywords and published in English between 2018 and 2023 were taken into consideration. RESULTS: The majorities of these articles were based on the type of periodontal phenotype and their impact on periodontal and restorative treatment outcomes were selected. The initial search yielded a total of 530 articles. Only 273 were relevant to the review's objectives, and these were considered for determining eligibility. Only 20 publications were eligible for analysis. CONCLUSION: Understanding these anatomical aspects of periodontal phenotype is crucial to both periodontology and restorative dentistry. The clinical outcome of restorative, prosthetic, orthodontic, surgical, and periodontal therapies is determined in large part by the periodontal phenotype, which also plays a significant role in clinical failure or success in dental treatments. TRIAL REGISTRATION: This study protocol registered with the International Prospective Register of Systematic Reviews (PROSPERO) dated 16th June 2023 with the registration ID CRD42023432568.

Multiplicative effect of stress and poor sleep quality on periodontitis: A university-based cross-sectional study.

BACKGROUND: The aim of this study was to evaluate the association of perceived stress and poor sleep quality with periodontitis in a university-based cohort of individuals. METHODS: A total of 235 individuals were included in this cross-sectional study. Perceived stress and sleep quality were evaluated through validated questionnaires, while periodontitis was identified with a full-mouth periodontal examination protocol using both European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) and Centers for Disease Control and Prevention (CDC)/AAP case definitions. Simple and multiple linear and ordinal logistic regression analyses were performed to evaluate the association between perceived stress and sleep quality with periodontitis prevalence and severity. RESULTS: Stage III/IV periodontitis resulted associated with both moderate/high perceived stress (odds ratio [OR] = 5.4; 95% confidence interval [CI]: 2.2-13.5; p < 0.001) and poor sleep quality (OR = 3.0; 95% CI: 1.2-7.4; p < 0.05). The interaction between moderate/high perceived stress and poor sleep quality presented a multiplicative association with stage III/IV periodontitis (EFP/AAP; OR = 5.8; 95% CI: 1.6-21.3; p < 0.001). Multiple linear regression analyses indicated a similar trend of association also with linear periodontal parameters, that is, mean clinical attachment level (CAL) and mean probing pocket depth (PPD). CONCLUSIONS: The findings from the present study suggest that stress and poor sleep quality may exert a multiplicative effect on periodontitis prevalence and severity.

Ibero-Panamerican Federation of Periodontology Delphi study on the trends of periodontology and periodontics by the year 2030. A Latin American consensus.

BACKGROUND AND OBJECTIVE: As elsewhere in the world, the prevalence of periodontitis in stages I-II is high in the Latin American population, this scenario emphasizes the need for identification of urgent needs for allocating adequate resources to provide diagnosis, prevention, and treatment of these diseases. The aim of this Delphi study was to predict the trends in periodontology/periodontics in the Latin American region by the year 2030. METHODS: A steering committee and an advisory group of experts in periodontology/periodontics were selected from 16 countries. An open questionnaire of 60 questions was validated and used following the Delphi methodology. RESULTS: Two hundred and twenty-five experts from Latin America answered the two rounds of the questionnaire. Moderate to strong consensus was reached on 45 questions (75%). The prediction was that the prevalence of gingivitis and periodontitis in stages I and II will be maintained, the importance of the link with systemic diseases will increase, and the impact of prevention and periodontal treatment will also increase, mainly in the private sector. There was a strong consensus that plastic and regenerative surgical procedures will increase, as well as the demand for training in the specialty of periodontology. CONCLUSIONS: The present study has provided relevant and useful information on predictions in periodontology/periodontics in Latin America, with important level of consensus among experts. It has been predicted that periodontitis will still be a highly prevalent disease, and its links with other medical conditions should demand more attention by health authorities to develop adequate prevention and management policies and strategies.

[Review on the development of periodontology in China].

