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Venerdì 20 gennaio 2012 –
Sabato 21 gennaio
2012 Trento Corso Parodontologia clinica ed implantologia (3°
incontro)
Venerdì 27 gennaio 2012 –
Sabato 28 gennaio
2012 Milano XX SIO International Congress
Giovedì 9 febbraio 2012 –
Sabato 11 febbraio
2012 Trento Corso Parodontologia clinica ed implantologia (4°
incontro)
Mercoledì 15 febbraio 2012
– Sabato 18 febbraio
2012 Pfäffikon, Switzerland EAO consensus meeting
Venerdì 9 marzo 2012 –
Sabato 10 marzo 2012
Trento Corso Parodontologia clinica ed implantologia (5° incontro)
Giovedì 15 marzo 2012 –
Sabato 17 marzo 2012
Bologna XVII Congresso Nazionale SIdP
Sabato 31 marzo 2012
Genova Evento ANDI
Mercoledì 9 maggio 2012 –
Sabato 12 maggio 2012
Gothenburg, Sweden Astratech World Congress
Mercoledì 6 giugno 2012 –
Sabato 9 giugno 2012
Vienna, Austria Europerio 7
Cristiano Tomasi DDS MSc Odont Dr. (PhD)
Department of Periodontology Institute of Odontology
The Sahlgrenska Academy at University of Gothenburg
Box 450 SE 405 30
Göteborg, Sweden
cristiano.tomasi@odontologi.gu.se
Studio Associato Tomasi Bottamedi Varotto
Via degli Orti 15/4
I-38122 Trento
Tel +39.0461.239968
Fax +39.0461.268504
cris@cristianotomasi.it
Dott. Tomasi Cristiano, Laureato con Lode in odontoiatria e p.d. nel 1991 presso l’Università di Verona.
Specializzato in Parodontologia clinica nel 2002 presso l’Università di Göteborg, Svezia.
Ha conseguito il titolo di Master of Science nel 2003 presso la stessa Università.
Nel 2005 ha vinto il primo premio europeo EFP per la ricerca parodontale riservato a specialisti presso scuole riconosciute dalla EFP (European Federation of Periodontology).
Nel 2007 ha vinto il primo premio per la ricerca della ScSP (Scandinavian Society of Periodontology) a Stoccolma.
Ha conseguito il dottorato di ricerca (PhD) nel 2007 presso l’Università di Göteborg dove attualmente è Fellow Researcher presso il dipartimento di Parodontologia.
Ha pubblicato numerosi articoli ad argomento parodontale ed implantare su riviste internazionali peer reviewed.
Professore a contratto in Parodontologia presso l’Università di Padova.
Relatore presso il corso post graduate in Parodontologia clinica dell’Università di Göteborg. Socio attivo della SIO e della SIdP.
Dal 1992 lavora nel proprio studio odontoiatrico in Trento, dove si occupa esclusivamente di parodontologia, piccola chirurgia orale e terapia implantare.
Consulente come parodontologo e per l’implantologia in altri studi
privati.
Dott. Cristiano Tomasi:
In 2003 achieved the Master of Science in dentistry and in 2007 the Doctor Odont.
Degree (PhD) at Sahlgrenska Academy at University of Gothenburg, Sweden with a thesis entitled “On approaches to periodontal infection control”.
Winner of European Federation of Periodontology prize for periodontal research in 2005 and of Scandinavian Society of Periodontology prize for young researchers in 2007.
Fellow researcher at the Department of Periodontology at the Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg.
Guest Professor at University of Padova, Italy.
Working in his private practice in Trento, Italy from 1992.
Objective: The aim of this cross-sectional study was to determine the clinical outcome and patient satisfaction in subjects treated with mandibular overdentures supported by two implants.
