Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 52
Filtrar
1.
BMC Oral Health ; 20(1): 346, 2020 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-33256683

RESUMO

BACKGROUND: The current study evaluated whether a new digitized scaling training program (DTP: n = 30; supervisor-student-ratio 1:10) improves the performance of undergraduate dental student during a preclinical course in regard to two different instruments [sonic scalers (AIR) and Gracey curettes (GRA)] compared to a conventional training program (CTP: n = 19; supervisor-student-ratio 1:4). METHODS: All the participants received a two-hour lecture on both instruments, followed by a 12-week period with a weekly training program lasting 45 min (10 sessions); one group was supported by DTP. At the end of the training phase, all the participants performed the subgingival scaling of six equivalent test teeth using GRA and AIR. Treatment time, proportion of removed simulated biofilm (relative cleaning efficacy, RCE-b) and hard deposits (RCE-d) were recorded. By using a pseudonymized questionnaire with a 5-point Likert scale, self-assessment of scaling effort, handling, root surface roughness/destruction and effectiveness were evaluated. In addition, personal data such as age, gender, handedness, regularity of playing computer games/consoles and previous dental/technical or medical education were elevated and correlated with cleaning efficacy. RESULTS: The DTP participants showed higher effectiveness in RCE-b compared to those who used the CTP with GRA (71.54% vs. 67.23%, p = 0.004) and AIR (71.75% vs. 62.63%, p ≤ 0.001), and the DTP students were faster with both instruments (p ≤ 0.001). For RCE-d, there was no significant difference between the DTP and CTP groups (GRA p = 0.471; AIR p = 0.158), whereas DTP showed better RCE-d results with GRA versus AIR (84.68% vs. 77.85%, p < 0.001). According to the questionnaire, no significant differences were detected between the training groups in terms of self-assessment, handling, treatment time, root surface roughness/destruction or effectiveness of the instruments. The CTP group favored AIR compared to GRA regarding the fatigue effect. The CTP and playing computer games/consoles regularly was correlated with lower RCE-b, whereas previous education in medicine/dentistry was correlated with higher RCE-b values. CONCLUSIONS: Within the limitations of the study, the DTP with a reduced supervision effort compared to the CTP resulted in higher effectiveness and lower instrumentation time for removing simulated biofilms.

2.
Periodontol 2000 ; 84(1): 35-44, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32844413

RESUMO

It is well established that dental plaque on teeth leads to gingivitis and periodontitis, and that several mechanical and chemical methods of plaque control can prevent gingivitis. The aim of the current review is to summarize and synthesize the available scientific evidence supporting practices for mechanical oral hygiene to prevent periodontal diseases. Evidence for contemporary practices of mechanical oral hygiene to prevent periodontal disease relies on studies of gingivitis patients. General recommendations concerning the ideal oral hygiene devices and procedures are still inconclusive. However, toothbrushing and interdental cleaning remain the mainstays of prevention of periodontal diseases. The primary approach requires individually tailored instruction for implementation of a systematic oral hygiene regimen.


Assuntos
Placa Dentária/prevenção & controle , Gengivite/prevenção & controle , Doenças Periodontais/prevenção & controle , Dispositivos para o Cuidado Bucal Domiciliar , Humanos , Higiene Bucal , Escovação Dentária
3.
Clin Oral Investig ; 2020 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-32474807

RESUMO

OBJECTIVES: Whereas the key role of subgingival instrumentation in periodontal therapy is well known, the influence of operators' experience/training with different devices on treatment results is yet uncertain. Therefore, we assessed untrained undergraduate students, working on manikins, as to how effectively they learn to use curettes (GRA) and sonic scalers (AIR); hypothesizing that AIR will result in higher relative cleaning efficacy (RCE) than GRA. MATERIAL AND METHODS: Before baseline evaluation (T0), 30 operators (9 males, 21 females) received a 2-h theoretical lesson for both instruments, followed by a 12-week period with a weekly digitized training program for 45 min. During three sessions (T1-T3), the operators had to instrument six equivalent test teeth with GRA and AIR. At T0-T3, treatment time, proportion of removed simulated biofilm (RCE-b), and hard deposits (RCE-d) were measured. RESULTS: At T0, RCE-b was in mean(SD) 64.18(25.74) % for GRA, 62.25(26.69) % for AIR; (p = 0.172) and RCE-d 85.48(12.32) %/ 65.71(15.27) % (p < 0.001). At T3, operators reached highest RCE-b in both groups (GRA/AIR 71.54(23.90) %/71.75(23.05)%; p = 0.864); RCE-d GRA/AIR: 84.68(16.84) %/77.85(13.98) %; p < 0.001). Both groups achieved shorter treatment times after training. At T3, using curettes was faster (GRA/AIR 16.67(3.31) min/19.80(4.52) min; p < 0.001). CONCLUSIONS: After systematic digitized training, untrained operators were able to clean 70% of the root surfaces with curettes and sonic scalers. CLINICAL RELEVANCE: It can be concluded that a systematic digitized and interactive training program in manikin heads is helpful in the training of root surface debridement.

