SEPA JCP

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JCP Digest Scientific release from the European Federation of Periodontology

01

Journal of Clinical Periodontology

Paper Digest

2014:41

Rapporteurs: Eshkol-Yogev Inbar, Asher Ran, Grossman Arnon, Horwitz-Berkun Rachel with Goldstein Moshe.

'PS UIF Original Article QMFBTF HP UP: IUUQ XXX FGQ PSH NFNCFST KDQ QIQ -PHJO BOE OBWJHBUF UP 7PMVNF *TTVF

Study:

Paper Digest

01

Periodontal Health for a better life

JCP Digest Scientific release from the European Federation of Periodontology

Affiliation: Prepared by the residents from the Postgraduate Program of Periodontology at the Dept of Periodontology, Faculty of Dental Medicine, the Hadassah-Hebrew University Medical Center, Jerusalem.

Israel.

9Extraction Sockets:

The aim of this study was to analyze the prevalence of extraction sockets with fibrous scar tissue occupying the extraction site (rather than bone)

following 12 or more weeks of healing and to evaluate the associated risk factors.

Methods:

Computerized tomography was used to evaluate socket characteristics and calculate “Hounsfield unit� scores (an index used to assess bone mineral density) A total of 1226 dental records from Seoul National University Dental Hospital archives including patients subjected to extractions prior to implant placement were evaluated.

Results:

Conclusions and impact:

9

Paper Digest

JCP Digest Scientific release from the European Federation of Periodontology

Rapporteurs: Seelam N, with Davideau JL, Tenenbaum H, and Huck O. http://onlinelibrary.wiley.com/doi/10.1111/jcpe.12241/full Access through EFP members page login: http://www.efp.org/members/jcp.php

Paper Digest

05

Periodontal Health for a better life

9The effect of periodontal status and

lesions or poorly responding sites.

2: to evaluate the clinical outcome of the adjunctive systemic use of azithromycin to non-surgical re-treatment of residual pockets.

Thirty-nine patients initially received meticulous oral hygiene instructions. They were then randomly assigned to either immediate surgery (n = 19) or SRP (n = 20). Six months following treatment, patients from both groups received re-debridement of the sites with residual pockets (≼6 mm) in

combination with systemic azithromycin. Clinical measurements were performed at baseline, 6 and 12 months. Chair-time was used to determine final financial costs (surgery â‚Ź200 and SRP â‚Ź100 per hour). Patient discomfort and number of painkillers were also assessed.

At 6 months, only 6 patients (32%) in the surgery group had residual pockets ≼6 mm and received re-debridement with adjunctive systemic azithromycin. In the SRP group this was the case for 14 patients (70%). At 12 months the prevalence of residual pockets ≼6 mm was less than 1% for

both treatment groups. At 6 months, surgery costs were an extra â‚Ź 746 compared with SRP, but â‚Ź 46 of this amount could be offset as a result of a reduced need for supportive care at 12 months.

There was no difference in discomfort and pain experience between groups.

Rapporteurs: Behaeghe, E; De Geest, S, Hoflack, M, Quirynen, M, Teughels, W. Link to Original JCP article : http://onlinelibrary.wiley.com/doi/10.1111/jcpe.12248/full Access through EFP members page login: http://www.efp.org/members/jcp.php

06

9Patient-reported outcome measures

Summarised from original article with kind permission from Wiley Online Library

Summarised from original article with kind permission from Wiley Online Library

Study Aims:

To evaluate the influence of periodontal status on masticatory performance in dentate subjects with

identical areas of occlusal support.

Methods:

This prospective cohort study recruited 1839 elderly patients (67.2 Âą 7.9 years) selected randomly from the Suita study that was established to promote prevention of cardiovascular diseases in Japan. Number of functional teeth and occlusal support were evaluated using the “Eichner indexâ€?

(A1-3, B1-4, C1-3 groups). Periodontal status was assessed using the Community Periodontal Index (CPI), coded from 0 to 4, by means of partial

mouth recording (10 index teeth). Masticatory performance was objectively evaluated by optical density measurement of the glucose concentration released from a “gummy jelly� and correlated with the surface area of the masticated test jelly. Results were adjusted for age and gender. Subjects for whom masticatory performance could not be accurately measured were excluded.

- A large number of enrolled subjects were classified as Eichner A1 (n=653) without missing teeth and with occlusal contacts in all posterior areas. In this group, 54.1% of subjects had no periodontal pockets (CPI = 0-2).

- Teeth with periodontal pockets (CPI ≼ 3) represented 30% of the Eichner A1 group while this proportion increased to 70% in Eichner B3 group (occlusal contacts in one posterior area).

- In Eichner groups A1 and B3, patients with moderate and severe periodontitis (CPI = 3-4) showed reduced masticatory performance in comparison with those without periodontitis (CPI = 0-2). No significant differences were highlighted in other Eichner A and B groups.

- The proportion of subjects wearing dentures increased from Eichner A2 group (8.3%) to Eichner B4 group (93.4%) and associated with a significant decrease of occlusal support.

- Masticatory performance of denture wearers from Eichner B2 and B3 groups decreased respectively in subjects with moderate periodontitis (B2) and in subjects with moderate and severe periodontitis (B3) in comparison with those without periodontitis.

- When only non-denture wearers were considered, no significant differences in masticatory performance was observed in Eichner A2 to B3 groups according to periodontal status.

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Scientific release from the European Federation of Periodontology

Methods:

This randomised clinical trial recruited 87 patients with moderate-advanced chronic periodontitis, who after a baseline clinical examination, were divided into 2 groups: 40 patients were assigned to an individually customised oral health program (ITOEP) based on cognitive behavioural principles, while the other group (ST) consisted of 47 patients who received standard oral health information and individual oral hygiene instructions. Both groups received non-surgical periodontal treatment and were asked to complete individualised questionnai-

res containing OHRQoL measures at baseline and 12-months later. Two different instruments were used: 1) the General Oral Health Assessment Index (GOHAI) that focuses on the frequency of symptoms (disease); and 2) the UK Oral Health related quality of life measure (OHRQoL-UK) that assesses the positive effects of oral conditions on patient well-being. The patient’s global rating of oral health and socio-demographic information were also recorded.

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Scientific release from the European Federation of Periodontology

connective tissue graft for the treatment of multiple gingival recessions: a comparative short-and long-term controlled randomised clinical trial

Zucchelli G, Mounssif I, Mazzotti C, Stefanini M, Marzadori M, Petracci E, Montebugnoli L. J Clin Periodontol. April 2014: 41; 396-403

Relevant background to study:

Surgical interventions to cover exposed roots in cases of gingival recession are commonly required due to aesthetic impairment. The “envelope� or

3-sided type of coronally advanced flap (CAF) represents a safe and predictable approach for multiple recession-type defects.

Study Aims:

The aim of this study was to compare short-and long-term (up to 5 years) root coverage and aesthetic outcomes of the CAF alone or in combination with a connective tissue graft (CTG)

for the treatment of multiple gingival recessions in patients undergoing a very strict supportive care programme.

Methods:

Fifty volunteers with aesthetic complaints and multiple Miller class I and II recession defects (≼ 2mm) in the upper jaw, and presenting with at least 1-mm of keratinized tissue apical to the recession were enrolled and randomised. They presented good overall oral hygiene and low bleeding scores.

Surgery involved the envelope-type of CAF, either alone or in combination with a CTG derived from

the de-epithelialization of a palatal free gingival graft. Patients were carefully monitored following surgery and were regularly recalled for prophylaxis throughout the follow-up period. Clinical parameters, as well as patients’ experiences with the surgical intervention and satisfaction with results were evaluated.