Material and methods: One hundred and fifty-nine patients, who received restorative therapy in the edentulous mandible consisting of a bar-retained overdenture supported by two osseointegrated implants in a private clinic in Italy, were recalled for a clinical and radiographic examination. One hundred and forty-one subjects with 280 implants attended the examination. The average follow-up time was 3.9 years. The radiographic examination included assessments of the distance between the implant margin and the most coronal position of bone-to-implant contact at the mesial and distal aspects of each implant. A questionnaire regarding comfort, satisfaction with the treatment, aesthetics, speaking capacity and efficiency in chewing was obtained from each subject. Biological and technical complications were recorded and the number of visits due to complications between the delivery of the prostheses and the re-examination was determined.
Results: The results from the examination revealed that the number of lost implants was small and the average marginal bone level around the implants was 0.67 mm apical of the implant margin. The most frequently observed complication was hyperplasia of the mucosal tissue under the bar construction. Few patients experienced loosening of retention. The vast majority of patients reported to be satisfied in relation to the restorative therapy from both functional and aesthetic points of view.
Conclusion: Patients with edentulous mandibles implants supporting a bar-retained overdenture may be successfully rehabilitated by means of two implants supporting a bar-retained overdenture.
Background: There is limited information regarding mar- ginal bone-level changes around immediately loaded im- plants placed with the osteotome technique. The aim of this case series is to prospectively evaluate the clinical and radio- graphic outcome of immediately loaded implants placed with the osteotome technique over a 12-month period.
Methods: Eighteen patients in need of oral prosthetic reha- bilitation that included single implant placement in positions #4 to #13 and/or #20 to #29 participated in this prospective trial. A modified implant installation procedure with an under preparation of the implant bed using the osteotome technique and immediate loading of the implant was performed. Clinical examinations were performed at 2 weeks, 6 months, and 12 months of follow-up. Radiographic examinations were per- formed at implant installation and at the 6- and 12-month follow-up visits.
Resultsts: One implant failed to integrate and was removed at 3 months after implant installation. Four of 20 implants had insertion torque value >35 Ncm. The mean marginal bone loss was -0.09 mm at the 6-month and -0.19 mm at the 12- month follow-up visits.
Conclusion: The present case series indicates that implants placed with the osteotome technique and immediately loaded did not demonstrate a high insertion torque and exhibited minimal marginal bone loss. J Periodontol 2011;82:1556- 1562.
Objective: The aim of this study was to assess the influence of inclination of the object on the reliability and reproducibility of linear measurements of anatomic structures of the mandible on images obtained using cone-beam CT (CBCT).
Methods: Ten linear dimensions between anatomical landmarks were measured in a dry mandible. The measurements were performed with a manual calliper three times by three observers. The mandible was scanned with Planmeca Promax 3D cone-beam CT (Planmeca Oy, Helsinki, Finland) with the base of the mandible parallel as well as tilted 45u to the horizontal plane. Computer measurements of the linear dimension were performed by three observers. The radiographic measurements were performed four times for each experimental setting. A total of 240 measurements were performed. Reproducibility was evaluated through comparison of standard deviation (SD) and estimation of intraclass correlation coefficient (ICC). The error was estimated as the absolute difference between the radiographic measurements and the mean manual calliper measurements.
Resultslts: The mean SD for the radiographic measurements was 0.36 mm for the horizontally positioned mandible and 0.48 mm for the inclined mandible. The ICC between examiners was 0.996mm, between sessions was 0.990mm and between CBCT measurements and calliper was 0.992mm. The overall absolute mean measurement error was 0.40mm (SD 0.39mm). The percentage of errors that exceeded 1 mm was 6.7%.
Conclusionion: The results revealed high reliability of measurements performed on CBCT images independently from object position, examiner’s experience and high reproducibility in repeated measurements settings.
