RESUMO
BACKGROUND: The aim of this randomized clinical trial was to compare a flapless technique of alveolar ridge preservation (ARP) to a flap technique to determine if preserving the periosteal blood supply would limit loss of crestal ridge width and height. METHODS: Twenty-four patients were randomly assigned to receive ARP using either a flapless or flap technique. Sockets were grafted with demineralized bone matrix and mineralized particulate allograft then covered with a barrier in both groups. Re-entry was performed at 4 months to obtain samples for histological analysis and subsequent implant placement. RESULTS: Ridge width of the flapless group at the crest decreased from 8.3 ± 1.3 mm to 7.0 ± 1.9 mm for a mean loss of 1.3 ± 0.9 mm (p < 0.05), whereas the flap group decreased from 8.5 ± 1.5 mm to 7.5 ± 1.5 mm for a mean loss of 1.0 ± 1.1 mm (p < 0.05). The mean midbuccal vertical change for the flap group was a loss of 0.9 ± 1.3 mm (p < 0.05) versus 0.5 ± 0.9 mm (p < 0.05) for the flapless group. There was no statistically significant difference between the groups. Histologically, flapless ARP revealed more vital mineralized tissue (44 ± 10%) compared to the flap group (p>0.05). In the flapless group, the occlusal soft tissue was significantly thicker than in the flap group at the 4-month re-entry (p< 0.05). CONCLUSIONS: Crestal ridge width, height, and percentage of vital mineralized bone following treatment with a flapless ARP technique, was not significantly different from a flap technique.
Assuntos
Perda do Osso Alveolar , Aumento do Rebordo Alveolar , Humanos , Processo Alveolar/cirurgia , Alvéolo Dental/cirurgia , Retalhos Cirúrgicos/cirurgia , Extração Dentária , Aumento do Rebordo Alveolar/métodos , Perda do Osso Alveolar/cirurgiaRESUMO
BACKGROUND: Clinicians predominantly use personal judgment for risk assessment. Periodontal risk assessment tools (PRATs) provide an effective and logical system to stratify patients based on their individual treatment needs. This retrospective longitudinal study aimed to validate the association of different risk categories of four PRATs (Staging and grading; Periodontal Risk Assessment (PRA); Periodontal Risk Calculator; and PerioRisk) with periodontal related tooth loss (TLP), and to compare their prognostic performance. METHODS: Data on medical history, smoking status, and clinical periodontal parameters were retrieved from patients who received surgical and non-surgical periodontal treatment. A comparison of the rate of TLP and non-periodontal related tooth loss (TLO) within the risk tool classes were performed by means of Kruskal-Wallis test followed by post-hoc comparison with the Bonferroni test. Both univariate and multivariate Cox Proportional hazard regression models were built to analyze the prognostic significance for each single risk assessment tool class on TLP. RESULTS: A total of 167 patients with 4321 teeth followed up for a mean period of 26 years were assigned to four PRATs. PerioRisk class 5 had a hazard ratio of 18.43, Stage 4 had a hazard ratio of 7.99, and PRA class 3 had a hazard ratio of 6.13 compared with class/stage I. With respect to prognostic performance, PerioRisk tool demonstrated the best discrimination and model fit followed by PRA. CONCLUSION: All PRATs displayed very good predictive capability of TLP. PerioRisk showed the best discrimination and model fit, followed by PRA.
