How predictable are periodontal regenerative procedures?

Periodontal regeneration has become one of the primary objectives of periodontal therapy. The resulting scientific endeavours have elucidated modes of periodontal wound healing, the growth of periodontal cells and their association with the surrounding matrix, and growth-promoting factors. The periodontal regeneration industry is producing better and more expensive devices, but the criteria for evaluating their success have not progressed to the same extent. Although clinical measurements of attachment level and probing depths, along with radiography, are good methods of evaluating tooth survival and prognosis, they do not indicate true biological regeneration. In addition, the regeneration industry may encourage the overuse of allografts and alloplasts which may serve as an impediment to simple wound healing. This review is a critical assessment of the clinical use of various regenerative tools, specifically bone replacements and membranes. The future of the regeneration industry may depend on the merging of various technologies and biological concepts, including the possible use of biological barriers, various bone and periodontal growth inducers, and artificial matrices that will attract or carry the cells necessary for regeneration.     

How relevant is counselling in relation to dentistry?

This article attempts to explain reasons behind the general public's fear of dentistry by examining the historical perspective and, using case scenarios, demonstrates areas where patients' dental treatment might have been helped by the use of counselling. Distinguishing between the use of counselling skills vis-à-vis professional counselling, the wider issues for the dental profession - education, boundaries and the need for referrals - are explored. It is suggested that if a counsellor were included as part of the dental team, patients and professionals would benefit. The counsellor could act as an advisor and educator for the team in addition to undertaking professional counselling on referral. Patients with anxiety or phobias could be recognised and helped appropriately and occupational stress experienced by practitioners would be reduced.     

Is religiosity related to periodontal health among the adult Jewish population in Jerusalem?

Zini A, Sgan‐Cohen H D, Marcenes W. Is religiosity related to periodontal health among the adult Jewish population in Jerusalem? J Periodont Res 2012; 47: 418–425. © 2011 John Wiley & Sons A/S Background and Objective: Religiosity may be a relevant protective factor for periodontitis, as it is for other chronic systemic diseases. The objective of the present study was to assess the relationship between periodontitis and religiosity, and whether oral health‐related behaviours, spirituality and social support are included in the potential pathways that explain the association between religiosity and periodontitis. Material and Methods: Cross‐sectional data were part of a retrospective study. The stratified random‐sampling technique was limited to the Jerusalem Jewish population. Conceptual hierarchical data analysis modelling was adopted, assuming that socio‐economic position was the most distal determinant, age and gender were confounders, and social support, spirituality and oral health behaviours were mediators in the relationship between religiosity and periodontitis. Results: Kappa intra‐examiner values (0.89) were satisfactory. Response rate was 88.0%. The final sample included 123 men and 125 women. The mean age was 38.6 years (SD 3.25 years), with 33.9% declared to be ‘orthodox’, 33.1%‘religious’ and 33.1%‘secular’. Higher levels of religiosity (p = 0.01), support of internal life through spirituality (p = 0.03), higher family social support (p = 0.02) and low levels of plaque (p = 0.05) were related to lower levels of periodontitis. Religiosity led to higher family social support and support of internal life through spirituality, which was related to plaque level and periodontitis. Conclusion: Religiosity had a protective effect against periodontitis through extrinsic and intrinsic pathways. This should be considered as part of aetiology and prognosis, in potential prevention and care of periodontitis.     

Occlusion and periodontal disease--where is the link?

The effect of occlusion on the periodontium has been the subject of much debate. Interest on this subject has decreased over the years but has been renewed with the popularity of implant dentistry. This paper reviews the literature and explores the relationship between trauma from occlusion with periodontal disease and peri-implant bone loss. With regards to periodontal disease, there are two schools of thought on the effect that trauma from occlusion has on the periodontium. One believes that trauma from occlusion is a co-destructive factor in the initiation and progression of periodontal disease. The other believes that it is not. Up till now, there are no conclusive explanations on the association between trauma from occlusion and periodontal disease. For dental implants, current literature suggests that there is an association between occlusal overloading and peri-implant bone loss even in the absence of inflammation. However, there is a need for more randomized clinical trials to validate this relationship.     

Do X‐linked diseases affect periodontal health?

