Treatment Of Advanced Periodontitis Research Articles

Combination of Platelet-rich Fibrin (PRF) in Advanced Periodontitis Stage Treatment

Introduction: The treatment of advanced periodontitis has been a challenge for clinicians. Platelet-rich fibrin (PRF) is a second-generation platelet concentrate that contains various growth factorss and cytokines that promote tissue regeneration. The use of PRF in combination with other regenerative materials and techniques has been shown to be effective in the treatment of intrabony defects. This case series aims to evaluate the efficacy of PRF combinations in the regenerative treatment of patients with advanced periodontitis. Case report: Two patients diagnosed with advanced periodontitis (stage III/IV grade C) were selected for this study. After the completion of periodontal initial therapy, there were still pockets with a probing depth ≥ 5 mm (5–10 mm). Therefore, surgical interventions were planned. The first case used the combination of PRF with bone graft and guided tissue regeneration (GTR), while open flap debridement (OFD) with the addition of PRF and bone graft to create sticky bone was done in the second case. Three to five months of follow-up showed favorable outcomes, as evidenced by reductions in probing depth (PD), gains in clinical attachment level, and filling of bone defects, as well as improvements in patient comfort and rapid wound healing. Conclusion: The combination of PRF with grafting material and/or GTR has been shown to be a beneficial therapeutic approach for periodontal regenerative therapy. Platelet-rich fibrin in periodontal surgery may accelerate the tissue healing process.

Complications and treatment errors related to regenerative periodontal surgery.

Regenerative periodontal surgical procedures are an important component in the treatment of advanced periodontitis. They aim to improve the long-term prognosis of teeth that are periodontally compromised by the presence of intrabony and/or furcation defects, resulting biologically in formation of root cementum, periodontal ligament, and alveolar bone and evidenced clinically by reduction of deep pockets to maintainable probing depths and/or improvements of vertical and horizontal furcation depth. Over the last 25 years, substantial clinical evidence has been accumulated to support the value of regenerative procedures in periodontally compromised dentitions. However, treatment success requires close attention to certain factors on the level of the patient, the tooth/defect, and the operator. Ignoring these factors in case selection, treatment planning, and treatment execution will increase the risk of complications that may jeopardize clinical success and may even be considered as treatment errors. Based on the currently available evidence from clinical practice guidelines, treatment algorithms, and on expert opinion, the present article provides an overview on the main factors, which influence the outcomes of regenerative periodontal surgery and gives recommendations on how to prevent complications and treatment errors.

Measurements of gingival recession changes: Comparison of the conventional clinical and direct digital approach

This study aimed to compare the novel digital and convectional clinical approach of measuring gingival recession (REC) changes associated with the treatment of advanced periodontitis. Assessment of REC changes was performed independently by clinical and digital approach on a sample of ten patients with advanced periodontitis (n=99 teeth). Clinical assessment was performed with subtracting REC measurements (measured as a distance between gingival margin and cemento-enamel junction) obtained at two different time-points (dT=12 months) by a calibrated examiner (intra-examiner agreement > 90%). In contrast, a direct digital assessment was performed by measuring the distance between gingival margins on composite superimposed digital models obtained at two different time-points by intraoral scanning (CEREC Omnicam AC, Dentsply Sirona). Measurements (n=594 sites) obtained with both approaches were compared using Bland–Altman analysis. Bland-Altman analysis revealed poor agreement between the digital and clinical approach regardless of measurements site position with an overall bias of 0.41mm and 95% limits of agreement range of -1.81 to 2.62mm. The present study revealed significant disagreement between both approaches for REC changes measurements. The clinical approach of REC changes with the periodontal probe is less accurate than the digital one due to already known limitations of the conventional approach and the benefits of the digital approach with increased resolution and accuracy.

PC302: The effect of biofilm removal using an Air‐Flow® device in the treatment of advanced periodontitis

PC302: The effect of biofilm removal using an Air‐Flow^® device in the treatment of advanced periodontitis

Efficacy of dental stem cell transplantation in the treatment of advanced periodontitis

Introduction: Periodontitis is the most common cause for tooth loss in adults and advanced types affect 10–15% of adults worldwide. The attempts to save tooth and regenerate periodontal apparatus including cementum, periodontal ligament and alveolar bone reach to the dental tissue derived stem cell therapy. Although there have been several periodontitis models suggested, apical involvement of tooth root is especially challenging to be regenerated and various dental stem cell therapy for the state has never been investigated.