Chinese Journal of Stomatology has gone through 70 years of ups and downs, witnessing the development of periodontics in China from a faltering start to twists and turns, and finally innovative development. This article aims to review the periodontology-related papers published in the Chinese Journal of Stomatology. Based on the characteristics of the times, they are summarized into five stages: staggering start, forced stagnation, vigorous development, standardized innovation, and disciplinary integration. Researches on periodontal diseases in China initially focused on learning and reference, gradually caught up with the international level, and finally created in-depth insights and innovations. Eventually, Chinese periodontology has formed a research system with Chinese characteristics and achieved substantial achievements in clinical diagnosis and treatment, basic research, periodontal medicine, and disciplinary integration. Although the current status of Chinese periodontology still lags behind that of developed countries, these representative studies demonstrate the unremitting efforts and hard work of periodontists for generations, laying a solid foundation for the innovation and development of periodontology in our country.

[Interpretation of the European Federation of Periodontology S3 level clinical practice guideline for prevention and treatment of peri-implant diseases].

The S3 level clinical practice guideline for the prevention and treatment of peri-implant diseases, developed by the European Federation of Periodontology, was published in June, 2023 (DOI: 10.1111/jcpe.13823), which culminated in the recommendations for implementation of various different interventions before, during and after implant placement/loading. Aim of the present article is to summarize and interpret the key points of this guideline and help clinicians understand this guideline better, in order to standardize the prevention and treatment of peri-implant diseases.

Assessment of suturing and scaling skills of periodontology and oral medicine residents by OSATS method: a pilot study.

INTRODUCTION: Updating the method for evaluating suturing and scaling skills in dental education has attracted relatively little attention and there is no consensus to what should be assessed and how. The purpose of this study was to investigate the applicability of the Objective Structured Assessment of Technical Skill (OSATS) method for these two basic skills, the possible association between the scores and demographic factors, and the level of satisfaction of residents with this method. METHODS: All six periodontics and three oral medicine residents were recruited by census method and video-recorded while performing a simple interrupted suture, a figure eight suture and scaling on a model. Then, the videos were evaluated independently via a checklist and a global rating scale (GRS) by two expert raters. Agreement between raters and residents' satisfaction were evaluated. Correlation between demographic factors of participants and scores was also assessed. T-test and linear regression analysis were used. RESULTS: There was no significant difference between the scores based on the views of the two raters for each of the checklist (ICC = 0.99, CI = 0.96-0.99, P < 0.001) and GRS (ICC = 0.97, CI = 0.86-0.99, P < 0.001). Linear regression showed no correlation between gender and scores but periodontics major and higher year of education showed correlation with higher scores. CONCLUSION: Considering the excellent agreement between raters in using both the checklist and GRS components of OSATS, and satisfaction of 88% the residents with this method, it seems to be able to provide a reliable assessment.

Evaluation of the Effect of Surgical Experience Level on the Success of the Coronally Advanced Flap (CAF) Technique.

PURPOSE: To investigate the effects of experience level on the clinical and esthetic results of coronally advanced flap (CAF) surgery. MATERIAL AND METHODS: A postgraduate student's first 40 CAF operations in the periodontology residency program were followed. The Miller Class I gingival recessions were divided into four chronologic groups (n: 10 in each). Clinical and esthetic evaluations were performed at baseline and after 6 months. The results of chronologic intervals were statistically compared. RESULTS: While the overall mean root coverage (RC) percentage was 73.6% and the complete RC was 60%, the mean RC percentages of the groups, respectively, were 45%, 55%, 86%, and 95%, showing that the mean and complete RC percentage increased as the experience level increased (P < .05). Similarly, as the experience level increased, closure of the gingival recession depth and width and esthetic scores increased, while the surgical time decreased significantly (P < .05). Complications were observed in three patients during the first interval and in two patients during the second interval, while no complications were observed in the other groups. CONCLUSIONS: This study showed that experience level can significantly affect the clinical and esthetic outcomes, operative time, and complication rates of CAF surgery. All education programs should determine how many of each surgical procedure residents must perform before they are considered experienced or expert surgeons who can work independently and predictably achieve safe, acceptable outcomes.

Periodontists' perceptions and attitudes toward the use of social media for professional purposes in Saudi Arabia.