4.
J Dent ; 99: 103417, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32592828

RESUMO

OBJECTIVES: To assess if long-term treatment costs in periodontitis patients differ between stage III vs. IV and grade B vs. C according to the 2018 classification of periodontal diseases. METHODS: A cohort of 231 periodontitis patients (followed over a mean of 18.4 years) was evaluated. Costs for active periodontal therapy (APT, including scaling and root planning, open flap debridement, root resections) and supportive periodontal therapy (SPT, including also restorative, endodontic, prosthetic and surgical treatment) were estimated from a mixed payer-perspective in Germany (in Euro 2020). Multi-dimensional staging and grading was applied. The impact of stage, grade, sex and age on total and annual costs was assessed. RESULTS: Mean (SD) total and annual treatment costs were 7154 (2554) Euro and 437 (222) Euro. Costs were generated during SPT (92 %) and by periodontal treatment (88 %) and decreased significantly with longer follow-up (p < 0.001). Total costs were 7120 (2692) Euro in stage III (n = 154) vs. 7221 (2271) Euro in stage IV (n = 77; p > 0.05), and 6256 (1605) Euro in grade B (n = 35) vs. 7314 (2660) Euro in grade C (n = 196; p < 0.001). Annual costs were 426 (219) Euro vs. 459 (228) Euro for stage III vs. stage IV (p > 0.05) and 308 (163) Euro vs. 460 (224) Euro for grade B vs. grade C (p < 0.001). Multivariable modelling found grade, but not stage, sex and age significantly associated with costs. CONCLUSIONS: Within the limitations of this study, and in patients with severe periodontitis who were systematically treated long-term, grading, but not staging was associated with costs. CLINICAL SIGNIFICANCE: Treatment costs were higher in patients with more progressive periodontitis and were found to decrease during follow-up. Dentists need to consider costs during treatment planning and communication with patients.

5.
BMC Oral Health ; 20(1): 136, 2020 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-32384897

RESUMO

BACKGROUND: Interdental rubber picks (IRP) have become a frequent and convenient alternative for interdental cleaning. However, only little evidence exists supporting the effectiveness of newer designs available on the market. Therefore, a new in vitro model was evaluated to measure the experimental cleaning efficacy (ECE), as well as the force needed for insertion and during the use of IRP, with high reproducibility. METHODS: Five different sizes of commercially marketed IRP with elastomeric fingers (IRP-F) (GUM SOFT-PICKS® Advanced, Sunstar Deutschland GmbH, Schönau, Germany) or slats (IRP-S) (TePe EasyPick™, TePe D-A-CH GmbH, Hamburg, Germany) were tested. Interdental tooth surfaces were reproduced by a 3D-printer (Form 2, Formlabs Sommerville, MA, USA) according to human teeth and matched to morphologically equivalent pairs (isosceles triangle, concave, convex) fitting to different gap sizes (1.0 mm, 1.1 mm, 1.3 mm). The pre-/post brushing situations at interdental areas (standardized cleaning, computer aided ten cycles) were photographically recorded and quantified by digital image subtraction to calculate ECE [%]. Forces were registered with a load cell [N]. RESULTS: IRP-F have to be inserted with significant higher forces of 3.2 ± 1.8 N compared to IRP-S (2.0 ± 1.6 N; p < 0.001) independent of the size and type of artificial interdental area. During cleaning process IRP-S showed significantly lower values for pushing/pulling (1.0 ± 0.8 N/0.5 ± 0.4 N) compared to IRP-F (1.6 ± 0.8 N/0.7 ± 0.3 N; p < 0.001) concomitant to significantly lower ECE (19.1 ± 9.8 vs. 21.7 ± 10.0%, p = 0.002). Highest ECE was measured with largest size of IRP-F/IRP-S independent the morphology of interdental area. CONCLUSIONS: New interdental cleaning aids can be tested by the new experimental setup supported by 3D printing technology. Within the limitations of an in vitro study, IRP-F cleaned more effectively at higher forces compared to IRP-S.


