| 1. |
- Cosgarea, Raluca, et al.
(author)
-
Non-surgical periodontal treatment in conjunction with 3 or 7 days systemic administration of amoxicillin and metronidazole in severe chronic periodontitis patients : A placebo-controlled randomized clinical study
- 2016
-
In: Journal of Clinical Periodontology. - : John Wiley & Sons. - 0303-6979 .- 1600-051X. ; 43:9, s. 767-777
-
Journal article (peer-reviewed)abstract
- AIM: To evaluate the effect of 3 or 7 days systemic administration of amoxicillin (AMX) and metronidazole (MET) or placebo as adjunct to non-surgical periodontal treatment in severe chronic periodontitis patients. METHODS: One hundred and two patients with severe chronic periodontitis [e.g. ≥1 site with probing pocket depth (PD) ≥ 6 mm per quadrant] were randomly divided into three equally sized groups and treated with either scaling and root planing within 24 h (SRP) + placebo (Group A) or SRP + AMX + MET (both 500 mg × 3 times daily) for 3 days (Group B) or SRP + AMX + MET (both 500 mg × 3 times daily) for 7 days (Group C). PD, clinical attachment level (CAL), bleeding on probing (BOP), full-mouth plaque scores (FMPS) and gingival bleeding index (GBI) were assessed prior to treatment (baseline), and at 3 and 6 months post-treatment. The primary outcome variable was the difference (Δ) in the number of sites with PD ≥ 6 mm. RESULTS: Ninety-one patients completed the study. At both 3 and 6 months, all three treatment protocols resulted in statistically significant improvements compared to baseline for all evaluated clinical parameters (p < 0.001). At 6 months, a statistically significantly greater reduction in the mean number of sites with PD ≥ 6 mm was observed in group B (28.62 ± 15.32 sites) and group C (30.45 ± 15.04 sites) compared to the placebo group (17.10 ± 14.68 sites). Furthermore, both the 3- and the 7-day antibiotic regimen resulted in statistically significantly higher clinical improvements compared to the placebo group (p < 0.05). CONCLUSION: The present findings indicate that in patients with severe chronic periodontitis, non-surgical periodontal therapy in conjunction with a 3 or 7 days systemic administration of AMX + MET may lead to significantly greater clinical improvements compared to non-surgical therapy alone.
|
|
| 2. |
|
|
| 3. |
- Eick, Sigrun, et al.
(author)
-
Adhesion of Porphyromonas gingivalis and Tannerella forsythia to dentin and titanium with sandblasted and acid etched surface coated with serum and serum proteins - An in vitro study
- 2017
-
In: Archives of Oral Biology. - : Elsevier. - 0003-9969 .- 1879-1506. ; 75, s. 81-88
-
Journal article (peer-reviewed)abstract
- Objective: To evaluate the adhesion of selected bacterial strains incl. expression of important virulence factors at dentin and titanium SLA surfaces coated with layers of serum proteins. Methods: Dentin-and moderately rough SLA titanium-discs were coated overnight with human serum, or IgG, or human serum albumin (HSA). Thereafter, Porphyromonas gingivalis, Tannerella forsythia, or a six species mixture were added for 4 h and 24 h. The number of adhered bacteria (colony forming units; CFU) was determined. Arg-gingipain activity of P. gingivalis and mRNA expressions of P. gingivalis and T forsythia proteases and T. forsythia protease inhibitor were measured. Results: Coating specimens never resulted in differences exceeding 1.1 log10 CFU, comparing to controls, irrespective the substrate. Counts of T forsythia were statistically significantly higher at titanium than dentin, the difference was up to 3.7 log10 CFU after 24 h (p = 0.002). No statistically significant variation regarding adhesion of the mixed culture was detected between surfaces or among coatings. Arggingipain activity of P. gingivalis was associated with 1og10 CFU but not with the surface or the coating. Titanium negatively influenced mRNA expression of T. forsythia protease inhibitor at 24 h (p = 0.026 uncoated, p = 0.009 with serum). Conclusions: The present findings indicate that: a) single bacterial species (T forsythia) can adhere more readily to titanium SLA than to dentin, b) low expression of T. forsythia protease inhibitor may influence the virulence of the species on titanium SLA surfaces in comparison with teeth, and c) surface properties (e.g. material and/or protein layers) do not appear to significantly influence multi-species adhesion. (C) 2016 Elsevier Ltd. All rights reserved.
|
|
| 4. |
- Eick, Sigrun, et al.
(author)
-
Gingipains impair attachment of epithelial cell to dental titanium abutment surfaces
- 2019
-
In: Journal of Biomedical Materials Research. Part B - Applied biomaterials. - : John Wiley & Sons. - 1552-4973 .- 1552-4981. ; 107:8, s. 2549-2556
-
Journal article (peer-reviewed)abstract
- The study investigated in vitro the effect of Porphyromonas gingivalis and its cysteine proteases (gingipains) on epithelial cell adhesion to titanium-zirconium alloy surfaces. Titanium-zirconium discs with a standard machined (M) or chemically modified hydrophilic surface (modM) were coated with lamin-5 and incubated with telomerase-inactivated gingival keratinocytes (TIGK). Three P. gingivalis strains or gingipains were either added simultaneously with TIGK or after TIGK cells were already attached to the disks. Adhered TIGK cells were counted at 24 h. All P. gingivalis strains clearly inhibited adhesion of TIGK cells to M and modM surfaces. Compared with bacteria/gingipain-free TIGK cell cultures, the number of attached TIGK cells was reduced by about 80% and 60% when P. gingivalis was added simultaneously or after TIGK cells were already attached to the disks (each p < 0.01), respectively. Counts of attached cells were similarly reduced when only gingipains were used. Adhesion molecules of TIGK cells, in particular E-cadherin, were cleaved by P. gingivalis. In conclusion, P. gingivalis and gingipains interfere with the adhesion of epithelial cells to titanium-zirconium alloy surfaces by cleaving adhesion molecules, while a chemically modified hydrophilic titanium-zirconium alloy surface did not yield any protection. (c) 2019 Wiley Periodicals, Inc. J Biomed Mater Res B Part B, 2019.
|
|
| 5. |
- Herrera, David, et al.
