Biologically guided implant therapy: A diagnostic and therapeutic strategy of conservation and preservation based on periodontal staging and grading

Biologically guided implant therapy is based on the new periodontitis classification system recently released by the American Academy of Periodontology and the European Federation of Periodontology that uses staging and grading for the diagnosis of periodontitis. This paper proposes that periodontitis staging and grading should be used in dental implant therapy as a means to ensure maximum conservation of teeth and maximum preservation of alveolar bone. These biologic principles should guide the treatment planning process and supersede a mechanically based, restoratively driven rationale that should be secondary to the biologic principles of conservation and preservation but part of the collaborative treatment planning process. And treatment alternatives throughout the patient’s lifetime should be provided for in case of prosthesis loss due to periâ implantitis. The use of grading will help with recognition of systemic aspects that can have a negative impact.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149297/1/jper10267_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149297/2/jper10267.pd

Guest Editorial: Clarifications on the use of the new classification of periodontitis

This editorial provides clarifications on the application of the Stage and Grade classification of periodontitis. In particular it describes: (1) how to apply the extent criterion to the defined Stage of the disease; and (2) how to calculate tooth loss because of periodontitis in Stage III and IV cases presenting with evidently hopeless (irrational to treat) teeth with a clinical definition of such teeth.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155462/1/jcpe13286_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155462/2/jcpe13286.pd

Staging and grading of periodontitis: Framework and proposal of a new classification and case definition

BackgroundAuthors were assigned the task to develop case definitions for periodontitis in the context of the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions. The aim of this manuscript is to review evidence and rationale for a revision of the current classification, to provide a framework for case definition that fully implicates state‐of‐the‐art knowledge and can be adapted as new evidence emerges, and to suggest a case definition system that can be implemented in clinical practice, research and epidemiologic surveillance.MethodsEvidence gathered in four commissioned reviews was analyzed and interpreted with special emphasis to changes with regards to the understanding available prior to the 1999 classification. Authors analyzed case definition systems employed for a variety of chronic diseases and identified key criteria for a classification/case definition of periodontitis.ResultsThe manuscript discusses the merits of a periodontitis case definition system based on Staging and Grading and proposes a case definition framework. Stage I to IV of periodontitis is defined based on severity (primarily periodontal breakdown with reference to root length and periodontitis‐associated tooth loss), complexity of management (pocket depth, infrabony defects, furcation involvement, tooth hypermobility, masticatory dysfunction) and additionally described as extent (localized or generalized). Grade of periodontitis is estimated with direct or indirect evidence of progression rate in three categories: slow, moderate and rapid progression (Grade A‐C). Risk factor analysis is used as grade modifier.ConclusionsThe paper describes a simple matrix based on stage and grade to appropriately define periodontitis in an individual patient. The proposed case definition extends beyond description based on severity to include characterization of biological features of the disease and represents a first step towards adoption of precision medicine concepts to the management of periodontitis. It also provides the necessary framework for introduction of biomarkers in diagnosis and prognosis.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/144639/1/jcpe12945_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/144639/2/jcpe12945.pd

Using periodontal staging and grading system as a prognostic factor for future tooth loss: A long- term retrospective study

BackgroundA new classification of periodontal diseases aimed to identify periodontal disease based on a multidimensional staging and grading system has been recently proposed. However, up to date, its prognostic predictive capability has not been investigated. The aim of this study was to assess if parameters included in the new classification were predictive of tooth loss after a long- term follow- up (>10 years) in patients with periodontitis.MethodsPatients presented with periodontitis at the University of Michigan between January 1966 and January 2004 were screened and categorized according to the new classification of periodontitis. Number/Reasons of teeth loss in patients who underwent at least one session/year of maintenance during the entire follow- up period were extracted and used to analyze the prognostic capabilities of variables (staging, grading, and Extent) included in the new classification.ResultsA total number of 292 patients with a mean follow- up of 289.7 ± 79.6 months were included. 31 (10.6%) patients were classified as Stage 1, 85 (29.1%) as Stage 2, 146 (50%) as Stage 3, and 30 (10.3%) as Stage 4. For grading, 34 (11.7%) were classified as Grade A, 193 (66.1%) as Grade B, and 65 (22.2%) as Grade C. Results of multilevel Cox regression analyses revealed a statistically significant association between stage (HR:3.73 between Stage 4 and Stage 1) and grade (HR: 4.83 between Grade C and Grade A) at baseline and periodontal related tooth loss, whereas no differences were detected for the extent of periodontitis.ConclusionThis study provides the initial evidence regarding the predictive ability of the new classification of periodontitis. Patients in either Stage 4 or Grade C showed a significantly higher periodontal- related tooth loss.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154975/1/jper10442_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154975/2/jper10442.pd

Development of a nomogram for the prediction of periodontal tooth loss using the staging and grading system: A long- term cohort study

