Periodontal Practice Research Articles

Tooth loss during long-term periodontal therapy in specialized practices – a retrospective cohort study from a periodontal practice-based research network (Perio-PBRN)

ObjectivesTo investigate tooth-specific, clinical tooth-, and patient-related factors associated with tooth loss (TL) in patients with mild to severe periodontitis treated in a periodontal practice-based research network (Perio-PBRN) over at least 5 years.Materials and methodsThe Perio-PBRN consists of five German periodontal practices where clinical data were collected regarding patient age, tooth type, bleeding on probing (BOP), pocket probing depth (PPD), furcation involvement (FI), number of attended appointments, and other variables of interest. The data were evaluated regarding factors influencing TL.ResultsData from 687 patients (aged 54.5 ± 11.1 years) with mild (N = 23, 3.35%), moderate (N = 247, 35.95%) or severe (N = 417, 60.70%) periodontitis and 15,931 teeth over a mean observation period of 6.83 ± 1.40 years per patient were gathered via the Perio-PBRN. In this period, a total of 657 teeth were lost (4.12%, overall TL: 0.14 ± 0.22 teeth/patient/y). The risk of TL was significantly increased for teeth with persistent PPD ≥ 6 mm (hazard ratio: 6.81 [95% confidence interval: 5.07–9.15] in comparison to PPD < 4 mm. Additionally, BOP (3.90 [2.46–6.19]), furcation involvement, jaw, age and tooth type showed a significant influence on TL, while number of visits were not significantly associated with TL.ConclusionsPeriodontal care of patients with moderate to severe disease in specialized practices was associated with a low rate of TL. Known tooth-related prognostic factors were confirmed. However, the results must be interpreted cautiously without knowledge of risk factors such as smoking and diabetes.Clinical relevancePBRNs can help gather large amounts of periodontal practice-level data.Trial registrationThe study was registered in the German Clinical Trials Register (DRKS 00011448).

Feasibility of Immediate, Early and Delayed Implant Placement for Single Tooth Replacement in the Premaxilla: A Retrospective Cone-Beam Computed Tomography Study of 100 Cases.

To assess the feasibility of immediate (IIP), early (EIP) and delayed implant placement (DIP) for single tooth replacement in the premaxilla on the basis of the complete indication area of each approach in routine practice. Data from 100 patients (59 women, 41 men, all Caucasians) aged between 19 and 81 years old (mean age 51.71) who had been consecutively treated with a single implant in the premaxilla (13-23) in one private periodontal practice were retrospectively collected. Demographic data, diagnostic information and linear measurements were extracted from patient files and CBCTs. The feasibility of IIP, EIP and DIP was assessed for all cases by both authors, based on the following criteria: availability of apical bone, position of the tooth in relation to the morphology of the alveolar process, buccal bone morphology and presence of midfacial recession. The reasons for not being able to perform an approach, and the viable alternatives for each approach were secondary outcomes. DIP was considered to have been preceded by alveolar ridge preservation (ARP). Ninety-two patients could be treated by means of IIP, EIP or DIP. In eight patients none of these approaches were possible as they required bone augmentation prior to implant placement. Fifty-two patients (95% CI: 42%-62%) could by treated with IIP, 58 (95% CI: 48%-67%) with EIP and 88 (95% CI: 80%-93%) with DIP. The feasibility proportions of IIP and EIP were significantly lower than the one of DIP (p < 0.001). All patients who could be treated with IIP could also be treated with EIP or DIP. Lack of apical bone for implant anchorage was the main reason for not being able to perform IIP and EIP. Complete loss of the buccal bone wall and the need for bone augmentation prior to implant placement were the reasons for not being able to perform DIP. From the results of this retrospective CBCT analysis, DIP is nearly always possible in contrast to IIP and EIP. Therefore, and since it is much easier than IIP and EIP, inexperienced clinicians should mainly focus on ARP and DIP in clinical practice deferring IIP and EIP until more surgical skills have been acquired.

An aid to dental and periodontal practice

An aid to dental and periodontal practice

Precision Medicine in Periodontics: A Literature Review.