Assuntos
Dispositivos para o Cuidado Bucal Domiciliar , Placa Dentária/prevenção & controle , Escovação Dentária/instrumentação , Alemanha , Humanos , Fotografia Dentária , Pressão , Reprodutibilidade dos Testes , Escovação Dentária/métodos
6.
J Clin Periodontol ; 47(8): 952-961, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32473059

RESUMO

AIM: This pilot study assessed the oral-health-related quality of life (OHRQoL) after long-term periodontal therapy and explored OHRQoL differences along the 2018 Classification of Periodontal Diseases. METHODS: Sixty patients were examined before (T0) and after active periodontal therapy (APT/T1) and 32.0 ± 2.9 [range: 27-38] years of supportive periodontal therapy (SPT/T2). Periodontal diagnosis at T0 was assessed according to the 2018 Classification of Periodontal Diseases (stage 1/2/3/4: n = 1/3/44/13; grade n = A/B/C: 0/8/53). OHRQoL at T2 was measured using the Oral Health Impact Profile-G14 (OHIP-G14). Patients' Eichner's classification, accumulated tooth loss and treatment outcomes (SSO criteria) were assessed at T2. Generalized linear modelling (GLM) assessed associations between different factors and OHrQoL. RESULTS: Mean OHIP-G14 sum score was 3.7 (SD 5.6). There was no statistically significant association between OHIP-G14 and gender, stage, SSO criteria and tooth loss. OHIP-G14 was significantly lower in older patients (-0.2[-0.3;0] per year, p = .008), non-smokers (-5.9[-9.9;-1.9] p = .003) and former smokers (-7.4[-11.6;-3.2]; p < .001) versus current smokers, patients with Eichner class A1-B2 versus C2 (p < .05), sufficient adherence during SPT (-2.3[-4.6;-0.1], p = .044) versus insufficient ones. Patients with grade B (4.4[1.3;7.4]; p < .005) showed higher OHIP-G14 than those with grade C. CONCLUSION: A number of aspects, grounded in the initial diagnosis, the adherence to SPT, the resulting dentition, socio-demographic and behavioural covariates, were associated with good OHrQoL.

7.
Clin Oral Investig ; 24(2): 607-617, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31111282

RESUMO

OBJECTIVES: There is uncertainty regarding the benefits of periodontal endoscopy (PE) for subgingival instrumentation. Moreover, the influence of operators' experience and training with such a device on treatment results is unclear. Therefore, we compared in an in vitro study the use of PE for scaling and root planing (SRP) with the conventional non-surgical therapy, hypothesizing that using a PE allows to remove more simulated hard deposits than without (nPE), influenced by the operators' experience and training. MATERIAL AND METHODS: A sonic device and Gracey curettes were utilized by 11 operators (six dentists, five dental hygienists) in periodontitis manikins heads. The time required for treatment and the proportion of removed simulated hard deposits by SRP were measured. RESULTS: Using the PE led to a significant difference in removal of simulated hard deposits (%) (mean ± SD) irrespective of operators' experience (PE 90.78 ± 12.10% (range 58.80-100%); nPE 79.98 ± 22.15% (range 38.10-100%, p < 0.001)), sub-analyses for different tooth types demonstrated a significant difference in favor of PE for front teeth (p < 0.001) and in the upper jaw independent of the tooth type (p < 0.001). Comparison of treatment times for two quadrants with and without PE showed a significantly longer treatment time with PE (∆22.27 ± 17.98 mins, p <0.001). CONCLUSIONS: Within the present pilot study, the use of PE led to more removal of simulated hard deposits but was concomitantly related to more time and financial effort. Using PE was most beneficial in the front area. CLINICAL RELEVANCE: PE may provide additional benefits for the removal of hard deposits compared to traditional SRP. The beneficial effect of PE seems not to be influenced by operators experience nor by pocket probing depth.