Assuntos
Periodontite , Perda de Dente , Humanos , Estudos Longitudinais , Periodontite/terapia , Prognóstico , Estudos Retrospectivos , Medição de RiscoRESUMO
BACKGROUND: The British Society of Periodontology (BSP) implemented a simplified version of the 2017 World Workshop Classification (WWC) on staging and grading of periodontitis, for use in UK clinical practice. The aim of this study was to assess the long-term (>10 years) prognostic capability of BSP's implementation (BSP-i) compared with the 2017 WWC, using periodontal-related tooth loss (TLP) as a disease outcome. METHODS: Data on medical history, smoking status, and clinical periodontal parameters were retrieved from 270 patients who received non-surgical and surgical periodontal therapy from 1966 to 2007. Each patient received a baseline diagnosis according to the 2017 WWC and the BSP-i guidelines for implementation. Univariate multilevel Cox regression frailty models were performed to analyze the association between variables with TLP. A post-hoc comparison with Bonferroni correction was performed to analyze interclass comparisons. The prognostic performance of both systems was analyzed using Harrell C index. RESULTS: The prognostic performance of both systems was very similar (0.922 for the 2017 WWC and 0.925 for the BSP-i). The singular prognostic performance of BSP stage was slightly higher than that of 2017 WWC stage (0.9212 versus 0.9188), while the 2017 WWC grade showed a slightly better performance than BSP grade (0.9175 versus 0.9155). BSP-i's extent performed better than the 2017 WWC extent (0.9203 versus 0.9098); however, in the 2017 WWC extent, the class "localized" was associated with a better prognosis than "generalized." CONCLUSION: The overall prognostic performance of the two systems was excellent, with both systems having a Harrell C index score of >0.92.
Assuntos
Periodontite , Perda de Dente , Humanos , Periodontia , Periodontite/complicações , PrognósticoRESUMO
BACKGROUND: A new periodontitis classification was recently introduced involving multidimensional staging and grading. The aim of the study was to assess if individuals well-trained in periodontics consistently used the new classification for patients with severe periodontitis. The secondary goal was to identify "gray zones" related to classifications. METHODS: Participants (raters) individually classified 10 pre-selected severe periodontitis cases using the 2017 World Workshop classification. An internet case-based study was conducted after inviting members from American Academy of Periodontology and European Federation of Periodontology. Gold-standard diagnoses were determined by five experts who developed the new periodontitis classification. Inter-reliability agreement among raters was assessed using Fleiss Kappa index with the jackknife method for linearly weighted kappa calculations. McNemar test was used to determine symmetry between raters and gold-standard panel. RESULTS: A total of 103 raters participated and classified nine clinical cases. Fleiss Kappa values showed moderate inter-examiner consistency among raters for stage (K value: 0.49; 95% CI, 0.19 to 0.79), grade (K value: 0.50; 95% CI, 0.30 to 0.70) and extent (K value: 0.51; 95% CI, 0.23 to 0.77). When analyzed as composite (stage, grade, extent) a moderate inter-reliability was present among raters, k = 0.479 (K value: 0.47; 95% CI, 0.442 to 0.515). Agreement between raters and gold-standard panel was staging 76.6%; grading 82%; and extent 84.8%. In six of nine cases 77% to 99% of raters consistently agreed with gold-standard panel, and the other three cases had gray zone factors that reduced rater consistency. CONCLUSIONS: Clinicians trained in the 2017 World Workshop periodontitis classification demonstrated moderate concordance in classifying nine severe periodontitis cases, and in six of nine cases raters consistently agreed with the gold-standard panel.
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Periodontite , Humanos , Periodontia , Periodontite/diagnóstico , Reprodutibilidade dos TestesRESUMO
AIM: Tooth-level prognostic systems can be used for treatment planning and risk assessment. This retrospective longitudinal study aimed to evaluate the prognostic performance of 10 different tooth-level risk assessment systems in terms of their ability to predict periodontal-related tooth loss (TLP). MATERIALS AND METHODS: Data were retrieved retrospectively from patients who received surgical and non-surgical periodontal treatment. Data on medical history and smoking status at baseline and the last maintenance visit were collected. Ten tooth-level prognostic systems were compared using both univariate and multivariate Cox proportional hazard regression models to analyse the prognostic capability of each system for predicting TLP risk. RESULTS: One-hundred and forty-eight patients with 3787 teeth, followed-up for a mean period of 26.5 ± 7.4 years, were evaluated according to 10 different tooth-level prognostic systems, making up a total of 37,870 individual measurements. All compared prognostic systems were able to stratify the risk of TLP at baseline when different classes of association were compared. After controlling for maintenance, age, and gender, all systems exhibited excellent predictive capacity for TLP with no system scoring a Harrell's C-index less than 0.925. CONCLUSIONS: All tooth-level prognostic systems displayed excellent predictive capability for TLP. Overall, the Miller and McEntire system may have shown the best discrimination and model fit, followed by the Nunn et al. system.