Periodontitis, a widespread health issue, requires effective prevention and management strategies due to its increasing prevalence and detrimental social consequences. The chronic inflammation associated with periodontitis also exacerbates systemic conditions, emphasizing the need for advanced approaches in addressing this public health concern. The traditional methods of periodontal diagnosis, which primarily rely on clinical indicators such as pocket depth, clinical attachment loss, mobility, and radiographic measurements of alveolar bone loss, have limitations in guiding therapy due to the intricate and multifaceted nature of periodontal diseases. Precision periodontics is the amalgamation of genomics, bioinformatics, and advanced technology, mainly biomarkers reflecting a precise patient-centered treatment. However, implementing this approach in periodontology is new due to the lack of validated periodontal biomarkers for diagnostic use. This article explores the foundations of personalized therapy in periodontal diagnosis. It discusses the current state and prospects of periodontal biomarkers as a crucial step toward realizing a precision approach in periodontal practice.

Potential barriers to the rational antibiotic use in dental and periodontal practice: A questionnaire-based online survey.

Dentists, through inappropriate antibiotic prescription, may contribute to the global problem of antibiotic resistance (AR). Understanding dentists' antibiotic prescription patterns, source of knowledge, and the driving forces behind their prescription practices may be crucial for the effective implementation of the rational use of antibiotics (RUA) in dentistry. Active members of the Turkish Dental Association were invited to participate in an electronic survey comprising questions focusing on their role, knowledge and perceptions regarding RUA, the perceived barriers to adapting RUA in daily dental work, and the actual antibiotic prescription practices. The potential impact of age, gender, professional experience, and the mode of dental practice was also evaluated. Dentists' prescription practices for periodontal disease/conditions were evaluated as well. Based on 1,005 valid responses, there was consensus on the necessity of RUA (99.1%); however, its implementation was low. The main barriers were dentists' own safety concerns (74.4%), strong patients' demands (42.2%) and the fact that prescribing antibiotics became a professional habit (35.8%). Different educational background resulted in clear variances in everyday prescription practices. The implementation of RUA was not sufficient and the perceived barriers had an impact on daily prescribing habits. Support for dental professionals through the efficient dissemination of evidencebased clinical guidelines and decision-making aids is likely to require additional help from professional organizations in order to actively combat AR.

The use of an ultrasonic device in periodontal practice in elderly and senile people

The majority of periodontal visits in dental care to the population are made up of patients in the elderly age group (according to the WHO classification, these include persons 60–74 years old). Features of periodontal treatment of elderly people require a new approach to standard treatment regimens. In recent years, treatment with the «Vector» device (Dürr Dental, Germany) has found widespread use in periodontal consultations. The purpose of the study is to determine the volume of periodontal care for the elderly population in the State Medical Institution of the RO «SP» in Rostov-on-Don in dynamics from 2020 to 2022 using the «Vector» device. Results of the study: periodontal doctors performed ultrasonic removal of supragingival and subgingival dental plaque in the area of one tooth (using the Vector apparatus) in 2020, 1825 services, and in 2022 2562, which is 737 services more than in 2020, At the same time, 1241 services were performed for elderly people in 2020, and in 2022 there were 552 more services.Conclusion: the use of the «Vector» device in addition to traditional treatment regimens for chronic generalized periodontitis in elderly patients accelerates periodontal recovery time.

Role of CBCT in Periodontal Diagnosis; Mandatory or Overkill

Radiographs have been a very essential tool for diagnosis as well as prognosis and treatment planning in dentistry. However, there are various limitations associated with the use of 2 dimensional radiographs which are most commonly used. The use of 3 dimensional radiographs has a number of advantages over the conventional techniques, especially in the field of periodontics. This review aims to shed light on the importance of CBCT as a diagnostic aid in routine periodontal practice.

Metabolomics: a step towards personalized periodontal diagnosis

A multifaced rather than streamlined approach has always been at the forefront of periodontal diagnostics. With the evolution of how diagnostic medicine is applied and executed, the ability to accurately anticipate the probability of dysbiosis in a patient has become the need of the hour. Translational metabolomics has already exhibited an astounding potential in the field of diagnostic medicine, both as an indicator as well as a predictor of disease activity. However, it is currently still an evolving technique and is not without its fair share of pitfalls. Addressing these lacunae and active research towards making it possible for implementation into clinical periodontal practice can be invaluable source and should be explored, more so now than ever with the constant evolution of disease pathogenesis and progression as well. The current paper focuses on the practical utility of the rapidly expanding plethora of metabolomics highlighting the concerns surrounding their applications in periodontal diagnosis.

