Formation of Normal Gingival Epithelial Phenotypes Around Osseo‐Integrated Oral Implants in Humans

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141694/1/jper0933.pd

Periodontal infrabony defects: Systematic review of healing by defect morphology following regenerative surgery.

AbstractBackgroundIt is thought that infrabony defect morphology affects the outcome of periodontal regenerative surgery. However, this has not been systematically investigated.AimsTo investigate how well defect morphology is described in papers reporting regenerative therapy of periodontal infrabony defects and to investigate its effect on clinical and radiographic outcomes.Materials and MethodsA search was conducted in 3 electronic databases for publications reporting clinical and radiographic outcomes of periodontal intra‐bony defects after regenerative therapy, divided by defect morphology.ResultsThe initial search resulted in 4487 papers, reduced to 143 after first and second screening. Fifteen of these publications were suitable for a fixed‐effects meta‐analysis. Initial defect depth was found to influence radiographic bone gain 12 months post‐surgery, while narrower angles and increased number of walls influenced both radiographic bone gain and clinical attachment level (CAL) gain at 12 months. These associations seemed to occur irrespective of biomaterials used. Risk of bias ranged from low to high.ConclusionDeeper defects with narrower angles and increased number of walls exhibit improved CAL and radiographic bone gain at 12 months post‐regenerative surgery. More data are needed about other aspects of defect morphology such as extension to buccal/lingual surfaces

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

The in vitro effect of different PRP concentrations on osteoblasts and fibroblasts

Objectives:The aim of this study was to assess the biological rationale for the use of platelet-rich plasma (PRP) by evaluating the effect of different concentrations of PRP on osteoblasts (OB) and fibroblasts (FB) function in vitro. Materials and methods:PRP was obtained from volunteer donors using standard protocols. Primary human cultures of oral FBs and OBs were exposed to both activated and non-activated plasma as well as various concentrations of PRP (2.5 x, 3.5 x and max (4.2-5.5 x)). Cell proliferation was evaluated after 24 and 72 h using an MTT proliferation assay. Production of osteocalcin (OCN), osteoprotegerin (OPG) and transforming growth factor beta 1 (TGF-beta 1) was evaluated in OB after 24 and 72 h. Statistical analysis was performed using one-way ANOVA. Results:PRP-stimulated cell proliferation in both OBs and FBs. The effect of different PRP concentrations on cell proliferation was most notable at 72 h. The maximum effect was achieved with a concentration of 2.5 x, with higher concentrations resulting in a reduction of cell proliferation. Upregulation of OCN levels and downregulation of OPG levels were noted with increasing PRP concentrations at both 24 and 72 h. TGF-beta 1 levels were stimulated by increasing concentrations of PRP, with the increased levels being maintained at 72 h. Conclusions:PRP preparations exert a dose-specific effect on oral FBs and OBs. Optimal results were observed at a platelet concentration of 2.5 x, which was approximately half of the maximal concentrate that could be obtained. Increased concentrations resulted in a reduction in proliferation and a suboptimal effect on OB function. Hence, different PRP concentrations may have an impact on the results that can be obtained in vivo

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

Multi-stakeholder contribution to the identification of a core outcome set and measurements in implant dentistry (ID-COSM initiative) using the Delphi methodology

AIM: To obtain input from multiple stakeholders and generate agreement on essential outcomes in implant dentistry using the Delphi methodology and incorporate them into an international consensus defining a core outcome set. MATERIALS AND METHODS: Candidate outcomes in implant dentistry were generated from scientific evidence through five commissioned systematic reviews and from people with lived experience in dental implants (PWLE) through four international focus groups. A steering committee identified stakeholders among representatives from dental professionals, industry-related experts and PWLE. Participants underwent a three-round Delphi survey using a multi-stakeholder approach; they assessed candidate outcomes and additional outcomes identified in the first Delphi round. The process followed the COMET methodology. RESULTS: From the 665 potential outcomes identified in the systematic reviews and 89 in the PWLE focus group, the steering committee selected 100 and organized them into 13 categories, to be included in the first-round questionnaire as candidate outcomes. A total of 99 dental experts, 7 dental-industry-related experts and 17 PWLE participated in the first round, and 11 additional outcomes were added to the second round. There was no attrition between the first and second rounds, where 61 (54.9%) outcomes exceeded the pre-established threshold of agreement. PWLE and experts participated in the third round that applied "a priori" standard filters to distil a list of candidate essential outcomes. CONCLUSION: This Delphi study utilized a standardized, transparent and inclusive methodology and preliminarily validated 13 essential outcomes organized into four core areas. These results informed the final stage of the ID-COSM consensus

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

Aesthetic- And patient- related outcomes following root coverage procedures: A systematic review and network meta- analysis