Results:

Up to one year of follow-up, no significant differences were detected between the two groups in terms of recession reduction and complete root coverage (cf. Fig. 1). In the longer term (5 years), however, the addition of a CTG yielded statistically significantly greater reductions in recession depth (RD), although the difference was clinically very small (RD from 3.15mm to 0.09mm vs. RD from 3.05mm to 0.3mm). Furthermore, the CTG demonstrated a more than three times greater

likelihood of complete root coverage, overall better contour scores, and promoted significantly greater keratinized tissue heights after 1 and 5 years. By contrast sites treated with CAF alone exhibited a better post-operative course (less patient pain/discomfort) and better colour matching with less keloid formation. Patients were generally highly satisfied with aesthetic outcomes, with no differences between groups.

...

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Rapporteurs: Darnaud C1, Prouvost B1, Colliot C1 with Sarfati A 2

http://onlinelibrary.wiley.com/doi/10.1111/jcpe.12266/full Access through EFP members page login: http://www.efp.org/members/jcp.php

Paper Digest

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Periodontal Health for a better life

JCP Digest Scientific release from the European Federation of Periodontology

Affiliation: 1. Third-year residents.

2. Assistant professor; in charge of the journal club. Postgraduate Program of Periodontology, Department of Periodontology, UFR of Odontology, Paris Diderot University, Paris, France.

Rothschild Hospital, AP-HP.

9Risk factors associated with the longevity

Relevant background to study:

To examine the patient reported outcome measures (PROM) involving patients’ perception of bleeding, pain, swelling and bruising for crown lengthening (CL), open flap debridement (OFD)

or straight forward implant placement (IMP) during the first week following surgery, and to examine the prevalence of post-surgical complications.

Methods:

This observational clinical audit study recruited 468 consecutive patients who were in need of periodontal surgery (CL: n=259; OFD: n=94; IMP: n=115) between 2009-2011, at the Periodontics Unit of the National Dental Centre, Singapore. The patients were asked to chart their perceptions on bleeding, swelling, pain and bruising over the first week of the healing period on days 0, 3, 5 and 7 using a visual analogue scale (VAS) with equal units ranging from 0 to 10 with 0 designated as no bleeding, swelling, pain or

bruising and 10 for excruciating pain, extreme bleeding, swelling, or bruising. On day 7, patients were examined clinically for post-surgical complications (tenderness on palpation, swelling, suppuration, flap dehiscence). Additional confounding factors such as gender, procedure type, surgery duration, surgeon’s experience, use of painkillers and periosteal releasing incisions were recorded and taken into consideration using a linear random-effect mixed model.

- PROM for bleeding, swelling, pain and bruising during the first week of healing were modest and decreased to almost 0 over 7 days. The decrease in VAS scores was the slowest for swelling, pain or bruising.

- IMP had the lowest median VAS score on the day of surgery whereas the decrease in VAS scores was the slowest for OFD. - Surgeries lasting 60 minutes or more had higher VAS scores for swelling and bruising for all days recorded and a higher VAS score for pain at the day of surgery.

- The use of a periosteal releasing incision resulted in a significantly higher VAS score for swelling.

- After adjustment for confounders in a linear mixed random-effects model, the PROM showed that: ¡ Surgery duration of less than 60 minutes and time after surgery decreased the VAS scores for bleeding, swelling, pain and bruising. ¡ VAS scores for swelling were lower for males and lower when no periosteal releasing incisions were employed. ¡ Longer operator experience only reduced the VAS score for bleeding.

- At day 7, the prevalence of flap dehiscence and tenderness to palpation was around 10% and the prevalence for swelling and suppuration was below 5% for all types of surgical procedures.

Results:

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Paper Digest

2014:41

Paper Digest

09

P

Rapporteurs: Halperin-Sterenfeld M, Eskander L, Saminsky M, Rozitsky D, Levi I, Weinberg G, with Eli E. Machtei Link to Original JCP article : http://onlinelibrary.wiley.com/doi/10.1111/jcpe.12289/full Open access article.

Periodontal Health for a better life

JCP Digest Scientific release from the European Federation of Periodontology

Affiliation: Prepared by Residents from the Postgraduate programme at the department of Periodontology, School of graduate dentistry, Rambam HCC and The Faculty of Medicine – Technion, Israeli Institute of Technology, Haifa, Israel.

9Subgingival air-polishing with erythritol

Journal of Clinical eriodontology

2014:41

Rapporteurs: Almohandes A, Bougas K, Gkatziou D, Krajewski W, Lopez-Lago Garcia A with Abrahamsson I Link to Original JCP article : http://onlinelibrary.wiley.com/doi/10.1111/jcpe.12298/full Access through EFP members page login: http://www.efp.org/members/jcp.php

Study:

during periodontal maintenance: Randomised clinical trial of twelve months

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Periodontal Health for a better life

graft techniques for the treatment of deep gingival recession in the lower incisors.

A controlled randomised clinical trial Zucchelli G, Marzadori M, Mounssif I, Mazzotti C, Stefanini M. J Clin Periodontol. 2014; 41: 806-813.

Study Aims:

The aim of this study was to assess the influence of (i) the degree of furcation involvement, and (ii) the associated risk factors, upon the loss of multi-

rooted teeth in patients treated for periodontitis and included in a maintenance program.

Methods:

The reported study was a retrospective cohort study of 172 patients treated for chronic or aggressive periodontitis. A periodontal examination was performed at baseline, after periodontal therapy, and again following a maintenance program (mean duration = 11.5Âą5.2 years).

Furcation involvement was assessed using the classification proposed by Hamp et al. (1975).

Compliance, as determined by the criteria of

Demirel & Efeodlu (1995), was based upon attendance or failure to attend the scheduled appointments. Smoking status was recorded as smokers, former smokers and non-smokers. The tooth was treated as the unit of analysis. Univariate and multivariate regression analyses were conducted to determine the risk of loss of multi-rooted teeth throughout the duration of the study

Results:

- Class I furcation involvement was not a significant risk factor, compared to no furcation involvement.

- Risk factors for multi-rooted tooth loss in subjects treated for periodontitis and enrolled into a maintenance program were class II and III furcation involvement, smoking and a lack of

compliance.

- Non-smokers and former smokers did not differ with respect to multi-rooted tooth loss.

- Tooth loss was less frequent in the mandible than the maxilla.

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mes. Most of the existing studies have evaluated this technique for moderate recession defects in the maxillary arch and there is a lack of evidence regarding its effectiveness with lower incisors.

Study Aims:

To compare clinical and aesthetic outcomes of two different but similar surgical techniques in the

treatment of single labial gingival recession defects of lower incisors.

Methods:

Fifty patients participated in this double masked, randomised controlled clinical trial. All of the participants contributed one recession defect, classified as Miller class I or II (≼ 3mm in depth).

Patients were only allowed to proceed with the surgical procedures if they could demonstrate an acceptable level of oral hygiene.. The roots were debrided before surgery and treated with 24% EDTA for 2 minutes following root exposure. All surgeries were performed by the same operator. Test group (n=25) treatment was: CAF + CTG + Labial Sub-mucosal Tissue (LST) removal. In order to remove the LST an incision was made deep to detach it from the periosteum and another incision was made superficially to separate it from the

alveolar mucosa. This way, the flap was released of tension and adapted more closely to the underlying periosteum. Control group (n=25) treatment: CAF + CTG without removal of the LST. Clinical measurements were performed 1 week before and 12 months following surgery, except for CTG thickness and bone dehiscence length, which were measured during the procedure. Oral hygiene was reinforced regularly during this period. Evaluation of aesthetics was performed 12 months following surgery both by the patients and by a periodontist.

Postoperative pain was also evaluated by measuring the mean use of analgesics in the week following the surgical procedures.

Results:

Both treatment protocols were successful in treating recession defects by reducing their size. Additionally, probing pocket depths were reduced and keratinised tissue height and width increased with both techniques. Significantly less CTG exposure occurred in patients who had the LST removed and

this was associated with greater percentage of root coverage, less keloid formation and a more aesthetic result. The study failed to identify differences in postoperative pain and morbidity between the two groups.

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Paper Digest

2014:41

Paper Digest

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Scientific release from the European Federation of Periodontology

Rapporteurs: Duzenli D, Kuka S, Cihangir S, with Yilmaz S.

