Management of Multiple Recession-Type Defects After Orthodontic Therapy: A Clinical Report Based on Scientific Evidence

Treatment of multiple recession-type defects (MRTDs) developed subsequent to orthodontic therapy requires a solid knowledge of the anatomy/characteristics of the defects. Surgical approaches based on the use of subepithelial connective tissue grafts (SCTGs) are considered the “gold standard” for the treatment of MRTDs, but their use may be limited by the availability of donor tissue. The objective of this case report is to present the outcomes of treatment achieved by a SCTG in a patient presenting MRTDs in all four quadrants of the mouth. Case Presentation: A non-smoking 23-year-old female patient presenting 15 Miller Class I or II gingival recessions (GRs) at anterior and posterior teeth of the maxilla and mandible, developed after orthodontic therapy, was referred for treatment in March 2013. Defects were treated using four SCTG-based procedures using grafts harvested from two donor sites at different time frames. Twenty-four months after treatment, gingival thickness modification led to esthetic and functional results. Conclusion: The use of SCTGs harvested twice from the same donor site for the treatment of MRTDs led to safe and predictable outcomes (i.e., clinically significant gains in GR depth, attachment level, and esthetics)

Prevalência das Doenças Periodontais no Brasil

In 1993 a review of epidemiological surveys of the prevalence of periodontal diseases in Brazil 10 has shown that 86.7% of the total of examined individuals had evidence of marginal gingivitis or periodontal damage. The aim of this paper was to evaluate the prevalence of periodontal disease through a critical review of the dental literature of several independent epidemiologic studies that have been conducted during the last 10 years in Brazil (1993-2003). Differences in epidemiological methodology and clinical differential diagnosis made comparative evaluation of surveys data difficult and subjective. However, it can be concluded that the general prevalence rate of periodontal diseases was 92.92%. This review also revealed a lack of data on the epidemiology of periodontal disease in all Brazilian geographic regions. All the epidemiological data reviewed pointed to dental plaque as the primary aetiological agent in gingivitis and periodontitis.Em 1993, através de uma revisão da literatura dos levantamentos epidemiológicos até então realizados 10 evidenciou que 86,7% do total de indivíduos examinados apresentavam atividade de doença periodontal. O propósito deste artigo foi avaliar a prevalência de doença periodontal através de uma revisão crítica da literatura odontológica referente a diversos estudos epidemiológicos independentes realizados e publicados no Brasil entre 1993 e 2003. Diferenças na metodologia empregada não permitiram muitas comparações entre os dados coletados. Entretanto, concluiu-se que a prevalência geral de doença periodontal encontrada foi de 92,92%. Esta revisão também revelou uma carência de dados sobre a epidemiologia das doenças periodontais em todas as regiões geográficas brasileiras. Todos os levantamentos epidemiológicos estudados apontam a placa dental como único agente etiológico das doenças gengivais e periodontais

Errores y complicaciones en la práctica clínica periodontal por sesgo metodológico y mala interpretación de la evidencia

Durante y después de la realización de procedimientos periodontales o relacionados con implantes pueden surgir diferentes tipos de errores y complicaciones. Algunos de los agentes causales de errores y complicaciones más relevantes, aunque también controvertidos y menos comentados, son los sesgos metodológicos y la mala interpretación de la evidencia. La correcta evaluación de la literatura requiere de un sólido conocimiento clínico combinado con un enfoque sistemático basado en el reconocimiento de los sesgos metodológicos comunes y la evitación de errores interpretativos para recuperar críticamente, diseccionar y aplicar juiciosamente la información disponible para la promoción de la salud periodontal y periimplantaria. Esta revisión aborda tipos comunes de sesgos metodológicos y errores interpretativos que pueden alterar las percepciones del lector sobre el efecto real y las ramificaciones potenciales de los resultados comunicados de un determinado enfoque terapéutico debido a una mala interpretación de las pruebas disponibles: (1) tipos de sesgos metodológicos; (2) sesgo de giro e interpretativo; (3) trampas de interpretación al evaluar las pruebas (4) elección de criterios de valoración relevantes para responder a la(s) pregunta(s) de interés; y (5) equilibrio entre significación estadística y relevancia clínica.Different types of errors and complications may arise during and after the execution of periodontal or implant-related procedures. Some of the most relevant, although also controversial, and less commented, causative agents of errors and complications are methodological biases and bad interpretation of the evidence. Proper assessment of the literature requires of solid clinical knowledge combined with a systematic approach built on the recognition of common methodological biases and the avoidance of interpretive errors to critically retrieve, dissect, and judiciously apply available information for the promotion of periodontal and peri-implant health. This review addresses common types of methodological bias and interpretive errors that can alter the reader's perceptions on the real effect and potential ramifications of the reported outcomes of a given therapeutic approach due to bad interpretation of the available evidence: (1) types of methodological biases; (2) spin and interpretive bias; (3) interpretation pitfalls when assessing the evidence (4) choice of relevant endpoints to answer the question(s) of interest; and (5) balance between statistical significance and clinical relevance