Background: Periodontitis remains a major public health issue and current management approaches have failed to impact upon the most high-risk proportion of the population and those with the most severe disease. The objective of this session was to assess if and how, current understanding of periodontitis provides the opportunity to develop new preventive and therapeutic strategies. Materials and Methods: Based on the current understanding of the pathophysiology of periodontal diseases, the Workshop discussed the potential of antimicrobial peptides, probiotics, pro-resolving lipid mediators, and micronutritional approaches. Evidence-based position papers and expert discussions formed the basis of deliberations. Results and Discussion: Current preventive and treatment approaches are only partially effective, and this appears due to the therapeutic focus remaining primarily upon biofilm management rather than embracing a pivotal role for inflammation as a driver of biofilm composition as well as tissue damage. There is a need to develop new, more effective, and efficient preventive and treatment approaches for gingivitis and periodontitis, which embrace recent advances in understanding of host modulation and inflammation resolution, as well as direct management of the microbiota.
Background: The goal was to evaluate the clinical outcome of non-surgical retreatment at molar furcation sites by ultrasonic de- bridement with or without adjunctive application of locally deliv- ered doxycycline, and to explore factors affecting the healing results.
Methods: This study involves 32 patients with chronic peri- odontitis, who received initial pocket/root debridement by ultrasonic instrumentation, followed by random assignment to retreatment of remaining pathologic sites at 3 months by ultrasonic instrumen- tation with or without adjunctive local application of an 8.8% doxy- cycline gel. Clinical examinations of plaque, probing depth (PD), relative attachment level, furcation involvement, and bleeding after furcation probing were performed initially, before retreatment at 3 months (baseline), and 3 and 9 months after retreatment. The primary efficacy variable was reduction in the degree of furcation involvement. A multilevel logistic model was used to evaluate the impact of patient and tooth site related factors on the main outcome variable.
Results: The retreatment including locally delivered doxycy- cline resulted in closure of 50% of degree I furcation sites, com- pared to 29% for sites treated with mechanical debridement only (P >0.05). Of the degree II furcation sites, 17% in the test and 11% in the control group were reduced in depth (P >0.05). The logistic multilevel model with ‘‘furcation improvement’’ as the dichotomous outcome variable revealed that local applica- tion of doxycycline had no statistically significant effect. The odds ratio for ‘‘furcation improvement’’ was 0.80 (95% confi- dence interval [CI], 0.65 to 0.99) for 1-mm increase of initial ver- tical PD, 0.36 (95% CI, 0.17 to 0.80) for initial furcation involvement degree II compared to degree I, and 0.24 (95% CI, 0.08 to 0.72) for smokers compared to non-smokers.
Conclusionion: Improvement in molar furcation involvement after non-surgical periodontal therapy was not enhanced by adjunctive locally applied doxycycline and negatively affected by increased vertical PD and tobacco smoking.
Objective: The purpose of the present study was to describe the severity and pattern of peri-implantitis-associated bone loss. Material and Methods: Intra-oral radiographs from 182 subjects were analysed. Bone-level measurements were performed in 419 implants with a history of bone loss. All radiographs obtained in the interval from the 1-year follow-up to the end-point examination (5–23 years) were analysed. The amount of bone loss that occurred from 1 year after prosthesis insertion was assessed and the pattern of bone loss was evaluated. Results: The average bone loss after the first year of function was 1.68 mm and 32% of the implants demonstrated bone loss X2 mm. The multilevel model revealed that the bone loss showed a non-linear pattern and that the rate of bone loss increased over time. The model also revealed that the pattern of peri-implantitis associated bone loss was similar within the same subject.
Conclusion: It is suggested that peri-implantitis-associated bone loss varies between subjects and is, in most cases, characterized by a non-linear progression, with the rate of loss increasing over time.
Aim: The aim of the study was to evaluate the flexibility of five different splint systems [polyethylene fibre-reinforced splint (RibbondÒ THM, Ribbond Inc., Seattle, WA, USA), resin splint (RS), wire-composite splint (WCS), button-bracket splint (BS) and titanium trauma splint (TTS)] commonly used in clinical practice for the treatment of dental traumatic injuries involving the periodontal supporting tissues.