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Periodontite , Perda de Dente , Humanos , Estudos Longitudinais , Prognóstico , Estudos RetrospectivosRESUMO
Bleeding on probing (BOP) is regarded as an indispensable diagnostic tool for evaluating periodontal disease activity; however, its role in peri-implant disease is more intricate. Much of the confusion about the interpretation originates from drawing parallels between periodontal and peri-implant conditions. BOP can originate from two forms of probing in implants: traumatic or pathologic induction. This, in addition to the dichotomous scale of BOP can complicate diagnosis. The objective of this commentary is to discuss the following: 1) the value of BOP as a diagnostic tool for peri-implant diseases; 2) the reasons it should be distinct from value for diagnosing periodontal and peri-implant diseases; and 3) the current best evidence on how to implement it in daily clinical practice. A comprehensive bleeding index is proposed for evaluating and monitoring peri-implant conditions. BOP should be used in addition to other parameters such as visual signs of inflammation, probing depth, and progressive bone loss before a peri-implant diagnosis is established.
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Implantes Dentários , Peri-Implantite , Implantes Dentários/efeitos adversos , Humanos , Inflamação , Peri-Implantite/diagnóstico , Índice PeriodontalRESUMO
AIM: To develop and internally validate a nomogram built on a multivariate prediction model including parameters from the new classification of periodontal diseases, able to predict, at baseline, the occurrence of tooth loss due to periodontal reason (TLP). MATERIALS AND METHODS: A total of 315 individuals diagnosed with periodontal disease and receiving a minimum of one annual supportive periodontal therapy visit were included in the study. Patients were staged and graded based upon baseline data. The population was divided into a development (254 patients) and a validation (61 patients) cohort to allow subsequent temporal validation of the model. According to the TLP at the 10-year follow-up, patients were categorized as "low tooth loss" (≤ 1 TLP) or "high tooth loss" (≥ 2 TLP). Bootstrap internal validation was performed on the whole data set to calculate an optimism-corrected estimate of performance. RESULTS: The generated nomogram showed a strong predictive capability (AUC = 0.81) and good calibration with an intercept = 0 and slope = 1. These findings were confirmed by internal validation using bootstrapping (average bootstrap AUC = 0.83). CONCLUSIONS: The clinical implementation of the present nomogram guides the prediction of patients with high risk of disease progression and subsequent tooth loss for personalized care.
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Periodontite , Perda de Dente , Estudos de Coortes , Humanos , Estudos Longitudinais , Nomogramas , Perda de Dente/etiologiaRESUMO
Twenty-six patients with a horizontal ridge defect were entered into this 4-month randomized, controlled, blinded clinical trial to compare a cancellous block allograft to a demineralized bone matrix (DBM) allograft for ridge augmentation. Six patients were excluded from the study, leaving 20 for data interpretation. Both groups had a xenograft overlay and a collagen membrane. For the Block group there was a significant gain of 4.8 ± 1.9 mm (P = .00002; 95% confidence interval [CI]: 3.49 to 6.21), while the DBM group gained 4.6 ± 2.4 mm (P = .0002; 95% CI: 2.88 to 6.36). Vertical change was minimal for both groups (P > .05). The Block group had a mean of 40% vital bone while the DBM group had 35%.
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Aumento do Rebordo Alveolar , Transplante Ósseo , Aloenxertos , Matriz Óssea , Humanos , Transplante HomólogoRESUMO
This editorial provides clarifications on the application of the Stage and Grade classification of periodontitis. In particular it describes: (1) how to apply the extent criterion to the defined Stage of the disease; and (2) how to calculate tooth loss because of periodontitis in Stage III and IV cases presenting with evidently hopeless (irrational to treat) teeth with a clinical definition of such teeth.