BACKGROUND: There is a notable increase in the usage of social media platforms, especially for health communication, as more clinicians and patients count on this kind of technology. Therefore, this research aimed to investigate the perception and attitude toward social media (SM) use for professionalism and dental practice promotion among periodontal specialists working in Saudi Arabia (KSA). METHODS: Electronic surveys were distributed in person or online using WhatsApp, Snapchat or Email from October 2022 until March 2023. The questionnaire was targeting periodontists in KSA, and it consists of three parts: the first part includes sociodemographic and professional data; the second part asks about the daily usage of SM in dental practice; and the third part asks about the periodontist's opinion about SM usage. Descriptive data were presented as numbers and percentages. The association between the demographic variables and the means of periodontists' opinions was tested using Pearson's chi-square test. Any value equal to or less than 0.05 was considered statistically significant. RESULTS: A total of 121 responses were received from the periodontists. Most of the participants were in the 36-45 age group, with a percentage of 40.5%. In terms of gender, males made up 52.9% of the population, while females made up 47.1%, and the majority of the participants were consultants. The most common SM platform used by periodontists for daily using and dental practice promotion was Snapchat (56.2%), followed by Instagram and Twitter (54.5% and 49.6%, respectively). There was a significant difference in proportions among Twitter, Snapchat and TikTok between older and younger periodontists, with a p value < 0.05. There was no significant difference between the gender of the participants and their opinions regarding the usage of SM. CONCLUSIONS: This study highlighted the effectiveness of SM in the promotion of dental practices and the discipline of periodontics, as more clinicians and patients rely on this kind of technology. These online platforms can improve periodontal practice in terms of dental health education, counseling, advertising, and oral health services.

Influence of decision-making algorithms on the diagnostic accuracy using the current classification of periodontal diseases-a randomized controlled trial.

OBJECTIVES: To examine the influence of the decision-making algorithms published by Tonetti and Sanz in 2019 on the diagnostic accuracy in two differently experienced groups of dental students using the current classification of periodontal diseases. MATERIALS AND METHODS: Eighty-three students of two different clinical experience levels were randomly allocated to control and study group, receiving the staging and grading matrix, resulting in four subgroups. All diagnosed two patient cases with corresponding periodontal charts, panoramic radiographs, and intraoral photographs. Both presented severe periodontal disease (stage III, grade C) but considerably differed in complexity and phenotype according to the current classification of periodontal diseases. Controls received the staging and grading matrix published within the classification, while study groups were additionally provided with decision-trees published by Tonetti and Sanz. Obtained data was analyzed using chi-square test, Spearman's rank correlation, and logistic regression. RESULTS: Using the algorithms significantly enhanced the diagnostic accuracy in staging (p = 0.001*, OR = 4.425) and grading (p < 0.001**, OR = 30.303) regardless of the clinical experience. In addition, even compared to the more experienced control, less experienced students using algorithms showed significantly higher accuracy in grading (p = 0.020*). No influence on the criteria extent could be observed comparing study groups to controls. CONCLUSION: The decision-making algorithms may enhance diagnostic accuracy in dental students using the current classification of periodontal diseases. CLINICAL RELEVANCE: The investigated decision-making algorithms significantly increased the diagnostic accuracy of differently experienced under graduated dental students and might be beneficial in periodontal education.

Advances in antimicrobial hydrogels for dental tissue engineering: regenerative strategies for endodontics and periodontics.

Dental tissue infections have been affecting millions of patients globally leading to pain, severe tissue damage, or even tooth loss. Commercial sterilizers may not be adequate to prevent frequent dental infections. Antimicrobial hydrogels have been introduced as an effective therapeutic strategy for endodontics and periodontics since they have the capability of imitating the native extracellular matrix of soft tissues. Hydrogel networks are considered excellent drug delivery platforms due to their high-water retention capacity. In this regard, drugs or nanoparticles can be incorporated into the hydrogels to endow antimicrobial properties as well as to improve their regenerative potential, once biocompatibility criteria are met avoiding high dosages. Herein, novel antimicrobial hydrogel formulations were discussed for the first time in the scope of endodontics and periodontics. Such hydrogels seem outstanding candidates especially when designed not only as simple volume fillers but also as smart biomaterials with condition-specific adaptability within the dynamic microenvironment of the defect site. Multifunctional hydrogels play a pivotal role against infections, inflammation, oxidative stress, etc. along the way of dental regeneration. Modern techniques (e.g., 3D and 4D-printing) hold promise to develop the next generation of antimicrobial hydrogels together with their limitations such as infeasibility of implantation.