Genetic factors play an important etiologic role in destructive periodontal diseases. There have been reports that sex chromosomes, especially disorders associated with the X chromosome, affect periodontal health. Although numerous X‐linked diseases have been reported to be associated with various periodontal diseases, the association of gingivitis and/or periodontitis with these genetic syndromes should be considered tenuous and raises the question of whether the periodontal manifestation truly arises from an underlying X‐linked genetic etiology. A brief overview of genetics in relation to sex chromosomes and putative X‐linked genetic periodontal diseases is given.     

What periodontal recall interval is supported by evidence?

Recall sessions are an integral part of supportive periodontal therapy. The aim of the current article is to review the existing evidence to support if and to what extent a predefined frequency of periodontal recall sessions ensures periodontal health and stability. Factors that potentially affect the time interval for recall are described. Moreover, original data on the relevance of residual diseased sites (ie, bleeding pockets) at patient level to predict the progression of periodontitis are presented. Overall, wide heterogeneity was found in the published literature with regards to the proposed supportive periodontal therapy recall frequency once active periodontal therapy has been completed. Available data clearly show that a primary and secondary preventive regimen based on routine supportive periodontal therapy is beneficial to preserve a periodontally healthy dentition and prevent tooth loss. However, convincing evidence regarding the appropriateness, risk-benefit, and cost-effectiveness of different recall intervals is currently scarce. In patients affected by moderate to advanced periodontitis, a supportive periodontal therapy protocol based on a 2-4 month recall interval appears reasonable. Limited data suggest that the amount/proportion of residual diseased sites (intended as pockets or bleeding pockets) and risk assessment tools may be of value in establishing the appropriate recall frequency.     

How effective is that treatment? The number needed to treat

The Number Needed to Treat (NNT) is a tool useful for comparing the relative effectiveness of two or more therapeutic or preventive interventions. The NNT may be presented by authors of a clinical research article, or, if not provided, may be calculated by the reader if the authors have reported outcomes as positive or negative per research subject. The NNT is simply calculated as the inverse of the absolute risk reduction. The NNT is most meaningful when reported within a confidence interval and when describing clinical trials of higher validity such as randomized controlled trials and meta-analyses of such trials. Several example NNTs from the dental and medical literature are reported.     

Susceptibility to gingivitis: a way to predict periodontal disease?

Clinical studies suggest that gingival inflammatory response to plaque accumulation may vary between individuals. Evidence seems to indicate that there is an association between susceptibility to gingivitis and susceptibility to periodontitis. Recently, among participants in a large scale experimental gingivitis trial, we were able to identify and characterize subjects that differ significantly in their gingival inflammatory response to plaque accumulation. Research efforts are being focused on the effect of genetic, anatomic and environmental host-related factors which may be implicated in the pathogenesis of the gingival inflammatory process, and whether susceptibility to periodontitis and susceptibility to gingivitis may partly share common risk factors. In this respect, it is possible that identification of factors related to increased susceptibility to gingivitis may help identify, at an early age, subjects at risk of periodontitis.     

How predictable is orthognathic surgery?

There are a number of increasingly sophisticated techniques available for orthognathic treatment planning. All are based on the determination of the skeletal pattern and the position of the dentition. However, they all suffer from difficulties associated with predicting the soft tissue profile. The aim of this retrospective cephalometric investigation was, therefore, to compare the ability to predict accurately the outcome of orthognathic treatment using the 'hand planning' technique and the orthognathic planning and analysis (OPAL) computer program, with an emphasis on the soft tissue profile. Seventy adult subjects were divided into two groups not specific for gender or age: the Class III patients had undergone bimaxillary surgery and the Class II patients sagittal split mandibular advancement. In each group, the pre-treatment and post-debond lateral cephalograms were utilized to calculate the actual orthodontic and surgical movements. These values were then used to produce a prediction using both the hand planning technique and the OPAL program. The resultant predictions were digitized using a customized computer program and compared with the actual outcome. The results show that there was marked individual variation when planning by hand and using the OPAL program. In the mandibular surgery group, hand planning and OPAL were of similar accuracy and few points differed significantly between prediction and outcome. However, for the bimaxillary group, a number of points showed bias and the hand planning technique appeared to be more accurate than the OPAL program, particularly in the region of the lips. Although the usefulness of predictions is acknowledged, these results suggest that they should be used with a certain amount of caution.     

How to train periodontal endoscopy? Results of a pilot study removing simulated hard deposits in vitro

Clinical Oral Investigations - There is uncertainty regarding the benefits of periodontal endoscopy (PE) for subgingival instrumentation. Moreover, the influence of operators’ experience and...