SAA and PLTP activity in plasma of periodontal patients before and after full‐mouth tooth extraction

To assess whether treatment of advanced periodontal disease affects plasma levels of serum amyloid A (SAA) and phospholipid transfer protein (PLTP) activity. We measured the levels of SAA and PLTP activity in plasma of 66 patients with advanced periodontal disease before and after treatment by full-mouth tooth extraction (FME). At baseline, median SAA levels in our study population were within the normal range (2.7 microg ml(-1)) but SAA was elevated (>5 microg ml(-1)) in 18% of periodontitis patients. Three months after FME, SAA levels were significantly reduced (P = 0.04). SAA did not correlate with any of the periodontal disease parameters. PLTP activity was elevated in patients with periodontitis, compared to the PLTP activity reference group (age-matched systemically healthy adults, n = 29; 18 micromol ml(-1) h(-1)vs 13 micromol ml(-1) h(-1), respectively, P = 0.002). PLTP activity inversely correlated with average periodontal pocket depth (PPD) per tooth (r(s) = -0.372; P = 0.002). Three months after FME, median PLTP activity did not change significantly. Full-mouth tooth extraction significantly reduces SAA, a marker of inflammation, while it does not affect plasma PLTP activity. However, the inverse correlation between PLTP activity and average PPD suggests that increased PLTP activity may limit periodontal tissue damage.

Periodontal antimicrobials — finding the right solutions

Strengthened by promising research data and commercial backing, interest in the field of anti-infective periodontal therapy is rapidly expanding. Management of the periodontal microbiota with antibiotic drugs and antiseptic agents in conjunction with mechanical debridement seems to be more effective than mechanical therapy alone, at least in the treatment of advanced periodontal disease. The choice of a periodontal chemotherapeutic regimen requires an understanding of the usual infecting flora, available antimicrobial agents, and pathogen susceptibility patterns. Systemic administration of combinations of metronidazole and either amoxicillin or ciprofloxacin has been widely used with great success; however the presence of subgingival yeasts and resistant bacteria can be a problem in some periodontitis patients. Valuable antiseptic agents for subgingival application include 10% povidone-iodine for professional use and 0.1-0.5% sodium hypochlorite for patient self-care. These antiseptics have significantly broader spectra of antimicrobial action, are less likely to induce development of resistant bacteria and adverse host reactions, and are considerably less expensive than commercially available antibiotics in controlled release devices. In practice, mechanical debridement combined with subgingival povidone-iodine application in the dental office and sodium hypochlorite irrigation for patient self-care are valuable antimicrobial remedies in the treatment of virtually all types of periodontal disease. Management of moderate to severe periodontitis may require additional systemic antibiotic and/or surgical treatment.

Detection and Prediction of Tooth Mobility During the Periodontitis Healing Process

The focus of the article is on a generic approach to prediction of a healing process based on automatic measurement and modelling of mechanical disease indicators. As a specific example the healing process after treatment of advanced periodontitis is characterised and predicted based on measurement of tooth mobility (TM). For the measurement a new mechatronic instrument was developed that includes a pneumatically driven probe with incorporated sensors of tooth displacement and loading force. TM is measured by a computer controlled data acquisition system and predicted by a non-parametric regression. Similarly as in the characterisation of technical processes, a measured sample is described by TM time series detected on a particular patient, while the regression is determined by a set of samples obtained from a group of patients following periodontal therapy. The influence of surgical access therapy and systemic administration of metronidazole as an adjunct to the mechanical treatment is demonstrated. For this purpose the average changes of tooth mobility are determined on variously treated subgroups. A new method of healing process prediction is demonstrated and its performance is described by a prediction quality.

