Peri-implant diseases: Consensus Report of the Sixth European Workshop on Periodontology

Issues related to peri-implant disease were discussed. It was observed that the most common lesions that occur, i.e. peri-implant mucositis and peri-implantitis are caused by bacteria. While the lesion of peri-implant mucositis resides in the soft tissues, peri-implantitis also affects the supporting bone. Peri-implant mucositis occurs in about 80% of subjects (50% of sites) restored with implants, and peri-implantitis in between 28% and 56% of subjects (12–40% of sites). A number of risk indicators were identified including (i) poor oral hygiene, (ii) a history of periodontitis, (iii) diabetes and (iv) smoking. It was concluded that the treatment of peri-implant disease must include anti-infective measures. With respect to peri-implant mucositis, it appeared that non-surgical mechanical therapy caused the reduction in inflammation (bleeding on probing) but also that the adjunctive use of antimicrobial mouthrinses had a positive effect. It was agreed that the outcome of non-surgical treatment of peri-implantitis was unpredictable. The primary objective of surgical treatment in peri-implantitis is to get access to the implant surface for debridement and decontamination in order to achieve resolution of the inflammatory lesion. There was limited evidence that such treatment with the adjunctive use of systemic antibiotics could resolve a number of peri-implantitis lesions. There was no evidence that so-called regenerative procedures had additional beneficial effects on treatment outcome.     

Periodontal tissue engineering and regeneration: Consensus Report of the Sixth European Workshop on Periodontology

Aim: To review the scientific preclinical background and clinical studies of current methods of periodontal regeneration in the treatment of infrabony defects and soft tissue deficiencies
Method: Five commissioned review papers including two systematic reviews were scrutinized by a group of experts in order to derive consensus conclusions, clinical relevance/implications and to propose future research requirements.
Results: The following five papers were assessed:
  1. Biological mediators and periodontal regeneration: a review of enamel matrix proteins at the cellular and molecular levels.
  2. Regeneration of periodontal tissues: combination of barrier membranes and grafting materials – Biological foundation and preclinical evidence.
  3. Clinical outcomes with bioactive agents alone or in combination with grafting or GTR
  4. Treatment of gingival recession with coronally advanced flap procedures. A systematic review.
  5. Soft tissue management at implant sites     

Periodontal diseases and health: Consensus Report of the Sixth European Workshop on Periodontology

Introduction: The remit of this group was to update the knowledge base on periodontal diseases and health.
Material and Methods: The literature was systematically searched and critically reviewed in five specific topics.
Results: Prevalence of periodontitis: The data suggest a trend towards a lower prevalence of periodontitis in recent years.
Adverse pregnancy outcome: The findings indicate a likely association between periodontal disease and an increased risk of adverse pregnancy outcomes. There is no evidence that treating periodontal disease decreases the rate of adverse pregnancy outcomes.
Prevalence and distribution of periodontal pathogens: Genetic analysis of bacteria has demonstrated an unanticipated diversity within species. Carriage rates and particular subsets of these species vary between ethnic groups. Few of these differences can be related to differences in disease prevalence.
Diabetes mellitus: Evidence on the association supports the concept of increased severity but not extent of periodontitis in subjects with poorly controlled diabetes. It is inconclusive that periodontal treatment results in improved metabolic control.
Cardiovascular diseases: Evidence suggests that having periodontitis contributes to the total infectious and inflammation burden and may contribute to cardiovascular events and stroke in susceptible subjects. The impact of periodontal therapy must be further investigated.     

Effect of non-surgical periodontal therapy

Incisors, cuspids and premolars in 49 patients with advanced chronic periodontitis were treated with initial, non-surgical periodontal therapy. The results were monitored by probing attachment level measurements at 6 sites of each tooth every 3rd month during a period of 24 months. A series of 9 probing attachment level measurements for each site was subjected to linear regression analysis. The slope of the regression line, the projected probing attachment loss during the 24-month interval (delta y) and the probability level of the slope were calculated for each site. 2 groups of sites with probing attachment loss were identified: group 1: sites with delta y greater than 1.5 mm and p less than 0.05; group 2: sites with delta y greater than 1.0 mm and p less than 0.05. Group 1 included 120 sites (5%) and group 2 included 265 sites (10%) of the total of 2532 available sites. In both groups, probing attachment loss was more frequently noticed for sites with an initial probing depth less than or equal to 3.5 mm than for sites with initial probing depth greater than or equal to 7.0 mm. The finding that the majority of sites with probing, attachment loss was found amongst initially shallow or moderately deep lesions may indicate attachment loss due to trauma associated with therapy rather than loss as a result of a continuing, inflammatory disease process.     

