Evaluation of acceptance and preference of topical lidocaine application versus articaine injection anesthesia after nonsurgical periodontal treatment: A randomized clinical trial.

BACKGROUND: To compare acceptance and preference of topical lidocaine gel anesthesia with articaine injection anesthesia in patients with moderate periodontitis undergoing scaling and root debridement. METHODS: Ninety-one patients completed this randomized multicenter split-mouth controlled study and underwent two separate periodontal treatment sessions on different days, one with a topical intrapocket lidocaine gel application and the other with an articaine injection anesthesia in a different order depending on randomization. Parameters measured were the patients' preference for topical lidocaine gel anesthesia or injection anesthesia with articaine (primary efficacy criterion), their maximum and average pain, and their intensity of numbness as well as experience of side effects; the probing depth; and the dentists' preference and their evaluations of handling/application, onset and duration of anesthetic effect, and patient compliance. RESULTS: After having experienced both alternatives, 58.3% of the patients preferred the topical lidocaine gel instillation into the periodontal pockets. The safety profile of the lidocaine gel differed positively from the safety profile of articaine injection in type and frequency of adverse drug reactions. The dentists' acceptance and preference regarding either anesthetic method studied were balanced. CONCLUSIONS: Instillation of lidocaine gel into the periodontal pocket is a preferred alternative to injection anesthesia for most of the patients and an equivalent alternative for dentists in nonsurgical periodontal therapy.

Comparison of periodontitis patients' classification in the 2018 versus 1999 classification.

OBJECTIVES: We aimed to assess how the 2018 and 1999 classifications of periodontal diseases reflect (a) patients' characteristics, (b) disease severity/extent/progression and (c) tooth loss (TL) during observation period. METHODS: A total of 251 patients were followed over 21.8 ± 6.2 years. For the 1999 classification, using clinical attachment level (CAL), patients were classified as localized/generalized, mild/moderate/severe and aggressive/chronic periodontitis. For the 2018 classification, patients were staged according to their CAL or bone loss (BL) and the number of lost teeth (stages I-IV). Further factors like probing pocket depths (PPD) or furcation involvement modified the stage. The extent was sub-classified as generalized/localized. Patients were graded according to the BL/age index, smoking and/or diabetes. RESULTS: According to the 1999 classification, most patients suffered from generalized severe chronic periodontitis (203/251) or generalized aggressive periodontitis (45/251). Patients with aggressive periodontitis were younger and less often female or smokers. They showed similar TL (0.25 ± 0.22 teeth/patient*year) as generalized severe chronic periodontitis patients (0.23 ± 0.25 teeth/patient*year). According to the 2018 classification, most patients were classified as generalized III-C (140/251), III-B (31/251) or IV-C (64/251). Patients' age, smoking status, CAL, PPD and BL were well reflected. TL differed between IV-C (0.36 ± 0.47), generalized III-C (0.21 ± 0.24) and localized forms (0.10-0.15). CONCLUSIONS: Patients' characteristics, disease severity/extent/progression and TL were well reflected by the 2018 classification.

Tooth loss in generalized aggressive periodontitis: Prognostic factors after 17 years of supportive periodontal treatment.

AIM: This retrospective longitudinal study assessed the risk of and prognostic factors for tooth loss in patients with generalized aggressive periodontitis (GAgP) after periodontal treatment in a university setting. METHODS: Fifty-seven patients (1,505 teeth) were examined before (T0) and after active periodontal therapy (APT, T1) as well as after 17.4 ± 4.8 [range: 9-28] years of supportive periodontal therapy (SPT, T2). Descriptive statistics and a Cox-proportional-hazards shared-frailty model were applied. RESULTS: Overall, 98 and 134 teeth were lost during APT and SPT, respectively, with 0.14 ± 0.18 teeth being lost per patient and year. During SPT, three patients (5%) lost ≥10 teeth, 14 (25%) lost 4-9 teeth, 40 lost 0-3 (70%) teeth, respectively. One-third (n = 19) of all patients lost no teeth. Mean PPD of the teeth surviving SPT was stable from T1 (3.5 ± 1.1 mm) to T2 (3.4 ± 1.1 mm). Nearly, 84% of all survived teeth showed stable or improved bone level at T2. Risk of tooth loss was significantly increased in active smokers (HR[95% CI]: 4.94[1.91/12.75]), the upper dental arch (1.94[1,16/3.25]), with each mm of residual PPD (1.41[1.29/1.53]), teeth with furcation involvement (FI) (HR 4.00-4.44 for different degrees) and mobility (5.39 [2.06/14.1] for degree III). CONCLUSION: Within the provided conservative treatment regimen, GAgP patients lost only few teeth.