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Periodontite , Perda de Dente , Dente , HumanosRESUMO
This editorial provides clarifications on the application of the Stage and Grade classification of periodontitis. In particular it describes: (1) how to apply the extent criterion to the defined Stage of the disease; and (2) how to calculate tooth loss because of periodontitis in Stage III and IV cases presenting with evidently hopeless (irrational to treat) teeth with a clinical definition of such teeth.
Assuntos
Periodontite , Perda de Dente , Dente , HumanosRESUMO
Twenty patients completed this randomized, controlled, blinded clinical trial comparing ridge preservation with a bioabsorbable polylactic acid membrane (PLA group) compared to an acellular dermal matrix membrane guided bone regeneration (ADMG group). An intrasocket corticocancellous allograft plus a facial overlay xenograft was used for both groups. Final crestal ridge width was significantly greater for the ADMG group (P < .05). Soft tissue thickness, conversely, was thicker for the PLA group. Vertical ridge height change increased significantly for the midbuccal site of the ADMG group. Histologic evaluation showed high percentages of vital bone for both groups.
Assuntos
Aumento do Rebordo Alveolar , Regeneração Óssea , Transplante Ósseo , Humanos , Membranas Artificiais , Extração Dentária , Alvéolo Dental , CicatrizaçãoRESUMO
BACKGROUND: A new classification of periodontal diseases aimed to identify periodontal disease based on a multidimensional staging and grading system has been recently proposed. However, up to date, its prognostic predictive capability has not been investigated. The aim of this study was to assess if parameters included in the new classification were predictive of tooth loss after a long-term follow-up (>10 years) in patients with periodontitis. METHODS: Patients presented with periodontitis at the University of Michigan between January 1966 and January 2004 were screened and categorized according to the new classification of periodontitis. Number/Reasons of teeth loss in patients who underwent at least one session/year of maintenance during the entire follow-up period were extracted and used to analyze the prognostic capabilities of variables (staging, grading, and Extent) included in the new classification. RESULTS: A total number of 292 patients with a mean follow-up of 289.7 ± 79.6 months were included. 31 (10.6%) patients were classified as Stage 1, 85 (29.1%) as Stage 2, 146 (50%) as Stage 3, and 30 (10.3%) as Stage 4. For grading, 34 (11.7%) were classified as Grade A, 193 (66.1%) as Grade B, and 65 (22.2%) as Grade C. Results of multilevel Cox regression analyses revealed a statistically significant association between stage (HR:3.73 between Stage 4 and Stage 1) and grade (HR: 4.83 between Grade C and Grade A) at baseline and periodontal related tooth loss, whereas no differences were detected for the extent of periodontitis. CONCLUSION: This study provides the initial evidence regarding the predictive ability of the new classification of periodontitis. Patients in either Stage 4 or Grade C showed a significantly higher periodontal-related tooth loss.
Assuntos
Periodontite , Perda de Dente , Seguimentos , Humanos , Estudos Longitudinais , Prognóstico , Estudos RetrospectivosRESUMO
Twenty patients were randomly assigned to receive either a platform-switched or platform-matched implant to replace a single maxillary anterior tooth. Primary outcome variables were the implant interproximal bone loss, facial recession, and papilla fill at 12 months. The platform-switched group showed crestal bone loss of 0.1 ± 0.3 (mesial) and 0 mm (distal) while the platform-matched group showed losses of 0.6 ± 0.5 mm (mesial) and 0.7 ± 0.7 mm (distal) (P < .05). Facial recessions for the platform-switched and platform-matched groups were 0.1 ± 0.3 mm and 0.4 ± 0.8 mm, respectively.
