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Background: The human chromosomal region 9p21.3 has been shown to be strongly associated with Coronary Heart Disease (CHD) in several Genome-wide Association Studies (GWAS). Recently, this region has also been shown to be associated with Aggressive Periodontitis (AgP), strengthening the hypothesis that the established epidemiological association between periodontitis and CHD is caused by a shared genetic background, in addition to common environmental and behavioural risk factors. However, the size of the analyzed cohorts in this primary analysis was small compared to other association studies on complex diseases. Using our own AgP cohort, we attempted to confirm the described associations for the chromosomal region 9p21.3. Methods: We analyzed our cohort consisting of patients suffering from the most severe form of AgP, generalized AgP (gAgP) (n = 130) and appropriate periodontally healthy control individuals (n = 339) by genotyping four tagging SNPs (rs2891168, rs1333042, rs1333048 and rs496892), located in the chromosomal region 9p21.3, that have been associated with AgP. Results: The results confirmed significant associations between three of the four SNPs and gAgP. The combination of our results with those from the study which described this association for the first time in a meta-analysis of the four tagging SNPs produced clearly lower p-values compared with the results of each individual study. According to these results, the most plausible genetic model for the association of all four tested SNPs with gAgP seems to be the multiplicative one. Conclusion: We positively replicated the finding of an association between the chromosomal region 9p21.3 and gAgP. This result strengthens support for the hypothesis that shared susceptibility genes within this chromosomal locus might be involved in the pathogenesis of both CHD and gAgP.
Aim: Evaluation of long‐term results after connective tissue graft (CTG) using the envelope technique and the effect on patient‐centred outcomes (Oral Health Impact Profile: OHIP) in a private practice setting.
Materials and Methods: Fifteen patients (11 female, mean age: 45.0 ± 8.88 years) underwent root coverage procedure using a CTG involving maxillary Miller class I teeth. Pre‐operatively, 3 and 120 ± 12 months after surgery, all patients were examined, completed OHIP questionnaire, and were asked to assess improvement and their satisfaction with the results of surgery. All procedures were performed by the same investigator.
Results: Recession depth at 3 months of 1.19 ± 0.93 mm was reduced to that of 0.63 ± 0.64 mm at 120 ± 12 months after surgery (p = .117). Recession width (−1.23 ± 2.27 mm) decreased as well (p = .117), while relative root coverage increased from 48.46 ± 32.18% at 3 months to 71.22 ± 30.86% at 120 months (p = .011). The number of cases with complete root coverage increased from two (15.4%) to six (40.0%) from 3 to 120 months (p = .046). OHIP score (12.07 ± 10.15) did not change after 10 years (12.13 ± 9.86, p = .889). Ten years after surgery, 12 patients (80%) reported they would make the decision again to undergo CTG transplantation.
Conclusions: Within the limitations of the study design with a high risk of bias in a practice setting, long‐term stability of recession reduction, OHIP and patient‐perceived satisfaction remained stable over 10 years.
Purpose. The aim of this prospective longitudinal clinical pilot study was the evaluation of the effect on the Oral Health Impact Profile (OHIP) and patient-centered results of the envelope technique for Connective Tissue Graft (CTG). Methods. Sixteen patients (11 females) 24 to 71 years of age (42.6±11.1) received CTG that had been harvested from the palate and grafted using the envelope technique. Prior to and 3 months after surgery, all patients were examined clinically, completed the OHIP-G49 questionnaire, and were asked to judge the results of surgery. Results. Mean baseline recession depth of 2.5±0.8 mm was reduced by 1.2±0.9 mm (P<.001). Root coverage amounted to 48±39%. In 5 of 16 defects complete root coverage was achieved. Pain at the donor site was more pronounced than at recipient site regarding prevalence (8/6; P=.007), intensity (2.1±2.3/1.1±1.9 [visual analogue scale]; P=.016), and duration (1.4±2.3/0.8±1.4 days; P=.042). Baseline OHIP (15.7±12.1) was decreased by 3.6±8.5 three months after surgery (P=.139). Thirteen patients (81%) would undergo CTG surgery for similar reasons again. Conclusions. Root coverage using CTG according to the envelope technique provided improvement of OHIP as early as 3 months after surgery. Over all, patients were reasonably satisfied with the surgical technique and its results.
Objective: To evaluate the benefit of resective surgical periodontal therapy (root amputation or resection, root separation, tunnelling) in periodontitis patients exhibiting class II and III furcation involvement (FI) compared with non‐surgical treatment (SRP) or open flap debridement (OFD).
Material: Outcomes were tooth survival (primary), vertical probing attachment gain, and reduction in probing pocket depth (secondary) evidenced by randomized clinical trials, prospective and retrospective cohort studies and case series with ≥ 12 months of follow‐up. Search was performed on 3 electronic databases from January 1998 to December 2018.
Results: From a total of 683 articles, 66 studies were identified for full‐text analysis and 7 studies finally included. Six hundred sixty‐seven patients contributed 2,021 teeth with class II or III FI. Data were very heterogeneous regarding follow‐up and distribution of FI. A total of 1,515 teeth survived 4 to 30.8 years after therapy. Survival ranged from 38%–94.4% (root amputation or resection, root separation), 62%–67% (tunnelling), 63%–85% (OFD) and 68%–80% (SRP). Overall, treatment provided better results for class II FI than class III.
