Influence of fixed orthodontic steel retainers on gingival health and recessions of mandibular anterior teeth in an intact periodontium - a randomized, clinical controlled trial.

OBJECTIVE: Aim of this randomized clinical controlled trial was to evaluate the influence of fixed orthodontic steel retainers on gingival health and recessions of mandibular anterior teeth. MATERIALS AND METHODS: After end of the orthodontic treatment, patients were randomly assigned into the test (fixed steel retainer) or control group (modified removable vacuum-formed retainer). Periodontal parameters (periodontal probing depth: PPD; recession: REC; bleeding on probing: BOP) as well as plaque and gingival index were assessed on mandibular anterior teeth directly before attaching/handing over the retainer (baseline: BL), 6 and 12 months after orthodontic treatment. RESULTS: 37 patients (test: n = 15, mean age: 16.1±4.2 years; control: n = 17, mean age: 17.1±5.4 years) completed the study. REC and PPD failed to show significant pairwise differences. The number of patients showing gingival health in the area of the mandibular anterior teeth (test: BL n = 10, 6 months n = 9, 12 months n = 11; control: BL n = 10, 6 months n = 16, 12 months n = 15) revealed a significant difference for the intra-group comparison between BL and 6 months in the control group (p = 0.043). The inter-group comparisons failed to show significant differences. CONCLUSION: Young orthodontically treated patients with fixed steel retainers show in 73.3% healthy gingival conditions after one year which are comparable to the control group (88.2%). Gingival recessions were in a clinically non-relevant range at any time of the examination. CLINICAL TRIAL NUMBER: DRKS00016710.

Oral health-related quality of life and patient-reported outcome measures after 10 years of supportive periodontal care.

OBJECTIVE: The aim of this retrospective study was to evaluate the oral health-related quality of life (oHRQoL) and patient-reported outcome measures (PROMs) after 10 years of supportive periodontal care (SPC). MATERIAL AND METHODS: Patients were re-examined 120±12 months after active periodontal therapy. Dental and periodontal status and oHRQoL by completing Oral Health Impact Profile-G49 (OHIP-G49) and PROMs by marking a visual analogue scale (VAS) for self-perceived esthetics (VASe), chewing function (VASc), and hygiene ability (VASh) were assessed. Patient- and tooth-related factors (age, insurance status, number of SPC, compliance, change of therapist, smoking, tooth loss, need for surgery or antibiotic intake, bleeding on probing (BOP), periodontal inflamed surface area) influencing oHRQoL and PROMs were evaluated. RESULTS: One hundred eight periodontally compromised patients (59 female, mean age 65.4±10.7 years) lost 135 teeth during 10 years of SPC. At re-examination, 1.8% of all sites showed PPD ≥6mm. The mean OHIP-G49 sum score was 17.6±18.5, and VAS resulted in 76.0±22.5 (VASe), 86.3±16.3 (VASc), and 79.8±15.8 (VASh). Linear regression analyses identified a positive correlation with oHRQoL and/or PROMs for private insurance status (OHIP-G49, p=0.015, R2=0.204; VASc, p=0.005, R2=0.084; VASh, p=0.012, R2=0.222) and compliance to SPC (VASe, p=0.032; R2=0.204), as well as a negative correlation for active smoking (VASc, p=0.012, R2=0.084), increased BOP (VASh, p=0.029, R2=0.222) at the start of SPC, and number of lost molars (VASh, p=0.008, R2=0.222). CONCLUSION: It is realistic to obtain satisfactory oHRQoL and PROM values in most of the patients after 10 years of SPC. The identified factors may help to predict patient satisfaction in the long-term course of therapy. CLINICAL RELEVANCE: Systematic therapy of periodontally compromised patients provides values for oHRQoL and PROMs in a favorable range 10 years after therapy. This should encourage dentists to implement SPC in their daily routine. CLINICAL TRIAL NUMBER: NCT03048045.

Esthetic and clinical outcomes after immediate placement and restoration: Comparison of two implant systems in the anterior maxilla-A cross-sectional study.