Editor: Iain Chapple, Birmingham, UK

http://onlinelibrary.wiley.com/doi/10.1111/jcpe.12315/full

Link to Original JCP article :

Periodontal Health for a better life

JCP Digest

Affiliation: Prepared by the residents from the Postgraduate Programme of Periodontology at the Department of Periodontology, Faculty of Dentistry, Yeditepe University, Istanbul-TURKIYE

Access through EFP members page login: http://www.efp.org/members/jcp.php

9Study: Retaining or Replacing Molars with

Study:

Summarised from original article with kind permission from Wiley Online Library

Summarised from original article with kind permission from Wiley Online Library

The objective of supportive periodontal therapy (SPT) is to remove newly formed bacterial deposits form residual pockets thus maintaining periodontal health. A variety of hand and ultrasonic instruments can be used. Air-polishing devices that

produce a jet of compressed air containing low abrasive agents via a nozzle, and which can be inserted to the top of the pocket may also be employed for this purpose.

Study Aims:

To evaluate the efficacy of repeated sub-gingival air-polishing containing erythritol powder with

0.3% chlorhexidine in residual pockets of >4 mm over 12 months.

Methods:

50 maintenance patients (≼ 3 months following completion of comprehensive periodontal treatment), with contra-lateral residual pockets >4 mm (at least one per quadrant) were included in this single-centre, randomised clinical trial. Clinical measurements (PD, PI, BOP, REC, root hypersensitivity) and microbial sampling were performed 3-monthly, while treatment was provided at 0, 3, 6,

and 9 months (providing that PD>4 mm). One site per patient was assigned to sub-gingival air-polishing with erythritol powder containing 0.3% chlorhexidine (test side) and the other site to ultrasonic debridement (control). The presence of PD >4 mm at 12 months was the primary end-point.

A reduction in number of sites with PD >4mm was achieved from 4.6 to 3.6 in test sites and 4.8 to 3.9 in control sites (p<0.001). Likewise, changes in BOP were statistically significant (0-12 months) for both groups. However, none of the changes were significantly different between groups. Patients' pain/discomfort perception was judged to be lower

at test sites. No difference was found in bacterial detection frequencies (0-12 months) in both groups. When comparing test and control sites, lower frequencies of Aa count>1000 cells/ml were observed in test sites. Two control site samples recorded Aa at 100,000 cells/ml while none of the test sites did.

Results:

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Relevant background to study:

Following successful periodontal treatment, patients usually transfer into supportive periodontal therapy (SPT), which is known to be vital to the long-term preservation of periodontally treated teeth. Patient adherence to SPT represents an essential factor for long-term tooth preservation after periodontal therapy. Following treatment with

Copyright Š 1999-2014 John Wiley & Sons, Inc. All Rights Reserved.

Study Aims:

To evaluate patient compliance rates and influential factors in a systematic SIT programme over a 3-year period.

Methods:

This retrospective 3-year cohort study recruited 241 consecutive patients who had been provided with implants and implant-supported prostheses between January 2005 and December 2008, in a private practice specialising in implants. Inclusion criteria were: age â&#x2030;Ľ 18 years; all treatment provided in the study centre; availability of medical data (including smoking habit); and a post-operative observational period â&#x2030;Ľ 3 years.

The patients had received two-stage implant surgery by one dentist and 5 different implant systems were used. Following the delivery of implantâ&#x20AC;&#x201C;supported restorations, all patients received oral hygiene (OH) instructions and were scheduled for 3-monthly SIT. The necessity for

...

implant-supported restorations special oral hygiene measures are required to prevent inflammation and peri-implant diseases. Therefore, a systematic supportive post-implant therapy (SIT) programme appears necessary for the long-term prevention of peri-implant diseases.

self-performed OH and compliance with SIT was emphasised. Extent of compliance was defined according to patientsâ&#x20AC;&#x2122; attendance at SIT appointments. At the end of the 3-year observation period, all implants were clinically examined for peri-implant mucositis and peri-implantitis by probing pocket depth, pus/suppuration, plaque and bleeding on probing. In 2012 patients were retrospectively evaluated using their records, for gender; age, smoking habits, medical history, geographic distance to the study centre and complexity of the implant surgery. Regression analysis was implemented to evaluate the effect of different variables on yearly and overall compliance.

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SOCIEDAD ESPAĂ&#x2018;OLA DE PERIODONCIA Y OSTEOINTEGRACIĂ&#x201C;N

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2014:41 Journal of Clinical eriodontology

Paper Digest

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Scientific release from the European Federation of Periodontology

Rapporteurs: Moreno F, Tsarouchi D, Kousounis E, Nibali L, with Donos N.

Editor: Iain Chapple, Birmingham, UK

http://onlinelibrary.wiley.com/doi/10.1111/jcpe.12317/full

Link to Original JCP article : Access through EFP members page login: http://www.efp.org/members/jcp.php

Periodontal Health for a Better Life

Affiliation: Prepared by the residents from the Postgraduate Programme of Periodontology at the Department of Periodontology, Eastman Dental Institute, University College London, London, UK.

9Study: Genome-wide exploration identifies

Freitag-Wolf S, Dommisch H, Graetz C, Jockel-Schneider Y, Harks I, Staufenbiel I, Meyle J, Eickholz P, Noack B, Bruckmann C, Gieger C, Jepsen S, Lieb W, Schreiber S, KĂśnig IR, Schaefer AS. J Clin Periodontol 2014; 41: 1115â&#x20AC;&#x201C;1121.

Copyright Š 1999-2014 John Wiley & Sons, Inc. All Rights Reserved.

Relevant background to study:

...

sex-specific genetic effects of alleles upstream NPY to increase the risk of severe periodontitis in men

Schwendicke F, Graetz C, Stolpe M, DĂśrfer CE. J ClinPeriodontol. 2014; 41: 1090-1097.

Frisch E, Ziebolz D, Vach K, Ratka-KrĂźger P. J Clin Periodontol. 2014; 41: 1007-1014.

Summarised from original article with kind permission from Wiley Online Library Copyright Š 1999-2014 John Wiley & Sons, Inc. All Rights Reserved.

Coverage of localised labial gingival recessions can be achieved with several techniques. Of these, coronally advanced flaps (CAF) in association with connective tissue grafts (CTG) seem to obtain more root coverage and achieve better aesthetic outco-

...

11

Journal of Clinical eriodontology

Relevant background to study:

Furcation Involvement: a Cost-effectiveness Comparison of Different Strategies

patient compliance rates and impacting factors: 3-year follow-up

MĂźller N1, MoĂŤne R, Cancela JA, Mombelli A. J Clin Periodontol. 2014; 41:883-889.

Periodontal Health for a better life

Copyright Š 1999-2014 John Wiley & Sons, Inc. All Rights Reserved.

may continue during periodontal maintenance.

Evidence for the impact of the severity of furcation involvement and the associated risk factors, upon long-term tooth loss is limited.

Affiliation: Prepared by the 2nd year residents from the Postgraduate Programme in Periodontology, Specialist Clinic in Periodontology, Public Dental Service, Region of Västra GÜtaland and Department of Periodontology, The Sahlgrenska Academy at University of Gothenburg

9Supportive post-implant therapy:

08

Affiliation: Prepared by the students of the Graduate Programme in Periodontology, Department of Restorative Dentistry and Periodontology, Trinity College Dublin, School of Dental Science, Ireland.

Summarised from original article with kind permission from Wiley Online Library

The treatment of multi-rooted teeth with furcation involvement is challenging for clinicians.

Usually the clinical response to non-surgical treatment is unpredictable and loss of attachment

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9Coronally advanced flap + connective tissue

Copyright Š 1999-2014 John Wiley & Sons, Inc. All Rights Reserved.

Relevant background to study:

...