Prospective 3-year study of cross-arch fixed partial dentures in patients with advanced periodontal disease

Statement of Problem. Several choices exist for the treatment of advanced periodontal disease. One is a combined periodontal and prosthetic treatment that includes cross-arch fixed partial dentures (FPDs). However, the outcomes of such therapy have been reported mainly from studies in Scandinavian countries. Purpose. The aims of this study were: (1) to longitudinally evaluate, after periodontal and prosthodontic treatment that included cross-arch FPDs, treatment outcomes in Korean patients who suffered from severe periodontitis; and (2) to evaluate the patients' treatment assessments and the FPDs after 3 years. Material and Methods. This survey included 39 Korean patients provided with 50 FPDs. Clinical and radiographic examinations were performed at the time of delivery of the FPDs and at the 3-year follow-up examinations. The prostheses were divided into 3 groups according to design (end abutments, unilateral cantilever, and bilateral cantilevers) and the amount of supporting tissues at the time of insertion. On average, only 26% of the total original periodontal tissue remained at the time of insertion. The FPDs consisted of 11 to 14 units, with a mean of 5 to 7 abutments in the 3 groups. The mean periodontal ligament area of the abutments was 79% of the total ligament area of the replaced teeth. Results. At the 3-year follow-up examination, the FPDs were stable in all patients, who in general displayed good oral hygiene and had healthy periodontal conditions. The change in periodontal ligament area over the 3-year observation period was negligible (1 mm2 per dental unit) and showed no statistically significant difference in relation to FPD design. Most patients were satisfied with the function of their FPDs with respect to mastication, phonetics, hygiene, esthetics, and chewing comfort. A few patients stated that they were careful with the FPDs and avoided certain foods (for example, raw peanuts and grilled squid) because they felt insecure with the cantilever segments. Most patients reported that they would choose the same treatment again. Conclusion. Patients with advanced periodontal disease demonstrated successful outcomes over a 3-year period and reported satisfaction with combined periodontal and restorative treatment that included cross-arch FPDs. (J Prosthet Dent 2001;86:489-94.)

Guided tissue regeneration in the treatment of degree II furcations in maxillary molars

he present clinical trial was designed to evaluate the clinical effect of GTR in the treatment of degree II furcation defects in maxillary molars. 28 patients, 21 to 59 years of age, referred for treatment of advanced periodontal disease were included. They presented with similar periodontal lesions in the right and the left maxillary molar regions, but had only one surface which exhibited furcation involvement. A total of 28 pairs of contralateral furcation defects of degree II including 18 interproximal pairs (10 mesial, 8 distal) and 10 buccal pairs, were available for the study. After the completion of basic therapy, the furcation involved molars in the right and left quadrants in each patient were randomly assigned to either a test or a control treatment procedure. Following flap elevation, scaling, root planing and granulation tissue removal, an e-PTFE membrane at the test site was adjusted to cover the entrance to the furcation defect and adjacent bone and was retained in this position with sling sutures. The mucoperiostal flaps were subsequently adjusted and positioned to cover the entire surface of the membrane and were secured in this position. An identical surgical procedure was performed in the control tooth regions with the exception of the placement of a teflon membrane. No periodontal dressing was used. Starting the day before surgery and continuing for 7 days, the patients received 1 + 1 g of Amoxicillin per day; morning and evening. The sutures were removed after 10 days. At the test sites, the membranes were removed after 6 weeks of healing. The treated sites were examined and re-entry procedures performed 6 months after reconstructive surgery. Open flap debridement at maxillary furcations of degree II resulted in some gingival recession and probing depth reduction, but no change occurred in parameters describing probing attachment or bone levels. The addition of GTR at buccal furcations enhanced the treatment result by promoting probing attachment and bone gain and reduced the amount of soft tissue recession above what was accomplished by flap debridement alone. No such benefit of membrane therapy was observed at mesial and distal furcations.

Costs of periodontal and prosthodontic treatment and evaluation of oral health in patients after treatment of advanced periodontal disease

Retrospective estimations of dental care costs of periodontal and prosthodontic treatment and evaluation of oral health in 37 patients with advanced periodontal disease were carried out. Measures of their subjective evaluation of oral health 7-10 yr after the treatment are presented as a health profile and as indices in single numbers. The relations between oral health as an index and the dimensions in the health profile are analyzed. Dental care costs for treatment in the mandible was SEK 35 550, for the maxilla SEK 45 380 and for both jaws SEK 74 230. After the treatment oral health as well as general health were in excess of 75 on a 0 to 100 scale. Chewing ability, comfort and aesthetics were the variables found to significantly affect the subjective oral health. Oral health in terms of periodontal and prosthodontic conditions was maintained over the observation period.