(author)
-
Consensus report of the second European Consensus Workshop on Education in Periodontology
- 2024
-
In: JOURNAL OF CLINICAL PERIODONTOLOGY. - 0303-6979 .- 1600-051X.
-
Journal article (peer-reviewed)abstract
- BackgroundThe second European Consensus Workshop on Education in Periodontology was commissioned, as a result of the changes in the discipline and the advances in educational methods/technology, to update the 2009 Consensus report of the first European Federation of Periodontology (EFP) Workshop on the same topic that was jointly authored by the Association for Dental Education in Europe.AimTo identify and propose changes necessary in periodontal education at three levels, namely undergraduate, specialist and continuing professional development (CPD), with respect to learning outcomes, competencies and methods of learning/training and evaluation.MethodsFour working groups (WGs) considered education in periodontology at the undergraduate, specialist and CPD levels, and education methods. Four commissioned position papers, one per WG, summarized the relevant information. Workshop participants gathered at an in-person consensus meeting to discuss the individual reviews, and this consensus report summarizes the conclusions.ResultsThe learning outcomes for undergraduate and specialist education in periodontology have been updated, and a proposal for learning outcomes for CPD programmes was made. Learning/teaching/training and evaluation methods were proposed for each level of education, which included face-to-face, virtual and blended learning methods.ConclusionDevelopments in oral/dental medicine and in contemporary educational technologies have been translated into updated learning outcomes and learning/teaching/ training/evaluation methods relevant to education in periodontology.
|
|
| 6. |
- Horváth, Attila, et al.
(author)
-
Histological evaluation of human intrabony periodontal defects treated with an unsintered nanocrystalline hydroxyapatite paste
- 2013
-
In: Clinical Oral Investigations. - : Springer. - 1432-6981 .- 1436-3771. ; 17:2, s. 423-430
-
Journal article (peer-reviewed)abstract
- OBJECTIVES: The aim of the study was to clinically and histologically evaluate the healing of human intrabony defects treated with open flap surgery (OFD) and application of a new, resorbable, fully synthetic, unsintered, nanocrystalline, phase-pure hydroxyapatite (nano-HA). MATERIALS AND METHODS: Six patients, each of them displaying very advanced intrabony defects around teeth scheduled for extraction due to advanced chronic periodontitis and further prosthodontic considerations, were included in the study. Following local anaesthesia, mucoperiosteal flaps were reflected; the granulation tissue was removed, and the roots were meticulously debrided by hand and ultrasonic instruments. A notch was placed at the most apical extent of the calculus present on the root surface or at the most apical part of the defect (if no calculus was present) in order to serve as a reference for the histological evaluation. Following defect fill with nano-HA, the flaps were sutured by means of mattress sutures to allow primary intention healing. At 7 months after regenerative surgery, the teeth were extracted together with some of their surrounding soft and hard tissues and processed for histological analysis. RESULTS: The postoperative healing was uneventful in all cases. At 7 months following surgery, mean PPD reduction and mean CAL gain measured 4.0 ± 0.8 and 2.5 ± 0.8 mm, respectively. The histological analysis revealed a healing predominantly characterized by epithelial downgrowth. Limited formation of new cementum with inserting connective tissue fibers and bone regeneration occurred in three out of the six biopsies (i.e. 0-0.86 and 0-1.33 mm, respectively). Complete resorption of the nano-HA was found in four out of the six biopsies. A few remnants of the graft particles (either surrounded by newly formed mineralized tissue or encapsulated in connective tissue) were found in two out of the six biopsies. CONCLUSION: Within their limits, the present results indicate that nano-HA has limited potential to promote periodontal regeneration in human intrabony defects. CLINICAL RELEVANCE: The clinical outcomes obtained following surgery with OFD + nano-HA may not reflect true periodontal regeneration.
|
|
| 7. |
- Horváth, Attila, et al.
(author)
-
Histologisk evaluering af humane intraossøse parodontale defekter behandlet med en usintret nanokrystallinsk hydroxyapatit pasta
- 2013
-
In: Tandlægebladet. - : Dansk Tandlægeforening. - 0039-9353. ; 117:1, s. 12-13
-
Journal article (other academic/artistic)abstract
- Formål Formålet med undersøgelsen var at evaluere den kliniske og histologiske heling af humane intraossøse defekter behandlet med konventionel flapkirurgi (OFD) og anvendelse af en ny, resorberbar, fuldsyntetisk, usintret, nanokrystallinsk, hydroxyapatit (nano-HA ). Materialer og metoder Seks patienter, som hver viste en meget avanceret intraossøs defekt omkring en tand planlagt til ekstraktion på grund af svær kronisk marginal parodontitis og yderligere restaurerende overvejelser, blev inkluderet i undersøgelsen. Efter lokalbedøvelse, mucoperiosteal lapløft, granulationsvævs fjernelse og omhyggelig roddepuration og afglatning med hånd- og ultralydsinstrumenter blev der på roden placeret et mindre boremærke ved den mest apikale tilstedeværelse af tandsten eller ved bunden af defekten (hvis ikke tandsten var til stede); boremærket tjente som reference ved den histologiske evaluering. Efter defektudfyldelse med nano-HA blev lapperne syet ved hjælp af madras-suturer mhp. primær heling. Syv måneder efter regenerativ kirurgi blev tænderne ekstraheret sammen med en mindre del af de omgivende bløde og hårde væv og præpareret til histologisk undersøgelse. Resultater Postoperativ heling var komplikationsfri i alle tilfælde. Syv måneder efter operationen sås der betydelig pochedybdereduktion og klinisk fæstegevinst på 4,0 mm ± 0,8 mm og 2,5 mm ± 0,8 mm, henholdsvis. Den histologiske analyse viste, at helingen hovedsageligt kendetegnede sig ved et lang epitelialt fæste. Begrænset dannelse af ny cement med indlejrede kollagenfibre og knogleregeneration sås hos tre ud af de seks biopsier på op til henholdsvis 0,86 mm og 1,33 mm. Komplet resorption af nano-HA-partikler blev fundet i fire ud af de seks biopsier. Nogle få rester af de implanterede partikler (enten omgivet af nydannet mineraliseret væv eller indkapslet i bindevæv) blev fundet i to ud af de seks biopsier. Konklusion De foreliggende resultater viser, at nano-HA har begrænset mulighed for at fremme parodontal regeneration i humane intraossøse defekter. Klinisk relevans: De kliniske resultater opnået efter kirurgi med OFD + nano-HA afspejler måske ikke ægte parodontal regeneration. Horváth A, Stavropoulos A, Windisch P et al. Histological evaluation of human intrabony periodontal defects treated with an unsintered nanocrystalline hydroxyapatite paste. Clin Oral Investig 2012.