Materials and methods: For the experimental study, a resin cast of the upper arch was manufactured, where teeth 11, 12 and 21 (used for the stress analysis) were inserted in a non-rigid fashion so as to allow for replacement, whereas the other teeth were permanently fixed to the corresponding sockets. Two different test sessions were performed for each splint: (i) stress analysis with increasing intensity ranging between 0 and 50 N directed along the tooth’s longitudinal axis; (ii) stress analysis with 45° of oblique force of increasing intensity ranging between 0 and 30 N. For each loading direction, five recordings were conducted without a splint, followed by five with the splint applied. The energy required to modify the position of the teeth was calculated for both the splinted and un-splinted teeth and the difference between the two values was determined. Energy variation was assessed for the testing of both axial (DEa) and oblique force (DEo). DE represents the rigidity index of the analysed contention devices: high DE values correspond to high rigidity materials.
Results: The RS showed the highest DE value for the axial stress analysis, whereas the highest DE value at a 45° was recorded for the WCS and RS. For both tests, the lowest DE values were recorded for the TTS and Ribbond THM splints.
Conclusions: The data show that the contention devices with the highest flexibility are the TTS and the Ribbond THM as they exhibit a lower energy variation needed for splint deformation compared with the other materials that were examined.
Aim: To use multilevel, multivariate models to analyze factors that may affect bone alterations during healing after an implant immediately placed into an extraction socket.
Material and methods: Data included in the current analysis were obtained from a clinical trial in which a series of measurements were performed to characterize the extraction site immediately after implant installation and at re-entry 4 months later. A regression multilevel, multivariate model was built to analyze factors affecting the following variables: (i) the distance between the implant surface and the outer bony crest (S-OC), (ii) the horizontal residual gap (S-IC), (iii) the vertical residual gap (R-D) and (iv) the vertical position of the bone crest opposite the implant (R-C).
Results: It was demonstrated that (i) the S-OC change was significantly affected by the thickness of the bone crest; (ii) the size of the residual gap was dependent of the size of the initial gap and the thickness of the bone crest; and (iii) the reduction of the buccal vertical gap was dependent on the age of the subject. Moreover, the position of the implant opposite the alveolar crest of the buccal ridge and its bucco-lingual implant position influenced the amount of buccal crest resorption.
Conclusions: Clinicians must consider the thickness of the buccal bony wall in the extraction site and the vertical as well as the horizontal positioning of the implant in the socket, because these factors will influence hard tissue changes during healing
Astract: Periodontal disease is clinically identified and diag- nosed based on the following signs: the presence of bleeding following periodontal pocket probing; re- duced tissue resistance to pocket probing; and attachment loss. These signs develop as a result of the tissue response to the presence of a bacterial biofilm, resulting in an inflammatory lesion, rich in leukocytes and poor in collagen, in the gingival connective tissue adjacent to the tooth surface (58, 61). Hence, the main goal in the treatment of patients with periodontitis is to establish proper infection control (i.e. to reduce the bacterial load below the individual threshold level for disease). Root ⁄ pocket instrumentation (scaling and root planing), together with effective self-performed supragingival plaque-control measures, serves this purpose by altering the subgingival ecological environment through disruption of the microbial biofilm, reducing the number of bacteria and suppressing inflammation
Background: Reconstructive procedures present a higher rate of biological costs due to the necessity of bone harvest and grafts, use of semipermeable barriers etc. On the hand, implant supported cantilever prostheses could allow a simpler rehabilitation procedure.
Aims: The aim of the present study was to assess the clinical outcome of patients treated with implant-supported fixed partial dentures (FPD) with cantilever after a mean follow-up time of 8 years.
Material and methods: The study included 45 consecutive partially edentulous patients treated between January 1994 and August 2006 with 59 partial cantilever fixed prostheses supported by 116 ITI implants. The primary outcome variable considered was the presence of complications at the subject and bridge level; the secondary outcome variable was marginal bone loss (MBL). The frequency of complications was analyzed according to cantilever location and opposite dentition and tested by Fisher’s exact test. A multilevel regression model was constructed to analyze the factors influencing MBL with three levels: subject as the highest, and then implant and site. During the follow-up period, 11 implants showed a bone loss exceeding the limit for success, out of which two implants showed an infection of the peri-implant tissue.
