Georgios S. Chatzopoulos

Association of susceptible genotypes to periodontal disease with the clinical outcome and tooth survival after non-surgical periodontal therapy: A systematic review and meta-analysis

Background The real clinical utility of genetic testing is the prognostic value of genetic factors in the clinical outcome of periodontal treatment and the tooth survival. A meta-analysis was undertaken to estimate the effect of a susceptible genotype to periodontitis on the clinical outcomes of non-surgical periodontal therapy and the tooth survival. Material and Methods A systematic search of MEDLINE-Pubmed, Cochrane Library and Scopus was performed. Additionally, a hand search was done in three journals. No specific language restriction was applied. Two reviewers screened independently titles and abstracts or full text copies. Quality assessment of all the included studies was held. Results Initial screening of electronic databases resulted in 283 articles. Ten studies met the inclusion criteria, nine of them examined the clinical outcome, while the other one investigated the tooth survival in susceptible individuals after non-surgical periodontal therapy. Eight of included studies were selected for the meta-analysis. IL-1 positive genotypes increase the risk of tooth loss, while no association found between the bleeding on probing (BOP), clinical attachment loss (CAL) and plaque index (PI) with the genotype status. Probing pocket depth (PPD) reduction in the first three months and in long-term results found to have a significant association with the genotype. Conclusions There is no difference in the clinical measurements after non-surgical periodontal treatment, apart from PPD. More publications are needed to identify a cause-effect relationship. Key words:Periodontal disease, periodontitis, periodontal therapy, clinical outcome, tooth loss, susceptibility, polymorphism, genotype, meta-analysis, systematic review.

Implant and endodontic treatment selection are influenced by patients' demographic characteristics, insurance status, and medical history: A retrospective cohort study

OBJECTIVE The aim of this study was to examine any potential association between demographic characteristics, socioeconomic status, dental insurance, and medical and tobacco history between patients that received endodontic treatment or extraction and implant treatment in a university dental clinic. METHOD AND MATERIALS Dental charts of patients who received root canal treatment and implant therapy were retrieved from the University of Minnesota School of Dentistry records. Age at the time of the procedure, gender, medical history, tobacco use, dental insurance status, zip code, and type of treatment provided were recorded. Patients who had both treatment modalities were excluded from the analysis. RESULTS A total of 8,540 records of patients with a mean age of 50.66 years who have received either endodontic treatment (73.6%) or implant therapy (26.4%) were included. A statistically significant (P < .05) association was found between endodontic treatment or implant treatment as related to age, socioeconomic status, high blood pressure, asthma, thyroid disorders, arthritis, artificial joint, osteoporosis, depression, anxiety, cancer, and cancer treatment. Nonsmokers were significantly more likely to select a treatment plan with implants rather than an endodontic therapy. CONCLUSION Within the limitations of this retrospective study, demographic parameters, insurance status, smoking, and medical history significantly affected the treatment selection between implant and endodontic treatment in a university setting.

Photodynamic therapy in the treatment of aggressive periodontitis: A systematic review

Background Aggressive periodontitis (AgP) is a severe form of periodontal diseases with rapid destruction of the supporting bone around teeth. The efficacy of PDT in suppressing periodontal pathogens may be crucial in adopting new protocols for the treatment of AgP. Thus, the aim of this systematic review was to investigate the possible role of PDT in the treatment of AgP as an adjunctive therapy or monotherapy. Material and Methods A systematic search of the literature was performed. Additionally, the references from all the selected full-text studies were searched for relevant articles. Two reviewers screened independently titles and abstracts or full text copies. Quality assessment of all the included studies was held. Results Initial screening of electronic databases yielded 418 potentially relevant publications. After screening of the titles and full-text examination, five studies were included in the systematic review. Four publications evaluated the effects of PDT adjunctive to SRP in patients with AgP: two of them compared the clinical outcomes of SRP and PDT with a control group that received therapy with SRP and antibiotics (metronidazole and amoxicillin); two publications included SRP and PDT in the test group, and SRP alone in the control group. In one study, PDT was tested as a monotherapy compared with SRP alone. Conclusions Within the limitations of this review, PDT may exhibit a beneficial role in the therapy of aggressive periodontitis after repeated applications. In the future, more methodologically sound, long-term randomized clinical trials are needed to be conducted. Key words:Photodynamic therapy, periodontitis, systematic review.

