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1.
J Clin Periodontol ; 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33512724

RESUMO

This editorial provides a summary of new evidence derived from four recent systematic reviews on regenerative/reconstructive periodontal surgery recently published in the Journal of Clinical Periodontology. We hereby discuss how the results of these papers combined can be useful for the clinical periodontist, in the light of the recent European Federation of Periodontology (EFP) guidelines, and for researcher involved in this field of investigation.

2.
Periodontol 2000 ; 85(1): 161-181, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33226705

RESUMO

Periodontitis is an infectious, inflammatory disease that is associated with a complex interplay between specific bacteria, host response, and environmental factors. Because of its high degree of familial aggregation, specifically for the more aggressive forms of the disease, genetics factors have been implicated in disease pathogenesis for several decades. This review provides an overview of what we currently know regarding the genetic and epigenetic contributions to periodontal disease and discusses future opportunities in the field.

3.
J Clin Periodontol ; 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-33260273

RESUMO

AIM: The objective of this study was to evaluate consistency and accuracy of the periodontitis staging and grading classification system. METHODS: Thirty participants (10 periodontal experts, 10 general dentists and 10 undergraduate students) and a gold standard examiner were asked to classify 25 fully documented periodontitis cases twice. Fleiss kappa was used to estimate consistency across examiners. Intraclass correlation coefficient (ICC) was used to calculate consistency across time. Quadratic weighted kappa and percentage of complete agreement versus gold standard were computed to assess accuracy. RESULTS: Fleiss kappa for stage, extent and grade were 0.48, 0.37 and 0.45 respectively. The highest ICC was provided by students for stage (0.91), whereas the lowest ICC by general dentists for extent (0.79). Pair-wise comparisons against gold standard showed mean value of kappa >0.81 for stage and >0.41 for grade and extent. Agreement with the gold standard for all three components of the case definition was achieved in 47.2% of cases. The study identified specific factors associated with lower consistency and accuracy. CONCLUSIONS: Diagnosis was highly consistent across time and moderately between examiners. Accuracy was almost perfect for stage and moderate for grade and extent. Additional efforts are required to improve training of general dentists.

4.
J Clin Periodontol ; 2020 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-33025619

RESUMO

BACKGROUND: It is thought that infrabony defect morphology affects the outcome of periodontal regenerative surgery. However, this has not been systematically investigated. AIMS: To investigate how well defect morphology is described in papers reporting regenerative therapy of periodontal infrabony defects and to investigate its effect on clinical and radiographic outcomes. MATERIALS AND METHODS: A search was conducted in 3 electronic databases for publications reporting clinical and radiographic outcomes of periodontal intra-bony defects after regenerative therapy, divided by defect morphology. RESULTS: The initial search resulted in 4487 papers, reduced to 143 after first and second screening. Fifteen of these publications were suitable for a fixed-effects meta-analysis. Initial defect depth was found to influence radiographic bone gain 12 months post-surgery, while narrower angles and increased number of walls influenced both radiographic bone gain and clinical attachment level (CAL) gain at 12 months. These associations seemed to occur irrespective of biomaterials used. Risk of bias ranged from low to high. CONCLUSION: Deeper defects with narrower angles and increased number of walls exhibit improved CAL and radiographic bone gain at 12 months post-regenerative surgery. More data are needed about other aspects of defect morphology such as extension to buccal/lingual surfaces.

