Periodontal Outcomes Research Articles

Adjunctive daily supplementation with encapsulated fruit, vegetable and berry juice powder concentrates and clinical periodontal outcomes: a double‐blind RCT

AimA double-blind randomized controlled trial to determine whether dietary supplementation with fruit/vegetable/berry juice powder concentrates, simultaneously with non-surgical periodontal therapy, improved 2-month treatment outcomes.MethodsVolunteers with chronic periodontitis were randomly assigned to one of three groups: fruit/vegetable (FV), fruit/vegetable/berry (FVB) or placebo. Supplements were taken daily during non-surgical debridement and maintenance and outcomes assessed at 2, 5 and 8 months after completion. Primary outcomes were mean probing pocket depth (PPD), clinical attachment gain, % sites bleeding on probing (% BOP) at 2 months. Adherence and plasma β-carotene were determined.ResultsSixty-one nutritionally replete (by serum biochemistry) volunteers enrolled and 60 (n = 20 per arm) completed the 2-month review. Clinical outcomes improved in all groups at 2 months, with additional improvement in PPD versus placebo for FV (p < 0.03). Gingival crevicular fluid volumes diminished more in supplement groups than placebo (FVB; p < 0.05) at 2 months, but not at later times. The % BOP (5 months) and cumulative plaque scores (8 months) were lowered more in the FV group (p < 0.05).ConclusionsAdjunctive juice powder concentrates appear to improve initial pocket depth reductions in nutritionally replete patients, where plasma micronutrient bioavailability is attainable. Definitive multicentre studies in untreated and treated patients are required to ascertain the clinical significance of such changes.

Periodontal healing following avulsion and replantation of teeth: a multi‐centre randomized controlled trial to compare two root canal medicaments

Non-setting calcium hydroxide (Ultracal XS(®) ) is recommended by the International Association of Dental Traumatology as the initial medicament following avulsion and replantation for mature teeth. There is experimental evidence to suggest Ledermix(®) , placed as an alternative inter-visit dressing may improve periodontal healing. This study investigated, using a multi-centre randomized controlled trial, the effect of two root canal medicaments, Ledermix(®) and Ultracal XS(®) , on periodontal healing of avulsed and replanted teeth. Children were recruited if they fulfilled all inclusion criteria. Treatment followed a standardized protocol. Assessment of periodontal healing or ankylosis was made clinically and radiographically by an experienced, 'blinded', clinician at 12months. Over 200 patients were assessed for eligibility at five centres. Twenty-nine patients were eligible for inclusion. Final analysis involved 22 patients with 27 teeth. Ankylosis was detected in four of the 12 teeth in the Ledermix(®) group and nine of 15 in the Ultracal XS(®) group. No significant difference between medicaments was found in the proportion of teeth or patients showing periodontal healing. There was no significant difference in periodontal healing between the two medicaments at either a tooth or patient level. The numbers recruited fell short of an estimated power calculation. For patients meeting the inclusion criteria and completing the trial, periodontal healing was seen in 52% of teeth at the 12-month assessment between both groups. The only factor found to significantly influence the periodontal outcome was dry time.

Comprehensive Periodontal Therapy: A Statement by the American Academy of Periodontology

Comprehensive Periodontal Therapy: A Statement by the American Academy of Periodontology

Do probiotics offer opportunities to manipulate the periodontal oral microbiota?

As in other fields of healthcare, probiotics have been introduced for prevention and treatment of periodontal diseases. This review was initiated to explore whether the use of probiotics can influence the periodontal microbiota and periodontal health. Literature on the mode of action of oral probiotics was reviewed and a systematic review was performed on the microbiological and clinical effects of oral probiotics on periodontal health. Three animal and 11 in vivo human studies were retrieved. Six studies reported on microbiological effects whereas eight studies report on clinical effects. Seven studies were performed on healthy or gingivitis patients and four studies on periodontitis patients. Many of the retrieved studies are pilot in nature and with low quality. The high degree of heterogeneity between studies hampered analysis. Taking into consideration all limitations, the currently available data indicate an effect of probiotics on the oral microbiota and a more limited effect on clinical periodontal outcome measures. However, there is an urgent need for properly conducted clinical trials where probiotics are used as adjuncts to standard periodontal care, similar to antibiotics, using probiotic strains with, at least at an in vitro level, proven periodontal probiotic effects.