Antibiotic therapy for the prevention of osteoradionecrosis following tooth extraction in head-and-neck cancer patients postradiotherapy: An 11-year retrospective study

Introducción: Una de las complicaciones más importantes de la radioterapia (RT) para el cáncer de cabeza y cuello (CCC) es la osteorradionecrosis (ORN) de los maxilares, que surge sobre todo a raíz de las extracciones dentales. El tratamiento de la ORN sigue representando un gran reto; por lo tanto, la prevención es de suma importancia. Así pues, el presente estudio tenía como objetivo evaluar retrospectivamente un protocolo de tratamiento antibiótico sistémico perioperatorio para la prevención de la ORN tras la extracción dental en pacientes con cabeza y cuello tras RT conformada 3D. Materiales y métodos: Se realizó una revisión retrospectiva de historias clínicas considerando pacientes HNC sometidos a RT en el periodo comprendido entre 2008 y 2019. Recibieron necesariamente antibioticoterapia oral con Clindamicina 300 mg cada 8 h durante 10 días, con la primera dosis 3 días antes de la extracción dentaria. Resultados: Cuarenta y nueve pacientes cumplían los criterios de estudio, con un total de 107 dientes extraídos. En cuanto a los 47 pacientes que no desarrollaron ORN, se identificaron 103 extracciones dentales (96,3%). Solo dos pacientes desarrollaron ORN en dos dientes adyacentes (3,7%). Conclusiones: El protocolo de terapia antibiótica sistémica perioperatoria propuesto parece ser eficaz para prevenir la ORN tras la extracción dental en pacientes con HNC postirradiado.Introduction: One of the most important complications of radiotherapy (RT) for head-and-neck cancer (HNC) is osteoradionecrosis (ORN) of the jaws, which mostly arises from tooth extractions. The ORN treatment still represents a great challenge; therefore, the prevention is of paramount importance. Thus, the present study aimed to evaluate retrospectively a perioperative systemic antibiotic therapy protocol for the prevention of ORN following tooth extraction in head-and-neck patients post-3D conformal RT. Materials and Methods: A retrospective medical record review was performed considering HNC patients submitted to RT in the period between 2008 and 2019. They necessarily received oral antibiotic therapy with Clindamycin 300 mg every 8 h for 10 days, with the first dose 3 days before the tooth extraction. Results: Forty-nine patients met the study criteria, with a total of 107 teeth extracted. Regarding the 47 patients who did not develop ORN, 103 tooth extractions were identified (96.3%). Only two patients developed ORN at two adjacent teeth sites (3.7%). Conclusion: The proposed perioperative systemic antibiotic therapy protocol seems to be efficient to prevent ORN following tooth extraction in postirradiated HNC patients

Leukocyte- and platelet-rich fibrin does not provide any additional benefit for tooth extraction in head and neck cancer patients post-radiotherapy : a randomized clinical trial