Results: After an average observation of 8.2 years of cantilever prostheses loading, the implant success and survival rates were 90.5% and 100%, respectively. Besides, the prosthetic success and survival rate were 57.7% and 100%, respectively. Discussion: None of the predictors included in the multilevel model presented a significant impact on the bone loss between baseline and the follow-up examination.
Conclusions: The authors concluded that the prognosis of implant-supported FPDs and marginal bone loss at implants were not influenced by the position or the length of the cantilever, the location of the bridge and type of opposite dentition. Implant-supported fixed cantilever prosthesis can be considered a suitable treatment choice.
Objective: The purpose of the present study was to describe the extent of peri-implantitis-associated bone loss with regard to implant position.
Material and Methods: Patient files and intra-oral radiographs from 182 subjects were analysed. Among the 1070 examined implants, 419 exhibited peri-implantitis-associated bone loss. The position of each implant within the jaw and fixed reconstructions was determined. In the radiographs the distance between the abutment-fixture junction and the most coronal position of bone to implant contact was assessed at the 419 "affected" implants using a magnifying lens (x 7) with a 0.1 mm graded scale.
Results: About 40% of the implants in each subject was affected by peri-implantitis-associated bone loss. The proportion of such implants varied between 30% and 52% in different jaw positions and the most common position was the lower front region. In addition, affected implants were found in larger proportions among "mid" than "end" abutments irrespective of supporting fixed complete or fixed partial dentures.
Conclusions: It is suggested that peri-implantitis occurs in all jaw positions and that an "end"-abutment position in a fixed reconstruction is not associated with an enhanced risk for peri-implantitis.
Introduction: The remit of this working group was to update the existing knowledge base in non-surgical periodontal therapy. The published systematic reviews from the fourth EAP Workshop formed the starting point for this update and in addition specific innovations not covered in previous workshops were included.
Material and Methods: The literature was systematically searched and critically reviewed. Five manuscripts were produced in five specific topics identified as areas where innovative approaches have been developed in non-surgical periodontal therapy and which were deemed to be strategically important for patient care and clinical practice.
Results: The results and conclusions of the review process are presented in the following papers, together with the group consensus statements, clinical implications and directions for future research: A systematic review of the effects of full mouth debridement with and without antiseptics in patients with chronic periodontitis. Advances in Power Driven Instrumentation. Laser application in non-surgical periodontal therapy - a systematic review. Antimicrobial therapy in periodontitis: the use of systemic antimicrobials against the subgingival biofilm. The cost-effectiveness of supportive periodontal-care for patients with chronic periodontitis.
The objective of this systematic review was to describe the incidence of tooth and implant loss reported in long-term studies. Prospective longitudinal studies reporting on teeth or implants survival with a follow-up period of at least 10 years were considered. Papers were excluded if the drop out rate exceeded 30% or if <70% of the initial subject sample was examined at 10 years of follow-up. Seventy publications on teeth were identified as potentially relevant for the focussed question. The analysis of the abstracts yielded 37 studies eligible for full-text analysis. The inclusion criteria were met in 11 of the publications that included in all 3015 subjects. The initial search on implant studies generated 52 publications that possibly could be included. Following the evaluation of the abstracts and full-text analysis nine publications were found to fulfil the inclusion criteria. The nine studies included 476 subjects. The incidence of tooth loss among subjects with a follow-up period of 10-30 years varied from 1.3% to 5% in the majority of studies, while in two epidemiological studies on rural Chinese populations the incidences of tooth loss were 14% and 20%. The percentage of implants reported as lost during the follow-up period varied between 1% and 18%. In clinically well-maintained patients, the loss rate at teeth was lower than that at implant. Bone level changes appeared to be small at teeth as well as at implants in well-maintained patients. Comparisons of the longevity at teeth and dental implants are difficult due to heterogeneity among the studies.
Background: The aim of this study was to evaluate if adjunctive, locally delivered controlled-release doxycycline might improve the outcome of reinstrumentation of pathologic pockets persisting after initial periodontal therapy.