The use of statin drugs in medical practice. Literature review

Relevance. Simvastatin is a statin drug used for the clinical control of hypercholesterolemia. Over the past decades, there has been a steady increase in the number of studies on the possibilities of simvastatin, in many respects superior to the effect of lowering blood cholesterol levels. The use of simvastatin in the field of bone tissue regeneration, as well as its ability to reduce the inflammatory response, is being actively investigated.The purpose of the review: to consider modern ideas about simvastatin and to study its pleiotropic effects.Materials and methods. The analysis of scientific publications in the electronic databases eLIBRARY, PubMed and Google Scholar (articles, meta-analyses, systematic reviews) for the time interval from 2015 to 2022 was carried out. Materials containing information on the hypocholes-terolemic activity of simvastatin and its mechanism of action, the use of simvastatin in periodontal practice, as well as the osteoinductive effect of simvastatin and its use in bone engineering are included.Results. The review reviewed 83 articles, from which 53 articles were selected after reviewing the literature.Conclusion. Based on the analyzed data, it can be concluded that the effects of simvastatin are multifaceted. Its anti-inflammatory activity has been proven by inhibiting interleukins and inflammatory mediators, participation in bone tissue regeneration by gene expression and stimulation of osteoblast cell differentiation.

Periodontists’ perceptions and attitudes toward the use of social media for professional purposes in Saudi Arabia

BackgroundThere is a notable increase in the usage of social media platforms, especially for health communication, as more clinicians and patients count on this kind of technology. Therefore, this research aimed to investigate the perception and attitude toward social media (SM) use for professionalism and dental practice promotion among periodontal specialists working in Saudi Arabia (KSA).MethodsElectronic surveys were distributed in person or online using WhatsApp, Snapchat or Email from October 2022 until March 2023. The questionnaire was targeting periodontists in KSA, and it consists of three parts: the first part includes sociodemographic and professional data; the second part asks about the daily usage of SM in dental practice; and the third part asks about the periodontist's opinion about SM usage. Descriptive data were presented as numbers and percentages. The association between the demographic variables and the means of periodontists’ opinions was tested using Pearson’s chi-square test. Any value equal to or less than 0.05 was considered statistically significant.ResultsA total of 121 responses were received from the periodontists. Most of the participants were in the 36–45 age group, with a percentage of 40.5%. In terms of gender, males made up 52.9% of the population, while females made up 47.1%, and the majority of the participants were consultants. The most common SM platform used by periodontists for daily using and dental practice promotion was Snapchat (56.2%), followed by Instagram and Twitter (54.5% and 49.6%, respectively). There was a significant difference in proportions among Twitter, Snapchat and TikTok between older and younger periodontists, with a p value < 0.05. There was no significant difference between the gender of the participants and their opinions regarding the usage of SM.ConclusionsThis study highlighted the effectiveness of SM in the promotion of dental practices and the discipline of periodontics, as more clinicians and patients rely on this kind of technology. These online platforms can improve periodontal practice in terms of dental health education, counseling, advertising, and oral health services.

Resection of Multirooted Teeth: A Still Valid Treatment of Periodontal Disease - with Representative Cases

Root resection is an old dental treatment modality that is still currently used in the management of periodontal disease affecting multirooted teeth with furcations. This article explores this dental treatment modality, its history, and its use. This concept of dental treatment is illustrated by some representative cases done in a periodontal practice within primary healthcare settings with some learned lessons explained.

Prevalence of Peri-Implant Disease in Patients with Stage III or IV Periodontitis: Results of a Long-Term Follow-Up from a Specialized Periodontal Practice.