Assuntos
Endoscopia , Raspagem Dentária , Humanos , Periodontite , Projetos Piloto , Aplainamento Radicular
8.
J Clin Periodontol ; 46(9): 908-917, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31152600

RESUMO

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.


Assuntos
Periodontite Agressiva , Periodontite Crônica , Perda de Dente , Progressão da Doença , Feminino , Humanos , Perda da Inserção Periodontal , Fumar
9.
J Clin Periodontol ; 46(7): 699-712, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31025366

RESUMO

AIM: A range of predictors for tooth loss in periodontitis patients have been reported. We performed a systematic review and meta-analysis to assess the consistency and magnitude of any association between a total of 12 predictors and tooth loss. MATERIALS AND METHODS: Medline/Embase/Central were searched for longitudinal studies investigating the association between predictors and tooth loss in periodontitis patients. Random-effects meta-analysis was performed, and study quality assessed. RESULTS: Twenty studies (15,422 patients, mean follow-up: 12 years) were included. The mean annual tooth loss/patient was 0.12 (min./max: 0.01/0.36). Older patients (n = 8 studies; OR: 1.05, 95% CI: 1.03-1.08/year), non-compliant ones (n = 11; 1.51, 1.06-2.16), diabetics (n = 7; 1.80, 1.26-2.57), those with IL-1-polymorphism (n = 3; 1.80; 1.29-2.52) and smokers (n = 15; 1.98, 1.58-2.48) had a significantly higher risk of tooth loss. Teeth with bone loss (n = 3; 1.04, 1.03-1.05/%), high probing pocket depth (n = 6; 3.19, 1.70-5.98), mobility (n = 4; 3.71, 1.65-8.38) and molars (n = 4; 4.22, 2.12-8.39), especially with furcation involvement (n = 5; 2.68, 1.75-4.08) also showed higher risks. Gender (n = 16; 0.95, 0.86-1.05) and endodontic affection (n = 3; 3.62, 0.99-13.2) were not significantly associated with tooth loss. CONCLUSIONS: Older, non-compliant, smoking or diabetic patients, and teeth with bone loss, high probing pocket depth, mobility, or molars, especially with furcation involvement showed higher risks of tooth loss.


Assuntos
Defeitos da Furca , Periodontite , Perda de Dente , Humanos , Estudos Longitudinais , Dente Molar , Estudos Retrospectivos
10.
J Dent ; 83: 56-60, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30862558

RESUMO

OBJECTIVES: For extracted teeth in periodontitis patients, adhesively attaching their crown to the adjacent teeth temporarily closes the otherwise resulting gap, allowing to postpone more comprehensive prosthetic treatment to a more appropriate time if required. This study assessed the survival and maintenance efforts of adhesively attached extracted tooth crowns ('immediate pontics'; IPs). METHODS: Patients receiving active and supportive periodontal treatment involving IPs in a university setting were retrospectively assessed. Survival and repairs of IPs were recorded. Multilevel Cox and linear regression analyses were performed to assess factors associated with survival and maintenance efforts. RESULTS: Twenty-seven patients (male/female: 12/15) with 34 IPs (maxilla/mandible: 13/21) were followed over mean ± SD 8.0 ± 5.0 [range: 2.0-19.3] years. At baseline 85.2% suffered from periodontitis stage II or III and 59.3% showed rapid progression (grade C). The mean (95% CI) survival time of splinting was 5.3 ± 3.8 [range: 0.1-18.0] years. Three IPs had been removed without any significant association with patient- or tooth-level factors. 35.3% of the IPs (n = 12) required a repair, with a mean of 0.5 ± 0.9 [0-3] repairs per IP (annual: 0.1 ± 0.2 [0-0.5]). The risk of repairs significantly increased with patients' age (p = 0.018). CONCLUSION: IPs showed moderate survival. However, to maintain IPs, frequent repairs were needed. CLINICAL SIGNIFICANCE: Immediately and adhesively attached crowns of extracted teeth in periodontitis patients seems like a valid, albeit temporary strategy which may allow to postpone more comprehensive prosthetic treatment if required, for example during active periodontal therapy. However, to maintain immediate pontics, frequent repairs were needed.