Methods: Subjects with chronic periodontitis underwent initial treatment including full-mouth ultrasonic debridement and oral hygiene instructions. At the 3-month reexamination, 32 subjects with remaining pathologic sites were assigned randomly to one of two retreatment protocols: ultrasonic instrumentation alone (control) or ultrasonic instrumentation plus application of an 8.8% doxycycline gel (test). Clinical examinations of plaque, probing depth (PD), relative attachment level (RAL), and bleeding on probing were performed before retreatment (baseline) and after 3 and 9 months. Primary efficacy variables were the percentage of closed pockets, i.e., PD < or =4 mm, and changes in PD and RAL.
Results: Baseline examination revealed no significant difference in mean PD between treatment groups. The mean PD reduction at 3 months was 0.9 mm (95% confidence interval [CI]: 0.6 to 1.2) in the control group and 1.0 mm (95% CI: 0.7 to 1.3) in the test group (P >0.05). At 9 months, both treatment groups showed a mean PD reduction of 1.1 mm. The mean RAL gain was 0.6 mm at 3 months and approximately 0.8 at 9 months for both groups. The probability of pocket closure was not improved by the adjunctive antibiotic therapy. Only factors at the tooth site level (plaque presence, furcation involvement, and presence of an intrabony defect) were identified by multilevel analysis as significant for the treatment outcome.
Conclusion: Locally delivered doxycycline failed to improve the healing outcome of reinstrumentation of periodontal pockets showing a poor initial response to pocket/root debridement.
In August 23-25, 2007, the Scandinavian Society for Prosthetic Dentistry in collaboration with the Danish Society of Oral Implantology arranged a consensus conference on the topic 'Implants and/or teeth'. It was preceded by a workshop in which eight focused questions were raised and answered in eight review articles using a systematic approach. Twenty-eight academicians and clinicians discussed the eight review papers with the purpose to reach consensus on questions relevant for the topic. At the conference the consensus statements were presented as well as lectures based on the review articles. In this article the methods used at the consensus workshop are briefly described followed by the statements with comments.
Abstract: The main goal of the treatment of patients with periodontitis is to establish adequate infection control. To satisfy demands for acceptable aesthetics and chewing function with good long-term prognosis in patients with periodontitis requires the establishment of adequate infection control. Pocket instrumentation (scaling and root planing with or without flap elevation), combined with effective self-performed supragingival plaque control measures, constitutes the basic treatment modalities.
Aim: To investigate, by means of multilevel analysis, factors that may affect the short-term clinical outcome of non-surgical periodontal treatment.
Materials and Methods: Forty-one patients randomly assigned to two protocols of non-surgical therapy were included. The impact of different covariates on the probability of "pocket closure" [i.e. probing pocket depth (PPD)<or=4 mm] was explored using a logistic multilevel model. The impact on the final PPD was explored using a continuous multilevel model.
Results: The logistic model revealed a significant impact of smoking (p<0.001), presence of plaque at the site (p<0.001) and location of the pocket at a multi-rooted tooth (p<0.001). The model explained 44% of the total variability. Of the unexplained variance, 19% was attributed to inter-patient variability. The continuous model revealed the same factors to be significant and an additional significant impact of interactions between the covariates. The R(2) was 0.50 and the random slopes model revealed an increase in the variability of the final pocket depth with an increase in the initial PPD.
Conclusion: Smoking habits, plaque at site level and tooth type were
significant factors in determining the short-term clinical outcome of
non-surgical periodontal treatment.
Abstract:
AIM: To evaluate the incidence of disease
recurrence following a full-mouth pocket/root debridement approach with
ultrasonic instrumentation versus that following a traditional approach of
quadrant-wise scaling and root planing (Q-SRP) performed with hand
instrumentation.