5.
J Periodontal Res ; 2020 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-32959898

RESUMO

OBJECTIVE: To compare a behavioural management program (test) to a standard communication approach (control) to reduce plaque, improve clinical outcomes and patient's compliance with oral self-care. BACKGROUND: Since psychological factors affect oral health-related behaviours, approaches directed at changing behaviours and improving compliance might improve the effect of oral health education. MATERIALS AND METHODS: This was a randomized, single-blind, parallel-design trial involving 71 patients with mild to moderate periodontitis. During a run-in period, all participants began using a power toothbrush. Two sessions of non-surgical periodontal therapy were performed post-baseline, along with one of the two oral healthcare communication approaches. Plaque and bleeding scores, probing pocket depth (PPD) and clinical attachment level (CAL) were recorded at the screening visit, baseline visit and at 8 and 14 weeks post-baseline. Patients were asked to fill in oral self-care diaries. Experience questionnaires were administered to both clinicians and patients to assess subjective experience of the clinician-patient interactions during the visits. RESULTS: In both groups, a significant reduction in plaque and bleeding scores was observed from baseline to 8 weeks after baseline, which then remained stable at week 14, but no differences between the groups were noted. An improvement in CAL and PPD was recorded at week 8 post-baseline in the test compared to the control group. No inter-group differences in the clinician's and subject's experience questionnaires were observed. CONCLUSION: Both approaches significantly promoted periodontal health. However, changing lifestyle requires repeated communication/engagement over time and a behavioural management program based upon two visits did not provide additional benefit compared to a standard approach.

6.
J Periodontal Res ; 55(6): 801-809, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32840888

RESUMO

BACKGROUND: Non-surgical periodontal treatment (NSPT) is widely employed for the treatment of periodontal disease and yields significant clinical improvements. Gingival crevicular fluid (GCF) can be used to profile health and disease, and recent technological advances, such as multiplex bead immunoassays, are promising in identifying a wider array of GCF factors with the ultimate aim to predict the treatment response. OBJECTIVE: The aim of this systematic review was to compare the expression of GCF markers using multiplex bead immunoassays before treatment and during early, average, or late healing period, following non-surgical periodontal treatment (NSPT). METHODS: An electronic literature search was conducted by two independent examiners (VK and NC) in MEDLINE, EMBASE, OpenGrey, LILACS, and Cochrane Library up to January 2020. The PICO question formulated was as follows: "In patients with periodontal disease, does the expression of gingival crevicular fluid (GCF) markers detected using multiplex bead immunoassay differ at baseline compared with early (≤30 days), average (6-8 weeks), or late (≥3 months) healing after intervention?" RESULTS: A total of 366 publications were obtained and reviewed for eligibility for inclusion. Of these, 12 publications fulfilled the inclusion criteria and were included in the present review. Data for a total of 31 different GCF markers were extracted and summarized for early, average, or late healing after NSPT. Early healing following NSPT (≤ 30 days) indicated an increase in IL-1ß, TNFα, and IL-10. At the average healing period (6-8 weeks), IL-1ß, IL-1α, IL-6, TNF-α, IFN-γ, GM-CSF, MCP-1, and MIP-1α were all reduced, compared to their respective baseline values. Three months after NSPT, IL-1ß, IL-4, IL-6, IL-10, TNF-α, and IFN-γ were detected at reduced levels, compared to pre-treatment levels. Overall, the changes following treatment indicated a reduction of inflammation present at baseline. CONCLUSION: Following non-surgical periodontal treatment, an upregulation of inflammation markers is noted early post-operatively and a subsequent reduction of their levels three months following treatment. The investigation of levels of GCF markers associated with inflammation and regeneration, especially using multiplex bead immunoassay technologies, is a valuable tool to better understand the processes associated with healing following periodontal treatment.

7.
J Clin Periodontol ; 47(8): 980-990, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32557763

RESUMO

AIMS: The primary aim of this investigation was to analyse the periodontal microbiome in patients with aggressive periodontitis (AgP) following treatment. METHODS: Sixty-six AgP patients were recalled on average 7 years after completion of active periodontal treatment and had subgingival plaque samples collected and processed for 16S rRNA gene sequencing analyses. RESULTS: Of 66 participants, 52 showed persistent periodontal disease, while 13 participants were considered as "successfully treated AgP" (no probing pocket depths >4 mm) and 1 was fully edentulous. Genera associated with persistent generalized disease included Actinomyces, Alloprevotella, Capnocytophaga, Filifactor, Fretibacterium, Fusobacterium, Leptotrichia, Mogibacterium, Saccharibacteria [G-1], Selenomonas and Treponema. "Successfully treated" patients harboured higher proportions of Haemophilus, Rothia, and Lautropia and of Corynebacterium, Streptococcus and Peptidiphaga genera. Overall, patients with persistent generalized AgP (GAgP) revealed higher alpha diversity compared to persistent localized AgP (LAgP) and stable patients (p < .001). Beta diversity analyses revealed significant differences only between stable and persistent GAgP groups (p = .004). CONCLUSION: Patients with persistent AgP showed a more dysbiotic subgingival biofilm than those who have been successfully treated. It remains to be established whether such differences were predisposing to disease activity or were a result of a dysbiotic change associated with disease recurrence in the presence of sub-standard supportive periodontal therapy or other patient-related factors.