AIM: To assess the esthetic and clinical performance of a novel self-tapping implant system for single-tooth restorations in the esthetic zone after immediate placement and provisionalization. MATERIALS AND METHODS: This cross-sectional study included 52 patients contributing a total of 52 immediately placed and restored implants with ≥12 months after functional loading, comparing two different implant systems: Straumann® BLX (Institut Straumann AG, Basel, Switzerland; 25 patients) and Ankylos® (Dentsply Sirona, Hanau, Germany; 27 patients). As the primary outcome measure, peri-implant tissue esthetics were assessed by means of pink esthetics score (PES) rated by three independent clinicians. Moreover, as secondary outcome measures, the peri-implant tissue health was assessed by means of bleeding on probing, probing depth, and suppuration. Apart from that, the modified plaque index, keratinized mucosa width, and the presence of mucosal recessions were also assessed. When clinical signs suggested the possibility of peri-implantitis, radiographs were indicated to assess progressive bone loss. RESULTS: The mean PES ratings were 12.10 ± 1.10 for Ankylos versus 11.2 ± 1.86 for BLX, both achieving good esthetic results without significant differences (p = 0.143). There were no differences among most clinical parameters (plaque, bleeding on probing, probing depth, peri-implant mucosal recession), although peri-implant mucositis was present in one-third of the cases. The inter-rater agreement on esthetics was not significant (p < 0.250). CONCLUSION: Within the limitations of the present study, it was concluded that the use of either BLX or Ankylos implant systems was associated to comparable peri-implant health and good pink esthetic outcomes during immediate implantation and restoration protocols, for at least 12 months.

Minimal periodontal basic care - no surgery, no antibiotics, low adherence. What can be expected? A retrospective data analysis.

OBJECTIVE: This retrospective study aimed to evaluate tooth loss and the evolution of periodontal inflammatory parameters within a strict nonsurgically treated patient cohort with < 2 supportive periodontal care visits per year, defined as minimal periodontal basic care, of 2.5 to 10.7 years. METHOD AND MATERIALS: Data for nonsurgically treated patients were checked for: complete periodontal examination data at baseline (T0), after active periodontal therapy (T1), and after ≥ 2.5 years of supportive periodontal care (T2); smoking, diabetes mellitus, age (at least 18 years), plaque and gingival indices, bleeding on probing, percentage of residual pockets, supportive periodontal care adherence, and number of supportive periodontal care visits were assessed as risk factors for tooth loss. RESULTS: In total, 132 patients were included (76 female, mean age 56.7 ± 10.3 years), mean T1-T2: 4.5 ± 1.6 years. 26.5% of all patients lost 118 teeth (0.5 teeth/patient, 0.12 teeth/patient/year). Plaque and bleeding parameters were: mean plaque control record, 59.77 ± 28.07%; mean Papilla Bleeding Index, 47.46 ± 34.12%; mean bleeding on probing, 33.46 ± 21.52%. Supportive periodontal care duration (P = .013) and T2 bleeding on probing (P = .048) were identified as patient-related risk factors for tooth loss. CONCLUSION: Minimal periodontal basic care was characterized by elevated bleeding on probing, Papilla Bleeding Index, and plaque control record scores. This possibly highlights a lack of consequent applied surgical intervention (if needed) transitioning into regular supportive periodontal care, including insufficient patient behavioral changes regarding domestic oral hygiene procedures and possibly nonaddressed proinflammatory dietary habits as a negative effect. An apparently low tooth loss rate could be observed. The duration of supportive periodontal care was identified as a risk factor for tooth loss.

Retrospective long-term analysis of tooth loss over 20 years in a specialist practice setting: Periodontally healthy/gingivitis and compromised patients.