Assuntos
Periodontite , Extração Dentária , Coroas , Cimentos Dentários , Prótese Parcial Fixa , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos
11.
J Clin Periodontol ; 46(5): 522-528, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30762911

RESUMO

AIM: Recombinant secreted frizzled-related protein 5 (sFRP5) improved periodontal status in mice. Thus, this study aimed to investigate this finding in human periodontitis using an epidemiological approach. MATERIALS AND METHODS: sFRP5 and wnt5a concentrations were determined in human serum from the Food Chain Plus cohort using ELISAs. A total of 128 patients with periodontitis and tooth loss and 245 patients with periodontitis without tooth loss were compared to 373 sex-, smoker-, age- and BMI-matched individuals in a nested case-control design. RESULTS: Systemic sFRP5 serum levels were significantly lower in patients with periodontitis and tooth loss (2.5 [0.0-10.4] ng/ml, median [IQR]) compared to patients with periodontitis without tooth loss (6.0 [2.5-15.8] ng/ml, median [IQR], p = 0.04] and matched controls (7.0 [2.5-18.3] ng/ml, median [IQR], p = 0.02). No significant differences in sFRP5 serum levels were found among patients with periodontitis without tooth loss (6.0 [2.5-15.8] ng/ml, median [IQR]) and controls (3.1 [0.0-10.6] ng/ml, median [IQR], p = 0.06). CONCLUSIONS: sFRP5 might serve as a novel biomarker for periodontitis severity. Modulating the inflammatory background of severe forms of periodontitis, in the time of precision medicine, needs to be revealed in further studies.


Assuntos
Proteínas do Olho , Periodontite , Animais , Estudos de Casos e Controles , Humanos , Peptídeos e Proteínas de Sinalização Intracelular , Proteínas de Membrana , Camundongos
12.
J Invest Dermatol ; 139(6): 1237-1244, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30610840

RESUMO

Psoriasis is associated with periodontitis, a chronic inflammation of the gingival tissue. However, data about periodontal and dental status of psoriasis patients are sparse. Therefore, we conducted a prospective study comparing psoriasis patients with control individuals. 100 psoriasis patients presenting at the outpatient service of a specialized psoriasis center and 101 nonpsoriatic control individuals were included in the study. Oral health was assessed with standardized measures including Bleeding on Probing, Community Periodontal Index, and dental parameters according to the DMFT index (a cumulative index in which teeth [T] are registered as decayed [D], missing [M], and filled [F]). For analysis, a postmatching strategy was applied with 53 pairs of psoriasis patients and nonpsoriatic individuals in which relevant factors with possible impact on oral health status were considered. Logistic regression analyses were executed on the entire psoriasis and control population. According to the results, the matched psoriasis group had significantly higher values on Bleeding on Probing and the Community Periodontal Index compared with matched control individuals. Logistic regression analyses identified significant correlations of the psoriasis group with high Bleeding on Probing and Community Periodontal Index values but not, however, with missing teeth. Psoriasis patients had significantly higher values for parameters addressing periodontal inflammation. Psoriasis management should, therefore, include regular dental checks on periodontal status and respective treatment where required.


Assuntos
Saúde Bucal/estatística & dados numéricos , Periodontite/epidemiologia , Psoríase/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice Periodontal , Periodontite/diagnóstico , Periodontite/etiologia , Estudos Prospectivos , Fatores de Risco , Adulto Jovem
13.
Eur J Hum Genet ; 27(1): 102-113, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30218097

RESUMO

Periodontitis is one of the most common inflammatory diseases, with a prevalence of 11% worldwide for the severe forms and an estimated heritability of 50%. It is classified into the widespread moderate form chronic periodontitis (CP) and the rare early-onset and severe phenotype aggressive periodontitis (AgP). These different disease manifestations are thought to share risk alleles and predisposing environmental factors. To obtain novel insights into the shared genetic etiology and the underlying molecular mechanisms of both forms, we performed a two step-wise meta-analysis approach using genome-wide association studies of both phenotypes. Genotypes from imputed genome-wide association studies (GWAS) of AgP and CP comprising 5,095 cases and 9,908 controls of North-West European genetic background were included. Two loci were associated with periodontitis at a genome-wide significance level. They located within the pseudogene MTND1P5 on chromosome 8 (rs16870060-G, P = 3.69 × 10-9, OR = 1.36, 95% CI = [1.23-1.51]) and intronic of the long intergenic non-coding RNA LOC107984137 on chromosome 16, downstream of the gene SHISA9 (rs729876-T, P = 9.77 × 10-9, OR = 1.24, 95% CI = [1.15-1.34]). This study identified novel risk loci of periodontitis, adding to the genetic basis of AgP and CP.