Periodontal outcomes and social, racial and gender inequalities in Brazil: a systematic review of the literature between 1999 and 2008

The objective of this study was to review the Brazilian epidemiologic literature on periodontal outcomes and socio-demographic factors, assessing bibliographic and methodological characteristics of this scientific production, as well as the consistency and statistical significance of the examined associations. A systematic review was carried out in six bibliographic sources. The review was limited to the period between 1999 and 2008, without any other type of restriction. Among the 410 papers identified, 29 were included in the review. An increasing number of articles, specifically in the last four years of study, was observed. However, there is a concentration of studies in the South and Southeast regions of Brazil, and many of them are not closely connected to theoretical formulations in the field. In spite of these shortcomings, the review findings corroborate the idea that poor socioeconomic conditions are associated with periodontal outcomes, as demonstrated primarily by income and schooling indicators.

Periodontal Infection During Pregnancy and its Association with the Delivery of Pre-Term Low Birth Weight Babies

Objectives: This study was conducted to investigate any association between periodontal disease during pregnancy and delivery of pre-term low birth weight (PLBW) babies in a population of Pakistani women during pregnancy (age=18-35 years) who are nutritionally healthy, socio-economically sound and not under influence of any medical disease.Study Design: Cross-sectional study conducted at Department of Gynaecology and Obstetrics, Shaikh Zayed Hospital, Lahore.Patients And Methods: Study selected (calculated sample size=325) mothers after excluding known confounders for PLBW. Periodontal status of mothers and their delivery outcome recorded on a specially designed proforma. Sample divided into two groups according to delivery outcomes. SPSS 11.0 was used for data analysis. Percentage frequencies were calculated for periodontal and delivery outcome variables. Fisher's exact chi-square test with 5% level of significance was applied to analyze statistical association and Odd's ratio was also calculated.Results: Out of total 325, 21.2% (n=69) women delivered PLBW babies, out of which 15 had healthy periodontal status and 43.4% (n=30) had periodontal pockets depth of >4 mm, remaining had bleeding gums and calculus. Women delivering normal birth weight babies (n=256), 42 had healthy periodontal status, 35.9% (n=92) had periodontal pockets. No significant difference was observed in periodontal status of two groups (p>0.05). Odd's Ratio calculated for the periodontal pocket depth between both the groups was 0.72 (CI=95%; Chi=0.58).Conclusion: Study failed to show any association between periodontal disease (indicated by pocket depth) and the delivery of low birth weight. However, periodontal disease level was high in both the groups.

Factors affecting the clinical approach to impacted maxillary canines: A Bayesian network analysis

The aim of this study was to apply Bayesian networks to evaluate the relative role and possible causal relationships among various factors affecting the diagnosis and final treatment outcome of impacted maxillary canines. A total of 168 patients with infraosseous impacted maxillary canines had a combined surgical-orthodontic approach aimed to guide the impacted tooth to the center of the alveolar ridge. Demographic, orthodontic, and periodontal variables were recorded and analyzed by means of Bayesian network analysis. All 168 impacted canines were successfully moved and aligned in the dental arches with healthy periodontiums. According to the Bayesian network analysis, bilateral impaction was associated with palatal impaction and longer treatment; the pretreatment alpha-angle was a determinant for the duration of orthodontic traction, also because of the associations between greater angulation of impacted canines with more severe tooth displacement and with greater distance of the impacted canine from the occlusal plane; the posttreatment periodontal outcome was not related to the pretreatment radiographic variables. Bayesian network analysis was useful to identify possible relationships among the variables considered for diagnosis and treatment of impacted canines.