8.
Clin Oral Investig ; 24(12): 4291-4299, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32385656

RESUMO

AIM: Assessment of the effect of nonsurgical periodontal therapy on haematological parameters in patients with grades B (BP) and C periodontitis (CP). METHODS: Eight BP and 46 CP patients received full-mouth periodontal debridement within 48 h, if positive for Aggregatibacter actinomycetemcomitans with adjunctive systemic antibiotics (4 BP, 17 CP). Clinical data were collected prior and 12 weeks after periodontal therapy. Blood was sampled prior to and 1 day as well as 6 and 12 weeks after the first SD visit. Erythrocyte count, haemoglobin value, haematocrit (HCT), mean erythrocyte volume (MCV), mean corpuscular haemoglobin (MCH), MCH concentration (MCHC), platelets (PLT) and heat shock protein 27 (Hsp27) were assessed. RESULTS: Both groups showed significant clinical improvement (p < 0.05). Using univariate analysis, MCV was noticeably lower in CP than BP at all examinations, HCT only at baseline. For CP, MCHC was noticeably higher 12 weeks after SD than at baseline and 1 day (p ≤ 0.005) and Hsp27 increased noticeably at 1 day (p < 0.05). Repeated measures analysis of variance revealed African origin to be associated with lower MCV and female sex with lower MCHC. CONCLUSION: Based on multivariate analysis, periodontal diagnosis (BP/CP) was not associated with haematological parameters measured in this study or serum Hsp27. In CP, nonsurgical periodontal therapy improved MCHC 12 weeks after SD. Also in CP Hsp27 was increased 1 day after SD.

9.
J Periodontal Res ; 55(4): 574-580, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32232983

RESUMO

BACKGROUND AND OBJECTIVE: Evidence suggests that periodontitis has a negative effect on the quality of life of an individual, with increased impacts by greater disease severity. The aim of this study was to assess the association between quality of life and the presence of different severity and forms of periodontitis (aggressive and chronic), compared to a disease-free control group. MATERIALS AND METHODS: Four hundred and seventy one study participants were classified according to periodontal diagnosis using the 1999 Consensus Classification into chronic periodontitis (CP), aggressive periodontitis (AgP) and periodontally healthy. Oral health-related quality of life was assessed using the OHIP-14 questionnaire. Outcomes consisted of the prevalence of oral impacts reported occasionally, fairly often or very often (OFOVO) as well as fairly often or very often (FOVO), OHIP-14 total and domain scores. Logistic and linear regression analyses were carried out to test associations between periodontal diagnosis and quality of life outcomes, adjusted for smoking, age, ethnicity and body mass index. RESULTS: Over 90% of periodontitis patients reported at least one oral impact experienced occasionally, fairly often or very often (OFOVO) compared with 53.8% of periodontally healthy controls (P < .001). After adjustment for covariates, significant differences were found between the periodontitis groups and healthy controls for OHIP-14 outcome scores (P < .001) and across all of the OHIP-14 domains (P < .005). These differences were clinically meaningful as they were higher than the measurement errors. No significant differences were identified between AgP and CP in adjusted analysis when comparing OHIP-14 scores. CONCLUSION: Patients with periodontitis have worse quality of life than periodontally healthy individuals, with differences being clinically meaningful. AgP patients reported worse OHRQoL overall compared to CP patients, but these moderate and meaningful differences were explained through the adjustment process.