Systematic review of cyclosporin A-induced gingival overgrowth and genetic predisposition

OBJECTIVE This systematic review aimed to investigate the influence of gene polymorphisms on the development of gingival overgrowth in renal transplant patients treated with cyclosporin A. METHOD AND MATERIALS Electronic and hand literature searches were conducted by two independent reviewers in MEDLINE-Pubmed, Cochrane Library, ISI Web of Science, and SCOPUS Elsevier for prospective (case-control studies, cohort studies), cross-sectional, and retrospective studies published up to June 2016 (first week) in any language. Data were reviewed and extracted in duplicate independently. Methodologic quality assessment of the included studies was performed during the data extraction process. RESULTS Due to the estimated high risk of bias and the heterogeneity of the included studies in regards to the variety of medications administered to study patients, a systematic review of the literature and not a meta-analysis of the data was performed. Fourteen articles meeting study inclusion criteria were selected for data extraction that examined the association between various genetic polymorphisms and gingival overgrowth in kidney transplant patients receiving cyclosporin A. Interleukin-1A, interleukin-10, transforming growth factor-β1 and androgen receptor gene polymorphisms may have a significant effect on an individual susceptibility to cyclosporin A-induced gingival overgrowth in renal transplant patients. CONCLUSION Genetic polymorphisms seem to affect the development of cyclosporin A-induced gingival overgrowth in renal transplant patients. Pharmacogenetics and pharmacogenomics have the potential to determine the clinical outcome of a medication, the drug efficacy, and adverse drug reactions such as gingival overgrowth.

Prevalence of temporomandibular symptoms and parafunctional habits in a university dental clinic and association with gender, age, and missing teeth

Abstract Objective To assess the prevalence of symptoms of temporomandibular disorder (TMD) and parafunctional habits as well as to investigate their association with age, gender, and number of missing teeth. Methods This retrospective study is based on 4204 randomly selected patients who were examined to determine their symptoms of TMD, such as clicking, difficulty chewing, difficulty opening/closing, as well self-reported joint pain and parafunctional habits. Results Clenching/grinding was reported by 26.5% of the examined population, clicking by 14.8%, and difficulty chewing and closing by 3.6%. Significant associations between the number of missing teeth with clenching/grinding (p = 0.05) and difficulty chewing (p < 0.001) were detected. Age and gender showed significant effects on the examined parameters (p < 0.05). Discussion Understanding the TMD subjective symptoms in relation to age, gender, and tooth loss would be of great value for treatment planning and could provide other perspectives to establish preventive measures.

Association between susceptible genotypes to periodontitis and clinical outcomes of periodontal regenerative therapy: a systematic review

Background The aim of this review is to systematically investigate the effect of a susceptible genotype to periodontitis with the clinical outcomes of periodontal regeneration. Material and Methods Based on a focused question, an electronic search identified 155 unique citations. Three journals (Journal of Periodontology, Journal of Clinical Periodontology and Journal of Periodontal Research), references of relevant studies and review articles were hand-searched. Two independent reviewers implementing eligibility inclusion criteria selected the studies. Results Of the 155, four studies fulfilled the inclusion criteria. All studies were published between 2000 and 2004 and the samples’ size was 40 to 86 patients. Polymorphisms of Interleukin-1 (IL-1) gene were included in all. Three out of four studies failed to identify an association between susceptible genotypes to periodontitis and clinical outcomes of periodontal regeneration, while one found an association. The heterogeneity and small number of studies included prevented the conduct of a meta-analysis. No studies were identified evaluating the effect of other genotypes and as a result only IL-1 genotype studies were included. Conclusions Within the limits of the present review, no direct conclusion for the effect of a susceptible IL-1 genotype status to the clinical outcome after periodontal regeneration could be drawn. The need of more qualitative studies to explore a possible association emerges. Key words:Periodontitis, genotype, periodontal therapy, regeneration, susceptibility, systematic review.

Systemic medical conditions and periodontal status in older individuals

AIMS The purposes of this study are to: (1) assess the prevalence of systemic and periodontal disease in older individuals, (2) compare periodontal conditions between four age cohorts, and (3) investigate the relationship between periodontal disease and systemic medical conditions. METHODS Electronic records from a total of 5,000 adults were randomly selected from the University of Minnesota School of Dentistry database. Individuals ≥60 years of age, with at least six remaining teeth in their dentition with a complete medical history and full-mouth series of radiographs were included in the study to determine the severity of periodontal disease based on the percentage of radiographic bone loss. RESULTS A total of 2,163 patients were included in the final analysis. The multivariable regression analysis showed that patients self-reported tobacco use and diabetes were significantly associated with moderate and severe bone loss than none to mild, whereas the opposite was found for those with joint replacement, past use of steroids and acid reflux/GERD. CONCLUSION A number of systemic medical conditions and tobacco use are associated with periodontitis. This reflects the importance of an interdisciplinary interaction between dental and medical professionals.