Discriminant validity of the current gingivitis classification in adolescents: a cohort study.

OBJECTIVES: To compare the prevalence of gingivitis estimated by the 2018 European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) classification with the other case definitions and assess the ability of this classification system in discriminating sociodemographic and clinical factors associated with the presence of gingivitis in a cohort study. MATERIALS AND METHODS: A multistage random sample of 1134 12-year-old adolescents was submitted to a full-mouth examination according to the Community Periodontal Index. Socioeconomic and clinical variables were collected at baseline. Gingivitis was considered according to the following criteria: (a) ≥ 10% of bleeding sites (the 2018 EFP/AAP criteria); (b) ≥ 15% of bleeding sites; and (c) the mean full-mouth bleeding sites. Adjusted multilevel Poisson regression assessed the association between independent variables at baseline and each definition of gingivitis at 2-year follow-up. RESULTS: Seven hundred forty-two 14-year-old adolescents were re-revaluated at follow-up. The prevalence of gingivitis was 28.7% according to 10% of bleeding threshold. The 2018 EFP/AAP criteria and other definitions showed higher prevalence and mean of gingivitis for low-household income adolescents and for those with higher levels of dental plaque and untreated dental caries. Nonetheless, the highest strengths of association were observed for the threshold of ≥ 15% of bleeding sites. CONCLUSION: The 2018 EFP/AAP case definition of gingivitis showed a similar discriminant validity compared to the 15% threshold and the mean full-mouth bleeding sites. CLINICAL RELEVANCE: The 2018 EFP/AAP classification allows the discrimination of important risk factors and should be used for the establishment of priorities for large-scale therapeutic programs.

Prevalence of Radiographic Alveolar Bone Loss as a Function of Age in the Periodontics Clinic Population at the College of Dentistry, King Saud University, Riyadh, Saudi Arabia.

PURPOSE: The purpose of the present observational study was to assess the prevalence of radiographic alveolar bone loss (ABL) as a function of age at the Periodontics Clinics at the College of Dentistry, King Saud University, Riyadh, Saudi Arabia. MATERIALS AND METHODS: Medical and dental healthcare records of individuals visiting the Periodontics Clinics at College of Dentistry, King Saud University, Riyadh Saudi Arabia were assessed. The following information was retrieved: age, gender, educational status, and systemic diseases (diabetes mellitus [DM], hypertension, osteoporosis and obesity). Digital full-mouth radiographs were retrieved from patients' dental records, and marginal bone loss (MBL) was assessed on the mesial and distal surfaces of all teeth. Logistic regression analyses (LRA) were done to assess the correlation between ABL and gender, age, educational status and duration since diagnosis of the aforementioned systemic conditions. p < 0.05 was considered statistically significant. RESULTS: In total, medical and periodontal healthcare records of 495 individuals were retrieved and assessed. All individuals were citizens of the KSA. Among these, 107 were healthy controls and 98, 95, 96 and 99 individuals had a medical diagnosis of type-2 DM, hypertension, obesity and osteoporosis, respectively. There was no statistically significant difference in the mean age and gender of all medically compromised participants. The prevalence of mild, moderate, and severe periodontitis in the total patient population was 51.4%, 37.5% and 36.5%, respectively. Among all healthy controls, the prevalence of mild, moderate, and severe periodontitis was 16.3%, 25.5% and 33.4%, respectively. There was no difference in the prevalence of mild, moderate, and severe periodontitis in relation to advancing age in the entire patient population. CONCLUSION: Advancing age did not seem to affect ABL in the present patient population. Patient education, oral hygiene maintenance and SES seem to be more predictable indicators of ABL than increasing age.

Evaluation of Endo Perio Lesions Using Cone Beam Computed Tomography (CBCT) - A Cross Sectional Study.