The aim of this study was to examine the conditions of implants that had been in function for 5-17 years in stage III/IV periodontitis patients of a specialized periodontal practice. There were 83 patients (43 female/40 male, mean age 64.4 (9.69) years), with a total of 213 implants, who participated in the study. Assessments included periodontal and peri-implant probing depths, bleeding and plaque scores, and a radiographic examination. Smoking habits, participation in a supportive care program (SCP), and the Implant Disease Risk Assessment (IDRA) scores were recorded. A total of 44 patients presented with stage III periodontitis, and 39 with stage IV. In all, 85% of patients had adhered to regular SCP. On an implant/patient level, peri-implant health was found in 37.1.7% (79 implants)/24.1% (20 patients), peri-implant mucositis in 58.7% (125 implants)/66.3% (55 patients), and peri-implantitis in 4.2% (9 implants)/9.6% (8 patients). IDRA scores showed 30.5% of implants at moderate and 69.5% at high risk. The present long-term analysis shows a high prevalence of peri-implant disease in patients treated for advanced periodontitis. These findings underline the challenges involved in the long-term maintenance of oral health in stage III/IV periodontitis patients restored with dental implants.

КЛИНИЧЕСКАЯ ОЦЕНКА ЭФФЕКТИВНОСТИ ЛЕЧЕНИЯ ХРОНИЧЕСКОГО ПРОСТОГО МАРГИНАЛЬНОГО ГИНГИВИТА С ИСПОЛЬЗОВАНИЕМ СПРЕЯ ОТ КРОВОТОЧИВОСТИ ДЕСЕН «ДЕНТАБАЛАНС®» — СИНБИОТИЧЕСКОГО КОМПЛЕКСА, СОДЕРЖАЩЕГО STREPTOCOCUS THERMOPHILUS ЛИЗАТ И ПРЕБИОТИКИ (МНОГОЦЕНТРОВОЕ КЛИНИЧЕСКОЕ ИССЛЕДОВАНИЕ)

Subject. The subject of the study is the anti-inflammatory and anti-plaque effect of spray against gum bleeding «DentaBalance®» synbiotic complex in the treatment of chronic simple marginal gingivitis.&#x0D; Objectives. The aim of the study is to conduct a clinical evaluation of spray against gum bleeding «DentaBalance®» synbiotic complex in the complex treatment and hygienic oral care in patients with chronic simple marginal gingivitis (CSMG).&#x0D; Methodology. A pilot open prospective non-randomized multicenter study was conducted to evaluate the anti-inflammatory and anti-plaque effects of spray against gum bleeding «DentaBalance®» synbiotic complex in the treatment of CSMG. The sample consisted of 99 patients aged 20–33 years with CSMG in localized or generalized form, who used spray against gum bleeding «DentaBalance®» synbiotic complex including lysate from Streptococcus Thermophilus and prebiotics 2 times a day for 4 weeks on their own in-home therapy mode. The condition of the gum and oral hygiene was evaluated clinically and objectified indexically (BoP, OHI-S) at 3 observation points: initially, 7 and 28 days after the start of observation.&#x0D; Results. Based on the results of a short-term clinical study, a reliable anti-inflammatory and anti-plaque effect of spray against gum bleeding «DentaBalance®» synbiotic complex was determined. The anti-inflammatory effect was objectified by a significant decrease in the BoP index by 44.7% on the 7th day and by 33.5% additionally on the 28th day of observation. The cleansing effect on the OHI-S index increased from 16.87% on the 7th day of observation to 55.41% at its final stage. The expediency of using spray against gum bleeding «DentaBalance®» synbiotic complex in the complex treatment of CSMG is pathogenetically substantiated, the advantages and prospects of its use in periodontal practice are established.&#x0D; Conclusion. The effectiveness and safety of the spray against gum bleeding «DentaBalance®» synbiotic complex including lysate from Streptococcus Thermophilus and prebiotics for hygienic oral care and effective relief of gum inflammation symptoms in patients with CSMG has been pathogenetically substantiated and clinically proven.