OBJECTIVE: To assess tooth loss (TL) in initially periodontally healthy/gingivitis (PHG) and periodontally compromised (PC) individuals during a 15- to 25-year follow-up in a specialist practice and to identify the factors influencing TL. MATERIALS AND METHODS: Patients were re-examined 240 ± 60 months after active periodontal therapy (PC) or initial examination (PHG). PHG patients were periodontally healthy or had gingivitis, and PC patients exhibited at least stage II periodontitis. TL, patient-related outcomes, and risk factors for TL were assessed at the patient level (group-relation, gender, age, smoking, bleeding on probing, educational status, mean number of visits/year). RESULTS: Fifty-six PC patients receiving regular supportive periodontal care (12 female, mean age 49.1 ± 10.9 years, stage II: 10, stage III/IV: 46) lost 38 teeth (0.03 ± 0.05 teeth/year). Fifty-one PHG patients (23 female, mean age 34.5 ± 12.4 years) following regular oral prevention lost 39 teeth (0.04 ± 0.05 teeth/year) (p = .631). Both PC and PHG groups did not show any significant differences regarding visual analogue scale measurements [aesthetics (p = .309), chewing function (p = .362), hygiene (p = .989)] and overall Oral Health Impact Profile (p = .484). Age at the start of follow-up was identified as a risk factor for TL (p < .0001). CONCLUSION: PC and PHG patients exhibited similarly small TL rates over 240 ± 60 months, which should, however, be interpreted with caution in view of the group heterogeneity. Clinical trial number: DRKS00018840 (URL: https://drks.de).

Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivate for root coverage: 5-year results of an RCT using 3D digital measurement technology for volumetric comparison of soft tissue changes.

AIM: Comparison of the clinical efficacy (digitally volumetric, aesthetic, patient-centred outcomes) of tunnel technique (TUN) with subepithelial connective tissue graft (CTG) versus coronally advanced flap (CAF) with enamel matrix derivate (EMD) 5 years after gingival recession therapy. MATERIALS AND METHODS: In 18 patients contributing 36 RT1 recessions, study models were collected at baseline and follow-ups. Optical scans assessed recessions computer-assisted [recession depth, recession reduction (RECred), complete root coverage (CRC), percentage of root coverage (RC), pointwise (pTHK) and mean areal (aTHK) marginal soft tissue thickness]. Root coverage aesthetic Score (RES) was used for aesthetic evaluation and visual analogue scales for patient-centred data collection applied. RESULTS: Sixty months after surgery, 50.0% (TUN+CTG) and 0.0% (CAF+EMD) of sites showed CRC (p = 0.0118), 82.2% (TUN+CTG) and 32.0% (CAF+EMD) achieved RC, respectively (p = 0.0023). CTG achieved significantly better RECred (TUN+CTG: 1.75±0.74 mm; CAF+EMD: 0.50 ± 0.39 mm; p = 0.0009) and aTHK (TUN+CTG: 0.95 ± 0.41 mm; CAF+EMD: 0.26 ± 0.28 mm; p = 0.0013). RES showed superior outcomes (p = 0.0533) for TUN+CTG (6.86 ± 2.31) compared to CAF+EMD (4.63 ± 1.99). The study failed to find significant differences related to patient-centred outcomes (TUN+CTG: 8.30 ± 2.21; CAF+EMD: 7.50 ± 1.51; p = 0.1136). CONCLUSIONS: Five years after treatment, CTG resulted in better clinical and aesthetic outcomes than CAF+EMD. Increased THK was associated with improved outcomes for RECred and RC.

Five-Years Periodontal Outcomes of Early Removal of Unerupted Third Molars Referred for Orthodontic Purposes.

PURPOSE: The removal of third molars (M3) is one of the most common oral-maxillofacial surgical procedures affecting periodontal tissues of neighboring second molars (M2). The aim of this study was to evaluate the periodontal status of lower M2 following the removal of unerupted lower M3 up to 5 years after removal. PATIENTS AND METHODS: Primary predictor variable in this prospective cohort-study was time [baseline (BL; preoperatively), 6 and 60 months postoperatively]. The primary outcome variable was probing pocket depth (PPD). Clinical attachment level (CAL) was defined as a secondary outcome variable. Plaque index (PlI) and gingival index (GI) were assessed descriptively. All variables were compared using nonparametric tests. M3 were classified as either completely bony or partially bony unerupted. Risk factors (removed M3, type of impaction, mean BL PPD≥4 mm, gender, age) were analyzed (repeated measures ANCOVA). The significance level was set at 0.05. RESULTS: From originally 91 subjects enrolled in this study, 39 subjects (22 females; mean age: 21.6 ± 2.5 years) contributing 39 M3 completed the study after 5 years. Average BL PPD significantly decreased at 6 (-0.50 ± 0.61 mm, P = .001), 60 months (-0.81 ± 0.56, P < .0001), as well as between 6 and 60 months (-0.31 ± 0.51 mm, P = .030). Corresponding CAL values decreased accordingly (BL-6 months: -0.37 ± 0.59 mm, P = .004; BL-60 months: -0.67 ± 0.55 mm, P < .0001; 6 to 60 months: -0.34 ± 0.48 mm, P = .004). The was confirmed as risk factor for PPD (P = .026) and CAL (P = .042) changes. CONCLUSIONS: Average PPD and CAL of mandibular M2 in young subjects improved 5 years after early removal of unerupted M3 in favor of an initial partially bony unerupted type of impaction.