An accurate assessment of the disease extent and lesion size is needed for appropriate therapy decisions of endodontic-periodontic (endo-perio) lesions. CBCT imaging with less radiation and high spatial resolution can provide a comprehensive evaluation of endo-perio lesions. A total of 71 teeth with endo-perio lesions were assessed using CBCT. Periodontal bone defects were studied for bone loss pattern (horizontal/vertical) along with bone loss levels on mesial and distal sides in association with furcation involvement. The periapical lesions were studied for their prevalence and extent based on CBCT PAI Score. Horizontal and vertical bone loss were detected in 54 teeth (76.1%) and 17 teeth (23.95%), respectively. Mean crestal bone loss levels on mesial and distal aspects were 4.80 ± 3.21 mm and 5.74 ± 3.91 mm, respectively. The mean height, width, and depth of furcation defects were 3.19 ± 2.99 mm, 1.94 ± 0.98 mm, and 4.44 ± 1.92 mm, respectively. Periapical lesions were recorded in 55 teeth (77.5%). A CBCT PAI score of 5 was scored in 35 teeth with a mean lesion diameter of 11.3 ± 2.83 mm, while 16 teeth had healthy periapical tissues (scores of 0 and 1). CBCT is a valuable diagnostic tool that can help assess endo-perio lesions by providing morphometric measurements of periodontal bone defects and the extent of associated periapical lesions.

Dental Diode Lasers for Implant Uncovering: A Case Series.

Diode lasers are increasingly being utilized as an alternative to conventional soft tissue surgery. Diode lasers originally referred to wavelengths ranging from 810 to 980 nm, but a visible diode laser with a 445-nm wavelength has emerged as an additional wavelength for soft tissue surgery. The goal of this case series was to demonstrate the clinical results of both visible and near-infrared (NIR) wavelengths when utilized for stage-two implant surgery. Ten patients with 23 implants were treated at Stony Brook University, Department of Periodontology, for implant uncovering using both visible and nonvisible (NIR) diode lasers. The uncovering was performed utilizing 445-, 970-, and 980-nm wavelengths at a power setting of 2 W in either continuous or pulsed modes. The fiberoptic tips were initiated using blue articulating paper. Either topical benzocaine or infiltration anesthesia was utilized prior to soft tissue removal with the initiated tip. All patients healed uneventfully without any postoperative complications. Visible and NIR diode lasers provide an alternative and safe method to uncover submerged implants at stage-two surgery.

Assessing the surveillance use of 2018 EFP/AAP classification of periodontitis: A validation study and clustering analysis.

BACKGROUND: The performance of the 2018 European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) classification of periodontitis for epidemiology surveillance purposes remains to be investigated. This study assessed the surveillance use of the 2018 EFP/AAP classification and its agreement with the unsupervised clustering method compared with the 2012 Centers for Disease Control and Prevention(CDC)/AAP case definition. METHODS: Participants (n = 9424) in the National Health and Nutrition Examination Survey (NHANES) were staged by the 2018 EFP/AAP classification and classified into subgroups via k-medoids clustering. Concordance levels between periodontitis definitions and the clustering method were evaluated through the multiclass area under the receiver operating characteristic curve (multiclass AUC) among "periodontitis cases" and the general population, respectively. The multiclass AUC of the 2012 CDC/AAP definition versus clustering was used as a reference. The associations of periodontitis with chronic diseases were estimated using multivariable logistic regression. RESULTS: All the participants were identified as "periodontitis cases" by the 2018 EFP/AAP classification, and the prevalence of stage III-IV was 30%. The optimal numbers of clusters were three and four. The 2012 CDC/AAP definition versus clustering yielded a multiclass AUC of 0.82 and 0.85 among the general population and "periodontitis cases," respectively. The multiclass AUC of the 2018 EFP/AAP classification versus clustering was 0.77 and 0.78 for different target populations. Similar patterns prevailed in associations with chronic diseases between the 2018 EFP/AAP classification and clustering. CONCLUSIONS: The validity of the 2018 EFP/AAP classification was verified by the unsupervised clustering method, which performed better in distinguishing "periodontitis cases" than classifying the general population. For surveillance purposes, the 2012 CDC/AAP definition showed a higher agreement level with the clustering method than the 2018 EFP/AAP classification.