|
|
| 8. |
- Hämmerle, Christoph H F, et al.
(author)
-
Biology of soft tissue wound healing and regeneration : consensus report of group 1 of the 10th European workshop on periodontology
- 2014
-
In: Journal of Clinical Periodontology. - : John Wiley & Sons. - 0303-6979 .- 1600-051X. ; 41:s15, s. S1-S5
-
Journal article (other academic/artistic)abstract
- BACKGROUND:The scope of this consensus was to review the biological processes of soft tissue wound healing in the oral cavity and to histologically evaluate soft tissue healing in clinical and pre-clinical models. AIMS:To review the current knowledge regarding the biological processes of soft tissue wound healing at teeth, implants and on the edentulous ridge. Furthermore, to review soft tissue wound healing at these sites, when using barrier membranes, growth and differentiation factors and soft tissue substitutes. COLLECTION OF DATA:Searches of the literature with respect to recessions at teeth and soft tissue deficiencies at implants, augmentation of the area of keratinized tissue and soft tissue volume were conducted. The available evidence was collected, categorized and summarized. FUNDAMENTAL PRINCIPLES OF ORAL SOFT TISSUE WOUND HEALING:Oral mucosal and skin wound healing follow a similar pattern of the four phases of haemostasis, inflammation, proliferation and maturation/matrix remodelling. The soft connective tissue determines the characteristics of the overlaying oral epithelium. Within 7-14 days, epithelial healing of surgical wounds at teeth is completed. Soft tissue healing following surgery at implants requires 6-8 weeks for maturation. The resulting tissue resembles scar tissue. Well-designed pre-clinical studies providing histological data have been reported describing soft tissue wound healing, when using barrier membranes, growth and differentiation factors and soft tissue substitutes. Few controlled clinical studies with low numbers of patients are available for some of the treatments reviewed at teeth. Whereas, histological new attachment has been demonstrated in pre-clinical studies resulting from some of the treatments reviewed, human histological data commonly report a lack of new attachment but rather long junctional epithelial attachment and connective tissue adhesion. Regarding soft tissue healing at implants human data are very scarce. CONCLUSIONS:Oral soft tissue healing at teeth, implants and the edentulous ridge follows the same phases as skin wound healing. Histological studies in humans have not reported new attachment formation at teeth for the indications studied. Human histological data of soft tissue wound healing at implants are limited. CLINICAL RECOMMENDATIONS:The use of barriers membranes, growth and differentiation factors and soft tissue substitutes for the treatment of localized gingival/mucosal recessions, insufficient amount of keratinized tissue and insufficient soft tissue volume is at a developing stage.
|
|
| 9. |
- Kloukos, Dimitrios, et al.
(author)
-
Gingival Thickness Assessment at Mandibular Incisors of Orthodontic Patients with Ultrasound and Cone-beam CT : A Cross-sectional Study
- 2021
-
In: Oral Health & Preventive Dentistry. - : Quintessence. - 1602-1622 .- 1757-9996. ; 19:1, s. 263-270
-
Journal article (peer-reviewed)abstract
- Purpose: To use and evaluate two methods for measuring gingival thickness (GT) at mandibular incisors of orthodontic patients and compare their performance in assessing periodontal anatomy through soft tissue thickness. Materials and Methods: The sample consisted of 40 consecutive adult orthodontic patients. GT was measured just before bracket placement at both central mandibular incisors, mid-facially on the buccal aspect, 2 mm apically to the free gingival margin with two methods: clinically with an ultrasound device (USD) and radiographically with cone beam computed tomography (CBCT). Results: CBCT measurements were consistently higher than USD measurements, with the difference ranging from 0.13 mm to 0.21 mm. No statistically significant difference was noted between the repeated CBCT measurements at the right central incisor (bias = 0.05 mm; 95% CI =-0.01, 0.11; p = 0.104). Although the respective results for the left incisor statistically indicated that the measurements were not exactly replicated, the magnitude of the point estimate was small and not clinically significant (bias = 0.06 mm; 95% CI = 0.01, 0.11; p = 0.014). Small differences between CBCT measurements made by the 2 examiners at the left central incisor (bias = 0.06 mm; 95% CI = 0.01, 0.11; p = 0.014) were detected. However, this difference was minor and also not clinically significant. The respective analysis on the right incisor showed no statistically significant difference (bias = 0.05 mm; 95% CI =-0.01, 0.11; p = 0.246). Conclusions: Based on reproducibility, CBCT imaging for gingival thickness assessment proved to be as reliable as ultrasound determination. However, CBCT consistently yielded higher values, albeit at a marginal level, than did the ultrasound device.
|
|
| 10. |
- Kloukos, Dimitrios, et al.