Assuntos
Perda do Osso Alveolar , Implantes Dentários para Um Único Dente , Implantação Dentária Endóssea , Humanos , LasersRESUMO
Twenty-four patients completed this randomized, controlled, blinded clinical trial comparing ridge preservation with a membrane (acellular dermal matrix graft [ADMG]) vs no membrane on buccal overlay graft technique. An intrasocket corticocancellous allograft with a facial overlay xenograft was used for both groups, and an ADMG was used as a membrane with guided bone regeneration in the ADMG group (control group). In the No Membrane group (test group), ADMG was used to cover only the occlusal surface for graft containment, with no membrane on the buccal overlay graft. Final crestal ridge width and vertical ridge height had no significant difference between groups (P > .05). Facial contour was preserved for the ADMG group compared to No Membrane group. Histologic examination showed a high percentage of vital bone for both groups with no significant difference between groups.
Assuntos
Aumento do Rebordo Alveolar , Alvéolo Dental , Transplante Ósseo , Colágeno , Humanos , Membranas Artificiais , Extração DentáriaRESUMO
PURPOSE: The primary aim of this randomized, controlled, blinded, clinical trial was to compare a mix of particulate allograft and harvested autogenous particles (Autogenous) to an osteoinductive demineralized bone matrix (DBM) allograft on clinical and histologic outcomes for horizontal ridge augmentation procedure. MATERIALS AND METHODS: Fourteen patients with a horizontal ridge defect with at least 1 adjacent tooth were entered into this study. The test group of 7 subjects received corticocancellous particulate allograft (Mineross) mixed with autogenous bone chips (70:30) harvested using a bone scraper (SafeScraper TWIST). Seven subjects in the control group received DBM (Optecure-CCC). Both groups had a corticocancellous particulate allograft overlay and an acellular dermis membrane (ADMG) (AlloDerm GBR) to cover the grafts. RESULTS: For the Autogenous group, there was a gain of 3.5 ± 1.4 mm while the DBM group gained 3.8 ± 1.6 mm (P < 0.05). Vertical change was minimal for both groups (P > 0.05). The Autogenous group had a mean of 35% vital bone while the DBM had 39% (P > 0.05). CONCLUSIONS: Both treatments provided similar gain of ridge width and minimal loss of ridge height. The autogenous bone chips did not provide any additional benefit when compared with allograft alone that had lot verified osteoinductive activity.
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Aumento do Rebordo Alveolar , Transplante Ósseo , Aloenxertos , Matriz Óssea , HumanosRESUMO
Soft tissue augmentation procedures are becoming more popular these days. Different soft tissue graft harvesting approaches have been proposed. Nonetheless, the location of the donor site (whether anterior-, lateral-, superficial-, deep-palate or the maxillary tuberosity) can affect the graft shape and its composition. Soft tissue grafts from the maxillary tuberosity are rich in connective tissue fibers, with minimal presence of fatty or glandular components. Clinical, histological, and molecular evidence shows that a soft tissue graft obtained from the maxillary tuberosity has unique properties. In addition, harvesting from this area presents minimal risk for intra- or postoperative complications, leading to reduced patient morbidity. The aim of this commentary is to discuss the advantages and disadvantages of harvesting a soft tissue graft from the tuberosity and to compare it with the traditional palatal graft, while highlighting functional, esthetic, and patient-related outcomes.
Assuntos
Retração Gengival , Tecido Conjuntivo , Estética Dentária , Gengiva , Humanos , Maxila , PalatoRESUMO
Biologically guided implant therapy is based on the new periodontitis classification system recently released by the American Academy of Periodontology and the European Federation of Periodontology that uses staging and grading for the diagnosis of periodontitis. This paper proposes that periodontitis staging and grading should be used in dental implant therapy as a means to ensure maximum conservation of teeth and maximum preservation of alveolar bone. These biologic principles should guide the treatment planning process and supersede a mechanically based, restoratively driven rationale that should be secondary to the biologic principles of conservation and preservation but part of the collaborative treatment planning process. And treatment alternatives throughout the patient's lifetime should be provided for in case of prosthesis loss due to peri-implantitis. The use of grading will help with recognition of systemic aspects that can have a negative impact.