Assuntos
Periodontite Agressiva , Periodontite Crônica , Saúde Bucal , Qualidade de Vida , Periodontite Agressiva/complicações , Periodontite Crônica/complicações , Humanos , Inquéritos e Questionários
10.
J Clin Periodontol ; 47(1): 2-18, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31560804

RESUMO

AIM: To analyse, using a meta-analytical approach, the diagnostic accuracy of single molecular biomarkers in saliva for the detection of periodontitis in systemically healthy subjects. MATERIALS AND METHODS: Articles on molecular biomarkers in saliva providing a binary contingency table (or sensitivity and specificity values and group sample sizes) in individuals with clinically diagnosed periodontitis were considered eligible. Searches for candidate articles were conducted in six electronic databases. The methodological quality was assessed through the tool Quality Assessment of Diagnostic Studies. Meta-analyses were performed using the Hierarchical Summary Receiver Operating Characteristic model. RESULTS: Meta-analysis was possible for 5 of the 32 biomarkers studied. The highest values of sensitivity for the diagnosis of periodontitis were obtained for IL1beta (78.7%), followed by MMP8 (72.5%), IL6 and haemoglobin (72.0% for both molecules); the lowest sensitivity value was for MMP9 (70.3%). In terms of specificity estimates, MMP9 had the best result (81.5%), followed by IL1beta (78.0%) and haemoglobin (75.2%); MMP8 had the lowest specificity (70.5%). CONCLUSIONS: MMP8, MMP9, IL1beta, IL6 and Hb were salivary biomarkers with good capability to detect periodontitis in systemically healthy subjects. MMP8 and IL1beta are the most researched biomarkers in the field, both showing clinically fair effectiveness for the diagnosis of periodontitis.


Assuntos
Biomarcadores , Periodontite , Saliva , Humanos , Sensibilidade e Especificidade
11.
Clin Oral Investig ; 24(6): 1939-1951, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31628543

RESUMO

OBJECTIVE: The aim of this systematic review was to appraise the existing literature on periodontal disease in children affected by different types of neutrophil-associated primary immunodeficiencies (PIDs). METHODS: A PRESS-validated search strategy was developed to search through databases MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, LILACS, Google Scholar and Open Grey. All included studies were assessed for methodological quality and risk of bias. RESULTS: One hundred eighteen articles reporting on 160 PID patients were included for qualitative analysis. The majority (70%) were individual case reports. Clinical and radiographic manifestations of the periodontal disease included poor oral hygiene, generalised alveolar bone loss, severe gingival inflammation, increased pocket depths, tooth mobility and gingival recession. For most studies, the primary intervention was periodontal treatment in the form of scaling and root planing or dental extractions. Stabilisation of the periodontal condition varied between different PIDs. In severe congenital neutropenia (SCN), 61% of cases reported stabilisation of the periodontal condition, while for all other PIDs, 'stability' was reported in less than 43% of cases. CONCLUSION: The published literature suggests that patients with PIDs can present with severe periodontitis and that conventional treatment approaches have limited benefits.


Assuntos
Perda do Osso Alveolar , Gengivite , Doenças do Sistema Imunitário , Doenças Periodontais , Periodontite , Criança , Humanos , Doenças do Sistema Imunitário/complicações , Doenças Periodontais/complicações , Aplainamento Radicular
12.
J Clin Periodontol ; 47 Suppl 22: 320-351, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31860134