METHODS: Thirty-seven patients were re-examined
1 year after the completion of a 6-month clinical trial comparing two
different treatment protocols: a 1-h session of full-mouth ultrasonic
debridement (UD--19 patients) or four sessions of Q-SRP with hand
instruments (Q-SRP--18 patients). At 3 months, re-instrumentation was
performed of pockets showing a remaining probing pocket depth (PPD) of > or
=5 mm using the same type of instruments as used during the initial
treatment phase. The clinical examinations comprised assessments of plaque,
bleeding on probing (BoP) and PPD.
The primary outcome variable was the incidence of recurrent diseased sites (i.e.,
sites showing PPD > or =5 mm and BoP+) between the post-treatment and 1-year
follow-up examinations. All sites that were healed (PPD < or =4 mm and BoP(-))
at the post-treatment examination were included in the study sample, with a
mean number of sites per patient of 23.5.
RESULTS: In the UD group, 29 (7%) out of 430
initially healed sites showed disease recurrence at the 1-year follow-up
examination compared with 47 (11%) of 440 sites in the Q-SRP group (p>0.05).
Twelve patients (63%) in the UD group presented recurrent diseased pockets,
compared with 14 patients (78%) in the Q-SRP group. Two or more recurrent,
diseased pockets were observed in nine patients in the UD group versus 11 in
the Q-SRP group. All but one of the smokers belonged to the group of
patients presenting recurrences. A tendency towards a higher mean plaque
score was observed for the patients with recurrent sites.
CONCLUSION: The study revealed no significant
difference in the incidence of recurrence of diseased periodontal pockets
between the full-mouth UD approach and the traditional approach of Q-SRP.
Abstract:
The main objective of the treatment of patients with periodontitis is to establish adequate infection control in the dentogingival area. Pocket/root instrumentation (scaling and root planing), combined with effective self-performed supragingival plaque control measures, constitute the basic treatment modalities, but also locally applied antiseptics and antibiotics may be utilized. The purpose of this article is to give an overview of current clinical concepts on
periodontal infection control.
Abstract:
BACKGROUND: The erbium-doped:yttrium, aluminum,
and garnet (Er:YAG) laser is considered a useful tool for subgingival
debridement because the laser treatment creates minimal damage to the root
surface and has potential antimicrobial effects. The aim of this randomized
controlled clinical trial was to evaluate clinical and microbiologic effects
of pocket debridement using an Er:YAG laser in patients during periodontal
maintenance.
METHODS: Twenty patients at a recall visit for maintenance were
consecutively recruited if presenting at least four teeth with residual
probing depth (PD) > or = 5 mm. Two pockets in each of two jaw quadrants
were randomly assigned to subgingival debridement using 1) an Er:YAG laser
(test) or 2) an ultrasonic scaler (control). The laser beam was set at 160
mJ with a pulse frequency of 10 Hz. Clinical variables were recorded at
baseline, 1 month, and 4 months after treatment. Primary clinical outcome
variables were changes in PD and clinical attachment level (CAL).
Microbiologic analysis of subgingival samples was performed at baseline, 2
days, and 30 days after treatment using a checkerboard DNA-DNA hybridization
technique against 12 periodontal disease-associated species.
RESULTS: The mean initial PD was 6.0 mm (SD:
1.2) in the test group and 5.8 mm (SD: 0.9) in the control group. At 1 month
post-treatment, the PD reduction was significantly greater for test than
control sites (0.9 versus 0.5 mm; P <0.05). The CAL gain also was
significantly greater (0.5 versus 0.06 mm; P <0.01). At the 4-month
examination, no significant differences were detected in PD reduction (1.1
versus 1.0 mm) or CAL gain (0.6 versus 0.4 mm). Both treatments resulted in
reduction of the subgingival microflora. No significant differences in
microbiologic composition were identified between the treatment groups at
various time intervals. Degree of treatment discomfort scored significantly
lower for the test than the control treatment modality.
CONCLUSION: The results of the trial failed to
demonstrate any apparent advantage of using an Er:YAG laser for subgingival
debridement, except less treatment discomfort perceived by the patients.
Abstract:
AIM: To evaluate the clinical efficacy of (i) a
single session of "full-mouth ultrasonic debridement" (Fm-UD) as an initial
periodontal treatment approach and (ii) re-instrumentation of periodontal
pockets not properly responding to initial subgingival instrumentation.