AimTo develop and internally validate a nomogram built on a multivariate prediction model including parameters from the new classification of periodontal diseases, able to predict, at baseline, the occurrence of tooth loss due to periodontal reason (TLP).Materials and MethodsA total of 315 individuals diagnosed with periodontal disease and receiving a minimum of one annual supportive periodontal therapy visit were included in the study. Patients were staged and graded based upon baseline data. The population was divided into a development (254 patients) and a validation (61 patients) cohort to allow subsequent temporal validation of the model. According to the TLP at the 10- year follow- up, patients were categorized as - low tooth loss- (- ¤ 1 TLP) or - high tooth loss- (- ¥ 2 TLP). Bootstrap internal validation was performed on the whole data set to calculate an optimism- corrected estimate of performance.ResultsThe generated nomogram showed a strong predictive capability (AUC = 0.81) and good calibration with an intercept = 0 and slope = 1. These findings were confirmed by internal validation using bootstrapping (average bootstrap AUC = 0.83).ConclusionsThe clinical implementation of the present nomogram guides the prediction of patients with high risk of disease progression and subsequent tooth loss for personalized care.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163380/2/jcpe13362.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163380/1/jcpe13362_am.pd

Development and technical functionality of an Internet-based intervention for tinnitus in the UK

Purpose: Creative approaches to improve access to evidence-based tinnitus treatments are required. The purpose of this study was to develop an Internet-based cognitive behavioural therapy (iCBT) intervention, for those experiencing tinnitus in the United Kingdom(UK). Furthermore, it aimed, through technical functionality testing, to identify specific aspects of the iCBT that require improving. Method: An innovative iCBT intervention for treating tinnitus in the UK has been developed using a cognitivebehavioural theoretical framework. This iCBT was evaluated by two user groups during this developmental phase. Initially, five expert reviews evaluated the intervention, prior to evaluation by a group of 29 adults experiencing significant levels of tinnitus distress. Both groups evaluated iCBT in an independent measures design, using a specifically designed satisfaction outcome measure. Results: Overall, similar ratingswere given by the expert reviewers and adults with tinnitus, showing a high level of satisfaction regarding the content, suitability, presentation, usability and exercises provided in the intervention. The iCBT intervention has been refined following technical functionality testing. Conclusions: Rigorous testing of the developed iCBT intervention has been undertaken. These evaluations provide confidence that further clinical trials can commence in the UK, to assess the feasibility and effectiveness of this iCBT intervention for tinnitus

FACTORS INFLUENCING THE HARDNESS (MILLING ENERGY) AND MALTING QUALITY OF BARLEY

The hardness of samples of 41 barley cultivars grown in Australia was determined by measuring milling energy. The milling energy was negatively correlated (r= −0.49) with the starch and positively correlated (r=0.50) with the β‐glucan content. The correlation with protein content was not significant. This suggests that a low starch content and a high β‐glucan content may contribute to hardness but other factors may probably also be involved. The extent of modification of these barley samples measured by Calcofluor staining after steeping and 48 h of germination was correlated with the grain hardness (r= −0.56). Factors contributing to grain hardness may limit the rate of endosperm modification during malting, indicating the value of selecting softer cultivars for malting. 1990 The Institute of Brewing & Distillin

The effect of membrane exposure on lateral ridge augmentation: a case-controlled study

Abstract Background The effect of membrane exposure on guided bone regeneration (GBR) for lateral ridge augmentation has been poorly addressed. This case-controlled study aimed to investigate potential effect of membrane exposure lateral ridge augmentation and subsequent implant placement. Methods A total of 14 patients that did receive lateral ridge augmentation procedure using allogeneic cancellous graft particulate in combination with an alloplastic bioresorbable matrix barrier were retrospectively selected for this study. Bone width was measured at the crest with a digital caliper before bone augmentation and at the reopening for implant placement 4 months later for all patients. Cases where primary flap closure was achieved and the barrier did not expose throughout the time until implant placement were assigned to the control group (n = 7). Cases where primary closure could not be achieved or a barrier exposure happened within the first week following the initial surgery were assigned to the test group. Results The measured alveolar ridge width before surgery as well as after GBR procedure were not statistically significant different between the two groups (p > 0.05). Both groups showed a significant (p < 0.05) increase in their mean alveolar ridge width 4 months after later augmentation procedure, from 3.4 ± 1.2 to 6.0 ± 1.1 mm in the control group and from 3.6 ± 1.0 to 5.0 ± 1.4 mm in the test group. However, the mean alveolar ridge gain was significantly greater in the control group than in the test group (p < 0.05). Consequently, the reduction of the augmented alveolar ridge was significantly higher in the test group averaging to 4.7 mm than for the control group showing a loss of 3.1 mm after 4 months, respectively. However, in all 14 cases, successful implant placement was achieved after 4 months. Conclusions Within the limit of this study, it can be concluded that early exposure of a bioresorbable matrix barrier during lateral ridge augmentation may compromise the results of the GBR procedure but may still result in a favorable alveolar ridge width gain that allows for the placement of dental implants

Guest editorial: Clarifications on the use of the new classification of periodontitis

This editorial provides clarifications on the application of the Stage and Grade classification of periodontitis. In particular it describes: (1) how to apply the extent criterion to the defined Stage of the disease; and (2) how to calculate tooth loss because of periodontitis in Stage III and IV cases presenting with evidently hopeless (irrational to treat) teeth with a clinical definition of such teeth.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163551/2/jper10548_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163551/1/jper10548.pd