Assuntos
Loci Gênicos , Periodontite/genética , Polimorfismo Genético , Cromossomos Humanos Par 16/genética , Cromossomos Humanos Par 8/genética , Estudo de Associação Genômica Ampla , Humanos
14.
J Dent ; 80: 49-54, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30389428

RESUMO

OBJECTIVES: This study assessed the survival and maintenance needs of splinted teeth in periodontitis patients. METHODS: Patients receiving active and supportive periodontal treatment involving teeth splinting in a university setting were retrospectively assessed. Tooth and splint survival and number of splint-repairs were recorded. Multilevel Cox and generalized-mixed linear regression analyses were performed. RESULTS: Fifty-seven patients with 227 splinted teeth (maxilla/mandible: 148/79) were followed over mean ± SD 11.0 ± 7.2 [range: 2.0-32.4]) years. Twenty-six splinted teeth were extracted during this period, the mean (95% CI) time of splint retention was 7.3 ± 5.7 (0.1-22.7). Splinted teeth did not show significantly increased risk of tooth loss compared with non-splinted teeth (HR; 95% CI: 1.30; 0.87-1.93); while age (1.07; 1.05-1.09), PPD >6 mm (4.24; 1.26-14.31), bone loss (mean HR was 5.07-15.36 depending on severity), tooth location (posterior versus anterior teeth: HR 2.08; 1.24-3.49) and the number of occlusal contact areas (mean HR was 4.38-17.34 depending on the number of antagonistic contact areas) were associated with tooth loss. 75.3% splints required repair, with a mean of 2.6 ± 1.9 [1.0-8.0] repairs per splint during the mean observation time (0.4 ± 0.6 [0.0-3.5] repairs per splint/year). CONCLUSION: Splinting did not significantly increase the risk of tooth loss; splinted teeth showed long-term survival. To maintain splints, frequent repairs were needed. CLINICAL SIGNIFICANCE: Splinted teeth were not at significantly higher risk of tooth loss than non-splinted teeth. While splinting does not improve the prognosis of periodontally affected teeth, it can assist their retention by reducing their mobility.


Assuntos
Contenções Periodontais , Periodontite , Mobilidade Dentária , Assistência Odontológica , Humanos , Estudos Retrospectivos
15.
Sci Rep ; 8(1): 13678, 2018 09 12.
Artigo em Inglês | MEDLINE | ID: mdl-30209331

RESUMO

Evidence for a shared genetic basis of association between coronary artery disease (CAD) and periodontitis (PD) exists. To explore the joint genetic basis, we performed a GWAS meta-analysis. In the discovery stage, we used a German aggressive periodontitis sample (AgP-Ger; 680 cases vs 3,973 controls) and the CARDIoGRAMplusC4D CAD meta-analysis dataset (60,801 cases vs 123,504 controls). Two SNPs at the known CAD risk loci ADAMTS7 (rs11634042) and VAMP8 (rs1561198) passed the pre-assigned selection criteria (PAgP-Ger < 0.05; PCAD < 5 × 10-8; concordant effect direction) and were replicated in an independent GWAS meta-analysis dataset of PD (4,415 cases vs 5,935 controls). SNP rs1561198 showed significant association (PD[Replication]: P = 0.008 OR = 1.09, 95% CI = [1.02-1.16]; PD [Discovery + Replication]: P = 0.0002, OR = 1.11, 95% CI = [1.05-1.17]). For the associated haplotype block, allele specific cis-effects on VAMP8 expression were reported. Our data adds to the shared genetic basis of CAD and PD and indicate that the observed association of the two disease conditions cannot be solely explained by shared environmental risk factors. We conclude that the molecular pathway shared by CAD and PD involves VAMP8 function, which has a role in membrane vesicular trafficking, and is manipulated by pathogens to corrupt host immune defense.


