Enamel matrix proteins in the regenerative therapy of deep intrabony defects A multicentre randomized controlled clinical trial

Abstract Aim: This prospective multicentre randomized controlled clinical trial was designed to compare the clinical outcomes of papilla preservation flap surgery with or without the application of enamel matrix proteins (EMD). Material and methods: 172 patients with advanced chronic periodontitis were recruited in 12 centers in 7 countries. All patients had at least one intrabony defect of у3mm. Heavy smokers (у20 cigarettes/day) were excluded. The surgical procedures included access for root instrumentation using either the simplified or the modified papilla preservation flap in order to obtain optimal tissue adaptation and primary closure. After debridement, roots were conditioned for 2 min with a gel containing 24% EDTA. EMD was applied in the test subjects, and omitted in the controls. Postsurgically, a strict plaque control protocol was followed. At baseline and 1 year following the interventions, clinical attachment levels (CAL), pocket probing depths (PPD), recession (REC), full-mouth plaque scores and full-mouth bleeding scores were assessed. A total of 166 patients were available for the 1-year follow-up

Retrospective long-term analysis of tooth loss over 20 years in a specialist practice setting: periodontally healthy/gingivitis and 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)

Subgingival debridement efficacy of glycine powder air polishing

Background: Glycine powder air polishing (GPAP) has been shown to be significantly more effective in reducing the subgingival cultivable microflora in shallow periodontal pockets compared to curets and is safe when applied directly to root surfaces. The purpose of this study was to assess the subgingival debridement efficacy of GPAP in periodontal pockets with various depths. Methods: In each of 60 patients with severe periodontitis, one tooth with a probing depth (PD) ≥6 mm was randomly assigned to one of the following interventions: GPAP performed in teeth instrumented 3 months earlier (I); GPAP performed in previously non-instrumented teeth (NI); or no treatment (control). GPAP was performed for 5 seconds per surface. After extraction, teeth were stained with 0.5% toluidine blue, and subgingival debridement efficacy was assessed. Results: Overall, median debridement depth was 2.00 mm in I teeth and 1.86 mm in NI teeth, and the median debrided root surface was 49.24% and 45.64%, respectively. In anatomic PDs (APDs) of 2 to 3 mm, relative debridement depth (debridement depth/APD) ranged from 65% to 80% and 60% to 75% in 1 and NI teeth, respectively; the corresponding values for debrided root surface were 60% to 70% and 50% to 60%. In control teeth, virtually all subgingival root surfaces were stained. Clinical PD measurements were a median of 1.05 mm deeper than APD. Conclusion: GPAP for 5 seconds per surface is effective in removing most of the subgingival biofilm in periodontal pockets with an APD ≤3 mm.link_to_subscribed_fulltex

Xenogenic collagen matrix or autologous connective tissue graft as adjunct to coronally advanced flaps for coverage of multiple adjacent gingival recession: Randomized trial assessing non-inferiority in root coverage and superiority in oral health-related quality of life

Aim: To evaluate the non-inferiority of the adjunct of a xenogeneic collagen matrix (CMX) or connective tissue graft (CTG) to coronally advanced flaps (CAF) for coverage of multiple adjacent recessions and compare superiority in patient-reported outcomes (PROM). Material and methods: One hundred and eighty-seven subjects (92 CMX) with 485 recessions in 14 centres were randomized and followed up for 6 months. Patients filled daily diaries for 15 days to monitor patient-reported experience. The primary outcome was changed in position of the gingival margin. Multilevel analysis used centre, subject and tooth as levels and baseline parameters as covariates. Results: Average baseline recession was 2.5 ± 1.0 mm. The surgery was 15.7 min shorter (95%CI from 11.9 to 19.6, p <.0001) and perceived lighter (11.9 VAS units, 95%CI from 4.6 to 19.1, p =.0014) in CMX subjects. Time to recovery was 1.8 days shorter in CMX. Six-month root coverage was 1.7 ± 1.1 mm for CMX and 2.1 ± 1.0 mm for CTG (difference of 0.44 mm, 95%CI from 0.25 to 0.63 mm). The upper limit of the confidence interval was over the non-inferiority margin of 0.25 mm. Odds of complete root coverage were significantly higher for CTG (OR = 4.0, 95% CI 1.8â\u80\u938.8). Conclusion: Replacing CTG with CMX shortens time to recovery and decreases morbidity, but the tested generation of devices is probably inferior to autologous CTG in terms of root coverage. Significant variability in PROMs was observed among centres

Enamel matrix proteins in the regenerative therapy of deep intrabony defects: A multicentre randomized controlled clinical trial

Aim: This prospective multicentre randomized controlled clinical trial was designed to compare the clinical outcomes of papilla preservation flap surgery with or without the application of enamel matrix proteins (EMD). Material and methods: 172 patients with advanced chronic periodontitis were recruited in 12 centers in 7 countries. All patients had at least one intrabony defect of ≥3mm. Heavy smokers (≥20 cigarettes/day) were excluded. The surgical procedures included access for root instrumentation using either the simplified or the modified papilla preservation flap in order to obtain optimal tissue adaptation and primary closure. After debridement, roots were conditioned for 2 min with a gel containing 24% EDTA. EMD was applied in the test subjects, and omitted in the controls. Postsurgically, a strict plaque control protocol was followed. At baseline and 1 year following the interventions, clinical attachment levels (CAL), pocket probing depths (PPD), recession (REC), full-mouth plaque scores and full-mouth bleeding scores were assessed. A total of 166 patients were available for the 1-year follow-up. Results: At baseline, 86 test and 86 control patients presented with similar subject and defect characteristics. On average, the test defects gained 3.1 ± 1.5 mm of CAL, while the control defects yielded a significantly lower CAL gain of 2.5 ± 1.5 mm. Pocket reduction was also significantly higher in the test group (3.9 ± 1.7 mm) when compared to the controls (3.3 ± 1.7 mm). A multivariate analysis indicated that the treatment, the clinical centers, cigarette smoking, baseline PPD, and defect corticalisation significantly influenced CAL gains. A frequency distribution analysis of the studied outcomes indicated that EMD increased the predictability of clinically significant results (CAL gains ≥4 mm) and decreased the probability of obtaining negligible or no gains in CAL (CAL gains <2 mm). Conclusions: The results of this trial indicated that regenerative periodontal surgery with EMD offers an additional benefit in terms of CAL gains, PPD reductions and predictability of outcomes with respect to papilla preservation flaps alone. © Blackwell Munksgaard, 2002.link_to_subscribed_fulltex