One of the most important complications of radiotherapy (RT) for head and neck cancer (HNC) is osteoradionecrosis (ORN) of the jaws, arising mainly from tooth extractions. Thus, the present study aimed to evaluate the efficacy of leukocyte- and platelet-rich fibrin (L-PRF) in preventing ORN following tooth extraction in post-irradiated HNC patients, as well as other postoperative complications. 23 patients previously submitted to conventionally fractionated 3D-conformational RT for HNC underwent atraumatic tooth extractions with perioperative antibiotic therapy. Besides, they were randomly assigned to receive L-PRF clots to fill and cover the extraction sockets (n=11, Test Group) or not (n=12, Control Group). A visual analog scale was used to quantify postoperative pain on the 3rd and 7th days. For ORN diagnosis, patients were clinically assessed for up to 180 days. Other postoperative complications (edema, alveolitis, suture dehiscence, continuous bleeding, and oroantral communication) were also evaluated within this period. No case of ORN or another surgical complication was observed and there were no differences in the postoperative pain scores between the groups on the 3rd and 7th days. L-PRF did not seem to provide any additional benefits than those achieved by the combination of the surgical and drug protocols used for tooth extractions in the post-irradiated HNC patients

Economic burden of periodontitis in the United States and Europe: An updated estimation

BACKGROUND: The aim of this study is to estimate the direct and indirect economic burdens of periodontal disease in the USA and in Europe. METHODS: We used the most recent data available for the USA and for Europe (32 European countries) to estimate the cost of periodontal disease. Global health, dental and periodontal expenditures were estimated. We tried to estimate the direct and the indirect costs of periodontitis. Indirect costs, those related to productivity losses, are a consequence of periodontal disease proper, plus edentulism and caries due to periodontal disease. RESULTS: In 2018, the aggregate cost in the USA was estimated at $3.49B and €2.52B in Europe. Indirect costs due to periodontal disease amounted to$150.57B (95% confidence interval [CI]: 103.32-189.87) in the USA countries and €156.12B (95% CI: 123.72-221.86) in Europe. The majority of the projected indirect costs were due to edentulism related to periodontal disease and periodontal disease. Indirect costs were the majority of the estimated economic impact with an average of 0.73% (95% CI: 0.50-0.93%) of annual gross domestic product in the USA and 0.99% (95% CI: 0.78-1.40%) in Europe. CONCLUSIONS: Periodontal disease caused an estimated loss of $154.06B in the USA and €158.64B in Europe, in 2018. These results show that the economic burden of periodontal disease is significant and its indirect costs are impactful. This article is protected by copyright. All rights reserved

Outcome measures and methods of assessment of soft-tissue augmentation interventions in the context of dental implant therapy: A systematic review of clinical studies published in the last 10 years.

AIM The aim of the study was to identify and report outcome measures and methods of assessment on soft-tissue augmentation interventions in the context of dental implant therapy reported in clinical studies published in the last 10 years. MATERIAL AND METHODS The protocol of this PRISMA 2020-compliant systematic review was registered in PROSPERO (CRD42021252214). A literature search was conducted to identify articles that met the pre-established eligibility criteria. Data of interest, with an emphasis on outcome measures, were extracted. For each outcome, specific methods and timing of assessment were described in detail. Following a critical qualitative analysis of the data, outcome measures were categorized. Primary outcomes were identified and the frequency of reporting in the selected articles was calculated. Additionally, risk of bias assessments were performed for individual articles and primary outcomes. RESULTS Ninety-two articles, of which 39 reported randomized controlled trials (RCTs), 20 reported non-RCTs, and 33 reported case series studies, were selected. Outcome measures were categorized into either investigator-evaluated outcome measures (i.e., clinical, digital imaging, esthetic, histologic, biomarker, and safety) or patient-reported outcome measures (PROMs). Clinical outcomes were the most frequently reported type of outcome. Considering all categories, the most frequently reported primary outcomes were facial mucosa thickness assessed with clinical methods (22.83%), facial keratinized mucosa width assessed with clinical methods (19.57%), facial mucosal margin position/recession assessed with clinical methods (18.48%), facial mucosa thickness assessed with digital imaging methods (11.96%), facial soft-tissue volume assessed with digital imaging methods (9.78%), and supracrestal tissue height assessed with clinical methods (9.78%). No distinguishable patterns of association between specific types or quality (level of bias) of clinical studies and the choice of primary outcomes were observed. CONCLUSION Clinical research on peri-implant soft-tissue augmentation has progressively increased in the last 10 years. Although clinical outcome measures were the most frequently reported outcomes in the selected literature, trends in the field are indicative of a shift from traditional clinical assessment methods to the use of digital technologies. PROMs were generally underreported but should be considered an integral methodological component in future clinical studies

Outcome measures and methods of assessment of soft tissue augmentation interventions in the context of dental implant therapy: A systematic review of clinical studies published in the last 10 years.