(author)
-
Transgingival probing : a clinical gold standard for assessing gingival thickness
- 2021
-
In: Quintessence International. - : Quintessence. - 0033-6572. ; 52:5, s. 394-401
-
Journal article (peer-reviewed)abstract
- Objective: Transgingival probing is often used in the clinic to assess gingival thickness. However, what is not completely known is how well this method represents the true value of soft tissue thickness. The aim of this study was to assess differences and variation in gingival thickness when measured with trans-gingival probing or scanned with an intraoral device. Method and materials: This ex vivo study evaluated gingival thickness on 20 porcine cadavers. Gingival thickness was assessed at both central and lateral mandibular incisors through transgingival probing with a standard metal periodontal probe and also using intraoral scanning, which was considered as the method providing the 'true value' of soft tissue thickness. Intra-examiner repeatability and method error were evaluated. Results: No evidence of systematic difference for any of the mandibular central or lateral incisors (mandibular right incisors: mean difference -0.17 to -0.01 mm, and mandibular left incisors: mean difference -0.11 to 0.04 mm) was observed between the periodontal probe and intraoral scanning methods. The absolute differences between the repeated measurements with intraoral scanning for each tooth type (n = 30) were calculated: the overall median was 0.089 mm and the interquartile range was 0.080 mm. Conclusions: Transgingival probing with a standard metal periodontal probe for assessing gingival thickness is a reliable method, with values very close to the true gingival thickness, and it can thus be considered as the clinical gold standard.
|
|
| 11. |
|
|
| 12. |
- Laugisch, Oliver, et al.
(author)
-
Histologic evidence of periodontal regeneration in furcation defects : a systematic review
- 2019
-
In: Clinical Oral Investigations. - : Springer. - 1432-6981 .- 1436-3771. ; 23:7, s. 2861-2906
-
Research review (peer-reviewed)abstract
- Objective: To systematically review the available histologic evidence on periodontal regeneration in class II and III furcations in animals and humans. Materials and methods: A protocol including all aspects of a systematic review methodology was developed including definition of the focused question, defined search strategy, study inclusion criteria, determination of outcome measures, screening methods, data extraction and analysis, and data synthesis. The focused question was defined as follows: What is the regenerative effect obtained by using or not several biomaterials as adjuncts to open flap surgery in the treatment of periodontal furcation defects as evaluated in animal and human histological studies? Search strategy: Using the MEDLINE database, the literature was searched for articles published up to and including September 2018: combinations of several search terms were applied to identify appropriate studies. Reference lists of review articles and of the included articles in the present review were screened. A hand search of the most important dental journals was also performed. Criteria for study selection and inclusion: Only articles published in English describing animal and human histological studies evaluating the effect of surgical treatment, with or without the adjunctive use of potentially regenerative materials (i.e., barrier membranes, grafting materials, growth factors/proteins, and combinations thereof) for the treatment of periodontal furcation defects were considered. Only studies reporting a minimum of 8weeks healing following reconstructive surgery were included. The primary outcome variable was formation of periodontal supporting tissues [e.g., periodontal ligament, root cementum, and alveolar bone, given as linear measurements (in mm) or as a percentage of the instrumented root length (%)] following surgical treatment with or without regenerative materials, as determined histologically/histomorphometrically. Healing type and defect resolution (i.e., complete regeneration, long junctional epithelium, connective tissue attachment, connective tissue adhesion, or osseous repair) were also recorded. Results: In animals, periodontal regeneration was reported in class II and III defects with open flap debridement alone or combined with various types of bone grafts/bone substitues, biological factors, guided tissue regeneration, and different combinations thereof. The use of biological factors and combination approaches provided the best outcomes for class II defects whereas in class III defects, the combination approaches seem to offer the highest regenerative outcomes. In human class II furcations, the best outcomes were obtained with DFDBA combined with rhPDGF-BB and with GTR. In class III furcations, evidence from two case reports indicated very limited to no periodontal regeneration. Conclusions: Within their limits, the present results suggest that (a) in animals, complete periodontal regeneration has been demonstrated in class II and class III furcation defects, and (b) in humans, the evidence for substantial periodontal regeneration is limited to class II furcations. Clinical relevance: At present, regenerative periodontal surgery represents a valuable treatment option only for human class II furcation defects but not for class III furcations.
|
|
| 13. |
- Lindhe, Jan, 1935, et al.
(author)
-
The Mucosa at Teeth and Implants
- 2021
-
In: Lindhe's Clinical Periodontology and Implant Dentistry, 2 Volume Set, 7th Edition. - Oxford, UK : Wiley-Blackwell. - 9781119438885 ; , s. 86-112
-
Book chapter (peer-reviewed)
|
|
| 14. |
- Miron, Richard J., et al.
(author)
-
Twenty years of enamel matrix derivative : the past, the present and the future
- 2016
-
In: Journal of Clinical Periodontology. - : Blackwell Munksgaard. - 0303-6979 .- 1600-051X. ; 43:8, s. 668-683
-
Research review (peer-reviewed)abstract
- Background On June 5th, 2015 at Europerio 8, a group of leading experts were gathered to discuss what has now been 20years of documented evidence supporting the clinical use of enamel matrix derivative (EMD). Original experiments led by Lars Hammarstrom demonstrated that enamel matrix proteins could serve as key regenerative proteins capable of promoting periodontal regeneration including new cementum, with functionally oriented inserting new periodontal ligament fibres, and new alveolar bone formation. This pioneering work and vision by Lars Hammarstrom has paved the way to an enormous amount of publications related to its biological basis and clinical use. Twenty years later, it is clear that all these studies have greatly contributed to our understanding of how biologics can act as mediators for periodontal regeneration and have provided additional clinical means to support tissue regeneration of the periodontium. Aims This review article aims to: (1) provide the biological background necessary to understand the rational for the use of EMD for periodontal regeneration, (2) present animal and human histological evidence of periodontal regeneration following EMD application, (3) provide clinically relevant indications for the use of EMD and (4) discuss future avenues of research including key early findings leading to the development of Osteogain, a new carrier system for EMD specifically developed with better protein adsorption to bone grafting materials
|
|
| 15. |
- Molnár, Bálint, et al.