10

Rapporteurs: Crotty J, Gkikas G, Alotaibi M, with Polyzois I.

http://onlinelibrary.wiley.com/doi/10.1111/jcpe.12269/full Access through EFP members page login: http://www.efp.org/members/jcp.php

Study:

Salvi GE, Mischler DC, Schmidlin K, Matuliene G, Pjetursson BE, Brägger U, Lang NP. J Clin Periodontol 2014; 41: 701-707.

Study Aims:

08

2014:41 Journal of Clinical Periodontology

Link to Original JCP article :

of multi-rooted teeth. Long-term outcomes after active and supportive periodontal therapy

perception of bleeding, pain swelling and bruising after these procedures. The latter may be important in setting and managing patientsâ&#x20AC;&#x2122; expectations.

Although low rates of post-operative complications have been reported after routine periodontal and implant surgeries, little is known about the patientâ&#x20AC;&#x2122;s

...

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2014:41 Journal of Clinical Periodontology

Link to Original JCP article :

Study:

Periodontal Health for a better life

9Coronally advanced flap with and without

Summarised from original article with kind permission from Wiley Online Library

periodontal tissue destruction may also reduce masticatory ability. However, few studies have investigated this issue, taking into account occlusal support especially in elderly patients with a reduced number of teeth.

Journal of Clinical eriodontology

in this population the minimal important differences (MID) for two different quality of life measurements.

Copyright Š 1999-2014 John Wiley & Sons, Inc. All Rights Reserved.

Several risk factors such as tooth loss, occlusal support and maximum â&#x20AC;&#x153;bite forceâ&#x20AC;?, have been demonstrated to directly affect masticatory ability.

Decrease in masticatory ability adversely affects nutritional intake and negatively impacts upon quality of life. Previous studies have shown that

JCP Digest

To evaluate PRO at 12 months following nonsurgical periodontal treatment (NSPT) using two different oral hygiene educational programmes in patients with chronic periodontitis and to calculate

after routine periodontal and implant surgical procedures.

Copyright Š 1999-2014 John Wiley & Sons, Inc. All Rights Reserved.

Link to Original JCP article :

04

Affiliation: Prepared by residents from the Postgraduate Program of Periodontology at the Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.

Summarised from original article with kind permission from Wiley Online Library

Study Aims:

JCP Digest

Rapporteurs: Stoecklin-Wasmer C, Salvi G.E.

Paper Digest

Copyright Š 1999-2014 John Wiley & Sons, Inc. All Rights Reserved.

the disease and its management upon symptoms, function and psychosocial factors. One way to evaluate patient related outcomes (PRO) is oral health-related quality of life (OHRQoL) measures which ascertain patients' perceptions of their oral health and its impact upon their well-being.

Affiliation: Prepared by the 2nd year residents of the Postgraduate Program in Periodontology at the Periodontology section of the Dept. of Oral Health Sciences, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium.

Tan WC, Krishnaswamy G, Ong MM, Lang NP J Clin Periodontol. 2014 Jun;41(6):618-24. doi: 10.1111/jcpe.12248. Epub 2014 Apr 21.

Paper Digest

Periodontal Health for a better life

2014:41 Journal of Clinical Periodontology

http://onlinelibrary.wiley.com/doi/10.1111/jcpe.12207/full Access through EFP members page login:

Study:

Primary outcome measures of periodontal treatment are usually clinical outcomes such as changes in clinical attachment, plaque levels, bleeding on probing and change in probing pocket depth. However, the patientâ&#x20AC;&#x2122;s perspective may also be important for the understanding of the effects of

Paper Digest Paper Digest

Kosaka T, Ono T, Yoshimuta Y, Kida M, Kikui M, Nokubi T, Maeda Y, Kokubo Y, Watanabe M, Miyamoto Y. J Clin Periodontol. 2014: 41; 487-503.

Relevant background to study:

Study:

06

2014:41 Journal of Clinical Periodontology

Relevant background to study:

...

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Study:

Scientific release from the European Federation of Periodontology

JĂśnsson B, Ă&#x2013;hrn K. J Clin Periodontol. 2014: 41; 275-282.

Summarised from original article with kind permission from Wiley Online Library

Scientific release from the European Federation of Periodontology

JCP Digest

04

http://www.efp.org/members/jcp.php

9Evaluation of the effect of non-surgical

Copyright Š 1999-2014 John Wiley & Sons, Inc. All Rights Reserved.

JCP Digest

Periodontal Health for a better life

Affiliation: Prepared by a resident from the Postgraduate Program of Periodontology at the Dept. of Periodontology, Faculty of Dentistry, Complutense University, Madrid. Spain.

Summarised from original article with kind permission from Wiley Online Library

1: to compare the clinical outcome and the cost-effectiveness of immediate surgery to traditional scaling and root planing (SRP) in patients with advanced periodontitis, with a focus on residual

occlusal support on masticatory performance: the Suita study

Results:

Link to Original JCP article : http://onlinelibrary.wiley.com/doi/10.1111/jcpe.12202/full Access through EFP members page login:

03

periodontal treatment on oral health-related quality of life: estimation of minimal important differences 1 year after treatment

Study Aims:

Affiliation: Prepared by residents from the Postgraduate Program of Periodontology at the Dept. of Periodontology, Dental Faculty, University of Strasbourg, Strasbourg, France.

Rapporteurs: GarcĂ­a-Gargallo M, with Sanz M

Paper Digest

Copyright Š 1999-2014 John Wiley & Sons, Inc. All Rights Reserved.

Paper Digest

Link to Original JCP article :

Study:

9A randomised controlled trial on

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05

Journal of Clinical Periodontology

Paper Digest

2014:41

http://www.efp.org/members/jcp.php

is frequently needed in patients with advanced periodontal disease and therefore surgery without non-surgical pre-treatment could be considered valuable in some patients.

Impact: What can we learn as practitioners?

2014:41 Journal of Clinical Periodontology

Scientific release from the European Federation of Periodontology

Study:

The conditions of tissues for periodontal surgery may be more favourable when marginal inflammation has subsided after an initial round of nonsurgical debridement. However, surgical treatment

Results:

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JCP Digest

Affiliation: Prepared by the residents from the Postgraduate Program of Periodontology and Implant Dentistry at the Department of Periodontology, ACTA, Amsterdam, The Netherlands.

Relevant background to study:

CT scan of a site with erratic healing, 12 months after molar tooth extraction

Conclusions: The factors that were associated with erratic healing were:

Periodontal Health for a better life

Miremadi SR, De Bruyn H, Steyaert H, Princen K, Sabzevar MM, Cosyn J. J Clin Periodontol. 2014: 41; 164-171.

Methods:

Seventy subjects (5.71%) and 97 sites (4.24%) exhibited impaired extraction socket healing.

Maxillary incisor/canine sites showed the lowest prevalence (0.47%), whereas mandibular molar sites the highest (5.41%) occurrence.

72% of the cases of erratic healing were of teeth extracted due to periodontal reasons.

02

immediate surgery versus root planing in patients with advanced periodontal disease: a cost-effectiveness analysis

Summarised from original article with kind permission from Wiley Online Library :fgpi`^_k Â&#x; (000$)'(+ Af_e N`c\p Jfej# @eZ% 8cc I`^_kj I\j\im\[%

Study Aims:

Paper Digest

http://www.efp.org/members/jcp.php

Kim JH, Susin C, Min JH, Suh HY, Sang EJ, Ku Y, Wikesjo UM, Koo KT. J Clin Periodontol. Jan 2014: 41; 80-85.

â&#x20AC;&#x153;Erratic healingâ&#x20AC;? in the reported study is defined as extraction sockets that became occupied by soft tissue infiltration and required repeated debridement followed by guided bone regeneration at the time of implant placement.

Rapporteurs: Delatola C, de Jong TMH, Faber C, Sygkounas E with Loos BG and van der Velden U. http://onlinelibrary.wiley.com/doi/10.1111/jcpe.12201/full Access through EFP members page login :

Erratic Healing Impeding Factors In day-to-day clinical practice, adverse reactions following tooth extraction may arise and can result in impaired healing, which may reduce resulting socket bone fill and compromise definitive space restoration by implant placement.