Retrospectively analysed tooth loss in periodontally compromised patients: Long-term results 10 years after active periodontal therapy-Patient-related outcomes.

BACKGROUND AND OBJECTIVE: Long-term tooth retention is the ultimate goal of periodontal therapy. Aim of this study was to evaluate tooth loss (TL) during 10 years of supportive periodontal therapy (SPT) in periodontal compromised patients and to identify factors influencing TL on patient level. MATERIAL AND METHODS: Patients were re-examined 120 ± 12 months after active periodontal therapy. TL and risk factors [smoking, initial diagnosis, SPT adherence, interleukin-1 polymorphism, cardiovascular diseases, age at baseline, bleeding on probing (BOP), change of practitioner, insurance status, number of SPT, marital and educational status] influencing TL on patient level were assessed. RESULTS: One-hundred patients (52 female, mean age 65.6 ± 11 years) lost 121 of 2428 teeth (1.21 teeth/patient; 0.12 teeth/patient/y) during 10 years of SPT. Forty-two of these were lost for periodontal reasons (0.42 teeth/patient; 0.04 teeth/patient/y). Significantly more teeth were lost due to other reasons (P < .001). Smoking, baseline severity of periodontitis, non-adherent SPT, positive interleukin-1 polymorphism, marital and educational status, private insurance, older age at baseline and BOP, small number of SPT were identified as patient-related risk factors for TL (P < .05). CONCLUSION: During 120 ± 12 months of SPT, only a small number of teeth was lost in periodontally compromised patients showing the positive effect of a well-established periodontal treatment concept. The remaining risk for TL should be considered using risk-adopted SPT allocation.

Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivate for root coverage: 2-year results of an RCT using 3D digital measuring for volumetric comparison of gingival dimensions.

AIM: The aim of this randomized clinical trial was to compare clinical and volumetric outcomes of tunnel technique (TUN) with subepithelial connective tissue graft (CTG) versus coronally advanced flap (CAF) with enamel matrix derivate (EMD) 2 years after gingival recession (GR) treatment. MATERIALS AND METHODS: Twenty-three patients contributed 45 Miller class I or II GR. At baseline and follow-up examinations, study models were collected. Their three-dimensional scans allowed precise computer-assisted measurement of recession depth (REC), complete root coverage (CRC), percentage of root coverage (RC), pointwise (pTHK) and mean areal (aTHK) marginal soft tissue thickness. Clinical examination delivered probing depths (PPD) and height of keratinized tissue. RESULTS: 24 months after surgery, digitally evaluated CRC was present in 60.0% of the TUN + CTG and 0.0% of the CAF + EMD-treated sites (p < .0001), meaning a certain relapse of the gingival margin ragarding both approaches. RC amounted to 94.0% (TUN + CTG) and 57.3% (CAF + EMD), respectively (p < .0001). REC reduction (RECred) was significantly higher for TUN + CTG (1.81 ± 0.56 mm) than for CAF + EMD (0.90 ± 0.45 mm) (p < .0001). pTHK and aTHK values were significantly greater in the TUN + CTG group (1.41 ± 0.35 mm and 1.11 ± 0.26 mm) than in the CAF + EMD group (0.78 ± 0.32 mm and 0.60 ± 0.26 mm) (p < .0001). Statistical analysis detected positive correlations between THK and both RC and RECred (p < .001). CONCLUSIONS: Two years post-operatively, CTG showed better clinical and volumetric outcomes than EMD. Increased THK values were associated with improved outcomes regarding RC and RECred.

