Ti-Sun Kim

Guided tissue regeneration with bioabsorbable barriers III 10-year results in infrabony defects

OBJECTIVE Evaluation of the 10-year results after GTR-therapy of infrabony defects using two bioabsorbable barriers in a randomized-controlled clinical trial. MATERIAL AND METHODS In 15 patients with periodontitis, 15 pairs of infrabony defects were treated. For each patient, one defect received a polydioxanon (test: T) and the other received a polylactide acetyltributyl citrate (control: C) barrier by random assignment. At baseline, 12 and 120 +/- 6 months after surgery, the clinical parameters and standardized radiographs were obtained. RESULTS Nine patients were available for the 120-month re-examinations. Twelve and 120 +/- 6 months after therapy statistically significant (p<or=0.004) vertical probing attachment level (PAL-V) gain was found in both groups (T12: 3.9 +/- 1.6 mm; T120: 2.4 +/- 1.8 mm; C12: 4.0 +/- 1.1 mm; C120: 2.4 +/- 1.7 mm). From 12 to 120 months both groups experienced PAL-V loss (T: 1.4 +/- 1.5 mm, p=0.021; C: 1.6 +/- 2.5 mm, p=0.09). After 120 month, two teeth were lost in the control group (one periapical lesion, and one due to unknown reason). The study failed to show statistically significant differences between both groups regarding PAL-V gain 120 months after surgery. CONCLUSIONS PAL-V gain achieved after GTR therapy in infrabony defects using both bioabsorbable barriers was stable after 10 years in 15 of 22 defects (68%).

Is frequency of tooth brushing a risk factor for periodontitis? A systematic review and meta-analysis

OBJECTIVES The epidemiology of periodontitis regarding oral-hygiene practices particularly the frequency of tooth brushing has been the subject of relatively few dedicated studies. This paper provides a systematic review of available relevant epidemiological studies and a meta-analysis of the effect of tooth brushing frequency on periodontitis. To review and to quantify the risk for periodontitis associated with frequency of tooth brushing. METHODS Systematic literature search was conducted in nine online resources (PUBMED, ISI and 7 additional databases). Related and cross-referencing publications were reviewed. Papers published until end of March 2013 reporting associations between tooth brushing frequency and periodontitis were considered. A meta-analysis was performed to quantify this association. RESULTS Fourteen studies were identified. The test of heterogeneity for cross-sectional studies was not significant (P = 0.31). A fixed-effects model yielded a significant overall odds ratio estimate of 1.41 (95%CI: 1.25-1.58, P < 0.0001) for infrequent compared to frequent tooth brushing. For all fourteen studies, there was a slight indication for heterogeneity (I² = 48%, P = 0.02) and the corresponding result with a random-effects model was 1.44 (95%CI: 1.21-1.71, P < 0.0001). CONCLUSIONS There are relatively few studies evaluating the association between tooth brushing frequency and periodontitis. A clear effect was observed, indicating that infrequent tooth brushing was associated with severe forms of periodontal disease. Further epidemiological studies are needed to precisely estimate the effect of key risk factors for periodontitis and their interaction effects.

MR-Imaging of teeth and periodontal apparatus: an experimental study comparing high-resolution MRI with MDCT and CBCT

ObjectivesThe aim of this study was (1) to assess the ability of magnetic resonance imaging (MRI) to visualize dental and periodontal structures and (2) to compare findings with multidetector computed tomography (MDCT) and cone beam CT (CBCT).Materials and methodsFour porcine mandibles were examined with (1) 3T-MRI, (2) MDCT and (3) CBCT. Two observers independently reviewed MR, MDCT and CBCT images and assessed image quality of different dental and periodontal structures. To assess quantitatively the accuracy of the different imaging technique, both observers measured burr holes, previously drilled in the mandibles.ResultsDental structures, e.g. teeth roots, pulpa chamber and dentin, were imaged accurately with all imaging sources. Periodontal space and cortical/trabecular bone were better visualized by MRI (p < 0.001). MRI could excellently display the lamina dura, not detectable with MDCT and only inconstant visible with CBCT (p < 0.001). Burr hole measurements were highly precise with all imaging techniques.ConclusionsThis experimental study shows the diagnostic feasibility of MRI in visualization of teeth and periodontal anatomy. Detection of periodontal structures was significantly better with MRI than with MDCT or CBCT. Prospective trials have to evaluate further the potential benefit of MRI in a clinical setting.

