Probing pocket depth reduction after non‐surgical periodontal therapy: Tooth‐related factors

Werner, Nils; Heck, Katrin; Walter, Elias; Ern, Christina; Bumm, Caspar Victor; Folwaczny, Matthias

doi:10.1002/jper.23-0285

Cited by 7 publications

(1 citation statement)

References 54 publications

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“…In those early studies the higher the PPD (>3 mm) or/and CAL values were, the higher (>3 mm) the reduction of PPD and/or CAL gained upon periodontal treatments [15,16,30]. Even later on the same results were achieved [31]. What could be the reason for the behaviour of the gingival soft tissues?…”

Section: Discussionmentioning

confidence: 95%

Six-Month Follow-Up of Periodontal Condition in Rheumatoid Arthritis and Ankylosing Spondylitis Arthritis Patients Undergoing Anti-Tumour Necrosis Factor-α Therapy

Tar,

Végh,

Martos

et al. 2024

JCM

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In our present study, we aimed to assess the effects of anti-TNF therapy on periodontal condition in a mixed cohort of patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Moreover, we wished to determine whether the baseline dental condition of these patients would affect response to biological therapy. A cohort of 24 arthritis patients was consecutively recruited before starting anti-TNFα therapy. After the dropout of six patients, we evaluated the dental status of 18 subjects at baseline and after 6 months of biological therapy. Clinical responder (R) and non-responder (NR) status was determined after 6 months of anti-TNF treatment. Plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD), PPDmax, clinical attachment loss (CAL), and CALmax were determined. During the 6-month treatment period, six patients (3 RA and 3 AS) terminated the study prematurely as they did not respond to treatment (NR). Therefore, 18 patients were included in the full analysis. There were no major differences in PI, BOP, PPD, PPD max, CAL, and CALmax, among R and NR patients. TNF inhibition resulted in increased GI (0.65 ± 0.34 vs. 0.88 ± 0.30; p < 0.05), as well as decreased PPDmax (4 ± 1.94 vs. 2.72 ± 1.36; p < 0.05) and CALmax (5.22 ± 2.56 vs. 2.72 ± 1.36; p < 0.05) after 6 months. Eight patients had incomplete canal fillings or dead pulps and/or apical periodontitis; six in the R and two in the NR group. In our present study, anti-TNF therapy seemed to worsen the extent of gingival inflammation (GI); however our results also do not support the reduction of mean CPD and CAL as reported by others.

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Section: Discussionmentioning

confidence: 95%

Six-Month Follow-Up of Periodontal Condition in Rheumatoid Arthritis and Ankylosing Spondylitis Arthritis Patients Undergoing Anti-Tumour Necrosis Factor-α Therapy

Tar,

Végh,

Martos

et al. 2024

JCM

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Effectiveness of nonsurgical re‐instrumentation: Tooth‐related factors