Effect of triclosan on healing following non-surgical periodontal therapy in smokers

BACKGROUND: Tobacco smoking is an established risk factor for periodontitis, and is associated with periodontal attachment and tooth loss. Clinical studies have indicated that smoking may adversely affect and impede healing following periodontal therapy. Adjunctive antimicrobials, on the other hand, have been shown to enhance the effect of non-surgical periodontal therapy. The objective of this study was to evaluate the effect of a triclosan/copolymer/fluoride dentifrice on healing following non-surgical periodontal therapy in smokers. METHODS: Sixty smokers (aged 35-59 years; 23 females) with chronic periodontal disease volunteered to participate in a double-blind, randomized, controlled, clinical trial. The subjects were randomly assigned to use a triclosan/copolymer/fluoride (30 subjects) or a standard fluoride (30 subjects) dentifrice and received detailed information on proper techniques for self-performed plaque control. The participants then received non-surgical periodontal therapy followed by periodontal maintenance care every 6 months over 24 months. Clinical recordings included evaluation of oral hygiene standards, gingival health, and periodontal status. RESULTS: Subjects using the triclosan/copolymer/fluoride dentifrice exhibited significantly improved oral hygiene conditions, gingival health, and periodontal status compared with those using the standard fluoride dentifrice over the 24-month maintenance interval. CONCLUSIONS: The results suggest that an oral hygiene regimen including a triclosan/copolymer/fluoride dentifrice may sustain the short-term effect of non-surgical periodontal therapy in smokers.     

Laser application in non-surgical periodontal therapy: a systematic review

Objectives: The primary aim was to address the following focused question: What is the clinical effect of laser application compared with mechanical debridement in non-surgical periodontal therapy in patients with chronic periodontitis? A secondary aim was to survey the relevant literature in relation to safety of laser applications.
Material and Methods: Electronic databases of the PubMed and the Cochrane Library were searched and completed by manual searches up to December 2007.
Results: Following screening, 12 publications (11 studies) were eligible for the review. A meta-analysis could not be performed due to the heterogeneity of the studies. The results from a narrative synthesis indicate that Er:YAG laser monotherapy resulted in similar clinical outcomes, both in the short and the long term (up to 24 months), compared with mechanical debridement. There is insufficient evidence to support the clinical application of either CO₂, Nd:YAG, Nd:YAP, or different diode laser wavelengths.
Conclusions: The Er:YAG laser seems to possess characteristics most suitable for the non-surgical treatment of chronic periodontitis. Research conducted so far has indicated that its safety and effects might be expected to be within the range reported for conventional mechanical debridement. However, the evidence from the evaluated studies is weak.     

重度牙周炎非手术治疗的研究进展

重度牙周炎由于严重的牙槽骨破坏和附着丧失及多种伴发病变,通常需要非手术治疗、牙周手术及多学科联合治疗,但非手术治疗仍是最基础、最有效、最重要的内容。传统机械治疗存在一定局限性,牙周内窥镜、药物治疗、激光等因其具有某些优势,作为机械治疗的辅助手段越来越多的应用于临床。本文拟就重度牙周炎的非手术治疗内容及其研究进展进行综述。     

Lack of short-term adjunctive effect of systemic neridronate in non-surgical periodontal therapy of advanced generalized chronic periodontitis: an open label-randomized clinical trial