Is progression of periodontitis relevantly influenced by systemic antibiotics? A clinical randomized trial

AIM We investigated the long-term impact of adjunctive systemic antibiotics on periodontal disease progression. Periodontal therapy is frequently supplemented by systemic antibiotics, although its impact on the course of disease is still unclear. MATERIAL & METHODS This prospective, randomized, double-blind, placebo-controlled multi-centre trial comprising patients suffering from moderate to severe periodontitis evaluated the impact of rational adjunctive use of systemic amoxicillin 500 mg plus metronidazole 400 mg (3x/day, 7 days) on attachment loss. The primary outcome was the percentage of sites showing further attachment loss (PSAL) ≥1.3 mm after the 27.5 months observation period. Standardized therapy comprised mechanical debridement in conjunction with antibiotics or placebo administration, and maintenance therapy at 3 months intervals. RESULTS From 506 participating patients, 406 were included in the intention to treat analysis. Median PSAL observed in placebo group was 7.8% compared to 5.3% in antibiotics group (Q25 4.7%/Q75 14.1%; Q25 3.1%/Q75 9.9%; p < 0.001 respectively). CONCLUSIONS Both treatments were effective in preventing disease progression. Compared to placebo, the prescription of empiric adjunctive systemic antibiotics showed a small absolute, although statistically significant, additional reduction in further attachment loss. Therapists should consider the patients overall risk for periodontal disease when deciding for or against adjunctive antibiotics prescription.

Prognostic value of the periodontal risk assessment in patients with aggressive periodontitis

OBJECTIVES Aim of the study was to evaluate the predictive value of the modified periodontal risk assessment (PRA) in patients with aggressive periodontitis (AgP) for the first time. MATERIAL AND METHODS A total of 86 Patients with AgP were re-examined 5-17 years after active periodontal treatment. Risk profile according to the modified PRA was assigned and regularity of maintenance monitored. Tooth loss, bone loss and recurrence of periodontitis were analysed in association with gender, diagnosis, compliance and risk profile using uni- and multivariate parametric regression and Cox proportional hazards models. RESULTS A total of 14 patients showed a localized AgP, 60 a high-risk-profile and 19 were compliant with the proposed maintenance-interval. Of 2202 teeth 98 were lost. Multivariate analysis could not assign a statistically significant impact to risk-profile. By excluding Interleukin-1 composite genotype from the modified PRA a significant influence (p = 0.003, HR 2.74) was detected. The impact of compliance was shown to be nearly significant (p = 0.059, HR 2.0). In patients with generalized AgP a tendency for increased tooth loss was found. CONCLUSION The prognostic value of the modified PRA could not be confirmed in patients with AgP. However, exclusion of Interleukin-1 composite genotype led to a model with significant influence on tooth loss.

Interproximal bone loss at contra‐lateral teeth with and without root canal filling in periodontitis patients

AIM The purpose of this study was to test the hypothesis that teeth that are adequately endodontically treated develop more periodontal bone loss than their contra-lateral counterpart without root canal filling (RCF) in relation to the restoration margin (RM) in periodontitis patients. METHODS In 53 periodontitis patients (26 females; 34-73 years of age), 66 pairs of radiographs were sampled. Each pair of radiographs depicted one pair of contra-lateral teeth: one with and one without RCF. All radiographs were digitized. Using a PC program the linear distances cemento-enamel junction (CEJ) or RM to the alveolar crest (AC) and CEJ/RM to bony defect (BD) were measured at the site of most pronounced bone loss. Comparisons were made according to RCF, RM, site (mesial/distal), jaw and tooth type (anterior/posterior). RESULTS The study showed statistically significant differences for the distance CEJ/RM-BD only for tooth type (anterior: 6.17 ± 3.01 mm, posterior: 5.03 ± 2.59 mm, p=0.044; without RCF: 5.14 ± 2.82 mm, RCF: 5.57 ± 2.70 mm, p=0.159; without RM: 5.67 ± 2.98 mm, RM: 5.16 ± 2.61 mm; p=0.322; mesial: 5.62 ± 2.98 mm, distal: 5.06 ± 2.24 mm; p=0.238; maxilla: 5.55 ± 3.04 mm, mandible: 5.20 ± 2.52 mm; p=0.486). CONCLUSIONS Teeth with endodontic treatment failed to exhibit more bone loss than endodontically untreated teeth.