Clinical and patient-centred long-term results of root coverage using the envelope technique in a private practice setting: 10-year results-A case series.

AIM: Evaluation of long-term results after connective tissue graft (CTG) using the envelope technique and the effect on patient-centred outcomes (Oral Health Impact Profile: OHIP) in a private practice setting. MATERIALS AND METHODS: Fifteen patients (11 female, mean age: 45.0 ± 8.88 years) underwent root coverage procedure using a CTG involving maxillary Miller class I teeth. Pre-operatively, 3 and 120 ± 12 months after surgery, all patients were examined, completed OHIP questionnaire, and were asked to assess improvement and their satisfaction with the results of surgery. All procedures were performed by the same investigator. RESULTS: Recession depth at 3 months of 1.19 ± 0.93 mm was reduced to that of 0.63 ± 0.64 mm at 120 ± 12 months after surgery (p = .117). Recession width (-1.23 ± 2.27 mm) decreased as well (p = .117), while relative root coverage increased from 48.46 ± 32.18% at 3 months to 71.22 ± 30.86% at 120 months (p = .011). The number of cases with complete root coverage increased from two (15.4%) to six (40.0%) from 3 to 120 months (p = .046). OHIP score (12.07 ± 10.15) did not change after 10 years (12.13 ± 9.86, p = .889). Ten years after surgery, 12 patients (80%) reported they would make the decision again to undergo CTG transplantation. CONCLUSIONS: Within the limitations of the study design with a high risk of bias in a practice setting, long-term stability of recession reduction, OHIP and patient-perceived satisfaction remained stable over 10 years.

Twenty-year results after connective tissue grafts and guided tissue regeneration for root coverage.

BACKGROUND: Evaluation of clinical long-term results 20 years after connective tissue grafting (CTG) or guided tissue regeneration (GTR) using bioabsorbable barriers for root coverage therapy. METHODS: Initially, 15 patients with 38 Miller Class I and II recession defects underwent CTG or GTR according to random assignment. At baseline, 3, 120 ± 12, and 240 ± 12 months after surgery, data on probing depth, clinical attachment level, recession depth and width, amount of keratinized tissue, and bleeding on probing were obtained. Additionally, patients' smoking habits and participation in supportive periodontal therapy were investigated. RESULTS: Eight patients contributing 23 recessions were available at the 240 ± 12 months follow-up. Three and 120 ± 12 months after therapy with CTG, significantly better root coverage was observed compared with baseline (3 months: 3.01 ± 1.74 mm; P = 0.003; 120 ± 12 months: 2.11 ± 1.86 mm; P < 0.024). GTR resulted in significantly better root coverage compared with baseline after 3 months (2.25 ± 1.89 mm; P < 0.012). Although there were no significant changes in the recession depth between 3 and 240 ± 12 months in both groups (CTG: P = 0.097; GTR: P = 0.190), 1.57 ± 2.12 mm (CTG) and 1.19 ± 2.31 mm (GTR) of the achieved coverage after 3 months were lost. CTG showed significantly better relative root coverage percentage than GTR after 3 (P = 0.026) and 120 (P = 0.038) months. This study failed to detect a significant difference in the stability of root coverage after 240 ± 12 months between CTG and GTR (P = 0.448) and patients' assessments of their treatment outcomes (P = 0.503). CONCLUSION: Long-term stability of root coverage and patient-perceived esthetic outcomes failed to show significant differences between CTG and GTR at 20 years post-surgery.

Infrabony defects 20 years after open flap debridement and guided tissue regeneration.