Aim: To determine if the adjunctive use of intra-muscular neridronate (NE) during non-surgical periodontal treatment (PT) provides, in patients with generalized chronic periodontitis (GCP), adjunctive benefits as compared with PT alone 3 months after the completion of a 3-month NE therapy.
Material and Methods: Sixty GCP healthy patients were randomly assigned to control (CG) or test group (TG). CG patients received PT only. Thirty subjects in TG also received adjunctive NE (12.5 mg in an i.m. injection/week for 3 months). Clinical parameters were evaluated at baseline, at the end of NE treatment (3 months after PT) and 3 months after the completion of NE treatment (6 months after the beginning of PT).
Results: Groups were balanced at baseline and all clinical parameters showed improvement between baseline and follow-ups. At 6 months improvements from baseline at sites with deep pocket depth (7 mm) were 3.2 mm [95% confidence interval (CI): 2.7–3.9] in CG and 3.0 mm (95% CI: 2.3–3.8) in TG with a non-significant difference of 0.2 mm (95% CI: −1.0–0.5; ancova ; p =0.549) between groups. Secondary outcomes did not show significant differences between groups. No major adverse events were reported.
Conclusions: The adjunctive use of NE during PT did not result in additional short-term improvements in periodontal conditions of GCP patients when compared with PT.     

牙周非手术治疗1例慢性牙周炎伴畸形根面沟病例的6年维护效果评价

追踪1例慢性牙周炎伴右上侧切牙畸形根面沟病变的发生、发展以及对牙周非手术治疗、定期维护治疗反应的转归过程.6年前初诊为轻度慢性牙周炎,给予常规牙周基础治疗并维护1次;2年后复诊时牙周破坏显著加重,上下磨牙区出现深牙周袋同时伴右上侧切牙畸形根面沟周围骨质重度破坏至根尖区,再次对全口牙周袋进行龈下刮治及根面平整,期间完成右...     

比较非手术治疗对重度慢性牙周炎磨牙不同部位牙周病变的疗效

目的:根据磨牙中重度慢性牙周炎发生不同部位病变比较非手术治疗的疗效。方法:根据单个磨牙深牙周袋发生的部位(颊侧或舌/腭侧)将收集的上、下颌磨牙各分为两组(上颌I组、上颌II组、下颌I组、下颌II组),观察各组治疗前后牙周指标的变化,比较疗效差异。结果:4组病例治疗后6周各项牙周指标均较基线有明显改善,差异有显著性(P<0.01)。上颌两组间及下颌两组间比较,可见6周时上颌II组的PD、BI、CAL均高于上颌I组,差异有显著性(P<0.01);下颌II组的PD、BI、CAL高于下颌I组,差异有显著性(P<0.01)。结论:发生在磨牙的牙周炎症无论是上颌还是下颌,颊侧病变的预后均好于舌/腭侧,差异有显著性。     

The clinical and microbiological effects of non-surgical periodontal therapy in smokers and non-smokers

Abstract. 28 patients, 13 smokers and 15 non-smokers with untreated advanced periodontal disease, were subjected to a series of oral hygiene instructions and treated with non-surgical periodontal therapy. Baseline values regarding clinical data did not differ significantly between the groups. 6 months following therapy the full-mouth bleeding score among smokers was 36.5% as compared to 22.7% for non-smokers ( p <0.05). Probing depth was reduced by 1.9 mm for smokers and by 2.5 mm for non-smokers. This difference was statistically significant ( p <0.05). The level of P. gingivalis and P. intermedia/nigrescens was reduced in both groups as compared to baseline. A. actinomycetemcomitans , however demonstrated a slight increase in mean values at 6 months. This was especially notable for smokers in which A. actinomycetemcomitans were more difficult to eradicate. Conclusively, the microbiological response found in this study seems to be in conformity with the clinical response with little influence of the smoking habits     

Adjunctive effects to non-surgical periodontal therapy of systemic metronidazole and amoxycillin alone and combined. A placebo controlled study