Journal of Clinical Periodontology

03

Paper Digest

2014:41

Link to Original JCP article :

Study:

Relevant background to study:

02

Relevant background to study:

In recent years there has been significant debate concerning the retention of periodontally compromised furcation involved (FI) molars verses extraction and replacement with implant supported

crowns (ISCs). Besides evidence-based data relating to therapeutic decision making, the comparative cost-effectiveness of these two therapeutic approaches remains unexplored.

Study Aims:

The aim of this study was to evaluate the cost-effectiveness of retaining vital FI molars with various forms of periodontal treatment, both

non-surgical and surgical or replacing them with ISCs.

Relevant background to study:

Methods:

A simulation was performed using a private payment scheme within the German Healthcare System as a model, and applied to a 50-year-old male patient with an average remaining life expectancy of 29.7 years, who had FI molar teeth and was followed through his lifetime using a Tooth Level Markov Model. Periodontal treatment alternatives (scaling and root planing, flap debridement, root resection, guided tissue

regeneration and tunneling) were compared with ISCs in terms of cost, time until first re-treatment and total time of tooth or implant retention. Based on current literature, transition probabilities were calculated, Monte-Carlo micro-simulations were performed. The robustness of the model and effects of heterogeneity were evaluated using sensitivity analyses.

Periodontal disease expression is influenced by a complex interplay between genetics, socio-economic and other factors such as gender.

Several epidemiological studies suggest a higher risk for chronic periodontitis in men compared with women. There is, however, no evidence for such a gender bias in aggressive periodontitis (AgP).

Studies investigating the genetic basis of AgP have been relatively small in scale with only a limited number of risk alleles identified. Moreover, characteristics such as gender and its potential influence upon disease expression were rarely analysed.

Study Aims:

To test the hypothesis that for AgP gender interacts with specific single nucleotide polymorphisms

(SNPs) and alters disease risk.

Methods:

- Scaling and root planing was found less costly and more effective than ISCs in the treatment of FI I molars.

- ISCs were retained for a shorter time period than furcation involved teeth irrespective of the degree of furcation involvement.

- Periodontal treatments aimed at tooth retention were found to be more effective and less costly than tooth replacement with ISCs in the treatment FI II/III molars.

- Despite the need for different intervals of supportive periodontal treatment for furcation involved teeth, retaining such teeth was less costly than ISCs, with the exception of root resection.

- Despite long-term retention of FI molars, leading to local bone loss requiring additional surgical procedures, the costs were still found to be less than ISCs.

A genome-wide association study (GWAS) involving 329 German patients with AgP versus 983 controls was performed to investigate genetic constitution including gender as an interaction term for the expression of the disease. The SNP with the strongest gender association in AgP was further tested in an independent replication study of 382 AgP cases against 489 controls.

In the GWAS, whole genomes extracted from frozen blood samples were genotyped using Affymetrix Gene Chip Human Mapping 500K Arrays. The SNP with the strongest gene-gender interaction (SNP rs198712) was then genotyped in

the replication study with the TaqMan Assay hCV9946741, using an automated platform.

Logistic regression analysis was employed to study potential interactions between eligible SNPs and gender in AgP with a cut-off significance value of p<0.05. Gender-specific odds ratios (ORs) were calculated for the GWAS, the replication study and both studies pooled.

In addition, analysis of the annotation of the chromatin elements of different human cell types based upon ENCODE data was performed in order to assess the nature of the associated chromosomal region.

Results:

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Summarised from original article with kind permission from Wiley Online Library Copyright Š 1999-2014 John Wiley & Sons, Inc. All Rights Reserved.

...

FUNDACIĂ&#x201C;N ESPAĂ&#x2018;OLA DE PERIODONCIA E IMPLANTES DENTALES

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JCP Digest Scientific release from the European Federation of Periodontology

2014:41 Journal of Clinical Periodontology Rapporteurs: Eshkol-Yogev Inbar, Asher Ran, Grossman Arnon, Horwitz-Berkun Rachel with Goldstein Moshe.

For the Original Article please go to: http://www.efp.org/members/jcp.php Login and navigate to Volume 41, Issue 1

Study:

Paper Digest

01

Periodontal Health for a better life

Affiliation: Prepared by the residents from the Postgraduate Program of Periodontology at the Dept of Periodontology, Faculty of Dental Medicine, the Hadassah-Hebrew University Medical Center, Jerusalem.

Israel.

Extraction Sockets:

Erratic Healing Impeding Factors Kim JH, Susin C, Min JH, Suh HY, Sang EJ, Ku Y, Wikesjo UM, Koo KT. J Clin Periodontol. Jan 2014: 41; 80-85.

Summarised from original article with kind permission from Wiley Online Library Copyright © 1999-2014 John Wiley & Sons, Inc. All Rights Reserved.

Relevant background to study:

In day-to-day clinical practice, adverse reactions following tooth extraction may arise and can result in impaired healing, which may reduce resulting socket bone fill and compromise definitive space restoration by implant placement.

“Erratic healing” in the reported study is defined as extraction sockets that became occupied by soft tissue infiltration and required repeated debridement followed by guided bone regeneration at the time of implant placement.

Study Aims:

The aim of this study was to analyze the prevalence of extraction sockets with fibrous scar tissue occupying the extraction site (rather than bone)

following 12 or more weeks of healing and to evaluate the associated risk factors.

Methods:

Computerized tomography was used to evaluate socket characteristics and calculate “Hounsfield unit” scores (an index used to assess bone mineral density) A total of 1226 dental records from Seoul National University Dental Hospital archives including patients subjected to extractions prior to implant placement were evaluated.

Results:

Seventy subjects (5.71%) and 97 sites (4.24%) exhibited impaired extraction socket healing.

Maxillary incisor/canine sites showed the lowest prevalence (0.47%), whereas mandibular molar sites the highest (5.41%) occurrence.

72% of the cases of erratic healing were of teeth extracted due to periodontal reasons.

Conclusions and impact:



Conclusions: The factors that were associated with erratic healing were: • Age- subjects older than 60 years • Hypertension • Teeth- molars showed more erratic healing • Site- the highest incidence of bone loss was at the buccal wall (49.3%) • Single tooth extractions • The vast majority of erratic healing sites (72%) where of teeth extracted for periodontal reasons.

CT scan of a site with erratic healing, 12 months after molar tooth extraction

Impact: What can we learn as practitioners?

• Erratic extraction socket healing appears not to be a uncommon phenomenon! It may arise in one in every twenty cases!

• Spontaneous socket healing (without socket preservation) resulted in good healing in the vast majority of cases.

• When planning tooth extractions one should be aware of systemic and local factors that may be major contributors to erratic healing - older patients, hypertensive patients, cases of mandibular molars and advanced periodontal disease.

JCP Digest Scientific release from the European Federation of Periodontology

2014:41 Journal of Clinical Periodontology Rapporteurs: Delatola C, de Jong TMH, Faber C, Sygkounas E with Loos BG and van der Velden U. Link to Original JCP article : http://onlinelibrary.wiley.com/doi/10.1111/jcpe.12201/full Access through EFP members page login : http://www.efp.org/members/jcp.php

Study:

Paper Digest

02

Periodontal Health for a better life

Affiliation: Prepared by the residents from the Postgraduate Program of Periodontology and Implant Dentistry at the Department of Periodontology, ACTA, Amsterdam, The Netherlands.

A randomised controlled trial on

immediate surgery versus root planing in patients with advanced periodontal disease: a cost-effectiveness analysis Miremadi SR, De Bruyn H, Steyaert H, Princen K, Sabzevar MM, Cosyn J. J Clin Periodontol. 2014: 41; 164-171.

Summarised from original article with kind permission from Wiley Online Library Copyright © 1999-2014 John Wiley & Sons, Inc. All Rights Reserved.