Regenerative therapy of infrabony defects with or without systemic doxycycline. A randomized placebo‐controlled trial

AIM Comparison of regenerative therapy of infrabony defects with and without administration of postsurgical systemic doxycycline (DOXY). METHODS In each of 61 patients one infrabony defect was treated with enamel matrix derivative (EMD), EMD plus filler or membrane at two centres. By random assignment patients received either 200 mg DOXY per day or placebo (PLAC) for 7 days after surgery. Prior to and 6 months after surgery probing pocket depths (PPD) and vertical attachment level (PAL-V) were obtained. RESULTS Fifty-four patients (DOXY: 27; PLAC: 27) were re-examined after 6 months and had been treated exclusively with EMD. Seven to 8 days after surgery 81% of defects in both groups showed complete flap closure. In both groups significant (p < 0.001) PPD reduction (DOXY: 3.87 ± 1.44 mm; PLAC: 3.67 ± 1.30 mm) and PAL-V gain (DOXY: 3.11 ± 1.50 mm; PLAC: 3.32 ± 1.83 mm) were observed. However, the differences failed to be statistically significant (PPD: 0.20; p = 0.588; PAL-V: 0.21; p = 0.657). CONCLUSIONS Two hundred milligram systemic DOXY administered for 7 days after therapy of infrabony defects with EMD failed to result in better PPD reduction and PAL-V gain compared with PLAC which may be due to low power (50%) and, thus, random chance.

Comparison of two different microbiological test kits for detection of periodontal pathogens

Abstract Objective. The aim of this study was to compare the outcome of two different microbiological tests for detection of Aggregatibacter actinomycetemcomitans (A.a.), Porphyromonas gingivalis (P.g.), Tannerella forsythia (T.f.) and Treponema denticola (T.d.). Material and methods. A total of 69 adult patients with severe chronic (sCP) or aggressive periodontitis (AgP) participated in the study. Microbiological samples were examined for A.a., P.g., T.f. and T.d. using an RNA probe test (PADO) and a real-time polymerase chain reaction test (MERI). Results. For all periodontal pathogens under investigation, the median bacterial counts detected with PADO were smaller compared to those detected with MERI. P.g., T.f. and T.d. could be found in the majority of all patients with both tests. With MERI, A.a. was detected more often (24.6%) than with PADO (18.8%). Only 10.1% of the patients tested positive for A.a. with both tests. Conclusion. Both tests showed a high percentage of agreement for P.g., T.f. and T.d., but exhibited marked differences in the detection of A.a.

Periodontal pathogens and associated factors in aggressive periodontitis: results 5–17 years after active periodontal therapy

OBJECTIVES To assess the association between presence of periodontal pathogens and recurrence of disease in patients with aggressive periodontitis (AgP) after active periodontal therapy (APT) and further influencing factors. MATERIAL & METHODS Microbiological samples were taken from 73 patients with AgP 5-17 years after APT at 292 sites (deepest site per quadrant). Real-time polymerase chain reactions were used to detect the periodontal pathogens Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola. Uni- and multivariate analyses evaluated the associations between pathogens and recurrence of disease, smoking and adjunctive antibiotic therapy. RESULTS At re-examination A. actinomycetemcomitans could be detected in six patients (8.2%), P. gingivalis in 24 (32.9%), T. forsythia in 31 (42.5%) and T. denticola in 35 (48.0%). Increased levels of T. forsythia and T. denticola at re-examination were significantly associated with recurrence of disease in multivariate analyses (OR: 12.72, p < 0.001; OR 5.55, p = 0.002 respectively). Furthermore, high counts of T. denticola were found in patients with increased percentage of sites with clinical attachment levels (CAL) ≥ 6 mm compared to those with low counts (13.8% versus 3.2%, p = 0.005). CONCLUSION In patients with recurrence of disease T. forsythia and T. denticola were detected more frequently and in higher counts. Furthermore, T. denticola was found more frequently in patients with increased CAL.

IL-1-polymorphism and severity of periodontal disease

Abstract Objective. To determine the association between the interleukin (IL)-1-polymorphism and the severity of periodontal disease prior to active periodontal therapy. Materials and methods. Two hundred and six patients with obtained baseline x-rays were tested for IL-1-polymorphism. Relative bone loss before active periodontal treatment was measured with a Schei ruler and classified in five groups. Descriptive statistics and backward stepwise linear regression analyses were performed. Results. Forty-nine patients with moderate (mChP), 79 with severe chronic (sChP) and 78 with aggressive periodontitis (AgP) were included. Age correlated significantly with bone loss and number of teeth at baseline. Gender, smoking and IL-1-polymorphism were neither associated with bone loss nor with number of teeth prior to treatment. After adjusting for age as well as gender, AgP was significantly associated with more severe bone loss in untreated periodontal disease (p = 0.036). In non-smokers, mean number of teeth prior to active periodontal therapy correlated significantly with presence of IL-1 polymorphism. Conclusion. The IL-1-polymorphism is associated with lower number of teeth in non-smokers with untreated periodontal disease. Untreated AgP is associated with more severe bone loss than untreated ChP.