(author)
-
Treatment of multiple adjacent Miller Class I and II gingival recessions with collagen matrix and the modified coronally advanced tunnel technique
- 2013
-
In: Quintessence International. - : Quintessence. - 0033-6572. ; 44:1, s. 17-24
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: To clinically evaluate the treatment of Miller Class I and II multiple adjacent gingival recessions using the modified coronally advanced tunnel technique combined with a newly developed bioresorbable collagen matrix of porcine origin. METHOD AND MATERIALS: Eight healthy patients exhibiting at least three multiple Miller Class I and II multiple adjacent gingival recessions (a total of 42 recessions) were consecutively treated by means of the modified coronally advanced tunnel technique and collagen matrix. The following clinical parameters were assessed at baseline and 12 months postoperatively: full mouth plaque score (FMPS), full mouth bleeding score (FMBS), probing depth (PD), recession depth (RD), recession width (RW), keratinized tissue thickness (KTT), and keratinized tissue width (KTW). The primary outcome variable was complete root coverage. RESULTS: Neither allergic reactions nor soft tissue irritations or matrix exfoliations occurred. Postoperative pain and discomfort were reported to be low, and patient acceptance was generally high. At 12 months, complete root coverage was obtained in 2 out of the 8 patients and 30 of the 42 recessions (71%). CONCLUSION: Within their limits, the present results indicate that treatment of Miller Class I and II multiple adjacent gingival recessions by means of the modified coronally advanced tunnel technique and collagen matrix may result in statistically and clinically significant complete root coverage. Further studies are warranted to evaluate the performance of collagen matrix compared with connective tissue grafts and other soft tissue grafts
|
|
| 16. |
- Monje, Alberto, et al.
(author)
-
Strategies for implant surface decontamination in peri-implantitis therapy
- 2022
-
In: International journal of oral implantology. - : QUINTESSENCE PUBLISHING CO INC. - 2631-6420 .- 2631-6439. ; 15:3, s. 213-249
-
Research review (peer-reviewed)abstract
- Peri-implantitis is an infectious disease that leads to progressive bone loss. Surgical therapy has been advocated as a way of halting its progression and re-establishing peri-implant health. One of the most challenging but crucial tasks in the management of peri-implantitis is biofilm removal to achieve reosseointegration and promote the reduction of peri-implant pockets. A wide var-iety of strategies have been used for implant surface decontamination. Mechanical means have been demonstrated to be effective in eliminating calculus deposits and residual debris; however, the presence of undercuts and the grooves and porosities along the roughened implant surface make it difficult to achieve an aseptic surface. In conjunction with mechanical measures, use of chemical adjuncts has been advocated to dilute bacterial concentrations, destroy the bacteria's organic components and eliminate endotoxins. Pharmacological adjuncts have also been recommended to diminish the bacterial load. Other strategies, such as use of lasers, implantoplasty and electrolysis, have been suggested for implant surface decontamination to promote predictable clinical and radiographic outcomes.
|
|
| 17. |
- Sculean, Anton, et al.
(author)
-
A paradigm shift in mechanical biofilm management? Subgingival air polishing: a new way to improve mechanical biofilm management in the dental practice.
- 2013
-
In: Quintessence international (Berlin, Germany : 1985). - 1936-7163. ; 44:7, s. 475-7
-
Journal article (other academic/artistic)abstract
- In the past few years indications for the use of the air polishing technology have been expanded from supragingival use (airflow) to subgingival air polishing (perioflow) by the development of new low-abrasive glycine-based powders and devices with a subgingival nozzle. Several studies on the subgingival use of air polishing have been completed. On 7 June 2012, during the Europerio 7 Congress in Vienna, a consensus conference on mechanical biofilm management took place aiming to review the current evidence from the literature on the clinical relevance of the subgingival use of air polishing and to make practical recommendations for the clinician. Bernita Bush (Bern), Prof Johannes Einwag (Stuttgart), Prof Thomas Flemmig (Seattle), Carmen Lanoway (Munich), Prof Ursula Platzer (Hamburg), Prof Petra Schmage (Hamburg), Brigitte Schoeneich (Zurich), Prof Anton Sculean (Bern), Dr Clemens Walter (Basel), and Prof Jan Wennström (Gothenburg) discussed under the moderation of Klaus-Dieter Bastendorf and Christian Becker (both ADIC Association for Dental Infection Control) the available clinical studies to reach a consensus on available clinical evidence. This paper summarizes the main conclusions of the consensus conference and points to the clinical relevance of the findings for the dental practitioner.
|
|
| 18. |
- Sculean, Anton, et al.