Relevant background to study:

The conditions of tissues for periodontal surgery may be more favourable when marginal inflammation has subsided after an initial round of nonsurgical debridement. However, surgical treatment

is frequently needed in patients with advanced periodontal disease and therefore surgery without non-surgical pre-treatment could be considered valuable in some patients.

Study Aims:

1: to compare the clinical outcome and the cost-effectiveness of immediate surgery to traditional scaling and root planing (SRP) in patients with advanced periodontitis, with a focus on residual

lesions or poorly responding sites.

2: to evaluate the clinical outcome of the adjunctive systemic use of azithromycin to non-surgical re-treatment of residual pockets.

Methods:

Thirty-nine patients initially received meticulous oral hygiene instructions. They were then randomly assigned to either immediate surgery (n = 19) or SRP (n = 20). Six months following treatment, patients from both groups received re-debridement of the sites with residual pockets (≥6 mm) in

combination with systemic azithromycin. Clinical measurements were performed at baseline, 6 and 12 months. Chair-time was used to determine final financial costs (surgery €200 and SRP €100 per hour). Patient discomfort and number of painkillers were also assessed.

Results:

At 6 months, only 6 patients (32%) in the surgery group had residual pockets ≥6 mm and received re-debridement with adjunctive systemic azithromycin. In the SRP group this was the case for 14 patients (70%). At 12 months the prevalence of residual pockets ≥6 mm was less than 1% for

both treatment groups. At 6 months, surgery costs were an extra € 746 compared with SRP, but € 46 of this amount could be offset as a result of a reduced need for supportive care at 12 months.

There was no difference in discomfort and pain experience between groups.

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JCP Digest

2014:41 Journal of Clinical Periodontology

Scientific release from the European Federation of Periodontology

Conclusions, impact and limitations:



Conclusions: • At 6 months, both modes of treatment led to significant improvement of the periodontal condition, however with more residual pockets in the SRP group.

• Surgery reduced the need for additional treatment of residual pockets.

• Additional treatment by re-debridement with systemic azithromycin was effective in resolving residual pockets.

• The final (12 months) % of residual pockets was very low and similar in both groups (<1%).

• € 700 could be saved on average by performing SRP instead of surgery because surgery needed 100min. more chair time.

Paper Digest

02

Periodontal Health for a better life

Impact: • There was a substantial reduced need for subsequent systemic antibiotics in the surgery group compared to the SRP group.

• Periodontal surgeries without initial SRP may be a valid and efficient treatment in specific cases.

Limitations: • Residual pockets were defined as ≥6 mm; it would be interesting to include also a threshold of ≥5 mm.

• Information about furcation involvements and the presence of angular defects was lacking.

• It was unclear whether the periodontal surgeries were extended to all teeth regardless of pocket deph.

JCP Digest Scientific release from the European Federation of Periodontology

2014:41 Journal of Clinical Periodontology Rapporteurs: García-Gargallo M, with Sanz M Link to Original JCP article : http://onlinelibrary.wiley.com/doi/10.1111/jcpe.12202/full Access through EFP members page login: http://www.efp.org/members/jcp.php

Study:

Paper Digest

03

Periodontal Health for a better life

Affiliation: Prepared by a resident from the Postgraduate Program of Periodontology at the Dept. of Periodontology, Faculty of Dentistry, Complutense University, Madrid. Spain.

Evaluation of the effect of non-surgical

periodontal treatment on oral health-related quality of life: estimation of minimal important differences 1 year after treatment Jönsson B, Öhrn K. J Clin Periodontol. 2014: 41; 275-282.

Summarised from original article with kind permission from Wiley Online Library Copyright © 1999-2014 John Wiley & Sons, Inc. All Rights Reserved.

Relevant background to study:

Primary outcome measures of periodontal treatment are usually clinical outcomes such as changes in clinical attachment, plaque levels, bleeding on probing and change in probing pocket depth. However, the patient’s perspective may also be important for the understanding of the effects of

the disease and its management upon symptoms, function and psychosocial factors. One way to evaluate patient related outcomes (PRO) is oral health-related quality of life (OHRQoL) measures which ascertain patients' perceptions of their oral health and its impact upon their well-being.

Study Aims:

To evaluate PRO at 12 months following nonsurgical periodontal treatment (NSPT) using two different oral hygiene educational programmes in patients with chronic periodontitis and to calculate

in this population the minimal important differences (MID) for two different quality of life measurements.

Methods:

This randomised clinical trial recruited 87 patients with moderate-advanced chronic periodontitis, who after a baseline clinical examination, were divided into 2 groups: 40 patients were assigned to an individually customised oral health program (ITOEP) based on cognitive behavioural principles, while the other group (ST) consisted of 47 patients who received standard oral health information and individual oral hygiene instructions. Both groups received non-surgical periodontal treatment and were asked to complete individualised questionnai-

res containing OHRQoL measures at baseline and 12-months later. Two different instruments were used: 1) the General Oral Health Assessment Index (GOHAI) that focuses on the frequency of symptoms (disease); and 2) the UK Oral Health related quality of life measure (OHRQoL-UK) that assesses the positive effects of oral conditions on patient well-being. The patient’s global rating of oral health and socio-demographic information were also recorded.

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JCP Digest

2014:41 Journal of Clinical Periodontology

Scientific release from the European Federation of Periodontology

Results:

- There were no differences between the two educational programmes for any of the variables studied, with both programmes demonstrating higher OHRQoL measures after periodontal treatment, which indicates more positive well-being and reduced frequency of oral problems in both groups.

- After pooling the results from both educational interventions and comparing the PRO between baseline and one year after therapy, 58 (67%) participants perceived “improved” oral health after NSPT. - From the 16 different aspects evaluated by the OHQoL-UK, 8 aspects had significantly improved in mean value from baseline to 12 months (general health, confidence, mood, finances, personality, comfort, breath odour and overall)

Conclusions and impact:



Paper Digest

03

Periodontal Health for a better life

- Of the 12 different aspects evaluated by GOHAI, five aspects significantly improved from baseline to 12 months (discomfort when eating, unhappy with appearance, use of medication to relieve pain, worried or concerned, nervous or self-conscious and overall).

- The Minimally Important Differences (MID) were calculated for both OHQoL-UK and GOHAI indices. The mean change scores for those who reported “improved” oral health was 5.1 for OHQoL-UK and 3.0 for GOHAI. In total, 46% reported improvements equal to or higher than 5.1 in OHQoL-UK and 50% equal or higher than 3.0 in GOHAI. - There was a correlation between the changes in self-rated oral health and the mean change scores for both questionnaires.

What can we learn as practitioners?

• Non-surgical periodontal treatment improves patients’ perceptions of oral health-related quality of life measures including increased well-being and a positive impact on the person’s daily life.

• Both oral health programmes resulted in similar outcomes of oral health-related quality of life.

• The evaluation of PRO should be considered in all studies assessing the efficacy of periodontal interventions.

JCP Digest Scientific release from the European Federation of Periodontology

2014:41 Journal of Clinical Periodontology Rapporteurs: Stoecklin-Wasmer C, Salvi G.E. Link to Original JCP article : http://onlinelibrary.wiley.com/doi/10.1111/jcpe.12207/full Access through EFP members page login: http://www.efp.org/members/jcp.php

Study:

Paper Digest

04

Periodontal Health for a better life

Affiliation: Prepared by residents from the Postgraduate Program of Periodontology at the Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.

Coronally advanced flap with and without

connective tissue graft for the treatment of multiple gingival recessions: a comparative short-and long-term controlled randomised clinical trial

Zucchelli G, Mounssif I, Mazzotti C, Stefanini M, Marzadori M, Petracci E, Montebugnoli L. J Clin Periodontol. April 2014: 41; 396-403 Summarised from original article with kind permission from Wiley Online Library Copyright © 1999-2014 John Wiley & Sons, Inc. All Rights Reserved.