Removal of simulated biofilm: an evaluation of the effect on root surfaces roughness after scaling.

BACKGROUND: Despite the development of less invasive devices, a debate exists about the benefits and risks of hand versus powered root surface instrumentation used in supportive periodontal therapy (SPT). The aim of the in vitro study was to differentially compare plaque removal efficacy and root surface roughening of newly developed sonic, ultrasonic scaler, and curettes in the hands of experienced versus less experienced operators. MATERIALS AND METHODS: Sonic (AIR), ultrasonic devices (TIG), and double-gracey curettes (GRA) were utilized by seven experienced (EO) and four less experienced operators (LO) for root surface instrumentation of standardized plastic teeth on manikins' heads in a randomized sequence. The proportion of residual simulated plaque (RSP area in %) was planimetrically assessed, and the average root surface roughness produced (Ra and ∆Ra in µm) was measured by a precision profilometer. RESULTS: The uninstrumented root surfaces showed a Ra of (median (Q25/Q75)) 1.00 µm (0.83/1.16). Following instrumentation, EO left significantly less RSP than LO regardless of the used instruments (20.00 % (10.00/34.00) vs. 26.00 % (12.00/44.00) p < 0.001), whereas the ∆Ra values (0.29 µm (-0.04/0.96) vs. 0.35 µm (-0.04/1.01), p = 0.237) failed to show significant differences. The surface roughness was higher with GRA followed by AIR then TIG regardless of operators' experience (p < 0.001). CONCLUSION: Within the limits of the present study, the sonic device was most efficient in plaque removal, while the ultrasonic device produced the least surface roughness. CLINICAL RELEVANCE: All three tested instruments seem effective in the mechanical root debridement during SPT, whereat the ultrasonic device show the smoothest root surface of all.

Long-term tooth retention in chronic periodontitis - results after 18 years of a conservative periodontal treatment regimen in a university setting.

AIM: The longitudinal study assessed the risk of tooth loss under a non-regenerative treatment regimen and aimed to identify prognostic factors for tooth loss. METHODS: Three hundred and fifteen patients (8009 teeth) were examined before (T0) and after active periodontal therapy (APT, T1) as well as after (mean ± SD) 18 ± 6 years of supportive periodontal therapy (SPT, T2). Descriptive statistics and a Cox proportional hazards shared-frailty model were applied. RESULTS: Overall, 351 and 816 teeth were lost during APT and SPT, respectively, with 0.15 ± 0.17 teeth being lost per patient and year. Seventy-two percentage patients lost 0-3, 24% 4-9 and 4% ≥10 teeth. The proportion of teeth with probing-pocket depths (PPD) >6 mm was 17.2% (T0), 1.6% (T1) and remained stable at 1.7% up to T2. Tooth loss during SPT was significantly increased in older patients [HR (95% CI): 1.04 (1.01-1.07) per year] and smokers [2.62 (1.34-5.14)], with each mm of PPD [1.35 (1.17-1.56)], in multirooted compared with single-rooted teeth [1.86 (1.36-2.56)] and teeth with bone loss [BL; HR up to 23.6 (12.1-45.6) for BL > 70%]. CONCLUSION: The risk of tooth loss was generally low under the provided non-regenerative treatment regimen; a minority of patients were responsible for the majority of teeth lost during SPT.

Prognostic factors for the loss of molars--an 18-years retrospective cohort study.

AIM: The aim of this study was to identify long-term prognostic factors for the loss of molars with different degrees of furcation involvement (FI) during supportive periodontal therapy (SPT). METHODS: Three hundred and seventy-nine compliant subjects with 2373 molars at baseline were retrospectively assessed. After nonsurgical (n = 76) or surgical (n = 303) non-regenerative active periodontal therapy (APT: T0-T1), patients remained under SPT (T1-T2) for 18.3 ± 5.5 (9-30.8) years. Association between tooth- and subject-related factors with tooth loss was assessed using multilevel Cox regression-analysis. RESULTS: During APT 159 and during SPT 438 molars were extracted in 256 subjects, respectively, yielding an overall survival of 74.8% (T2). Survival probabilities after 15-years of SPT were 92.4% for molars with FI-0 compared to FI-1 = 85.6%, FI-2 = 74.9% and FI-3 = 62.3%. The risk of molar loss was significantly increased for teeth with FI-3 (hazard ratio: 2.39 [95% confidence interval: 1.54-3.70]), bone loss >50% (2.16 [1.36-3.42]), mobile teeth (2.07 [1.51-2.84]), maxillary molars (1.44 [1.12-1.85]) and endodontically treated teeth (1.89 [1.58-2.26]). For each mm of mean residual pocket probing depth, the hazard of tooth loss increased 1.89-fold (1.58-2.26). On a subject level, for each year of age, HR was 1.03 (1.01-1.05). CONCLUSIONS: Furcation involvement, bone loss, tooth mobility, mean pocket depth and age strongly predicted tooth loss during SPT. Long-term retention of periodontally compromised molars was possible via conservative non-regenerative active and supportive therapy.