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Perda do Osso Alveolar , Implantes Dentários , Peri-Implantite , Periodontite , Dente , Humanos , PeriodontiaRESUMO
A new periodontitis classification scheme has been adopted, in which forms of the disease previously recognized as "chronic" or "aggressive" are now grouped under a single category ("periodontitis") and are further characterized based on a multi-dimensional staging and grading system. Staging is largely dependent upon the severity of disease at presentation as well as on the complexity of disease management, while grading provides supplemental information about biological features of the disease including a history-based analysis of the rate of periodontitis progression; assessment of the risk for further progression; analysis of possible poor outcomes of treatment; and assessment of the risk that the disease or its treatment may negatively affect the general health of the patient. Necrotizing periodontal diseases, whose characteristic clinical phenotype includes typical features (papilla necrosis, bleeding, and pain) and are associated with host immune response impairments, remain a distinct periodontitis category. Endodontic-periodontal lesions, defined by a pathological communication between the pulpal and periodontal tissues at a given tooth, occur in either an acute or a chronic form, and are classified according to signs and symptoms that have direct impact on their prognosis and treatment. Periodontal abscesses are defined as acute lesions characterized by localized accumulation of pus within the gingival wall of the periodontal pocket/sulcus, rapid tissue destruction and are associated with risk for systemic dissemination.
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Doenças Periodontais , Periodontite , Consenso , Humanos , Bolsa Periodontal , PeriodontoRESUMO
BACKGROUND: Authors were assigned the task to develop case definitions for periodontitis in the context of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. The aim of this manuscript is to review evidence and rationale for a revision of the current classification, to provide a framework for case definition that fully implicates state-of-the-art knowledge and can be adapted as new evidence emerges, and to suggest a case definition system that can be implemented in clinical practice, research and epidemiologic surveillance. METHODS: Evidence gathered in four commissioned reviews was analyzed and interpreted with special emphasis to changes with regards to the understanding available prior to the 1999 classification. Authors analyzed case definition systems employed for a variety of chronic diseases and identified key criteria for a classification/case definition of periodontitis. RESULTS: The manuscript discusses the merits of a periodontitis case definition system based on Staging and Grading and proposes a case definition framework. Stage I to IV of periodontitis is defined based on severity (primarily periodontal breakdown with reference to root length and periodontitis-associated tooth loss), complexity of management (pocket depth, infrabony defects, furcation involvement, tooth hypermobility, masticatory dysfunction) and additionally described as extent (localized or generalized). Grade of periodontitis is estimated with direct or indirect evidence of progression rate in three categories: slow, moderate and rapid progression (Grade A-C). Risk factor analysis is used as grade modifier. CONCLUSIONS: The paper describes a simple matrix based on stage and grade to appropriately define periodontitis in an individual patient. The proposed case definition extends beyond description based on severity to include characterization of biological features of the disease and represents a first step towards adoption of precision medicine concepts to the management of periodontitis. It also provides the necessary framework for introduction of biomarkers in diagnosis and prognosis.
Assuntos
Periodontite , Perda de Dente , Humanos , Fatores de RiscoRESUMO
A new periodontitis classification scheme has been adopted, in which forms of the disease previously recognized as "chronic" or "aggressive" are now grouped under a single category ("periodontitis") and are further characterized based on a multi-dimensional staging and grading system. Staging is largely dependent upon the severity of disease at presentation as well as on the complexity of disease management, while grading provides supplemental information about biological features of the disease including a history-based analysis of the rate of periodontitis progression; assessment of the risk for further progression; analysis of possible poor outcomes of treatment; and assessment of the risk that the disease or its treatment may negatively affect the general health of the patient. Necrotizing periodontal diseases, whose characteristic clinical phenotype includes typical features (papilla necrosis, bleeding, and pain) and are associated with host immune response impairments, remain a distinct periodontitis category. Endodontic-periodontal lesions, defined by a pathological communication between the pulpal and periodontal tissues at a given tooth, occur in either an acute or a chronic form, and are classified according to signs and symptoms that have direct impact on their prognosis and treatment. Periodontal abscesses are defined as acute lesions characterized by localized accumulation of pus within the gingival wall of the periodontal pocket/sulcus, rapid tissue destruction and are associated with risk for systemic dissemination.