Periodontal Practice and Referral of Patients by General Dental Practitioners in Province No.1 Nepal

Introduction: General dental practitioners and periodontists working in a close alliance is considered to bestow effective outcome in the context of diagnosis and management of periodontal diseases. Recently, general practitioners are inclined to render the majority of non-surgical procedures by themselves and avoid surgical part. This obscures functional as well as esthetic demand contributing to periodontally challenged conditions. In advanced stages, no matter how efficiently a skilled periodontist handles the case, redemption is not possible.&#x0D; Objectives: To assess the periodontal practice and referral of patients by general dental practitioners to periodontists.&#x0D; Methodology: An online survey using Google Forms was conducted among the general dental practitioners working in private clinics in province no.1, Nepal from November 2021 to January 2022. A total of 64 general dental practitioners were surveyed using a self-administered questionnaire. Descriptive statistics were calculated.&#x0D; Results: The response rate for the present study was 51.2% out of which only 17.2% referred patients to periodontists for non-surgical periodontal therapy and scaling was the most performed procedure by all the practitioners themselves. However, 92.2% referred patients to periodontists for surgical procedures and a majority of the referrals were for mucogingival surgeries. Majority of them expressed satisfaction regarding the number of continuing dental education programs being conducted despite minimum participation.&#x0D; Conclusion: Majority of the general dental practitioners seemed to perform non-surgical periodontal therapy by themselves while considering referral for surgical interventions. Also, minimum participation despite remarkable satisfaction in the conduction of continuing education programmes calls for a need to explore the inadequacy.

SUB-EPITHELIAL CONNECTIVE TISSUE GRAFT COMBINED WITH PLATELET-RICH FIBRIN IN MANAGEMENT OF PERI-IMPLANT SOFT TISSUE DEHISCENCE – A CASE REPORT

Over the past 2 decades the use of dental implants to advance functional and esthetic demands of dentition has amplified significantly. Patients today have become extremely concerned about esthetics which has become an integral part of the periodontal practice. One of the major factors contributing to improved esthetics is soft and hard tissue management. A chief esthetic concern is soft tissue defects around implant restoration. Implant soft tissue dehiscences compromise the aesthetics of the supported restorations and also implant survival in the long run. The present case report gives a novel technique for soft tissue reconstruction and covering defects associated with a palatally placed maxillary implant-supported restoration. A pedicle subepithelial connective tissue graft was prepared from the palatal mucosa and was displaced into the receptor site, along with the PRF. The receptor and donor site were primarily covered. After surgery of four months, the peri-implant soft tissue margin was compared with the baseline. A 2 mm increase in buccal soft tissue margin was accomplished. There was good stability of the soft tissue margin and the esthetic appearance of the implant site was well preserved. This case report demonstraes the possibility of fully correcting peri-implant soft tissue defects and achieving high patient satisfaction through a subepithelial connective tissue graft in conjunction with growth factors. KEYWORDS: Buccal peri implant soft tissue dehiscence ,peri implant recession , PRF , sub epithelial connective tissue graft

EFFECTIVENESS OF USING DOMESTIC QUATERNARY AMMONIUM ANTISEPTIC IN GENERAL MEDICINE AND DENTISTRY (MODERN VIEW AND CLINICAL CASE)

Decamethoxine (DCM®) is a substance from a group of quaternary ammonium compounds. According to literary sources, the antimicrobial effect is due to a mechanism that combines damage to the cell membrane of bacteria and lysis of their protoplasts, as well as changes the permeability of the microbial cell membrane, causing its destruction. DCM® demonstrates activity against gram-positive and gram-negative bacteria (staphylococci, streptococci, diphtheria and Escherichia coli, salmonella, proteus, klebsiella, shigella, pseudomonads, clostridia), some fungi (yeast fungi, mold fungi). There are also reports of the antiviral activity of this compound. The purpose of this study was to highlight the results of the current work of Ukrainian scientists and analyze the properties and broad aspects of DCM® antiseptic, as well as demonstrate their clinical case for its effectiveness in periodontal practice. The analysis of the results of various publications allowed us to evaluate the full range of DCM® properties in terms of its therapeutic potential in modern preclinical and clinical studies, particularly in periodontal practice.

A Cross-Sectional Study to Evaluate Dental Professionals' Knowledge of Antiplaque Mouth Rinse Agents and their Application in Periodontal Practice.