RESUMO

BACKGROUND: The aim of this systematic review was to compare clinical, radiographic and patient-reported outcomes (PROMs) in intra-bony defects treated with regenerative surgery or access flap. MATERIALS AND METHODS: A systematic review protocol was written following the PRISMA checklist. Electronic and hand searches were performed to identify randomized clinical trials (RCTs) on regenerative treatment of deep intra-bony defects (≥3 mm) with a follow-up of at least 12 months. Primary outcome variables were probing pocket depth (PPD) reduction, clinical attachment level (CAL) gain and tooth loss. Secondary outcome variables were Rec, radiographic bone gain, pocket "closure," PROMs and adverse events. Meta-analysis was carried out when possible. To evaluate treatment effect, odds ratios were combined for dichotomous data and mean differences for continuous data using a random-effect model. RESULTS: A total of 79 RCTs (88 articles) published from 1990 to 2019 and accounting for 3,042 patients and 3,612 intra-bony defects were included in this systematic review. Only 10 of included studies were rated at low risk of bias. A total of 13 meta-analyses were performed. All regenerative procedures provided adjunctive benefit in terms of CAL gain (1.34 mm; 0.95-1.73) compared with open flap debridement alone. Both enamel matrix derivative (EMD) and guided tissue regeneration (GTR) were superior to OFD alone in improving CAL (1.27 mm; 0.79-1.74 mm and 1.43 mm; 0.76-2.22, respectively), although with moderate-high heterogeneity. Among biomaterials, the addition of deproteinized bovine bone mineral (DBBM) improved the clinical outcomes of both GTR with resorbable barriers and EMD. Papillary preservation flaps enhanced the clinical outcomes. The strength of evidence was low to moderate. CONCLUSION: EMD or GTR in combination with papillary preservation flaps should be considered the treatment of choice for residual pockets with deep (≥3 mm) intra-bony defects.

13.
J Clin Periodontol ; 46(12): 1166-1182, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31444912

RESUMO

AIM: To analyse, by means of a meta-analytical approach, the diagnostic accuracy of molecular biomarkers in gingival crevicular fluid (GCF) for the detection of periodontitis in systemically healthy subjects. MATERIAL AND METHODS: Studies on GCF molecular biomarkers providing a binary classification table (or sensitivity and specificity values and group sample sizes) in individuals with clinically diagnosed periodontitis were considered eligible. The search was performed using six electronic databases. The methodological quality of studies was assessed through the tool Quality Assessment of Diagnostic Studies. Meta-analyses were performed using the Hierarchical Summary Receiver Operating Characteristic, which adjusts classification data using random effects logistic regression. RESULTS: The included papers identified 36 potential biomarkers for the detection of periodontitis and for four of them meta-analyses were performed. The median sensitivity and specificity were for MMP8, 76.7% and 92.0%; for elastase, 74.6% and 81.1%; for cathepsin, 72.8% and 67.3%, respectively. The worst estimates of sensitivity and specificity were for trypsin (71.3% and 66.1%, respectively). CONCLUSIONS: MMP8 showed good sensitivity and excellent specificity, which resulted in this biomarker being clinically the most useful or effective for the diagnosis of periodontitis in systemically healthy subjects, regardless of smoking condition.


Assuntos
Líquido do Sulco Gengival , Periodontite , Biomarcadores , Catepsinas , Humanos , Sensibilidade e Especificidade
14.
J Clin Periodontol ; 46(12): 1228-1235, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31418893

RESUMO

BACKGROUND AND OBJECTIVE: Degree III furcation involvement (FI) represents a risk of molar tooth loss. A limited number of studies have assessed the survival of molars with degree III FI treated with tunnelling procedures. AIMS: The aim of the present study was to assess periodontal disease progression and tooth loss in a cohort of patients with degree III FI treated with tunnelling by two periodontists in a private practice setting in the UK and in a hospital setting in Sweden. MATERIALS AND METHODS: A retrospective study was conducted on 102 consecutive surgically created tunnelled molars in 62 periodontitis patients and followed up at least 5 years later (average 7-year and 9-month follow-up). RESULTS: Overall tooth loss for tunnelled molars was 29.4%. Multivariate analysis revealed statistically significant associations with tooth loss for 'irregular supportive periodontal therapy (SPT'; p = .039) and age (p = .037). Tooth loss occurred only in the Swedish sample, not undergoing regular SPT. CONCLUSION: A high rate of tooth loss was observed following tunnelling surgery, mainly in patients not undergoing regular supportive therapy. Clinical studies should be carried out to compare tunnelling with other treatment options for advanced furcation involvement in patients on SPT.