Self-Ligating Brackets in Orthodontics

To evaluate the clinical differences in relation to the use of self-ligating brackets in orthodontics. Electronic databases were searched; no restrictions relating to publication status or language of publication were applied. Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) investigating the influence of bracket type on alignment efficiency, subjective pain experience, bond failure rate, arch dimensional changes, rate of orthodontic space closure, periodontal outcomes, and root resorption were selected. Both authors were involved in study selection, validity assessment, and data extraction. Disagreements were resolved by discussion. Six RCTs and 11 CCTs were identified. Meta-analysis of the influence of bracket type on subjective pain experience failed to demonstrate a significant advantage for either type of appliance. Statistical analysis of other outcomes was unfeasible because of inadequate methodological design and heterogenous designs. At this stage there is insufficient high-quality evidence to support the use of self-ligating fixed orthodontic appliances over conventional appliance systems or vice versa.

Periodontal Disease and Pregnancy Outcomes

An increasing number of studies are confirming an association between periodontal disease (PD) and adverse outcomes in pregnancy. PD places pregnant women at greater risk for preterm birth than alcohol consumption or smoking. This underscores the importance of offering dental screening to women who are pregnant or contemplating pregnancy and the need for physicians who provide obstetric care to be aware of the possible connection between poor dental health and poor pregnancy outcomes.

An investigation of the MC‐SIMEX method with application to measurement error in periodontal outcomes

Measurement error is pervasive in medical research. In periodontal research studies, one measure of disease status is the probed pocket depth (PPD), the depth of the space between a tooth and the surrounding gum. In larger studies, these assessments are made by multiple examiners, each having distinct measurement error characteristics. Because PPD is recorded in whole millimeters, it may be regarded as discrete and its associated error as misclassification error. This study investigates the impact of this measurement error when evaluating the effect of periodontal disease status on levels of inflammatory markers in gingival crevicular fluid (GCF). The marker readings are either left or right censored, due to quantities that are either too small to be reliably quantified or so large that they saturate the detector. Additionally, marker readings from multiple periodontal sites within a subject's mouth are correlated. These considerations give rise to a clustered survival model for the marker readings in which the discrete predictor of interest is misclassified. Associations between the GCF markers and periodontal assessments are corrected for misclassification error using the MC-SIMEX method. Simulation studies reveal the impact of varying degrees of misclassification error on associations of interest. Analysis of pilot data from a periodontal study, for which examiner misclassification rates are estimated from calibration studies, further illustrates the approach.

P45 A study of maternal periodontal infection and pregnancy outcome from South India

P45 A study of maternal periodontal infection and pregnancy outcome from South India

Contextual effects in the occurrence of periodontal attachment loss and necrotizing gingival lesions among adolescents

The aim of this study was to assess and quantify the random effects resulting from clustering in the following individual-level periodontal outcomes: presence of clinical attachment loss of > or = 1 mm (CAL1), presence of clinical attachment loss of > or = 3 mm (CAL3), and presence of necrotizing ulcerative gingivitis (NUG); or in the following class-level periodontal outcomes: number of students with CAL1, number of students with CAL3, and number of students with NUG. Mixed-effects logistic regression analysis was used to model these outcomes among 9,162 adolescents in 310 classes in 98 schools spread over 20 communes in the Province of Santiago, Chile, who had been examined for clinical attachment level and NUG, and had completed questionnaires on oral health-related behaviors. The results of all six analyses demonstrated statistically significant random effects, which in all analyses were particularly related to the schools, whereas the class effects were smaller and the commune random effects were almost negligible. The random effects were quantified using the median odds ratio (MOR), and the class-level MOR ranged between 1.05 and 1.51, whereas the school-level MOR values ranged from 2.07 to 2.39. The results of the study demonstrate the potential of the application of multilevel modeling to periodontal epidemiologic data, over and beyond the conventional use of the technique to account for the intrinsic sites-teeth-subject hierarchy in periodontal data.