Relevant background to study:

Surgical interventions to cover exposed roots in cases of gingival recession are commonly required due to aesthetic impairment. The “envelope” or

3-sided type of coronally advanced flap (CAF) represents a safe and predictable approach for multiple recession-type defects.

Study Aims:

The aim of this study was to compare short-and long-term (up to 5 years) root coverage and aesthetic outcomes of the CAF alone or in combination with a connective tissue graft (CTG)

for the treatment of multiple gingival recessions in patients undergoing a very strict supportive care programme.

Methods:

Fifty volunteers with aesthetic complaints and multiple Miller class I and II recession defects (≥ 2mm) in the upper jaw, and presenting with at least 1-mm of keratinized tissue apical to the recession were enrolled and randomised. They presented good overall oral hygiene and low bleeding scores.

Surgery involved the envelope-type of CAF, either alone or in combination with a CTG derived from

the de-epithelialization of a palatal free gingival graft. Patients were carefully monitored following surgery and were regularly recalled for prophylaxis throughout the follow-up period. Clinical parameters, as well as patients’ experiences with the surgical intervention and satisfaction with results were evaluated.

Results:

Up to one year of follow-up, no significant differences were detected between the two groups in terms of recession reduction and complete root coverage (cf. Fig. 1). In the longer term (5 years), however, the addition of a CTG yielded statistically significantly greater reductions in recession depth (RD), although the difference was clinically very small (RD from 3.15mm to 0.09mm vs. RD from 3.05mm to 0.3mm). Furthermore, the CTG demonstrated a more than three times greater

likelihood of complete root coverage, overall better contour scores, and promoted significantly greater keratinized tissue heights after 1 and 5 years. By contrast sites treated with CAF alone exhibited a better post-operative course (less patient pain/discomfort) and better colour matching with less keloid formation. Patients were generally highly satisfied with aesthetic outcomes, with no differences between groups.

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JCP Digest

2014:41 Journal of Clinical Periodontology

Scientific release from the European Federation of Periodontology

Paper Digest

04

Periodontal Health for a better life

Control group (CAF).

Test group: CAF + CTG (baseline, 1- and 5-year outcome).

Impact:

ď&#x192;ź

What can we learn as practitioners? â&#x20AC;˘ Both procedures presented successful overall long-term root coverage results in the treatment of multiple gingival recessions. CAF alone can be considered the first choice treatment, due to favourable periodontal improvements, lower post-operative patient discomfort and only minor long-term marginal soft tissue relapse. Conversely, the

addition of a CTG seemed to provide greater soft tissue stability and may therefore facilitate long-term patient maintenance. Recession sites that require more predictability in complete root coverage due to high aesthetic demands or dentine hypersensitivity may therefore be treated adjunctively with CTG.

JCP Digest Scientific release from the European Federation of Periodontology

2014:41 Journal of Clinical Periodontology Rapporteurs: Seelam N, with Davideau JL, Tenenbaum H, and Huck O. Link to Original JCP article : http://onlinelibrary.wiley.com/doi/10.1111/jcpe.12241/full Access through EFP members page login: http://www.efp.org/members/jcp.php

Study:

Paper Digest

05

Periodontal Health for a better life

Affiliation: Prepared by residents from the Postgraduate Program of Periodontology at the Dept. of Periodontology, Dental Faculty, University of Strasbourg, Strasbourg, France.

The effect of periodontal status and

occlusal support on masticatory performance: the Suita study Kosaka T, Ono T, Yoshimuta Y, Kida M, Kikui M, Nokubi T, Maeda Y, Kokubo Y, Watanabe M, Miyamoto Y. J Clin Periodontol. 2014: 41; 487-503.

Summarised from original article with kind permission from Wiley Online Library Copyright © 1999-2014 John Wiley & Sons, Inc. All Rights Reserved.

Relevant background to study:

Several risk factors such as tooth loss, occlusal support and maximum “bite force”, have been demonstrated to directly affect masticatory ability.

Decrease in masticatory ability adversely affects nutritional intake and negatively impacts upon quality of life. Previous studies have shown that

periodontal tissue destruction may also reduce masticatory ability. However, few studies have investigated this issue, taking into account occlusal support especially in elderly patients with a reduced number of teeth.

Study Aims:

To evaluate the influence of periodontal status on masticatory performance in dentate subjects with

identical areas of occlusal support.

Methods:

This prospective cohort study recruited 1839 elderly patients (67.2 ± 7.9 years) selected randomly from the Suita study that was established to promote prevention of cardiovascular diseases in Japan. Number of functional teeth and occlusal support were evaluated using the “Eichner index” (A1-3, B1-4, C1-3 groups). Periodontal status was assessed using the Community Periodontal Index (CPI), coded from 0 to 4, by means of partial

mouth recording (10 index teeth). Masticatory performance was objectively evaluated by optical density measurement of the glucose concentration released from a “gummy jelly” and correlated with the surface area of the masticated test jelly. Results were adjusted for age and gender. Subjects for whom masticatory performance could not be accurately measured were excluded.

Results:

- A large number of enrolled subjects were classified as Eichner A1 (n=653) without missing teeth and with occlusal contacts in all posterior areas. In this group, 54.1% of subjects had no periodontal pockets (CPI = 0-2).

- Teeth with periodontal pockets (CPI ≥ 3) represented 30% of the Eichner A1 group while this proportion increased to 70% in Eichner B3 group (occlusal contacts in one posterior area).

- In Eichner groups A1 and B3, patients with moderate and severe periodontitis (CPI = 3-4) showed reduced masticatory performance in comparison with those without periodontitis (CPI = 0-2). No significant differences were highlighted in other Eichner A and B groups.

- The proportion of subjects wearing dentures increased from Eichner A2 group (8.3%) to Eichner B4 group (93.4%) and associated with a significant decrease of occlusal support.

- Masticatory performance of denture wearers from Eichner B2 and B3 groups decreased respectively in subjects with moderate periodontitis (B2) and in subjects with moderate and severe periodontitis (B3) in comparison with those without periodontitis.

- When only non-denture wearers were considered, no significant differences in masticatory performance was observed in Eichner A2 to B3 groups according to periodontal status.

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JCP Digest

2014:41 Journal of Clinical Periodontology

Scientific release from the European Federation of Periodontology

Conclusions, impact and limitations:



Conclusions: • Worsening of periodontal status affects masticatory performance in elderly people.

• The influence of periodontal status upon masticatory performance could be observed in patients without tooth loss and also in denture wearers.

Limitations: • Periodontal status was only evaluated on the basis of CPI and by means of partial mouth recording, and the latter is known to underestimate disease prevalence. A more precise evaluation of periodontal parameters including bleeding on probing, clinical attachment and bone levels, and mobility would provide additional data related to inflammatory status, periodontal diagnosis and their influence on masticatory performance.

Paper Digest

05

Periodontal Health for a better life

Practical considerations: • Periodontal screening and treatment associated with prosthetic rehabilitation in elderly subjects may improve masticatory performance and consequently lead to a better quality of life.

• Due to the random selection of patients, discrepancies among the sample size of each Eichner groups led to low statistical power for small sample sized groups • No data were provided regarding alveolar ridge or denture quality in subjects with tooth loss. Such parameters may have affected the evaluation of masticatory performance

JCP Digest Scientific release from the European Federation of Periodontology

2014:41 Journal of Clinical Periodontology Rapporteurs: Behaeghe, E; De Geest, S, Hoflack, M, Quirynen, M, Teughels, W. Link to Original JCP article : http://onlinelibrary.wiley.com/doi/10.1111/jcpe.12248/full Access through EFP members page login: http://www.efp.org/members/jcp.php

Study:

Paper Digest

06

Periodontal Health for a better life

Affiliation: Prepared by the 2nd year residents of the Postgraduate Program in Periodontology at the Periodontology section of the Dept. of Oral Health Sciences, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium.

Patient-reported outcome measures after routine periodontal and implant surgical procedures.