BACKGROUND AND AIM: Several studies have reported adjunctive benefits to scaling and root planing (SRP) of systemic amoxycillin and metronidazole in the treatment of periodontal diseases. To date no comparisons have been made of these antimicrobials alone or in combination. The aim of this study was to compare the adjunctive benefits to SRP of amoxycillin and metronidazole alone and combined. METHODS: 66 subjects <46 years of age with advanced chronic periodontal disease participated in this randomised, double blind, 4 parallel treatment group designed study. All subjects received quadrant SRP and then were prescribed amoxycillin capsules (250 mg) and metronidazole tablets (200 mg) (AM) or lactate capsules and metronidazole (PM) or amoxycillin and calcium lactate tablets (AP) or lactate and calcium lactate (PP). All medication was 3 of each per day for 7 days. Subgingival plaque samples were obtained and probing depth (PD), loss of attachment (LOA), bleeding on probing (BOP), suppuration (SUPP) and plaque (DEP) were recorded pre-treatment, 1, 3 and 6 months post-treatment. RESULTS: Final group sizes were: AM=15, PM=16, AP=16 and PP=15. PD improved in all groups. Treatment effects were highly significantly different and always greatest in the AM and least in the PP groups. Benefits of PM and AP over PP were also noted. LOA improved in all groups and showed the same highly significant treatment differences, again favouring AM. BOP improved in all groups, particularly in AM compared to the other groups. SUPP improved in all groups and was virtually eradicated in AM with differences among treatments highly significant. DEP changed little in any group and there were no significant differences among groups. Microbiological data showed significant differences in favour of AM compared to PP and PM for total aerobes and anaerobes at 1 month. P. intermedia counts were always lower in active groups compared to PP and reached significance for AM and AP at 1 month and AM and PM at 3 months. CONCLUSION: The significant differences among treatment groups and the overall trend in the data, in line with other studies, support the considerable adjunctive benefits to SRP of amoxycillin and metronidazole combined in the treatment of advanced chronic periodontal disease.     

Effect of non-surgical periodontal therapy combined with adjunctive antibiotics in subjects with "refractory" periodontal disease

The aim of the present study was to evaluate the clinical effect of non-surgical periodontal therapy with the adjunct of a selected antibiotic in subjects with refractory periodontitis. 10 subjects were selected for the study; all had a history of periodontal surgery, tetracycline therapy, and regular maintenance by a periodontist. Clinical registrations including gingival index, plaque index, presence of bleeding and suppuration, pocket depth, and duplicate measurements of attachment level were performed at baseline and at monthly intervals. When disease activity was detected based on the tolerance method, a bacterial sample was taken from the active site and its susceptibilities to a number of antibiotics were determined. For the selected 10 subjects, Augmentin was the antibiotic of choice. Each subject received 750 mg/day for 2 weeks, during which time a full-month scaling and root planing was performed under local anesthesia. Clinical re-evaluation was performed after 3, 6, 9 and 12 months. At the time disease activity was detected, the average loss of attachment at all active sites was 2.2 mm, and the increase in pocket depth 1.5 mm. At 3 months post-therapy, these sites had regained 2 mm of attachment which remained stable through the 12-month examination. Pocket depths decreased 2.5 mm over the first 6 months and then stabilized. The frequency of all sites that gained 1 mm or more of attachment increased by approximately 10% over the first 9 months following therapy. The frequency of all sites that decreased 1 mm or more in pocket depth increased approximately 15% over the same period.(ABSTRACT TRUNCATED AT 250 WORDS)     

牙周微创非手术治疗对薄龈生物型牙周炎患者上前牙区的疗效评价

目的 探讨薄龈生物型牙周炎患者上前牙区患牙实施牙周微创非手术治疗(minimally invasivenon-surgical therapy, MINST)的临床必要性。方法 选取2020年5月至2021年9月在南京医科大学附属口腔医院牙周科就诊的Ⅲ期/Ⅳ期薄龈生物型牙周炎患者18例,随机分成2组,针对上前牙,一组患者行牙周微创非手术治疗(MINST组),另一组行传统龈下刮治和根面平整术(subgingival scaling and root planing, SRP)(SRP组)。比较基线、术后3个月和术后6个月时患者的探诊深度(probing depth, PD)、临床附着丧失(clinical attachment loss, CAL)、牙龈退缩(gingival recession, GR)和探诊出血(bleeding on probing, BOP)阳性率指标变化及差异。术后即刻和术后1周记录受试者疼痛/不适的视觉模拟评分(visual analog scale, VAS),术后6个月记录受试者对治疗结果的VAS评分并进行美学效果的满意度调查。结果 无论基线位点的PD如何...