BackgroundAim of this systematic review (SR) of randomized controlled trials (RCTs) was to evaluate effect of different flap designs and graft materials for root coverage, in terms of aesthetics, patient satisfaction and self- reported morbidity (post- operative pain/discomfort).Material and MethodsA comprehensive literature search was performed. A mixed- modelling approach to network meta- analysis was utilized to formulate direct and indirect comparisons among treatments for Root Coverage Esthetic Score (RES), with its individual components, and for subjective patient- reported satisfaction and post- operative pain/discomfort (visual analogue scale (VAS) of 100).ResultsTwenty- six RCTs with a total of 867 treated patients (1708 recessions) were included. Coronally Advanced Flap (CAF) + Connective Tissue Graft (CTG) (0.74 (95% CI [0.24, 1.26], p = .005)), Tunnel (TUN) + CTG (0.84 (95% CI [0.15, 1.53]), p = .01) and CAF + Graft substitutes (GS) (0.55 (95% CI [0.006, 1.094], p = .04)) were significantly associated with higher RES than CAF. No significant difference between CAF + CTG and TUN + CTG was detected (0.09 (95% CI [- 0.54, 0.72], p = .77)). Addition of CTG resulted in less natural tissue texture (- 0.21 (95% CI [- 0.34, - 0.08]), p = .003) and gingival colour (- 0.06 (95% CI [- 0.12, - 0.03], p = .03)) than CAF. CTG techniques were associated with increased morbidity.ConclusionsConnective tissue graft procedures showed highest overall aesthetic performance for root coverage, although graft integration might impair soft tissue colour and appearance. Additionally, CTG- based techniques were also correlated with a greater patient satisfaction and morbidity.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163404/2/jcpe13346.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163404/1/jcpe13346_am.pd

Treatment of stage I–III periodontitis—The EFP S3 level clinical practice guideline

BACKGROUND The recently introduced 2017 World Workshop on the classification of periodontitis, incorporating stages and grades of disease, aims to link disease classification with approaches to prevention and treatment, as it describes not only disease severity and extent but also the degree of complexity and an individual's risk. There is, therefore, a need for evidence-based clinical guidelines providing recommendations to treat periodontitis. AIM The objective of the current project was to develop a S3 Level Clinical Practice Guideline (CPG) for the treatment of Stage I-III periodontitis. MATERIAL AND METHODS This S3 CPG was developed under the auspices of the European Federation of Periodontology (EFP), following the methodological guidance of the Association of Scientific Medical Societies in Germany and the Grading of Recommendations Assessment, Development and Evaluation (GRADE). The rigorous and transparent process included synthesis of relevant research in 15 specifically commissioned systematic reviews, evaluation of the quality and strength of evidence, the formulation of specific recommendations and consensus, on those recommendations, by leading experts and a broad base of stakeholders. RESULTS The S3 CPG approaches the treatment of periodontitis (stages I, II and III) using a pre-established stepwise approach to therapy that, depending on the disease stage, should be incremental, each including different interventions. Consensus was achieved on recommendations covering different interventions, aimed at (a) behavioural changes, supragingival biofilm, gingival inflammation and risk factor control; (b) supra- and sub-gingival instrumentation, with and without adjunctive therapies; (c) different types of periodontal surgical interventions; and (d) the necessary supportive periodontal care to extend benefits over time. CONCLUSION This S3 guideline informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to treat periodontitis and to maintain a healthy dentition for a lifetime, according to the available evidence at the time of publication

Involving people with lived experience in developing a core outcome set for implant dentistry research. The Impant Dentistry-Core Outcomes Sets and Measures (ID-COSM) project

AIMS: The aims of this project were to establish the outcomes for dental implant research that are important to people with lived experience (PWLE) and to achieve consensus with those developed by dental professionals (DPs) for a core outcome set (COS). This paper reports the process, outcomes and experiences of involving PWLE in developing a COS for dental implant research: the Implant Dentistry Core Outcome Sets and Measures project. MATERIALS AND METHODS: Overall methods were guided by the Core Outcome Set Measures in Effectiveness Trials (COMET) initiative. Initial outcome identification was achieved from focus groups with PWLE employing calibrated methods across two low-middle-income countries (China and Malaysia) and two high-income countries (Spain and the United Kingdom). Following consolidation of the results, the outcomes were incorporated into a three-stage Delphi process with PWLE participation. Finally, consensus between PWLE and DPs was achieved using a mixed live and recorded platform. The experiences of PWLE involvement in the process was also evaluated. RESULTS: Thirty-one PWLE participated in four focus groups. Thirty-four outcomes were suggested across the focus groups. Evaluation of the focus groups revealed a high level of satisfaction with the engagement process and some new learning. Seventeen PWLE contributed to the first 2 Delphi rounds and 7 to the third round. The final consensus included 17 PWLE (47%) and 19 DPs (53%). Out of the total of 11 final consensus outcomes considered essential by both PWLE and health professionals, 7 (64%) outcomes mapped across to ones that PWLE initially identified, broadening their definition. One outcome (PWLE effort required for treatment and maintenance) was entirely novel. CONCLUSIONS: We conclude that engaging PWLE in COS development can be achieved across widely different communities. Furthermore, the process both broadened and enriched overall outcome consensus, yielding important and novel perspectives for health-related research