Assuntos
Defeitos da Furca , Perda de Dente , Humanos , Dente Molar , Estudos Retrospectivos , Suécia
15.
J Clin Periodontol ; 46(10): 999-1012, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31254278

RESUMO

BACKGROUND: It is unclear whether patients with specific subgingival microbiological profiles benefit more from adjunctive systemic antibiotics. AIMS: To answer the question: "What is the clinical benefit in periodontitis patients taking adjunctive systemic antimicrobials to non-surgical therapy, depending on pre-treatment detection of periodontopathogenic bacteria?" MATERIALS AND METHODS: A search was conducted in four electronic databases for randomized controlled trials reporting clinical outcomes following adjunctive antibiotic therapy for patients divided by baseline microbiological profiles. RESULTS: The initial search resulted in 643 papers, reduced to five after screening and author contact. Four of these studies were suitable for a fixed effects two-stage individual participant data meta-analysis adjusted for baseline data. Collectively, adjunctive amoxicillin and metronidazole yielded superior clinical results (measured as reduction of PPDs) compared to placebo. No significant differences were detected for the effect of adjunctive antibiotics by the detection of Aggregatibacter actinomycetemcomitans on PPDs ≥ 5 mm (WMD = 1.16, 95% CI [-5.37, 7.68], I2  = 37.8%) or other clinical outcomes. All included studies had low risk of bias. CONCLUSION: There is no evidence to suggest that baseline detection of periodontopathogenic bacteria should be used as criterion for prescribing adjunctive antibiotics, although only limited information on microbial data and specific antimicrobials was available for analysis.


Assuntos
Anti-Infecciosos , Raspagem Dentária , Amoxicilina , Antibacterianos , Humanos , Metronidazol
16.
J Periodontol ; 90(11): 1252-1259, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31119743

RESUMO

BACKGROUND: While leukocytosis is a common feature of severe periodontitis, a smaller amount of evidence has been produced on erythrocytes counts in periodontitis, suggesting a possible tendency to anemia. The aim of this study was to investigate the associations between periodontitis and circulating leukocytes, erythrocytes, and platelets. METHODS: The study included 471 patients with periodontitis (including aggressive periodontitis [AgP], and chronic periodontitis [CP]) and periodontal health. A separate sample of 333 patients from a previous study (127 AgP and 206 periodontally healthy) was used as replication. Periodontal clinical data were collected and a blood sample was obtained from each participant for hematological analysis of leukocytes, erythrocytes and platelets. RESULTS: Adjusted linear regression analyses revealed associations between periodontitis and total leukocytes counts (p < 0.001), neutrophil counts (P <0.001) and hematocrit (HCT) levels (P = 0.045). Sub-analysis revealed no statistically significant differences between AgP and CP. Disease severity was correlated with total leukocyte and neutrophil counts and HCT (P <0.001, P <0.001 and P = 0.004, respectively). In the replication sample, adjusted linear regression analysis revealed associations between periodontitis and decreased hemoglobin (HB) (P = 0.009), mean corpuscular hemoglobin (MCH) (P = 0.023), and MCH concentration (P <0.001). A subset of patients included in these studies (14% to 15.7% of periodontitis versus 8.4% to 10.2% of healthy, respectively, in the two cohorts) were anemic based on the World Health Organization criteria. CONCLUSION: This paper, reporting results of periodontal examination and blood sampling in over 800 patients, suggest that not just leukocytosis but also tendency to "anemia of inflammation" are typical features of periodontitis.