Assuntos
Periodontite Agressiva/genética , Doença da Artéria Coronariana/genética , Predisposição Genética para Doença/genética , Estudos de Casos e Controles , Estudo de Associação Genômica Ampla/métodos , Haplótipos/genética , Humanos , Polimorfismo de Nucleotídeo Único/genética , Fatores de Risco
16.
Med. oral patol. oral cir. bucal (Internet) ; 23(5): e569-e578, sept. 2018. ilus, tab, graf
Artigo em Inglês | IBECS | ID: ibc-176376

RESUMO

Background: Aggregatibacter-actinomycetemcomitans (A.actinomycetemcomitans) are strongly associated with localized-aggressive-periodontitis (LAgP). The study's aim was to test for the first time the effect of total sonicated A.actinomycetemcomitans-bacterial-fragments on gingival mesenchymal stem/progenitor cells' (G-MSCs) proliferation and regenerative gene expression in-vitro. Material and Methods: G-MSCs were isolated, characterized, expanded and stimulated by total sonicated A.actinomycetemcomitans-bacterial-fragments (0 (negative-control), 15, 60, 120 and 240μg/ml; serovar-b; n=6/group). Cellular proliferation and NF-κβ (NFKB1), Alkaline Phosphatase (ALPL), Collagen-I (COL1A1), Collagen-III (COL3A1), Osteonectin (SPARC) and Osteopontin (SPP1) m-RNA expression were assessed via reverse-transcription-polymerase-chain-reaction (RT-PCR) at 24, 48 and 72 hours and CFUs-ability evaluated at twelve days. Results: G-MSCs demonstrated stem/progenitor cells' characteristics. A.actinomycetemcomitans-bacterial-fragments (up to 72 hours) resulted in marked G-MSCs' proliferation over-time (p<0.001) and elevated NFKB1 (p= 0.017), COL1A1 (p=0.025), SPARC (p=0.025), decreased ALPL (p=0.017), with no significant differences for COL3A1 and SPP1 expression or stimulation times (p>0.05; Friedman-test). Longer-term stimulation for twelve days reduced G-MSCs' CFUs. Conclusions: Sonicated A.actinomycetemcomitans-bacterial-fragments' exert beneficial short-term effects on G-MSCs' proliferative and non-mineralized tissue forming aptitude. Results shed new light on the importance of periodontal treatment for LAgP patients, using power driven sonic/ultrasonic devices, which, in addition to reducing the subgingival microbial load, produces cell-stimulatory A.actinomycetemcomitans-bacterial-fragments, with positive attributes on tissue reparative/regenerative responses of tissue resident stem/progenitor cells in their niche


No disponible


Assuntos
Humanos , Aggregatibacter actinomycetemcomitans/isolamento & purificação , Infecções por Pasteurellaceae/patologia , Células-Tronco/microbiologia , Gengiva/microbiologia , Periodontite/microbiologia , Periodontite/patologia , Proliferação de Células , Fatores Estimuladores de Colônias
17.
J Clin Periodontol ; 45(9): 1069-1077, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29981185

RESUMO

AIM: We assessed the long-term costs for treating chronic periodontitis (CP) patients. METHODS: A cohort of compliant CP patients was retrospectively evaluated. Costs for active periodontal therapy (APT, including scaling and root planning, open flap debridement, root resections) and supportive periodontal therapy (SPT including periodontal, restorative, endodontic, prosthetic and surgical treatments) were estimated from a mixed payer perspective in Germany. The impact of tooth- and patient-level factors on annual costs was assessed using mixed-modelling. RESULTS: Two hundred and seventy-three patients (mean ± SD age: 49.6 ± 8.8 years), with 24.3 ± 4.5 teeth, were included. Mean follow-up was 18.7 ± 5.7 years. Total treatment costs per patient and per tooth were 6,146 ± 2,236 and 222 ± 98 Euro, respectively. Costs were generated mainly by periodontal therapy and during SPT. Annualized patient- and tooth-level costs were 348 ± 159 and 12.4 ± 5.7 Euro, respectively. Annual costs increased significantly in older patients, regular attenders, those with fewer teeth (<24) at baseline and teeth with higher probing pocket depths or mobility 3 at baseline. CONCLUSIONS: Annual costs for treating CP patients were lower than those found for aggressive periodontitis patients. Regular attendance and having more severe periodontitis came with higher costs per year.