Conclusion: Within their limits, the data indicate that in class II and III FI, SRP and OFD may result in similar survival rates as root amputation/resection, root separation or tunnelling.
Aim: Comparison of the clinical efficacy (digitally volumetric, aesthetic, patient-centred outcomes) of tunnel technique (TUN) with subepithelial connective tissue graft (CTG) versus coronally advanced flap (CAF) with enamel matrix derivate (EMD) 5 years after gingival recession therapy. Materials and methods: In 18 patients contributing 36 RT1 recessions, study models were collected at baseline and follow-ups. Optical scans assessed recessions computer-assisted [recession depth, recession reduction (RECred), complete root coverage (CRC), percentage of root coverage (RC), pointwise (pTHK) and mean areal (aTHK) marginal soft tissue thickness]. Root coverage aesthetic Score (RES) was used for aesthetic evaluation and visual analogue scales for patient-centred data collection applied. Results: Sixty months after surgery, 50.0% (TUN+CTG) and 0.0% (CAF+EMD) of sites showed CRC (p = 0.0118), 82.2% (TUN+CTG) and 32.0% (CAF+EMD) achieved RC, respectively (p = 0.0023). CTG achieved significantly better RECred (TUN+CTG: 1.75±0.74 mm; CAF+EMD: 0.50 ± 0.39 mm; p = 0.0009) and aTHK (TUN+CTG: 0.95 ± 0.41 mm; CAF+EMD: 0.26 ± 0.28 mm; p = 0.0013). RES showed superior outcomes (p = 0.0533) for TUN+CTG (6.86 ± 2.31) compared to CAF+EMD (4.63 ± 1.99). The study failed to find significant differences related to patient-centred outcomes (TUN+CTG: 8.30 ± 2.21; CAF+EMD: 7.50 ± 1.51; p = 0.1136). Conclusions: Five years after treatment, CTG resulted in better clinical and aesthetic outcomes than CAF+EMD. Increased THK was associated with improved outcomes for RECred and RC.
Parodontitis ist eine chronisch entzündliche nichtübertragbare Erkrankung, die alle Anteile des Zahnhalteapparates (Parodonts) betrifft und dort weitgehend irreversible Schäden verursacht. Schätzungen legen nahe, dass in Deutschland ca. 10 Mio. Menschen an einer schweren Parodontitis erkrankt sind. Parodontitis zeigt über viele Jahre zumeist wenige oder nur milde Symptome, die von den Patienten oft nicht wahrgenommen oder richtig eingeordnet werden. Fehlendes Bewusstsein kann dazu führen, dass zahnärztliche Behandlung erst in einem fortgeschrittenen Erkrankungsverlauf in Anspruch genommen wird, wenn umfangreiche Therapiemaßnahmen notwendig geworden sind und sich die Prognose für den Erhalt der Zähne verschlechtert hat. Der parodontale Screeningindex (PSI) ist ein einfaches und schnelles Instrument, mit dem die Notwendigkeit weiterführender diagnostischer Maßnahmen beurteilt werden kann. Der Index wird mittlerweile bei vielen Patienten durchgeführt. Trotzdem bleiben die Versorgungszahlen niedrig und hinter dem zurück, was für das Absenken der bestehenden Parodontitislast notwendig wäre. Jede Zahnarztpraxis muss in der Lage sein, Parodontitistherapie umzusetzen. Fachzahnärzte oder Spezialisten können die allgemeinzahnärztlichen Kollegen wesentlich bei der Behandlung von schweren Formen von Parodontitis unterstützen. Dazu ist eine Aufwertung des Faches in der universitären Ausbildung erforderlich, aber auch die zunehmende postgraduale Ausdifferenzierung von Spezialisten oder Fachzahnärzten für Parodontologie. Die neuen Behandlungsrichtlinien für die Parodontaltherapie (PAR-Therapie) erlauben die Versorgung der parodontal erkrankten Patienten auf Basis international anerkannter wissenschaftlicher Standards und verbessern damit die Rahmenbedingungen für die Parodontitistherapie in der zahnärztlichen Praxis.
Objectives: The aim of this study was to develop a prognostic tool to estimate long-term tooth retention in periodontitis patients at the beginning of active periodontal therapy (APT). Material and methods: Tooth-related factors (type, location, bone loss (BL), infrabony defects, furcation involvement (FI), abutment status), and patient-related factors (age, gender, smoking, diabetes, plaque control record) were investigated in patients who had completed APT 10 years before. Descriptive analysis was performed, and a generalized linear-mixed model-tree was used to identify predictors for the main outcome variable tooth loss. To evaluate goodness-of-fit, the area under the curve (AUC) was calculated using cross-validation. A bootstrap approach was used to robustly identify risk factors while avoiding overfitting. Results: Only a small percentage of teeth was lost during 10 years of supportive periodontal therapy (SPT; 0.15/year/patient). The risk factors abutment function, diabetes, and the risk indicator BL, FI, and age (≤ 61 vs. > 61) were identified to predict tooth loss. The prediction model reached an AUC of 0.77. Conclusion: This quantitative prognostic model supports data-driven decision-making while establishing a treatment plan in periodontitis patients. In light of this, the presented prognostic tool may be of supporting value. Clinical relevance: In daily clinical practice, a quantitative prognostic tool may support dentists with data-based decision-making. However, it should be stressed that treatment planning is strongly associated with the patient’s wishes and adherence. The tool described here may support establishment of an individual treatment plan for periodontally compromised patients.