Periodontal maintenance

The main goal of periodontal therapy is to establish an oral environment compatible with periodontal health by the physical disruption of the plaque biofilm and adjunctive chemical means if required. Implicit in this objective is the ongoing requirement of detection and interception of new and recurrent disease, which continues at selected intervals for the life of the dentition after the initial ("active") phase of periodontal treatment. This concept of ongoing periodontal maintenance therapy has been embraced as the mandatory requirement for favourable periodontal outcomes based on institutional clinical trials and in practice-based studies in various parts of the world. This review examines the ramifications of periodontal maintenance therapy based upon a multi-level assessment of logistic issues and risk factors at three levels: (1) The patient level - treatment time; patient attendance compliance; and homecare measures, antiseptics/antibiotics and smoking. (2) The level of the individual tooth - tooth loss; and evaluation of success versus survival. (3) The level of each tooth surface ("site") - probing depth, loss of attachment and bleeding on probing; and changes in clinical attachment levels. In spite of the diversity of studies conducted, there is agreement on the efficacy of periodontal maintenance therapy when compared with studies on untreated populations and in treated cases that were not maintained.

Periodontal diagnosis and treatment – where does the future lie?

Knowledge in Dentistry is now estimated to doubleevery 4–5 years, by comparison with the 1950s whenit was estimated to take 25 years for such an expan-sion. Research into the human periodontal diseases isone of the primary drivers of such progress, andprevious volumes of Periodontology 2000 now requireupdating in the light of such a rapid evolution. Thisvolume addresses new innovations in periodontaldiagnosis and therapy, and specifically analyzes theimpact of the genomic and proteomic era as well asadvances in cell biology and cell signaling uponperiodontal diagnosis and therapy. Bearing in mindthe essential need for translation of basic researchinto clinical practice, we also attempt to tackle thethorny issue of how cost-effective periodontal ther-apy is and how we address the biggest challenge thatperiodontal physicians and surgeons face in day-to-day practice – the psychological approach to chang-ing patients behavior. Indeed, if we fail to implementsuch behavioral change, no amount of innovativebiological research will improve periodontal out-comes; sometimes we risk neglecting the basics inour excitement over the vast array of novel technol-ogies at our fingertips. Even a volume of 14 reviewsfrom global experts in their field cannot cover thehuge array of developments in these two broad areas,but I hope they provide a suitable springboard forresearchers and clinicians of all ages to move for-ward. I entered a career in clinical-academic perio-dontology because it had such a broad and diversebiological base for research and also provided anopportunity to practice broadly the art and science ofa discipline that sits equally comfortably withinmedical,as well as surgical, models of care – I havenot been disappointed. Dr Robert Genco once madethe profound statement that we were at the end ofthe beginning of research into human periodontaldiseases (13th International Congress on PeriodontalResearch, Osaka Japan, 1992). I genuinely feel that wehave made huge leaps in the last 17 years; however,we still remain at the end of the beginning, ratherthan at the beginning of the end.

Splinting duration and periodontal outcomes for replanted avulsed teeth: a systematic review

Splinting duration and periodontal outcomes for replanted avulsed teeth: a systematic review

Risk calculation and periodontal outcomes

Risk calculation and periodontal outcomes

Splinting duration and periodontal outcomes for replanted avulsed teeth: a systematic review

Clinical guidelines are now available for the management of avulsed teeth. The principles of evidence-based dentistry can be used to assess whether these guidelines are based on currently-available evidence. A qualitative systematic review was conducted of relevant clinical literature to examine the evidence on splinting duration and periodontal healing outcomes. The review was constrained markedly by small sample sizes, retrospective nature of clinical audits, dissimilarities of selected studies in their design, methodology and observation periods, and lack of uniformity in terminology for outcomes. A total of 138 replanted avulsed permanent teeth pooled from four papers each reporting both short-term splinting (14 days or less) and long-term splinting (over 14 days) in accord with current clinical guidelines, were studied. The evidence for an association between short-term splinting and an increased likelihood of functional periodontal healing, acceptable healing, or decreased development of replacement resorption, appears inconclusive. The study found no evidence to contraindicate the current guidelines and suggests that the likelihood of successful periodontal healing after replantation is unaffected by splinting duration. Pending future research to the contrary, it is recommended that dentists continue to use the currently-recommended splinting periods when replanting avulsed permanent teeth.