Experiences with guided tissue regeneration in the treatment of advanced periodontal disease

Abstract The aim of this study was to evaluate the predictability of guided tissue regeneration (GTR), using ePTFE‐membranes (Gore‐Tex®) in the treatment of advanced periodontal disease. The study presents long‐term results for 88 teeth in 23 patients at least 9 months after membrane surgery. The periodontal lesions included severe horizontal and/or vertical bone loss. The bone level (BL and BL) and the tissue level (TL), a new parameter between cemento‐enamel junction and coronal margin of the tissue in the defect, were recorded during surgery: immediately before application of the membrane (BL), after membrane removal (TL) and during a re‐entry procedure (BL') 9 to 12 months later. The average tissue gain in the periodontal defect (BL‐Tl) at membrane removal was 65.7% (p < 0.001) and the average gain in mineralized tissue at re‐entry (BL‐BL'), 30.4%, meaning more than 46% of the gained tissue at removal was mineralized at reentry. The decreased amount of mineralized tissue at re‐entry in relation to the tissue gain at membrane removal might be due to formation of a so‐called long connective tissue attachment or to mineralization‐induced shrinkage of the new tissue and some surgical difficulties in coverage of the newly formed tissue. Nevertheless, an absolute gain of 31% mineralized tissue after GTR can provide a marked improvement in the prognosis of a periodontally severely damaged tooth.

The relative importance of plaque and occlusion in periodontal disease.

A series of studies has investigated interactions between periodontal trauma and marginal periodontitis in relation to the initiation, progression and treatment of periodontal disease. Lesions of trauma in the periodontal ligament do not initiate the loss of connective tissue attachment characteristic of marginal periodontitis. Studies conducted in squirrel monkeys and beagle dogs in which jiggling forces were superimposed upon an established marginal periodontitis reported increased loss of alveolar bone, but the accelerated loss of attachment which occurred in the dog model did not occur in the monkey model. In order to clarify the relative importance of inflammation and tooth mobility in the treatment of advanced periodontal disease, periodontal responses were evaluated after removing combinations of traumatic and inflammatory components. Elimination of trauma in the presence of existing marginal inflammation did not reduce tooth mobility or increase bone volume. Osseous regeneration and decreased tooth mobility occurred after resolving both components; however, similar findings occurred after resolving inflammation in the presence of continued tooth mobility. After resolution of inflammation, remaining tooth mobility does not result in increased loss of connective tissue attachment. On a clinical level for periodontal disease treatment, the findings place decreased emphasis upon management of tooth mobility and increased emphasis upon resolution of marginal inflammation.

Interrelationship of inflammation and tooth mobility (trauma) in pathogenesis of periodontal disease.

A series of studies has investigated interactions between periodontal trauma and marginal periodontitis in relation to the initiation, progression and treatment of periodontal disease. Lesions of trauma in the periodontal ligament consequent to either single or jiggling displacing forces result in morphologic alterations in the ligament and alveolar bone. These changes do not initiate the loss of connective tissue attachment characteristic of marginal periodontitis. Studies conducted in squirrel monkeys and beagle dogs in which jiggling forces have been produced subjacent to an established marginal periodontitis reported increased loss of alveolar bone, but the accelerated loss of attachment which occurred in the dog model did not occur in the monkey model. To clarify the relative importance of inflammation and tooth mobility in the treatment of advanced periodontal disease, periodontal response was evaluated after removing traumatic and/or inflammatory components. Elimination of trauma in the presence of existing marginal inflammation did not reduce tooth mobility or increase bone volume. Osseous regeneration and decreased tooth mobility occurred after resolving both components, however, similar findings occurred after resolving inflammation in the presence of continued tooth mobility. Resolution of marginal inflammation is of prime importance in the management of periodontal disease. After resolution of inflammation, bone regeneration may occur around mobile teeth and, furthermore, any residual tooth mobility does not result in increased loss of connective tissue attachment.

Soft tissue surgical procedures in treatment of advanced periodontal disease.

Abstract— An attempt has been made to establish some basic principles underlying the proper handling of soft tissues in the surgical treatment of advanced periodontal disease. These elementary principles have been based on known or presumed histology.

Treatment of advanced periodontal disease by prosthodontic procedures

Treatment of advanced periodontal disease by prosthodontic procedures