Implant and root canal treatment: Survival rates and factors associated with treatment outcome

OBJECTIVES To assess and compare the survival rates of implant and root canal treatment as well as to investigate the effect of patient and tooth related variables on the treatment outcome in a large-scale population-based study. METHODS Dental records of patients who received root canal treatment and implant therapy were retrieved from the electronic records of the University of Minnesota School of Dentistry. Demographic characteristics, dental insurance status, socioeconomic status as well as medical history and tobacco use were recorded. The treatment outcome was included as a binary variable (survival/failure). RESULTS A total of 13,434 records of patients who had implant (33.6%) or root canal therapy (66.4%) were included. The survival rate analysis and Kaplan-Meier table revealed the majority of the implants were removed within the first year (58.8%), while only 35.2% of the root canal treatments failed in the same time period. The overall survival rate was significantly (p < 0.001) higher for implant therapy (98.3%) compared to root canal treatment (72.7%). A statistically significant association was found between treatment (p <n0.001), age (p < 0.001) and anxiety (p = 0.004) with treatment outcome CONCLUSIONS: Implant therapy exhibited significantly lower failures when compared to root canal treatment, but the selection of either treatment should be based on multiple factors. Higher age and anxiety were also significantly associated with root canal and implant treatment failure. CLINICAL SIGNIFICANCE Clinicians are in an increased dilemma that affects the decision-making process due to the inadequate evidence in regards to the question of retention or extraction of a tooth in the natural dentition. This study demonstrated that both root canal and implant treatments are sound options with high survival rates; however, root canal therapy exhibited a significantly higher failure rate.

Symptoms of temporomandibular disorder, self-reported bruxism, and the risk of implant failure: A retrospective analysis

Abstract Objective To investigate the association between symptoms of temporomandibular disorder and self-reported bruxism with the risk of implant failure. Methods This retrospective study is based on 2127 records of patients who had 4519 implants placed and restored at the University of Minnesota School of Dentistry. Patient and implant level information were retrieved from each dental record: age, gender, implant location, as well as history of clicking, pain, difficulty opening, difficulty chewing, and clenching or grinding. Results A total of 51 implant failures were identified in the sample. This corresponded to a failure rate of 1.1% at the implant level and 1.7% at the patient level. Among all the patient and implant level variables, the binary logistic regression showed that none of them were significantly associated with implant failure (p > 0.05). Discussion The identification of risk indicators for implant loss can foster long-term implant survival, peri-implant health, and ultimately, implant prosthesis survival.

Interleukin-6 and interleukin-10 gene polymorphisms and the risk of further periodontal disease progression

Susceptible genotypes to periodontal disease are associated with disease onset and progression. The aim of this study was to examine the effect of gene polymorphisms on the risk of further disease progression and the need for further treatment among adults with chronic periodontal disease. Sixty-seven patients diagnosed with chronic periodontitis were grouped according to genotype status and risk of further progression of disease and tooth loss. All individuals were clinically evaluated for probing pocket depth, clinical attachment loss and bleeding on probing at baseline and 45 days after treatment. Blood samples were collected at baseline and genotyping of the polymorphisms in IL-6 (rs1800796) and IL-10 (rs1800872) genes were performed by PCR. Following DNA separation and genotyping, 65.7% of the patients were homozygous carriers of the IL-6 -572G and 49.3% were carriers of the IL-10 -592A allele. Individuals at risk of disease progression ranged from 7.5% to 62.7% based on the criteria used. Carriers of the IL-10 -592A allele were significantly associated with BOP ≥ 30% and therefore exhibited a higher risk of further periodontal breakdown (p = 0.018) with an odds ratio of 1.18. None of the other definitions of disease progression were significantly associated with the examined IL-6 and IL-10 genotypes (p > 0.05). IL-10 polymorphism was associated with an increased risk of further disease progression and the potential need for further treatment following non-surgical periodontal treatment. Susceptible IL-6 genotypes were not associated with the risk of persisting or recurrent disease activity.