Assuntos
Periodontite Crônica , Perda de Dente , Adulto , Idoso , Seguimentos , Alemanha , Custos de Cuidados de Saúde , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
18.
J Clin Periodontol ; 45(6): 701-710, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29611218

RESUMO

OBJECTIVES: A large number of multivariable models which associate independent variables with the outcome tooth loss exist. Directly or indirectly, these make predictions as to the relative risk of tooth loss. We aimed to validate six of these prediction models. METHODS: We applied each model, if needed after adaptions, in a cohort of 301 compliant periodontitis patients who had been under supportive periodontal treatment (SPT) in a university setting over 21.7 ± 5.6 years. The models employed a range of tooth-level and patient-level parameters. Model accuracy, that is, the ability to rightly predict tooth loss during SPT using baseline parameters, was investigated by the area under the receiver-operating-characteristics curve (AUC). RESULTS: Most models showed low accuracy (AUC ranged between 0.52 and 0.67). The classification model from Avila et al. (2009) Journal of Periodontology, 80, 476-491, expressing the risk of tooth loss in five grades, was most accurate (mean AUC: 0.67, 95%CI: 0.65/0.69). When applying this model, the risk of false-positively predicting tooth loss was high, except when the highest grade (i.e. a tooth being considered as having a hopeless prognosis) was used. In this case, the specificity was 84% and the sensitivity 46%. CONCLUSIONS: Predicting tooth loss in this specific cohort of periodontitis patients was only limitedly possible.


Assuntos
Modelos Estatísticos , Periodontite/complicações , Perda de Dente/etiologia , Fatores Etários , Atitude Frente a Saúde , Comorbidade , Progressão da Doença , Estética Dentária , Humanos , Seguro Odontológico/estatística & dados numéricos , Cooperação do Paciente , Periodontite/terapia , Valor Preditivo dos Testes , Fumar
20.
Clin Oral Investig ; 22(1): 235-244, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28353021

RESUMO

OBJECTIVES: The aim of this retrospective study was to evaluate the long-term implant survival in patients with a history of chronic periodontitis, during supportive periodontal therapy (SPT), compared to periodontally healthy patients. MATERIALS AND METHODS: Twenty-nine periodontitis patients (test) with SPT for ≥9 years and implant-supported restorations (≥5 years follow-up) were recruited and pair-matched with 29 periodontally healthy patients (control). Subjects in both groups were examined following active periodontal therapy and/or implantation (T1) (test 69 implants, control 76 implants) and at end of SPT or supportive postimplant therapy (T2). Differences between the groups in implant survival (primary outcome), mean marginal bone loss (MBL) and pocket probing depths (PPDs) (secondary outcomes) were evaluated. RESULTS: Implant survival over 5 years was 97.1% in test compared to 97.4% in control group (p = 0.562). MBL was significantly different (test 18.7 ± 18.2%; control 12.5 ± 21.3%) (p < 0.05). PPDs increased at T2 in both groups (test: T1 3.4 ± 1.0 mm; T2 4.2 ± 1.6 mm; control: T1 1.0 ± 1.2 mm; T2 2.9 ± 0.8 mm; p < 0.05 between groups). Prognostic factors for implant loss appeared to be the presence of residual periodontal pockets of ≥4 mm (OR 1.90), bone height (OR 1.81) and age (OR 1.16) at T1. CONCLUSION: In terms of implant survival, no differences were observed between periodontitis and periodontally healthy patients. However, patients with history of periodontitis showed higher MBL and PPDs compared to periodontally healthy patients. CLINICAL RELEVANCE: The presence of a good periodontal maintenance program with preceding successful active periodontal treatment seems to be indispensable components of successful implant treatment in patients with history of chronic periodontitis.


Assuntos
Periodontite Crônica/complicações , Periodontite Crônica/terapia , Implantes Dentários , Falha de Restauração Dentária , Adulto , Idoso , Estudos de Casos e Controles , Prótese Dentária Fixada por Implante , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...