Three periodontitis phenotypes: Bone loss patterns, antibiotic—surgical treatment and the new classification

Delatola, Chryssa; Loos, Bruno G.; Laine, Marja L.

doi:10.1111/jcpe.13356

Cited by 12 publications

(14 citation statements)

References 24 publications

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“…Moreover, the primary outcomes selected in this systematic review were PPD reduction and CAL gain, which are the most commonly reported surrogate outcomes in studies on periodontal treatment, despite they present with several limitations 65 . Considering that the main goal of periodontal therapy is to achieve shallow pockets and absence of bleeding, the percentage of pocket closure could have been possibly a more valuable outcome to assess the performance of HMs 66 , but only a minority of the selected studies evaluated it. It is also suggested that with the aim of developing guidelines for periodontal therapy the proportion of threshold changes such as ≥ 2 mm or ≥ 3 mm in clinical attachment levels are preferable rather than mean changes 66 , but again only a minority of the included studies provided data in this respect.…”

Section: Discussionmentioning

confidence: 99%

“…Considering that the main goal of periodontal therapy is to achieve shallow pockets and absence of bleeding, the percentage of pocket closure could have been possibly a more valuable outcome to assess the performance of HMs 66 , but only a minority of the selected studies evaluated it. It is also suggested that with the aim of developing guidelines for periodontal therapy the proportion of threshold changes such as ≥ 2 mm or ≥ 3 mm in clinical attachment levels are preferable rather than mean changes 66 , but again only a minority of the included studies provided data in this respect. It should be noted that, since the rational of using of HMs has to do mainly with the modulation of the exaggerated immune-inflammatory response towards the microbial challenge, inflammatory indices (such as bleeding scores and gingival indices) should be taken into consideration when assessing the treatment response.…”

Section: Discussionmentioning

confidence: 99%

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Systematic review and meta-analysis on the adjunctive use of host immune modulators in non-surgical periodontal treatment in healthy and systemically compromised patients

Corbella

Calciolari

Alberti

et al. 2021

Sci Rep

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Considering the central role of inflammation in the pathogenesis of periodontitis, the combination of NSPT with different agents that can modulate the host immune-inflammatory response has been proposed to enhance the outcomes of NSPT. The aim of this paper is to systematically review the literature on the efficacy of systemic host modulators (HMs) as adjuncts to non-surgical periodontal therapy (NSPT) in improving pocket depth (PD) reduction and clinical attachment level (CAL) gain in healthy and systemically compromised patients. RCTs with ≥ 3 months follow-up were independently searched by two reviewers. Meta-analysis was performed when ≥ 3 studies on the same HM were identified. The quality of the evidence was rated according to the GRADE approach to rate the certainty of evidence. 38 articles were included in the qualitative assessment and 27 of them were included in the meta-analysis. There is low/very low evidence that the adjunctive use of sub-antimicrobial dose of doxycicline, melatonin and the combination of omega-3 and low dose aspirin (in type 2 diabetic patients) to NSPT would improve PD and/or CAL. Conflicting evidence is available on the efficacy of probiotics. Future studies controlling for confounding factors, using composite outcomes to define the endpoint of therapy and considering not only the patient- but also as the site-specific effect of systemic HMs are warranted. The dosage, posology and long-term effect of HMs still need to be clarified, also in association to the presence of systemic conditions potentially affecting the response to HMs administration.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Systematic review and meta-analysis on the adjunctive use of host immune modulators in non-surgical periodontal treatment in healthy and systemically compromised patients

Corbella

Calciolari

Alberti

et al. 2021

Sci Rep

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“…A destructive periodontal inflammation could occur because of the dysregulation of the immune fitness and, as a result further induction of microbial dysbiosis would be noticed. is latter heightens back the immune response asin a vicious cycle [3].…”

Section: Introductionmentioning

confidence: 99%

Antibiotics in the Treatment of Periodontitis: A Systematic Review of the Literature

