157 research outputs found
Current status of the influence of osteoporosis on periodontology and implant dentistry
No full textPurpose of review
This review summarizes recent evidence on the impact of osteoporosis on periodontonlogy and implant dentistry, prevalence of diseases, pathophysiology and treatment outcomes.
Recent findings
Patients with osteoporosis should be advised about the importance of returning for periodical periodontal maintenance as inadequate oral care may lead to a faster development of periodontitis. There is no definitive information on the development of bisphosphonate-related osteonecrosis of the jaw associated with dental implant therapy. Patients presenting severe periodontitis, undergoing intravenous bisphosphonate therapy (for long-term periods) and submitted to more invasive periodontal/peri-implant surgical procedures (that can promote superior dentoalveolar surgical trauma) might be advised about the possibility of developing bisphosphonate-related osteonecrosis of the jaw following dental therapy. Thus, individualized risk evaluation must be undertaken by both the medical and dental teams prior to any dental treatment.
Summary
The most recent literature on the impact of osteoporosis on the periodontal and peri-implant tissues was reviewed to emphasize the importance of oral hygiene measures, and the combined medical/dental assessment of importance when osteoporotic patients are in need of dentoalveolar surgical procedures (e.g. tooth extraction and dental implant placement)
Periodontal soft tissue root coverage procedures: A systematic review from the AAP regeneration workshop
No full textThis paper aims to create a "bridge" between research and practice by developing a practical, extensive, and clinically relevant study that translates evidence-based findings on soft tissue root coverage (RC) of recession-type defects to daily clinical practice.
This review is prepared in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement based on the proposed focused questions. A literature search with no restrictions regarding status or the language of publication was performed for MEDLINE and EMBASE databases up to and including June 2013. Systematic reviews (SRs), randomized clinical trials, controlled clinical trials, case series, and case reports evaluating recession areas that were treated by means of RC procedures were considered eligible for inclusion through the three parts of the study (part I, an overview of the base of SRs; part II, an alternative random-effects meta-analyses on mean percentage of RC and sites exhibiting complete RC; and part III, an SR of non-randomized trials exploring other conditions not extensively evaluated by previous SRs). Data on Class I, II, III, and IV recessions, type of histologic attachment achieved with treatment, recipient- and donor-site anatomic characteristics, smoking-related outcomes, root surface conditions, tooth type and location, long-term effectiveness outcomes, unusual conditions that may be reported during conventional daily practice, and patient-centered outcomes were assessed as well.
Of the 2,456 potentially eligible trials, 234 were included. Data on Class I, II, III, and IV gingival recessions, histologic attachment achieved after treatment, recipient- and donor-site anatomic characteristics, smoking-related outcomes, root surface conditions/biomodification, tooth type and location, long-term effectiveness outcomes and unusual conditions that may be reported during conventional daily practice, and patient-centered outcomes (i.e., esthetic, visual analog scale, complications, hypersensitivity, patients perceptions) were assessed. Subepithelial connective tissue (CT)-based procedures and coronally advanced flap plus acellular dermal matrix grafts, enamel matrix derivative, or collagen matrix led to the best improvements of recession depth, clinical attachment level (CAL) gain, and keratinized tissue (KT). Some conditions, such as smoking and use of magnification, may affect RC outcomes.
All RC procedures can provide significant reduction in recession depth and CAL gain for Miller Class I and II recession-type defects. Subepithelial CT graft-based procedures provided the best outcomes for clinical practice because of their superior percentages of mean and complete RC, as well as significant increase of KT
Long-term outcomes of untreated buccal gingival recessions: a systematic review and meta-analysis
No full textBackground: This review aims to: 1) assess the long‐term outcomes of untreated buccal gingival recession (GR) defects and the associated reported esthetic and functional alterations; and 2) evaluate which factors influence the progression/worsening of dental and periodontal tissue conditions of untreated GR defects.
Methods: Interventional and observational studies with duration of ≥24 months reporting outcomes from adult patients with localized or multiple GR defects not treated by root coverage or gingival augmentation procedures were considered eligible for inclusion. MEDLINE and EMBASE databases were searched for articles published through July 2015. Random‐effects meta‐analyses were performed comparing baseline versus most recent follow‐up outcomes (i.e., number of patients with ≥1 GR and number of sites with GR).
Results: Of 378 potentially eligible articles, eight (reporting six studies) met inclusion criteria. Of 1,647 GR defects with baseline and follow‐up information, 78.1% experienced GR depth increase during the follow‐up period, whereas the remaining experienced decrease or no change. Moreover, there was a 79.3% increase in the number of GR defects among the patients followed (i.e., new GR defects). Pooled estimates (data from four studies) showed significantly increased odds of recession development long term, regarding either number of patients (odds ratio 2.43; P = 0.03) or number of sites with GR (odds ratio 2.16; P = 0.0005).
Conclusion: Untreated recession defects in individuals with good oral hygiene have a high probability of progressing during long‐term follow‐up
Current status of dental implants survival and peri-implant bone loss in patients with uncontrolled type-2 diabetes mellitus
No full textPurpose of review
The current review summarizes recent evidence on the impact of type-2 diabetes mellitus (T2DM) on implant dentistry, highlighting the behavior of peri-implant bone.
Recent findings
There is no definitive information on the development and course of peri-implant bone loss associated with T2DM; however, poorly controlled T2DM patients present worse outcomes. Nevertheless, dental implants may be a successful therapy for these patients in a manner similar to healthy individuals, when glycemic levels and oral hygiene are strictly maintained.