AIM: Evaluation of 20-year results after open flap debridement (OFD) and guided tissue regeneration (GTR) of infrabony defects in a randomized controlled trial. MATERIALS AND METHODS: In originally 16 periodontitis patients (baseline examination), periodontal surgery was performed in 44 infrabony defects. Polylactide acetyltributyl citrate barriers were randomly assigned to 23 out of these 44 defects (parallel). Ten of these patients (GTR) exhibited a second, contra-lateral defect (OFD) each (split-mouth). At baseline, 12, 120 and 240 ± 12 months after surgery probing depths, attachment level, bleeding on probing as well was Plaque Index, Gingival Bleeding Index and plaque control record were obtained. RESULTS: Twelve patients contributing 38 defects were available at 240 months. At 12, 120 and 240 ± 12 months, both groups showed significant (p < 0.01) attachment gain (split-mouth: OFD: 12 months: 4.15 ± 2.93 mm; 120 months: 3.35 ± 2.37 mm, 240 months: 3.60 ± 2.55 mm; GTR: 12 months: 3.50 ± 2.47 mm; 120 months: 3.90 ± 2.76 mm, 240 months: 3.80 ± 2.69 mm; parallel: OFD: 12 months: 3.53 ± 2.04 mm; 120 months: 3.59 ± 2.54 mm, 240 months: 3.53 ± 2.50 mm; GTR: 12 months: 4.07 ± 2.88 mm; 120 months: 3.13 ± 2.22 mm, 240 months: 3.13 ± 2.22 mm). Seven teeth (3 OFD, 4 GTR) were lost. Only 1 patient out of 12 was kept in regular supportive periodontal therapy (SPT) over 20 years. The study failed to show significant attachment gain differences between both groups after 240 months. CONCLUSIONS: Twenty years after OFD and GTR in infrabony defects in a population with lack of regular SPT attachment gains at 12 months after surgery were stable. About 82% of the initially included teeth were still in place.

Effect of the Surgeon's Dominant Hand on Postoperative Periodontal Status of Adjacent Molars After Removal of Lower Third Molars.

PURPOSE: The purpose was to investigate the effect of the surgeon's dominant hand and the side (right or left) of surgical removal of third molars in the mandible on the probing pocket depth and probing attachment level on the adjacent second molars. PATIENTS AND METHODS: This study included 73 patients (46 female and 27 male patients; average age, 15.9 ± 1.9 years) with 146 asymptomatically submucosal (fully covered by oral mucosa) or impacted (completely enclosed by bone) lower third molars surgically removed by a right-handed surgeon. The probing pocket depth and probing attachment level (outcome variables), as well as the gingiva and plaque indexes (other variables), were documented preoperatively and 6 months after surgical removal. Descriptive and bivariate statistics were computed, and the P value was set at .05. RESULTS: The mean probing pocket depth decreased by 0.69 mm on the lower left second molar and by 0.64 mm on the lower right second molar over the follow-up of 6 months. The mean attachment gain was 0.45 mm for the lower left second molar and 0.40 mm for the lower right second molar. The side differences between these changes in probing pocket depth (P = .620) and probing attachment level (P = .545) were not significant. The gingival index (P = .029) and plaque index (P = .007) deteriorated significantly for the lower right compared with the lower left second molar. CONCLUSIONS: For a right-handed surgeon, the operated side had no influence on the changes in probing depth and attachment level on the adjacent second molars.

Surgical removal of third molars and periodontal tissues of adjacent second molars.

OBJECTIVES: The aim of this study was to investigate the effect of mandibular third-molar (M3) removal on periodontal health of adjacent second molars (M2). Probing pocket depths (PPD) and probing attachment levels (PAL) have been described for primary outcome. As cofactors involved, gender, complications, two suture materials and two types of impaction were chosen as secondary outcomes. MATERIALS AND METHODS: Seventy-eight patients (49 female; mean age: 16.0 ± 2.0 years) with 78 asymptomatic impacted mandibular M3 were included in this study. Plaque and gingival indices, PPD and PAL were recorded prior and 6 months after surgery. Impacted teeth were classified as either fully impacted (completely within in the bone) or submucosal (fully covered by oral mucosa). RESULTS: Average baseline PPD was reduced from 3.3 mm to 2.6 mm after 6 months (p < 0.05). Average PAL was reduced from 3.0 to 2.5 mm (p < 0.05). Preoperative PPD ≥ 4 mm at the distolingual and distobuccal sites was positively correlated with clinical improvement (PPD: p < 0.05; PAL: p < 0.05). The impaction class was also identified as positive cofactor for PPD (p = 0.039), but not for PAL. CONCLUSIONS: Young patients may benefit from an early removal of mandibular M3, especially in the presence of certain cofactors.