Hammami

Nasri

2021

International Journal of Dentistry

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Introduction. Systemic antibiotics present one of the alternative adjunctive therapies in nonsurgical periodontal treatment (NSPT). Different protocols have been proposed, but their indication and effectiveness are still controversial. The aim of this study is to assess the effectiveness of the addition of antibiotics after nonsurgical debridement during initial therapy and compare different antimicrobial prescription protocols. Materials and Methods. An electronic search was performed through MEDLINE and EBSCOhost databases using the appropriate MeSH words. The target studies have to be published during the last five years. Data from the selected studies were extracted and analyzed. Study selection was done based on inclusion and exclusion criteria. Results. Seven randomized clinical trials were included in our review. Their data were extracted using a grid established for this purpose. Collectively, different protocols have been proposed and almost all of them yield superior clinical and microbiological results compared to the placebo group. Conclusion. The overall findings of this review show a positive effect of the use of antibiotics as an adjunctive to NSPT, regardless of the antimicrobial agents used in our included studies. Sites with PD > 6 mm may benefit most from the adjunctive use of antibiotics in NSPT. This trial is registered with Clinicaltrials.gov identifiers: NCT02829983 (Bechara Andere et al., 2016); NCT02839421 (Ardila et al., 2020); NCT02735395 (Borges et al., 2017); NCT02359721 (Suryaprasanna et al., 2018); and NCT01318928 (Hans, 2015).

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“…Probing depth ≥ 5 mm is an indicative to schedule the further treatment necessities because sites or teeth with residual PD ≥ 5 mm have a higher risk for further attachment loss due to disease progression as well as a higher risk for tooth loss [ 28 , 31 ]. The local endpoints of periodontal therapy have been defined with shallow pockets (≤ 4 mm) without bleeding in patients with < 30% bleeding sites [ 32 ]. In our study we did not find a difference of BOP (primary outcome) between the groups.…”

Section: Discussionmentioning

confidence: 99%

Adjunctive air-polishing with erythritol in nonsurgical periodontal therapy: a randomized clinical trial

Jentsch

Flechsig²,

Kette³

et al. 2020

BMC Oral Health

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Background This study was aimed to investigate if the adjunctive use of erythritol air-polishing powder applied with the nozzle-system during subgingival instrumentation (SI) has an effect on the outcome of non-surgical periodontal treatment in patients with moderate to severe periodontitis. Methods Fourty-two individuals with periodontitis received nonsurgical periodontal therapy by SI without (controls, n = 21) and with adjunctive air-polishing using nozzle + erythritol powder (test, n = 21). They were analyzed for the clinical variables BOP (primary outcome at six months), probing depth (PD), attachment level, four selected microorganisms and two biomarkers at baseline, before SI as well as three and six months after SI. Statistical analysis included nonparametric tests for intra- and intergroup comparisons. Results In both groups, the clinical variables PD, attachment level and BOP significantly improved three and six months after SI. The number of sites with PD ≥ 5 mm was significantly lower in the test group than in the control group after six months. At six months versus baseline, there were significant reductions of Tannerella forsythia and Treponema denticola counts as well as lower levels of MMP-8 in the test group. Conclusions Subgingival instrumentation with adjunctive erythritol air-polishing powder does not reduce BOP. But it may add beneficial effects like reducing the probing depth measured as number of residual periodontal pocket with PD ≥ 5 mm when compared with subgingival instrumentation only. Clinical relevance The adjunctive use of erythritol air-polishing powder applied with the nozzle-system during SI may improve the clinical outcome of SI and may reduce the need for periodontal surgery. Trial registration The study was retrospectively registered in the German register of clinical trials, DRKS00015239 on 6th August 2018, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL.

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Three periodontitis phenotypes: Bone loss patterns, antibiotic—surgical treatment and the new classification

Cited by 12 publications

References 24 publications

Systematic review and meta-analysis on the adjunctive use of host immune modulators in non-surgical periodontal treatment in healthy and systemically compromised patients

Systematic review and meta-analysis on the adjunctive use of host immune modulators in non-surgical periodontal treatment in healthy and systemically compromised patients

Antibiotics in the Treatment of Periodontitis: A Systematic Review of the Literature

Adjunctive air-polishing with erythritol in nonsurgical periodontal therapy: a randomized clinical trial

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