Bumm,

Schwendicke,

Pitchika

et al. 2024

Journal of Periodontology

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BackgroundTo investigate tooth‐related factors that influence pocket closure (PC) and the reduction of pocket probing depths (PPD) after nonsurgical re‐instrumentation (NSRI) as part of step 3 therapy.MethodsA total of 480 patients (10,807 teeth) presenting with residual pockets 6.33 ± 3.79 months after steps 1 and 2 of periodontal therapy were included and retrospectively analyzed before and 5.93 ± 4.31 months after NSRI. Reduction of PPD and PC rates following NSRI were associated with tooth‐related factors, namely tooth type, arch, number of roots, furcation involvement (FI), pulp vitality, mobility, type of restoration, presence of plaque, and bleeding on probing (BOP), using mixed‐effects regression models.ResultsNSRI reduced periodontal pockets persisting after initial cause‐related therapy by (mean ± SD) 1.32 ± 1.79 mm in PPD, and PC rate was 40%. Moderate pockets (4–5 mm) responded better to NSRI than deep pockets (≥ 6 mm) in terms of PC (51% vs. 16%). Both PPD reduction and PC rates of deep residual pockets were significantly influenced by tooth type, arch, number of roots, and presence of BOP.ConclusionTooth type, arch, number of roots, and presence of BOP at re‐evaluation (before NSRI) had a significant and clinically relevant influence on NSRI as part of step 3 therapy. Considering these factors, particularly for deep residual pockets, may allow more tailored re‐intervention.Plain language summaryThe present study aimed to investigate the influence of tooth‐related factors on the outcome of repeated nonsurgical therapy of periodontitis. Therefore, 480 patients (10,807 teeth) presenting with clinical symptoms of persistent periodontitis after initial therapy were administered repeated nonsurgical therapy and retrospectively analyzed. Therapy outcomes were associated with tooth‐related factors, namely tooth type, tooth location (maxilla/mandible), number of roots, involvement of the root furcation area in multi‐rooted teeth, pulp vitality, mobility, restoration, presence of plaque and bleeding upon periodontal probing, using mixed‐effects models. The results revealed that repeated nonsurgical therapy was effective in reducing inflammation and clinical signs of disease, with moderate residual periodontal defects responding better than deep defects. Healing of deep defects after repeated nonsurgical therapy; however, was significantly influenced by the factors: tooth type, location, number of roots, and bleeding on probing. Considering these factors, particularly in deep residual defects which are commonly suggested to be treated surgically, may allow less invasiveness and thus a more tailored re‐intervention.

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The association between periodontal microbial biomarkers and primary therapy outcome

Werner,

Frasheri,

Heck

et al. 2024

Clin Oral Invest

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Objective This study aims to analyse the association between the baseline microbial load of selected periodontopathogenic bacteria collected from gingival crevicular fluid (GCF) and the primary outcome of steps I and II therapy. Materials and methods 222 patients with stage III periodontitis were included into this retrospective analysis that received steps 1 and 2 periodontal therapy without adjunctive systemic antibiotics. Baseline GCF samples were quantitatively analysed using ELISA-based kits for levels of periodontopathogens (Porphyromonas gingivalis (Pg), Aggregatibacter actinomycetemcomitans (Aa), Prevotella intermedia (Pi), Fusobacterium nucleatum (Fn), Treponema denticola (Td), and Tannerella forsythia (Tf)) and associated with the primary therapy outcome using a “treat-to-target” therapy endpoint (TE) defined as ≤ 4 sites with PD ≥ 5 mm six months after therapy. Results 38.2% of the patients achieved TE. Patients failing to achieve TE revealed significantly increased levels of Pg, Fn, and Tf at baseline (Pg: p = 0.010, Fn: p = 0.008 Tf: p = 0.004). Multivariate binary logistic regression adjusted for sex, mean probing depth, diabetes, and current smoking status showed an independent relationship between Tf and the TE (aOR 2.570, p = 0.023). Conclusion Increased microbial load is associated with decreased responsiveness to therapy. The findings suggest that specifically baseline Tf levels are associated with poorer treatment outcomes and might improve the accuracy of periodontal diagnosis. Clinical relevance The findings of this study support the concept of a critical biomass that is sufficient to induce and maintain an immune response within the periodontal pocket, which ultimately leads to irreversible tissue destruction. However, calculating this level in advance may serve as an early indicator for intervention. Key finding Baseline Tannerella forsythia levels are associated with poorer treatment outcome.

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Probing pocket depth reduction after non‐surgical periodontal therapy: Tooth‐related factors

Cited by 7 publications

References 54 publications

Six-Month Follow-Up of Periodontal Condition in Rheumatoid Arthritis and Ankylosing Spondylitis Arthritis Patients Undergoing Anti-Tumour Necrosis Factor-α Therapy

Six-Month Follow-Up of Periodontal Condition in Rheumatoid Arthritis and Ankylosing Spondylitis Arthritis Patients Undergoing Anti-Tumour Necrosis Factor-α Therapy

Effectiveness of nonsurgical re‐instrumentation: Tooth‐related factors

The association between periodontal microbial biomarkers and primary therapy outcome

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