METHODS: Forty-one patients, having on the average 35 periodontal
sites with probing pocket depth (PPD) > or =5 mm, were randomly assigned to
two different treatment protocols following stratification for smoking: a
single session of full-mouth subgingival instrumentation using a
piezoceramic ultrasonic device (EMS PiezonMaster 400, A+PerioSlim tips) with
water coolant (Fm-UD) or quadrant scaling/root planing (Q-SRP) with hand
instruments . At 3 months, all sites with remaining PPD> or =5 mm were
subjected to repeated debridement with either the ultrasonic device or hand
instruments.
Plaque, PPD, relative attachment level (RAL) and bleeding following pocket
probing (BoP) were assessed at baseline, 3 and 6 months. Primary efficacy
variables were percentage of "closed pockets" (PPD< or =4 mm), and changes
in BoP, PPD and RAL.
RESULTS: The percentage of "closed pockets" was
58% at 3 months for the Fm-UD approach and 66% for the Q-SRP approach
(p>0.05). Both treatment groups showed a mean reduction in PPD of 1.8 mm,
while the mean RAL gain amounted to 1.3 mm for Fm-UD and 1.2 mm for Q-SRP
(p>0.05). The re-treatment at 3 months resulted in a further mean PPD
reduction of 0.4 mm and RAL gain of 0.3 mm at 6 months, independent of the
use of ultrasonic or hand instruments. The efficiency of the initial
treatment phase (time used for instrumentation/number of pockets closed) was
significantly higher for the Fm-UD than the Q-SRP approach: 3.3 versus 8.8
min. per closed pocket (p<0.01). The efficiency of the re-treatment session
at 3 months was 11.5 min. for ultrasonic and 12.6 min. for hand
instrumentation (p>0.05).
CONCLUSION: The results demonstrated that a
single session of Fm-UD is a justified initial treatment approach that
offers tangible benefits for the chronic periodontitis patient.
Abstract:
OBJECTIVE: The outcome of non-surgical
periodontal therapy is known to be inferior in smokers compared to
non-smokers. In the present study, the question was asked whether such a
difference in healing response may be less evident following adjunctive use
of locally delivered controlled-release doxycycline.
METHODS: One hundred and three patients (42
smokers, 61 non-smokers), each having at least eight periodontal sites with
PPD (probing pocket depth) > or =5 mm, were following stratification for
smoking randomly assigned to two different treatment protocols; non-surgical
scaling/root planing (Control) or ultrasonic instrumentation+application of
a 8.5% w/w doxycycline gel (Atridox trade mark ) (Test). Instructions in
oral hygiene were given to all patients. Clinical examinations of plaque,
PPD, clinical attachment level (CAL) and bleeding following pocket probing
were performed at baseline and after 3 months. Primary efficacy endpoints
were changes in PPD and CAL. Patient mean values were calculated as basis
for statistical analysis (multiple regression analyses).
RESULTS: The baseline examination revealed no
significant difference in mean PPD between treatment groups or between
smokers and non-smokers (mean PPD 5.7-5.9 mm). The mean PPD reduction in the
control group at 3-month was 1.1 mm (SD=0.45) for smokers and 1.5 mm (0.67)
for non-smokers. In the test group the PPD reduction was 1.4 mm (0.60) and
1.6 mm (0.45) for smokers and non-smokers, respectively. The mean CAL gain
for smokers and non-smokers amounted to 0.5 mm (0.56) and 0.8 mm (0.71),
respectively, in the control group, and to 0.8 mm (0.72) and 0.9 mm (0.82),
respectively, in the test group. Multiple regression analysis revealed that
smoking and initial PPD negatively influenced the treatment outcome in terms
of PPD reduction and CAL gain, while the use of doxycycline had a
significant positive effect.
CONCLUSION: Locally applied controlled-release
doxycycline gel may partly counteract the negative effect of smoking on
periodontal healing following non-surgical therapy.