Objective: To assess tooth loss (TL) in initially periodontally healthy/gingivitis (PHG) and periodontally compromised (PC) individuals during a 15- to 25-year follow-up in a specialist practice and to identify the factors influencing TL. Materials and methods: Patients were re-examined 240 ± 60 months after active periodontal therapy (PC) or initial examination (PHG). PHG patients were periodontally healthy or had gingivitis, and PC patients exhibited at least stage II periodontitis. TL, patient-related outcomes, and risk factors for TL were assessed at the patient level (group-relation, gender, age, smoking, bleeding on probing, educational status, mean number of visits/year). Results: Fifty-six PC patients receiving regular supportive periodontal care (12 female, mean age 49.1 ± 10.9 years, stage II: 10, stage III/IV: 46) lost 38 teeth (0.03 ± 0.05 teeth/year). Fifty-one PHG patients (23 female, mean age 34.5 ± 12.4 years) following regular oral prevention lost 39 teeth (0.04 ± 0.05 teeth/year) (p = .631). Both PC and PHG groups did not show any significant differences regarding visual analogue scale measurements [aesthetics (p = .309), chewing function (p = .362), hygiene (p = .989)] and overall Oral Health Impact Profile (p = .484). Age at the start of follow-up was identified as a risk factor for TL (p < .0001). Conclusion: PC and PHG patients exhibited similarly small TL rates over 240 ± 60 months, which should, however, be interpreted with caution in view of the group heterogeneity. Clinical trial number: DRKS00018840 (URL: https://drks.de).
Objectives: The aim of this study was to develop a prognostic tool to estimate long-term tooth retention in periodontitis patients at the beginning of active periodontal therapy (APT). Material and methods: Tooth-related factors (type, location, bone loss (BL), infrabony defects, furcation involvement (FI), abutment status), and patient-related factors (age, gender, smoking, diabetes, plaque control record) were investigated in patients who had completed APT 10 years before. Descriptive analysis was performed, and a generalized linear-mixed model-tree was used to identify predictors for the main outcome variable tooth loss. To evaluate goodness-of-fit, the area under the curve (AUC) was calculated using cross-validation. A bootstrap approach was used to robustly identify risk factors while avoiding overfitting. Results: Only a small percentage of teeth was lost during 10 years of supportive periodontal therapy (SPT; 0.15/year/patient). The risk factors abutment function, diabetes, and the risk indicator BL, FI, and age (≤ 61 vs. > 61) were identified to predict tooth loss. The prediction model reached an AUC of 0.77. Conclusion: This quantitative prognostic model supports data-driven decision-making while establishing a treatment plan in periodontitis patients. In light of this, the presented prognostic tool may be of supporting value. Clinical relevance: In daily clinical practice, a quantitative prognostic tool may support dentists with data-based decision-making. However, it should be stressed that treatment planning is strongly associated with the patient’s wishes and adherence. The tool described here may support establishment of an individual treatment plan for periodontally compromised patients.
Aim: Assessment of the effect of nonsurgical periodontal therapy on haematological parameters in patients with grades B (BP) and C periodontitis (CP).
Methods: Eight BP and 46 CP patients received full-mouth periodontal debridement within 48 h, if positive for Aggregatibacter actinomycetemcomitans with adjunctive systemic antibiotics (4 BP, 17 CP). Clinical data were collected prior and 12 weeks after periodontal therapy. Blood was sampled prior to and 1 day as well as 6 and 12 weeks after the first SD visit. Erythrocyte count, haemoglobin value, haematocrit (HCT), mean erythrocyte volume (MCV), mean corpuscular haemoglobin (MCH), MCH concentration (MCHC), platelets (PLT) and heat shock protein 27 (Hsp27) were assessed.
Results: Both groups showed significant clinical improvement (p < 0.05). Using univariate analysis, MCV was noticeably lower in CP than BP at all examinations, HCT only at baseline. For CP, MCHC was noticeably higher 12 weeks after SD than at baseline and 1 day (p ≤ 0.005) and Hsp27 increased noticeably at 1 day (p < 0.05). Repeated measures analysis of variance revealed African origin to be associated with lower MCV and female sex with lower MCHC.
Conclusion: Based on multivariate analysis, periodontal diagnosis (BP/CP) was not associated with haematological parameters measured in this study or serum Hsp27. In CP, nonsurgical periodontal therapy improved MCHC 12 weeks after SD. Also in CP Hsp27 was increased 1 day after SD.