Mouth rinse agents reduce inflammation and microbial burden, improving periodontal clinical parameters. Yet, improper clinical use of these compounds might have several deleterious repercussions. Given the lack of research on the knowledge and application of antiplaque mouth rinse agents, this research was conducted. The research is an electronic survey wherein responses were gathered for ten items with predetermined answers in addition to covariate data. The questions were conceived to illuminate the level of knowledge possessed by dental professionals and their utilization pattern in periodontal practice. The data gathered underwent quantitative statistical analysis. Participants in the study included 100 dental professionals from various disciplines, all of whom agreed that mouth rinses are a vital adjuvant in periodontal therapy. Most acknowledged being aware of the various mouth rinse agents, but their knowledge and application of mouth rinses were largely confined to chlorhexidine gluconate, with little consideration being given to alternative antiplaque agents. Little knowledge exists among dental professionals regarding mouth rinse agents and their appropriate application. Dental schools, clinical advisory organizations, and other establishments could educate dental professionals on the specific guidelines for utilizing antiplaque mouth rinses in a dental context, especially as an adjunct to periodontal therapy.

A Cross-Sectional Evaluation of Dental Professional's Knowledge of Locally Delivered Antimicrobial Agents and their Application in Periodontal Practice.

Dentists must employ locally delivered antimicrobial agents (LDAs) in a way that is in line with current recommendations from the scientific literature and the guidelines set by professional organizations. Considering the dearth of research on this topic, it is not known what strategies are adapted when using LDAs in their periodontal practice. So, the purpose of this research was to investigate how LDAs are utilized by dental professionals in their distinct periodontal practices. This cross-sectional study used a closed-ended questionnaire. Dental professionals received electronic copies of the eight-item questionnaire. The questionnaire assessed the relevance of LDAs, how frequently they are used, which ones are used most, the number of patients who receive them, their understanding of pharmacological activities, and their knowledge of current treatment guidelines. The questionnaire's validity and reliability were evaluated before being presented to participants. Using the Statistical Package for the Social Sciences (SPSS), the input was analyzed. A total of 120 dental professionals, with an average age of 34.7 years, answered the questionnaire. Half of these individuals have no history of ever using LDAs. The most frequent LDA used in its different forms was chlorhexidine gluconate (CHX), followed by tetracycline. The majority of participants placed LDAs (80%) in less than 10 patients. Less than half acknowledged the different LDAs and their pharmacological activities. Not even 70% of clinicians were up-to-date on the current European Federation of Periodontology (EFP) guidelines. None of the participants discounted the significance of LDAs in periodontal care. Dental professionals regard LDAs as essential to periodontal therapy. Yet, they lacked knowledge about general, pharmacological, and clinical aspects. The patient experience with LDAs was limited by an inappropriate deployment pattern.

Digitally planned surgical crown lengthening in the aesthetic zone: Clinical case study and practical advice.

Surgical crown lengthening is one of the most common surgical procedures in periodontal practice. It is divided into functional and aesthetic surgical crown lengthening. In general, surgical crown lengthening is a predictable periodontal surgical procedure. Its most common complication is excessive regression of the dentoalveolar complex coronally. Aesthetic surgical crown lengthening can be performed predictably through prior digital planning, minimising the risk of potential complications such as excessive regression of the dentoalveolar complex coronally. This study aims to present a clinical case study of surgical crown lengthening with digital planning to derive practical recommendations.

Errors and complications in clinical periodontal practice due to methodologic bias and bad interpretation of the evidence.

Different types of errors and complications may arise during and after the execution of periodontal or implant-related procedures. Some of the most relevant, although also controversial, and less commented, causative agents of errors and complications are methodological biases and bad interpretation of the evidence. Proper assessment of the literature requires of solid clinical knowledge combined with a systematic approach built on the recognition of common methodological biases and the avoidance of interpretive errors to critically retrieve, dissect, and judiciously apply available information for the promotion of periodontal and peri-implant health. This review addresses common types of methodological bias and interpretive errors that can alter the reader's perceptions on the real effect and potential ramifications of the reported outcomes of a given therapeutic approach due to bad interpretation of the available evidence: (1) types of methodological biases; (2) spin and interpretive bias; (3) interpretation pitfalls when assessing the evidence (4) choice of relevant endpoints to answer the question(s) of interest; and (5) balance between statistical significance and clinical relevance.