Subgingival instrumentation to remove simulated plaque in vitro: influence of operators' experience and type of instrument.

BACKGROUND: There is uncertainty regarding the benefits and risks of hand versus powered root surface instrumentation. Moreover, the influence of operators' experience on treatment results is unclear. We compared newly developed sonic, ultrasonic and hand instruments, hypothesizing that powered devices allow to remove more simulated plaque in less time than hand instruments, with significant influence of operators' experience. METHODS: Sonic scaler (AIR), ultrasonic scaler (TIG) device and double Gracey curettes (GRA) were utilized by seven experienced operators (EOs) and four less experienced operators (LOs) in periodontitis manikin heads. The time required for treatment, the proportion of residual-simulated plaque and the weight loss caused by scaling as a proxy for root surface destruction were measured. RESULTS: Using different instruments led to significantly different proportions of removed simulated plaque regardless of operators' experience (AIR, 80.2 ± 21.3 %, TIG, 69.9 ± 22.5 %, GRA, 73.1 ± 20.0 %) (p < 0.001). Treatment times did not significantly differ between EO and LO (p > 0.05). Weight loss was increased when using hand instead of powered instruments (p < 0.001), with significantly higher weight loss induced by LO than EO (p = 0.004). CONCLUSION: Within the present study, EO did not remove more simulated plaque in less time but induced less root surface destruction. Using a sonic device was most beneficial for plaque removal. CLINICAL RELEVANCE: Successful root surface debridement requires both time and training regardless of the used instrument. Hand instruments might cause more damage to root surfaces, especially in the hands of less experienced operators.

Prosthetic rehabilitation of patients with history of moderate to severe periodontitis: a long-term evaluation.

OBJECTIVES: Long-term outcomes of conservative periodontal and prosthetic treatment of patients with moderate to severe periodontitis were to be evaluated. Groups of younger (YG) and middle-aged patients (MG) were to be compared regarding survival of fixed and removable dental prostheses (FDP, RDP) inserted after active periodontal therapy (APT). In addition, functional-occlusal status over more than 10 years of supportive periodontal therapy (SPT) was analysed. METHODS: The present multi-case-series retrospectively analysed data of 68 patients (34 YG and 34 MG) who had received APT and regular SPT ≥10 years. Tooth loss, occlusal status and survival and complications of prosthetics were evaluated descriptively and comparatively (t-test). RESULTS: There was no statistical difference between YG and MG concerning tooth loss/year (p > 0.05). Functional-occlusal status was retained during SPT in 75% and 69% of YG and MG. Restorations inserted after APT showed high survival for both age groups (100%). Mean survival time until the last SPT visit was 15.2 and 11.6 years for FDP and RDP in YG, and 12.5 and 13.1 years in MG. CONCLUSIONS: Prosthetic restorations in both younger and middle-aged patients with severe periodontitis showed high survival, if pre-prosthetic APT and regular SPT had been performed.

Retention of questionable and hopeless teeth in compliant patients treated for aggressive periodontitis.

AIM: The aim of this study was to determine the survival rates of questionable and hopeless teeth in patients with aggressive periodontitis (AgP) and chronic periodontitis (CP) during 15 years of supportive periodontal therapy (SPT). MATERIALS AND METHODS: Thirty-four AgP and 34 CP patients (SPT≥10 years) with bone loss of ≥50% at ≥2 teeth were consecutively recruited. Bone loss was measured on digitized radiographs and teeth were categorized as "questionable" (≥50 to <70% bone loss) or as "hopeless" (≥70%). Progression in pocket probing depths (PPD) during SPT, tooth loss and reasons for extraction were analysed. RESULTS: In AgP patients, 262 teeth were considered as questionable and 63 as hopeless (CP: 149/51). During active periodontal therapy, 25 questionable and 26 hopeless teeth were extracted (CP: 12/16). During 15.3 ± 4.1 years of SPT of AgP 28 questionable and 15 hopeless teeth were removed (CP: 28/12). The mean tooth loss per patient during SPT in total was 0.14 (AgP) and 0.16 (CP) teeth/year. There were no significant differences in tooth loss or longitudinal progression of PPD between AgP and CP patients. CONCLUSIONS: In patients with AgP, 88.2% (209 of 237) of questionable and 59.5% (22 of 37) of hopeless teeth survived 15 years during regular SPT in a dental school department.

Clinical effects after subgingival polishing with a non-aggressive ultrasonic device in initial therapy.

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.