Radiographic ratios for classifying furcation anatomy: proposal of a new evaluation method and an intra-rater and inter-rater operator reliability study.

OBJECTIVES: Even if it seems to be an important anatomical parameter for tissue regeneration, few studies in literature evaluate the "mean measure" of root divergence. Most of them are linear measurements, which hardly describe the dental furcation conformation in its entirety. It is left to the subjectivity of the operator deciding whether a furcation is convergent or divergent. The goal of this study is to create a visual evaluation method using specific measurements applied on endo-oral X-rays to overcome these problems, giving a conformation of the entire interradicular space and its divergence. MATERIAL AND METHODS: A user-friendly software (Paint®, Windows10®) was used to take three different measurements on endo-oral radiographs of upper and lower molars. Three blind operators measured 20 radiographs, to analyze the intra- and inter-operator reproducibility of the measurements. Then, the technique was repeated on 250 radiographic images to identify an average value and define a main conformation of the interradicular space. The ratio of these three measurements allowed to develop a new visual evaluation method of the interradicular space. RESULTS: Intra and inter-operator reproducibility was statistically confirmed on a sample of 20 anonymous endo-oral radiographs measured by 3 blind operators, indicating that the measurement technique was not operator dependent. Measurement made on 250 X-rays obtained with this technique permitted to subdivide in five groups the conformation of the interradicular space and define a mean value of the interradicular space. CONCLUSIONS: A new anatomical evaluation of the interradicular space in its entirety, which could help the clinicians in diagnostic and decisional phase in the therapy of furcated molars, can be obtained. CLINICAL RELEVANCE: A pre-operative evaluation of interradicular space conformation could affect therapy treatment choice.

The influence of interradicular anatomy on the predictability of periodontal regenerative therapy of furcation defects: a retrospective, multicenter clinical study.

BACKGROUND: The relationship between the anatomy of the interradicular space and success in regenerative therapy of furcation defects is discussed in this paper. The goal of this retrospective, multicenter clinical study is to clinically evaluate the relationship between the interradicular conformation and regenerative therapy success with the use of a novel measurement method. METHODS: One hundred thirty-eight radiographs of mandibular molars with furcation defects that had been treated with regenerative therapy were collected from six clinical centers. Data on the type of therapy and clinical parameters before and after treatment (follow-up of at least 12 months) were collected. The radiographs (before surgery and at least 12 months postoperatively) were measured with a visual evaluation method by a blind operator using graphics software. RESULTS: Success, defined as a reduction in horizontal and vertical furcation involvement, decrease in probing depths, and increase in clinical attachment level, was statistically assessed on 138 regenerated molars sites and were related to clinical variables such as age, sex, center, and treatment. No correlation was found between success in regenerative therapy and the conformation of the interradicular space, measured with a visual ratio method and a standard linear measurement. At the univariate analysis, the parameters that had a correlation with success were center, extent of furcation involvement, treatment, and sex. The use of enamel matrix derivative (EMD) seemed to be the most favorable therapy, with increase in CAL gain and reduction of vertical or horizontal furcation involvement. CONCLUSIONS: The regenerative outcome was not significantly influenced by the anatomy of furcation. The center, the degree of furcation involvement, sex, and treatment (EMD) were significantly associated with higher success of periodontal regeneration.

Effect of periodontal disease treatment during pregnancy on preterm birth incidence: a metaanalysis of randomized trials.

We conducted a metaanalysis of randomized controlled trials to determine whether periodontal disease treatment with scaling and/or root planing during pregnancy may reduce preterm birth (PTB) or low birthweight (LBW) infant incidence. Treatment resulted in significantly lower PTB (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.35-0.86; P = .008) and borderline significantly lower LBW (OR, 0.48; 95% CI, 0.23-1.00; P = .049), whereas no difference was found for spontaneous abortion/stillbirth (OR, 0.73; 95% CI, 0.41-1.31; P = .292). Subgroup analysis suggested significant effect of treatment in the absence of history of PTB or LBW (OR, 0.48; 95% CI, 0.29-0.77; P = .003) and less severe periodontal disease as defined by probing depth (OR, 0.49; 95% CI, 0.28-0.87; P = .014) or bleeding on probing site (OR, 0.37; 95% CI, 0.14-0.95; P = .04). If ongoing large and well-designed randomized trials support our results, we might need to reassess current practice or at least be cautious prior to rejecting treatment of periodontal disease with scaling and/or root planing during pregnancy.

Long-term retrospective observational cohort study on the survival rate of stepped screw titanium implants followed up to 20 years.

PURPOSE: The aim of this long-term retrospective study was twofold: (1) to evaluate the survival and success rates of stepped screw titanium implants with a sandblasted and acid-etched surface, and (2) to assess the influence of hypothetical predictors of implant failure on the survival rate. MATERIALS AND METHODS: From 75 possible candidates, 67 patients contributing 346 Frialit-2 (DPS Frialit-2 implant system, Friatech) implants placed between 1997 and 2005 were retrospectively evaluated. The inclusion criteria consisted of implants placed in either native or augmented bone, rehabilitated with an implant-supported prosthesis, and radiographically documented at the time of prosthetic loading (T0). At the follow-up recall performed between January and October 2018 (T1), clinical and radiologic examinations were conducted to evaluate the survival and success rates. The influence of specific variables on the survival rate was subsequently investigated, including gender and smoking habits, location and size of the implants, and bone augmentation procedures. Cox regression and shared frailty models were used, with the patient representing the statistical unit. RESULTS: A survival rate of 91.62% over a median observation time of 189 months with a range of 11 to 20 years was observed. A total of 14 out of 29 implants failed before delivery of the provisional prosthesis. Overall, the median marginal bone loss was 1.25 mm, with an annual increase of 0.12 mm. Different from the other variables, the results of the multivariate model indicated that smoking was strongly correlated with implant failure (P = .002). CONCLUSION: Considering the limitations of this study, stepped screw titanium implants with a sandblasted and acid-etched surface provided a good survival rate. Smoking might be considered a relevant risk factor for implant failure.