(author)
-
Biomaterials for promoting periodontal regeneration in human intrabony defects : a systematic review
- 2015
-
In: Periodontology 2000. - : John Wiley & Sons. - 0906-6713 .- 1600-0757. ; 68:1, s. 182-216
-
Research review (peer-reviewed)abstract
- Intrabony periodontal defects are a frequent complication of periodontitis and, if left untreated, may negatively affect long-term tooth prognosis. The optimal outcome of treatment in intrabony defects is considered to be the absence of bleeding on probing, the presence of shallow pockets associated with periodontal regeneration (i.e. formation of new root cementum with functionally orientated inserting periodontal ligament fibers connected to new alveolar bone) and no soft-tissue recession. A plethora of different surgical techniques, often including implantation of various types of bone graft and/or bone substitutes, root surface demineralization, guided tissue regeneration, growth and differentiation factors, enamel matrix proteins or various combinations thereof, have been employed to achieve periodontal regeneration. Despite positive observations in animal models and successful outcomes reported for many of the available regenerative techniques and materials in patients, including histologic reports, robust information on the degree to which reported clinical improvements reflect true periodontal regeneration does not exist. Thus, the aim of this review was to summarize, in a systematic manner, the available histologic evidence on the effect of reconstructive periodontal surgery using various types of biomaterials to enhance periodontal wound healing/regeneration in human intrabony defects. In addition, the inherent problems associated with performing human histologic studies and in interpreting the results, as well as certain ethical considerations, are discussed. The results of the present systematic review indicate that periodontal regeneration in human intrabony defects can be achieved to a variable extent using a range of methods and materials. Periodontal regeneration has been observed following the use of a variety of bone grafts and substitutes, guided tissue regeneration, biological factors and combinations thereof. Combination approaches appear to provide the best outcomes, whilst implantation of alloplastic material alone demonstrated limited, to no, periodontal regeneration.
|
|
| 19. |
- Sculean, Anton, et al.
(author)
-
Self-regenerative capacity of intra-oral bone defects
- 2019
-
In: Journal of Clinical Periodontology. - : John Wiley & Sons. - 0303-6979 .- 1600-051X. ; 46:S21, s. 70-81
-
Journal article (peer-reviewed)abstract
- Objective To provide an overview on the self-regenerative capacity of various types of intra-oral bone defects. Materials and Methods This paper has narratively reviewed the most important aspects of bone biology and the healing outcomes related to the self-regenerative capacity (i.e. without the placement of any biomaterial) of bone defects that occur following tooth extraction, autogenous graft harvesting, periapical lesions, cystic lesions of the jaws, third molar extraction and experimentally created ridge defects. Results In animals (i.e. dogs and monkeys), the greatest changes in horizontal and vertical dimension occur during the first 6 months following tooth extraction. In humans, bone remodelling may take from several months to years and exhibits marked inter-individual variability. Following tooth extraction at compromised sites (e.g. presence of severe bone loss at the time-point of extraction), the healing may occur slower and a substantial volume reduction can be expected than following tooth extraction at non-compromised sites. In the mandibular symphysis and ramus, the bone defects resulting following bone block harvesting are gradually healing to a large extent, but complete healing appears not to occur due to poorer space provision and wound stability capacities. Defects after peri-apical surgery display a substantial self-regenerative capacity and heal at a great extent without the use of any adjunct measures. The vast majority of jawbone defects after cystectomy heal at a great extent and without apparent influence in the shape of the jaw, without the need of adjunct measures. After surgical removal of mandibular third molars, bone fill can be observed over a period of at least 12 months, with the most substantial change (e.g. the greatest bone fill) occurring during the first 3 months after surgery. However, complete fill of these residual bone defects does not always occur. Conclusions Intra-oral bone defects possess a high self-regenerative capacity. Factors such as extent of bone loss, presence of bony walls, closed healing environment, space provision and mechanical wound stability substantially influence healing/regeneration.
|
|
| 20. |
- Stavropoulos, Andreas, et al.
(author)
-
Current Status of Regenerative Periodontal Treatment
- 2017
-
In: Current Issues in Auditing. - : Springer. - 2070-7401 .- 2196-3002. ; 4:1, s. 34-43
-
Research review (peer-reviewed)abstract
- Purpose of Review Periodontal regenerative therapy aims to completely restore the tooth’s supporting tissues (e.g., periodontal ligament, root cementum, alveolar bone, and gingiva) which have been lost following periodontal disease or trauma. The histologic outcomes should translate in substantial clinical improvements evidenced by probing depth reduction, gain in clinical attachment level, and bone fill. The present review provides a brief overview of the current status of periodontal regenerative therapy. Recent Findings There is plenty of evidence to support the use of guided tissue regeneration (GTR) techniques and the application of enamel matrix proteins (EMD) onto the exposed root result in true periodontal regenerative. The use of various growth factors and autologous blood concentrates for periodontal regeneration also have produced positive results, but more studies are needed. In general, both GTR and EMD, alone or in combination with bone grafts or substitutes, result in larger clinical improvements compared to conventional periodontal treatment for deep intrabony and furcation Class II defects. Important factors that negatively impact on the clinical outcomes of periodontal regeneration procedures are smoking, large number of remaining sites with bleeding on probing, bad oral hygiene, and increased tooth mobility. Conclusions The magnitude of improvement arising from periodontal regenerative techniques and procedures depends largely on operator skills, not only in terms of dexterity but also on the ability to choose the best approach regarding the surgical technique and the regenerative technology depending on patient- and site-specific criteria. The clinical improvements after regenerative treatment can be preserved on a long-term basis on the majority of treated sites, provided that patients do not smoke, keep high oral hygiene standards, and attend regularly SPT.
|
|
| 21. |
- Stavropoulos, Andreas, et al.