Assuntos
Periodontite Agressiva , Anemia , Periodontite Crônica , Humanos , Inflamação , Perda da Inserção Periodontal , Bolsa Periodontal
17.
BMC Oral Health ; 19(1): 65, 2019 04 27.
Artigo em Inglês | MEDLINE | ID: mdl-31029129

RESUMO

BACKGROUND: Past meta-analyses have shown adjunctive systemic Azithromycin (AZI) to provide minor clinical benefits in scaling and root surface debridement (S/RSD). However, these have not considered the covariance of key outcome parameters; probing pocket depth (PPD) and Clinical Attachment Level (CAL) or systematically examined some potential sources of heterogeneity. AIM: To jointly synthesize 6-month outcomes of systemic AZI as adjunctive to S/RSD in chronic periodontitis and investigate 3 potential sources of heterogeneity. METHODS: Four databases were searched for suitable randomized controlled clinical trials (RCTs). Standardized mean differences (SMD) in PPD and CAL between AZI + S/RSD and S/RSD alone, at 6-month follow-up were computed. Within-study covariances of PPD and CAL were derived from reported multiple time-point data. A multivariate meta-analysis with random effects jointly modelled PPD and CAL, factoring in their covariance. This model included 3 moderators with interaction effects; timing of AZI initiation (pre-therapy/post-therapy), type of S/RSD [full-mouth debridement (FMD)/partial-mouth debridement (PMD)], and baseline study-level mean values of PPD/CAL. RESULTS: Among 276 abstracts, 11 observations from 9 RCTs qualified for meta-analysis. Within-study correlation-coefficients of PPD with CAL significantly increased with increasing study-level baseline mean values (Spearman's r = 0.79, p < 0.01). The full multivariate meta-analysis model showed significant effects for the 3 moderators (Q statistic = 150.03, p < 0.01), retained significant residual heterogeneity (Q statistic = 88.50, p < 0.01) but outperformed (Likelihood- ratio statistic = 102.95, p < 0.01,) a null-model with no moderators (Q statistic = 201.5, p < 0.01). A significant effect was seen only on the SMD for PPD (estimate = 1.16 mm, 95% CI: 0.27 mm-2.07 mm mm, p = 0.01) but not CAL (estimate = 0.17 mm, 95% CI: -0.92 mm-1.26 mm, p = 0.76). SMD in PPD positively interacted with study baseline value (estimate = 0.11, 95% CI: 0.08-0.15, p < 0.01). Significant negative interactions of SMD in PPD with PMD (estimate = - 1.25 mm, 95% CI: -1.73 mm- -0.78 mm, p < 0.01) and pre-therapy drug initiation (estimate = - 1.18 mm, 95% CI: -1.48 mm--0.87 mm, p < 0.01) were evident. CONCLUSION: Joint synthesis of PPD and CAL showed, at 6-months, AZI + S/RSD provided a benefit over S/RSD alone for PPD alone when correlation with CAL was accounted for. Deeper study-level baseline PPD, FMD type of S/RSD, and post-therapy drug initiation associated with greater PPD reduction.


Assuntos
Antibacterianos/administração & dosagem , Azitromicina/administração & dosagem , Periodontite Crônica/terapia , Desbridamento , Raspagem Dentária/métodos , Periodontite/terapia , Azitromicina/uso terapêutico , Periodontite Crônica/tratamento farmacológico , Periodontite Crônica/patologia , Assistência Odontológica , Humanos , Bolsa Periodontal/patologia , Periodontite/tratamento farmacológico , Periodontite/patologia , Resultado do Tratamento
18.
Biochim Biophys Acta Mol Basis Dis ; 1865(2): 476-484, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30529255

RESUMO

Periodontitis is an infectious and inflammatory disease of the tooth-supporting tissues caused by the accumulation of subgingival plaque and the action of specific periodontopathogenic bacteria. Periodontitis has been associated with cardiovascular diseases and considered a cardiovascular risk factor. Several mechanisms have been proposed to explain this association, such as the infection of atherosclerotic plaques by periodontal pathogens, the pro-atherogenic effect on the lipid profile, the systemic dissemination of pro-inflammatory mediators or the contribution to type 2 diabetes mellitus. Periodontal treatment has also been related to improvement in cardiometabolic risk variables, and oral hygiene techniques may be useful in reducing cardiometabolic risk. The aim of this review is to provide new and recent insights on the relationship between periodontitis and cardiometabolic risk, focusing on recent evidence. Comments on shared potential therapeutic targets, such as the role of glucagon-like peptide 1, are also highlighted.