Summary
The most recent literature on the impact of T2DM on peri-implant bone loss was reviewed to evaluate the feasibility of dental implant therapy over the time for these patients
An evidence‐based system for the classification and clinical management of non‐proximal gingival recession defects
No full textGingival recession defect (GRD) may be defined as an apical migration of the gingival margin respective to the cementoenamel junction resulting in partial exposure of the root surface to the oral cavity, which may have important esthetic, functional, and periodontal health implications. A novel system for the classification and management of non-proximal GRDs is proposed in this article. This evidence-based system consists of two essential components: (1) Establishment of the GRD type based on the midbuccal/midlingual attachment level respective to the interproximal bone level, and (2) Assessment of the gingival phenotype according to the width of attached gingiva and gingival thickness. Each category of this new classification system is linked with treatment recommendations substantiated by relevant literature pertaining to the outcomes of validated root coverage procedures in specific scenarios, which can be used as a guide for clinical decision-making in daily practice
The Effect of Suturing Protocols on Coronally Advanced Flap Root‐Coverage Outcomes: A Meta‐Analysis
No full textThe purpose of this systematic review and meta-analysis was to investigate whether suturing protocols (suture removal timing and/or type of suture material) influence root coverage outcomes in recession defects treated with a coronally advanced flap (CAF) procedure.
Databases (MEDLINE, EMBASE) were searched for randomized clinical trials (RCTs) that assessed single-tooth, Miller Class I/II recession defects, surgically treated by CAF. Mixed-effects linear regression analysis evaluated differences on complete root coverage (CRC) between RCTs with early (<10 days postoperatively) and late (≥10 days) suture removal, as well as between RCTs using absorbable and non-absorbable sutures removed ≥10 days postoperatively.
Seventeen RCTs were eligible for inclusion. Overall, data from 325 single gingival recession defects revealed a statistically significant superior proportion of sites exhibiting CRC when sutures were removed ≥10 days postoperatively compared to those in which sutures were removed <10 days (P = 0.03). Conversely, there were no significant differences in CRC outcomes between absorbable and non-absorbable sutures when they were removed ≥10 days after surgery (P = 1.00). The majority of included RCTs (59%) reported use of non-absorbable suture materials.
Within the limitations of the available data, it can be concluded that early suture removal (<10 days) can negatively influence root-coverage outcomes in single-tooth defects treated by a CAF procedure. There is a strong need for studies designed specifically to investigate suturing protocols in root-coverage procedures
Commentary: Statistical Significance Versus Clinical Relevance in Periodontal Research: Implications for Clinical Practice
No full textOrthodontic treatment in periodontal patients: The use of periodontal gold standards to overcome the “grey zone”
No full textComplications and treatment errors in periodontal and implant therapy
No full textThe assortment of periodontal and implant-related treatments has been continuously improved over the last 50 years. Once the decision-making process has been established and the treatment procedure applied, the partial or complete resolution of the problem (eg, periodontal probing depth reduction, clinical attachment level gain, gingival recession reduction, dental hypersensitivity decrease) and a diagnosis change with no or minimal occurrence of adverse events (ie, complications, harms, technical errors, or adverse/side effects) can be expected. The clear identification of the potential types of adverse effects, complications, or even errors is important for contemporary decision-making processes, as they may be related to different local, systemic, and technical aspects. This chapter focused on four core components: (a) providing periodontal definitions for errors, complications, harms, and side effects; (b) defining the types of risk and the clinical impact of adverse effects, errors, and complications in periodontal and peri-implant therapies; (c) evaluating the influence of accidental errors versus the lack of a proper treatment planning; and (d) reporting on the importance of establishing the “net benefit ratio” between the clinical improvements promoted by the therapy and the occurrence of potential adverse events.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/177641/1/prd12442.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/177641/2/prd12442_am.pd
Long-term evaluation (20 years) of the outcomes of coronally advanced flap in the treatment of single recession-type defects
No full textBackground
Coronally advanced flap (CAF) has been considered as one of the most predictable and versatile root coverage procedures. Thus, the aims of this study are two‐fold: 1) to evaluate the long‐term outcomes following CAF in the treatment of gingival recession (GR); and 2) to explore the influence of several tooth/patient‐related factors on the stability of gingival margin at 5, 10, and 20 years after surgery.
Methods
Ninety‐four patients with 97 GR (73 Miller`s Class I and 24 Miller's Class III) were treated with CAF in a private practice between 1984 and 1996. Recession depth (RD), probing depth (PD), keratinized tissue (KT) width and patient/tooth‐associated variables were recorded for each GR at baseline, 1 year, 5 years, 10 years, 15 years and 20 years after surgery. Parametric, non‐parametric, and logistic regression statistics were used throughout the study
Results
A total of 72 patients with 72 GR were available for analysis at the 20‐year follow‐up examination (final patients’ dropout rate = 23.4%). Statistically significant improvements were found for RD in all evaluations (P < 0.05). Little more than a half (56%) of the sites treated with CAF did not display RD changes between the short‐term (i.e., 1 year) and long‐term (i.e., 20 years) examinations. Overall, mean root coverage (MRC) decreased from 68.59% to 56.11%. The achievement of complete root coverage (CRC) 1 year after treatment was associated to GR not presenting interdental tissue loss (P = 0.001), the root condition (i.e., lack of non‐carious cervical lesion [step] – P < 0.001), an attached KT band ≥ 2 mm (P = 0.019), and baseline RD (P = 0.020). GR recurrence seemed to be influenced by age, RD at 1‐year follow‐up, sites displaying an attached KT < 2 mm and interdental tissue loss.
Conclusions
The aging process, the condition of the interdental periodontal tissue, and the presence of an attached KT band < 2 mm seem to be negative factors influencing the stability of the gingival margin during the 20‐year observation period
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