(author)
-
Greater osseointegration potential with nanostructured surfaces on TiZsr : Accelerated vs. real‐time ageing
- 2021
-
In: Materials. - : MDPI AG. - 1996-1944. ; 14:7
-
Journal article (peer-reviewed)abstract
- Surface chemistry and nanotopography of dental implants can have a substantial impact on osseointegration. The aim of this investigation was to evaluate the effects of surface chemistry and nanotopography on the osseointegration of titanium‐zirconium (TiZr; Roxolid®) discs, using a biomechanical pull‐out model in rabbits. Two discs each were placed in both the right and left tibiae of 16 rabbits. Five groups of sandblasted acid etched (SLA) discs were tested: (1) hydrophobic without nanostructures (dry/micro) (n = 13); (2) hydrophobic with nanostructures, accelerated aged (dry/nano/AA) (n = 12); (3) hydrophilic without nanostructures (wet/micro) (n = 13); (4) hydrophilic with nanostructures, accelerated aged (wet/nano/AA; SLActive®) (n = 13); (5) hydrophilic with nanostructures, real‐time aged (wet/nano/RTA). The animals were sacrificed after four weeks and the biomechanical pull‐out force required to remove the discs was evaluated. Adjusted mean pullout force was greatest for group wet/nano/RTA (64.5 ± 17.7 N) and lowest for group dry/micro (33.8 ± 10.7 N). Multivariate mixed model analysis showed that the pull‐out force was significantly greater for all other disc types compared to the dry/micro group. Surface chemistry and topography both had a significant effect on pull‐out force (p < 0.0001 for both), but the effect of the interaction between chemistry and topography was not significant (p = 0.1056). The introduction of nanostructures on the TiZr surface significantly increases osseointegration. The introduction of hydrophilicity to the TiZr implant surface significantly increases the capacity for osseointegration, irrespective of the presence or absence of nanotopography.
|
|
| 22. |
- Stavropoulos, Andreas, et al.
(author)
-
Medium and Long-Term Clinical Benefits of Periodontal Regenerative/Reconstructive Procedures in Intrabony Defects : Systematic Review and Network Meta-Analysis of Randomized Controlled Clinical Studies.
- 2021
-
In: Journal of Clinical Periodontology. - : John Wiley & Sons. - 0303-6979 .- 1600-051X. ; 48:3, s. 410-430
-
Research review (peer-reviewed)abstract
- BackgroundSystematic reviews have established the short‐term improvements of periodontal regenerative/reconstructive procedures compared to conventional surgical treatment in intrabony defects. However, a hierarchy of periodontal regenerative/reconstructive procedures regarding the medium‐ to long‐term results of treatment does not exist.AimTo systematically assess the literature to answer the focused question “In periodontitis patients with intrabony defects, what are the medium‐ and long‐term benefits of periodontal regenerative/reconstructive procedures compared with open flap debridement (OFD), in terms of clinical and/or radiographic outcome parameters and tooth retention?”Material & MethodsRandomized controlled clinical trials (RCTs), reporting on clinical and/or radiographic outcome parameters of periodontal regenerative/reconstructive procedures ≥ 3 years post‐operatively were systematically assessed. Clinical [residual probing pocket depth (PD) and clinical attachment level (CAL) gain, tooth loss] and radiographic [residual defect depth (RDD), bone gain (RBL)] outcome parameters, were assessed. Descriptive statistics were calculated and Bayesian random‐effects network meta‐analyses (NMA) were performed where possible.ResultsThirty RCTs, presenting data 3 to 20 years after treatment with grafting, GTR, EMD, as monotherapies, combinations thereof, and/or adjunctive use of blood derived growth factor constructs, or with OFD only, were included. NMA based on 21 RCTs showed that OFD was clearly the least efficacious treatment; regenerative/reconstructive treatments resulted in significantly shallower residual PD in 4 out 8 comparisons [range of mean differences (MD): ‐2.37 to ‐0.60 mm] and larger CAL gain in 6 out 8 comparisons (range of MD: 1.26 to 2.66 mm), and combination approaches appeared as the most efficacious. Tooth loss after regenerative/reconstructive treatment was less frequent (0.4%) compared to OFD (2.8%), but the evidence was sparse. There was only sparse radiographic data not allowing any relevant comparisons.ConclusionPeriodontal regenerative/reconstructive therapy in intrabony defects results, in general, in shallower residual PD and larger CAL gain compared with OFD, translating in high rates of tooth survival, on a medium (3‐5 years) to long‐term basis (5‐20 years). Combination approaches appear, in general, more efficacious compared to monotherapy in terms of shallower residual PD and larger CAL gain. A clear hierarchy could, however, not be established due to limited evidence.
|
|
| 23. |
- Stavropoulos, Andreas, et al.
(author)
-
Meta-analysis on Medium to Long-term Outcomes of Periodontal Regenerative Procedures
- 2018
-
Conference paper (other academic/artistic)abstract
- Objectives: To systematically assess the literature and perform a meta-analysis wherever possible to answer the focused question “In patients with deep intrabony periodontal defects, what is the medium to long-term outcome (≥3y) of periodontal regenerative procedures comparing to open flap debridement in terms of clinical and/or radiographical outcome parameters?” Methods: Clinical trials (retro- & prospective case series with ≥5 patients, controlled-, and randomized controlled trials) reporting on clinical and/or radiographical parameters of periodontal regenerative procedures ≥3y post-operatively were systematically assessed for inclusion. Long-term clinical- (residual PPD; CAL gain; PPD reduction; REC increase) and radiographic- (bone gain; residual intrabony defect) parameters, and their changes between 1 year and long-term outcome, were extracted and/or calculated. Results: Seven retrospective studies, 14 case series, 3 CTs, and 27 RCTs were grouped into 2 observation periods, i.e. 3–5y and >5y after regenerative therapy, presenting data from 1394 and 618 sites, respectively. Analyses on Grafting, GTR, EMD, GTR+Grafting, EMD+Grafting, and EMD+GTR, and on OFD (from the control groups) showed that >5y after periodontal regenerative therapy in intrabony defects and irrespective the type of regenerative approach, CAL gain and PD reduction was about 1.5–2 times larger comparing to what was achieved with OFD (2.4-3.9mm vs. 1.5mm; 3.5-4.6mm vs. 2.7mm, respectively); residual PD after most of regenerative modalities was <5mm and about 1mm shallower than what was observed with OFD. Residual RDD after regenerative treatment was about ca. 2mm (i.e. 30–50%) shallower comparing to conventional surgery (1.4-2.9mm vs. 5.9mm, respectively). The clinical and radiographic improvements 1 year post-op, could be preserved on a long-term basis, with any changes being within 1mm. Conclusions: The additional clinical benefits of periodontal regenerative therapy over conventional periodontal surgery in intrabony defects remain largely stable on the long term. Grafting alone appears somehow less efficacious than GTR, EMD, GTR+grafting, or EMD+grafting on the long-term. Disclosure Statement: The submitter must disclose the names of the organizations with which any author have a relationship, the nature of the relationship, and the clinical or research area involved. The following is submitted: none
|
|
| 24. |
- Stavropoulos, Andreas, et al.