Assuntos
Doenças Cardiovasculares/etiologia , Periodontite/complicações , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/imunologia , Peptídeo 1 Semelhante ao Glucagon , Humanos , Lipídeos/sangue , Microbiota , Periodontite/epidemiologia , Periodontite/microbiologia , Periodontite/terapia , Fatores de Risco
19.
Clin Oral Investig ; 23(6): 2695-2703, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30350134

RESUMO

OBJECTIVE: The presence of periodontal disease (PD) in subjects affected by the metabolic syndrome (MetS) may affect their risk of developing cardiovascular disease. The aim of this cross-sectional study was to investigate the systemic impact of PD in MetS, by assessing measures of sub-clinical atherosclerosis and left ventricular mass and geometry. MATERIALS AND METHODS: A total of 103 patients undergoing treatment for MetS were examined for confirmation of diagnosis, blood sampling, and measures of pulse wave velocity (PWV), carotid intima-media thickness (c-IMT), left ventricular mass index (LVM), and relative wall thickness (RWT). All subjects underwent a detailed dental assessment, including measurements of DMFT (decayed-missing-filled teeth) and periodontal parameters. RESULTS: Ten patients (10%) were diagnosed with healthy-mild periodontitis, 38 patients (37%) were diagnosed in the moderate periodontitis group, and 55 (53%) had severe periodontitis. A total of 37% of subjects were affected by dental caries. Linear regression analysis revealed that patients with severe PD had increased average ventricular RWT (adjusted p = 0.032). Average full mouth probing pocket depth (PPD) was also associated with RWT (adjusted p = 0.006). No associations between PD and c-IMT, PWV, and LVM were detected after adjusted analyses. CONCLUSION: This study suggests that periodontitis may be associated with concentric left ventricular remodeling, a predictive index of cardiovascular events. CLINICAL RELEVANCE: The presence of periodontitis in patients with MetS might have an effect on left ventricular geometry. These findings stress the importance of prevention, diagnosis, and management of periodontitis in patients with MetS. TRAIL REGISTRATION: NCT03297749.


Assuntos
Síndrome Metabólica/complicações , Periodontite/complicações , Remodelação Ventricular , Idoso , Doenças Cardiovasculares/complicações , Espessura Intima-Media Carotídea , Estudos Transversais , Cárie Dentária/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Onda de Pulso , Fatores de Risco , Rigidez Vascular
20.
J Clin Periodontol ; 45(12): 1458-1464, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30307641

RESUMO

AIM: The aim of this study was to assess the stability over time of periodontal intrabony defects treated with minimally invasive non-surgical therapy (MINST) and supportive periodontal therapy (SPT). METHODS: Clinical and radiographic analysis was carried out in 21 intrabony defects treated with MINST in 14 consecutive patients included in a prospective study and reassessed after 5 years of SPT. Baseline, 1- and 5-year radiographs were analysed, and bone levels were compared by multilevel linear regression adjusted by latent variable method. RESULTS: None of the 21 teeth with intrabony defects was lost at 5 years. Average probing pocket depth, clinical attachment level and radiographic intrabony vertical defect depth reductions were 3.6, 3.5 and 2.6 mm, respectively, 5 years after treatment (p < 0.001 compared with baseline). Further non-statistically significant reductions were seen in clinical and radiographic measures between 1 and 5 years. Deeper initial defects and narrower angles were predictive of a bigger reduction in defect depth (p < 0.001 and p = 0.017, respectively). CONCLUSIONS: Clinical and radiographic improvements in intrabony defects after MINST seen at 1 year are stable up to 5 years, bringing evidence to support its long-term efficacy for the treatment of intrabony defects in non-smokers.


Assuntos
Perda do Osso Alveolar , Regeneração Tecidual Guiada Periodontal , Seguimentos , Humanos , Perda da Inserção Periodontal , Bolsa Periodontal , Estudos Prospectivos , Resultado do Tratamento
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