CAD/CAM Zirconia vs. slip-cast glass-infiltrated Alumina/Zirconia all-ceramic crowns: 2-year results of a randomized controlled clinical trial

The aim of this randomized controlled clinical trial was to compare the early clinical outcome of slip-cast glass-infiltrated Alumina/Zirconia and CAD/CAM Zirconia all-ceramic crowns. A total of 30 InCeram® Zirconia and Cercon® Zirconia crowns were fabricated and cemented with a glass ionomer cement in 20 patients. At baseline, 6-month, 1-year, and 2-year recall appointments, Californian Dental Association (CDA) quality evaluation system was used to evaluate the prosthetic replacements, and plaque and gingival index scores were used to explore the periodontal outcome of the treatments. No clinical sign of marginal discoloration, persistent pain and secondary caries was detected in any of the restorations. All InCeram® Zirconia crowns survived during the 2-year period, although one nonvital tooth experienced root fracture coupled with the fracture of the veneering porcelain of the restoration. One Cercon® Zirconia restoration fractured and was replaced. According to the CDA criteria, marginal integrity was rated excellent for InCeram® Zirconia (73%) and Cercon® Zirconia (80%) restorations, respectively. Slight color mismatch rate was higher for InCeram® Zirconia restorations (66%) than Cercon® Zirconia (26%) restorations. Plaque and gingival index scores were mostly zero and almost constant over time. Time-dependent changes in plaque and gingival index scores within and between groups were statistically similar (p>0.05). This clinical study demonstrates that single-tooth InCeram® Zirconia and Cercon® Zirconia crowns have comparable early clinical outcome, both seem as acceptable treatment modalities, and most importantly, all-ceramic alumina crowns strengthened by 25% zirconia can sufficiently withstand functional load in the posterior zone.

Periodontal Bacterial Profiles in Pregnant Women: Response to Treatment and Associations With Birth Outcomes in the Obstetrics and Periodontal Therapy (OPT) Study

A recent clinical trial (Obstetrics and Periodontal Therapy [OPT] Study) demonstrated that periodontal therapy during pregnancy improved periodontal outcomes but failed to impact preterm birth. The present study evaluated seven target bacteria, Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans), Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia (previously T. forsythensis), Prevotella intermedia, Campylobacter rectus, and Fusobacterium nucleatum, in subgingival dental plaque of pregnant women in the OPT Study and their association with birth outcomes. Pregnant women were randomly assigned to receive periodontal treatment before 21 weeks' gestation or after delivery. Subgingival plaque was sampled at baseline (13 to 16 weeks; 6 days of gestation) and at 29 to 32 weeks. We analyzed subgingival plaque samples from women who experienced fetal loss, delivered a live preterm infant (preterm women), or delivered a full-term infant (full-term women). Samples were analyzed using quantitative polymerase chain reaction. Associations between preterm birth and bacterial counts and percentages were tested using multiple linear regression. No significant differences were observed at baseline between preterm and full-term women for any measured bacterial species or group of species, after accounting for multiple comparisons. Changes in bacterial counts and proportions during pregnancy also were not associated with birth outcomes. In full-term and preterm women, periodontal therapy significantly reduced (P <0.01) counts of all target species except for A. actinomycetemcomitans. In pregnant women with periodontitis, non-surgical periodontal therapy significantly reduced levels of periodontal pathogens. Baseline levels of selected periodontal pathogens or changes in these bacteria resulting from therapy were not associated with preterm birth.

Fundamentals of Esthetic Implant Dentistry.

Fundamentals of Esthetic Implant Dentistry.