(author)
-
Pre-clinical in vivo models for the screening of bone biomaterials for oral/craniofacial indications : focus on small-animal models
- 2015
-
In: Periodontology 2000. - : John Wiley & Sons. - 0906-6713 .- 1600-0757. ; 68:1, s. 55-65
-
Journal article (peer-reviewed)abstract
- Preclinical in vivo experimental studies are performed for evaluating proof-of-principle concepts, safety and possible unwanted reactions of candidate bone biomaterials before proceeding to clinical testing. Specifically, models involving small animals have been developed for screening bone biomaterials for their potential to enhance bone formation. No single model can completely recreate the anatomic, physiologic, biomechanic and functional environment of the human mouth and jaws. Relevant aspects regarding physiology, anatomy, dimensions and handling are discussed in this paper to elucidate the advantages and disadvantages of small-animal models. Model selection should be based not on the 'expertise' or capacities of the team, but rather on a scientifically solid rationale, and the animal model selected should reflect the question for which an answer is sought. The rationale for using heterotopic or orthotopic testing sites, and intraosseous, periosseous or extraskeletal defect models, is discussed. The paper also discusses the relevance of critical size defect modeling, with focus on calvarial defects in rodents. In addition, the rabbit sinus model and the capsule model in the rat mandible are presented and discussed in detail. All animal experiments should be designed with care and include sample-size and study-power calculations, thus allowing generation of meaningful data. Moreover, animal experiments are subject to ethical approval by the relevant authority. All procedures and the postoperative handling and care, including postoperative analgesics, should follow best practice.
|
|
| 25. |
- Stavropoulos, Andreas, et al.
(author)
-
Regenerative Periodontal Therapy in Intrabony Defects and Long-Term Tooth Prognosis
- 2022
-
In: Dental Clinics of North America. - : Elsevier. - 0011-8532. ; 66:1, s. 103-109
-
Journal article (peer-reviewed)abstract
- Periodontal regenerative procedures, in particular combination approaches including grafting, result in significantly better clinical outcomes in intrabony defects, compared with OFD, on a medium to long term. This, in turn, translates into higher tooth retention in the long term, and therefore, periodontal regenerative/reconstructive therapy is strongly recommended for the treatment of intrabony defects.
|
|
| 26. |
- Stavropoulos, Andreas, et al.
(author)
-
Thorkild Karring 1937–2016
- 2017
-
In: Journal of Clinical Periodontology. - : John Wiley & Sons. - 0303-6979 .- 1600-051X. ; 44:2, s. 235-236
-
Journal article (other academic/artistic)
|
|
| 27. |
- Stähli, Alexandra, et al.
(author)
-
The effect of connective tissue graft or a collagen matrix on epithelial differentiation around teeth and implants : a preclinical study in minipigs
- 2023
-
In: Clinical Oral Investigations. - : Springer. - 1432-6981 .- 1436-3771. ; 27:8, s. 4553-4566
-
Journal article (peer-reviewed)abstract
- OBJECTIVES: This study aimed to histologically evaluate the healing at 8 weeks after coronally advanced flap (CAF) with either a superficial (SCTG) or deep palatal connective tissue graft (DCTG), or a collagen matrix (CM) to cover recession defects at teeth and implants.MATERIAL AND METHODS: One mandibular side of 6 miniature pigs received each 3 titanium implants 12 weeks after extraction. Eight weeks later, recession defects were created around implants and contralateral premolars and 4 weeks later randomly subjected to CAF + SCTG, CAF + DCTG, or CAF + CM. After 8 weeks, block biopsies were histologically analyzed.RESULTS: For the primary outcome, i.e., keratinization of the epithelium, all teeth and implants exhibited a keratinized epithelium with no histological differences among them also not in terms of statistically significant differences in length (SCTG 0.86 ± 0.92 mm, DCTG 1.13 ± 0.62 mm, and Cm, 1.44 ± 0.76 mm). Pocket formation was histologically seen at all teeth, around most implants with SCTG and DCTG, however not in the CM implant group. The connective tissue grafts showed hardly signs of degradation, whereas the CM was partly degraded and integrated in connective tissue. The mean gain in gingival height was similar in all experimental groups (SCTG 3.89 ± 0.80 mm, DCTG 4.01 ± 1.40 mm, CM 4.21 ± 0.64 mm). Statistically significant differences were found in the height of the junctional epithelium between the control teeth and the connective tissue groups (p = 0.009 and 0.044).CONCLUSIONS: In this animal model, the use of either a superficial or deep connective tissue graft or a collagen membrane did not seem to have any impact on the epithelial keratinization around both teeth and implants. All procedures (CAF + SCTG/DCTG/CM) resulted in a long JE that was even longer at implants.CLINICAL RELEVANCE: Deep/superficial palatal connective tissue graft yielded similar keratinization around teeth/implants. Given the absence of pocket formation and inflammatory processes at implants when using a CM, CAF + CM might bear potential clinical benefits.
|
|