AIM To identify and report outcome measures and methods of assessment on soft tissue augmentation interventions in the context of dental implant therapy reported in clinical studies published in the last 10 years. MATERIALS AND METHODS The protocol of this Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) 2020-compliant systematic review was registered in PROSPERO (CRD42021252214). A literature search was conducted to identify articles that met the pre-established eligibility criteria. Data of interest, with an emphasis on outcome measures, were extracted. For each outcome, specific methods and timing of assessment were described in detail. Following a critical qualitative analysis of the data, outcome measures were categorized. Primary outcomes were identified, and the frequency of reporting in the selected articles was calculated. Additionally, risk-of-bias assessments were performed for individual articles and primary outcomes. RESULTS Ninety-two articles, of which 39 reported randomized controlled trials (RCTs), 20 non-RCTs, and 33 case series studies, were selected. Outcome measures were categorized into either investigator-evaluated outcome measures (i.e., clinical, digital imaging, aesthetic, histological, biomarker, and safety) or patient-reported outcome measures (PROMs). Clinical outcomes were the most frequently reported type of outcome. Considering all categories, the most frequently reported primary outcomes were facial mucosa thickness assessed with clinical methods (22.83%), facial keratinized mucosa width assessed with clinical methods (19.57%), facial mucosal margin position/recession assessed with clinical methods (18.48%), facial mucosa thickness assessed with digital imaging methods (11.96%), facial soft tissue volume assessed with digital imaging methods (9.78%), and supracrestal tissue height assessed with clinical methods (9.78%). No distinguishable patterns of association between specific types or quality (level of bias) of clinical studies and the choice of primary outcomes were observed. CONCLUSIONS Clinical research on peri-implant soft tissue augmentation has progressively increased in the last 10 years. Although clinical outcome measures were the most frequently reported outcomes in the selected literature, trends in the field are indicative of a shift from traditional clinical assessment methods to the use of digital technologies. PROMs were generally under-reported but should be considered an integral methodological component in future clinical studies

Clinical efficacy of adjunctive methods for the non-surgical treatment of peri-implantitis: a systematic review and meta-analysis

Background: The aim of this systematic review (SR) was to evaluate the clinical efficacy of different adjunctive methods/therapies to the non-surgical treatment (NST) of peri-implantitis. Materials and methods: The protocol of the review was registered in PROSPERO database (CRD42022339709) and was designed according to PRISMA statement. Electronic and hand searches were performed to identify randomized clinical trials (RCTs) comparing non-surgical treatment of peri-implantitis alone versus NST plus any adjunctive method/treatment. The primary outcome was probing pocket depth (PPD) reduction. Results: Sixteen RCTs were included. Only 2 out of 1189 implants were lost and follow-up ranged from 3 to 12 months. PPD reduction across the studies varied from 0.17 to 3.1 mm, while defect resolution from 5.3% to 57.1%. Systemic antimicrobials were associated to higher PPD reduction (1.56 mm; [95% CI 0.24 to 2.89]; p = 0.02) with high heterogeneity, and treatment success (OR = 3.23; [95% CI 1.17 to 8.94]; p = 0.02), compared to NST alone. No differences were found with adjunctive local antimicrobials and lasers for PPD and bleeding on probing (BoP) reduction. Conclusions: Non-surgical treatment with or without adjunctive methods may reduce PPD and BoP even if complete resolution of the pocket is unpredictable. Among possible adjunctive methods, only systemic antibiotics seems to provide further benefits, but their usage should be considered with caution