Tan WC, Krishnaswamy G, Ong MM, Lang NP J Clin Periodontol. 2014 Jun;41(6):618-24. doi: 10.1111/jcpe.12248. Epub 2014 Apr 21.

Summarised from original article with kind permission from Wiley Online Library Copyright © 1999-2014 John Wiley & Sons, Inc. All Rights Reserved.

Relevant background to study:

Although low rates of post-operative complications have been reported after routine periodontal and implant surgeries, little is known about the patient’s

perception of bleeding, pain swelling and bruising after these procedures. The latter may be important in setting and managing patients’ expectations.

Study Aims:

To examine the patient reported outcome measures (PROM) involving patients’ perception of bleeding, pain, swelling and bruising for crown lengthening (CL), open flap debridement (OFD)

or straight forward implant placement (IMP) during the first week following surgery, and to examine the prevalence of post-surgical complications.

Methods:

This observational clinical audit study recruited 468 consecutive patients who were in need of periodontal surgery (CL: n=259; OFD: n=94; IMP: n=115) between 2009-2011, at the Periodontics Unit of the National Dental Centre, Singapore. The patients were asked to chart their perceptions on bleeding, swelling, pain and bruising over the first week of the healing period on days 0, 3, 5 and 7 using a visual analogue scale (VAS) with equal units ranging from 0 to 10 with 0 designated as no bleeding, swelling, pain or

bruising and 10 for excruciating pain, extreme bleeding, swelling, or bruising. On day 7, patients were examined clinically for post-surgical complications (tenderness on palpation, swelling, suppuration, flap dehiscence). Additional confounding factors such as gender, procedure type, surgery duration, surgeon’s experience, use of painkillers and periosteal releasing incisions were recorded and taken into consideration using a linear random-effect mixed model.

Results:

- PROM for bleeding, swelling, pain and bruising during the first week of healing were modest and decreased to almost 0 over 7 days. The decrease in VAS scores was the slowest for swelling, pain or bruising.

- IMP had the lowest median VAS score on the day of surgery whereas the decrease in VAS scores was the slowest for OFD. - Surgeries lasting 60 minutes or more had higher VAS scores for swelling and bruising for all days recorded and a higher VAS score for pain at the day of surgery.

- The use of a periosteal releasing incision resulted in a significantly higher VAS score for swelling.

- After adjustment for confounders in a linear mixed random-effects model, the PROM showed that: · Surgery duration of less than 60 minutes and time after surgery decreased the VAS scores for bleeding, swelling, pain and bruising. · VAS scores for swelling were lower for males and lower when no periosteal releasing incisions were employed. · Longer operator experience only reduced the VAS score for bleeding.

- At day 7, the prevalence of flap dehiscence and tenderness to palpation was around 10% and the prevalence for swelling and suppuration was below 5% for all types of surgical procedures.

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JCP Digest

2014:41 Journal of Clinical Periodontology

Scientific release from the European Federation of Periodontology

Conclusions and impact



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What can we learn as practitioners?

• The patient’s perception of bleeding, swelling, pain and bruising are modest but can last for up to 1 week.

• Longer operator surgical experience does not result in a lower patient perception of swelling, pain and bruising.

• Keeping surgery time below 1 hour results in a lower perception of bleeding, swelling, pain and bruising.

• There were no gender differences in the patient’s perception of bleeding, pain and bruising, but swelling was perceived by females to be worse than males.

• The use of periosteal releasing incisions results in a higher patient perception of swelling.

JCP Digest Scientific release from the European Federation of Periodontology

2014:41 Journal of Clinical Periodontology Rapporteurs: Darnaud C1, Prouvost B1, Colliot C1 with Sarfati A2 Link to Original JCP article : http://onlinelibrary.wiley.com/doi/10.1111/jcpe.12266/full Access through EFP members page login: http://www.efp.org/members/jcp.php

Study:

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Affiliation: 1. Third-year residents.

2. Assistant professor; in charge of the journal club. Postgraduate Program of Periodontology, Department of Periodontology, UFR of Odontology, Paris Diderot University, Paris, France.

Rothschild Hospital, AP-HP.

Risk factors associated with the longevity

of multi-rooted teeth. Long-term outcomes after active and supportive periodontal therapy Salvi GE, Mischler DC, Schmidlin K, Matuliene G, Pjetursson BE, Brägger U, Lang NP. J Clin Periodontol 2014; 41: 701-707.

Summarised from original article with kind permission from Wiley Online Library Copyright © 1999-2014 John Wiley & Sons, Inc. All Rights Reserved.

Relevant background to study:

The treatment of multi-rooted teeth with furcation involvement is challenging for clinicians.

Usually the clinical response to non-surgical treatment is unpredictable and loss of attachment

may continue during periodontal maintenance.

Evidence for the impact of the severity of furcation involvement and the associated risk factors, upon long-term tooth loss is limited.

Study Aims:

The aim of this study was to assess the influence of (i) the degree of furcation involvement, and (ii) the associated risk factors, upon the loss of multi-

rooted teeth in patients treated for periodontitis and included in a maintenance program.

Methods:

The reported study was a retrospective cohort study of 172 patients treated for chronic or aggressive periodontitis. A periodontal examination was performed at baseline, after periodontal therapy, and again following a maintenance program (mean duration = 11.5±5.2 years).

Furcation involvement was assessed using the classification proposed by Hamp et al. (1975).

Compliance, as determined by the criteria of

Demirel & Efeodlu (1995), was based upon attendance or failure to attend the scheduled appointments. Smoking status was recorded as smokers, former smokers and non-smokers. The tooth was treated as the unit of analysis. Univariate and multivariate regression analyses were conducted to determine the risk of loss of multi-rooted teeth throughout the duration of the study

Results:

- Class I furcation involvement was not a significant risk factor, compared to no furcation involvement.

- Risk factors for multi-rooted tooth loss in subjects treated for periodontitis and enrolled into a maintenance program were class II and III furcation involvement, smoking and a lack of

compliance.

- Non-smokers and former smokers did not differ with respect to multi-rooted tooth loss.

- Tooth loss was less frequent in the mandible than the maxilla.

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JCP Digest

2014:14 Journal of Clinical Periodontology

Scientific release from the European Federation of Periodontology

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Image courtesy of Dr Aleksandar DARIC

Conclusions, impact and limitations:



Conclusions: • Class II and III furcation involvement, current smoking and lack of compliance with maintenance program visits were all risk factors for multi-rooted tooth loss in patients treated for periodontitis.

Limitations: • The principle limitations of the reported study were its retrospective design, the use of multiple subgroup analyses potentially leading to small subgroup sample

Impact: • Compliance with a strict maintenance program may be essential to prevent multi-rooted tooth loss in furcation involved teeth.

• Smokers should be encouraged to adhere to a smoking cessation protocol.

sizes, and wide confidence intervals; and using the tooth as the statistical unit of analysis prevents the drawing of conclusions at the patient level.

JCP Digest Scientific release from the European Federation of Periodontology

2014:41 Journal of Clinical Periodontology Rapporteurs: Crotty J, Gkikas G, Alotaibi M, with Polyzois I. Link to Original JCP article : http://onlinelibrary.wiley.com/doi/10.1111/jcpe.12269/full Access through EFP members page login: http://www.efp.org/members/jcp.php

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Affiliation: Prepared by the students of the Graduate Programme in Periodontology, Department of Restorative Dentistry and Periodontology, Trinity College Dublin, School of Dental Science, Ireland.

Coronally advanced flap + connective tissue graft techniques for the treatment of deep gingival recession in the lower incisors.

A controlled randomised clinical trial Zucchelli G, Marzadori M, Mounssif I, Mazzotti C, Stefanini M. J Clin Periodontol. 2014; 41: 806-813.

Summarised from original article with kind permission from Wiley Online Library Copyright © 1999-2014 John Wiley & Sons, Inc. All Rights Reserved.

Relevant background to study:

Coverage of localised labial gingival recessions can be achieved with several techniques. Of these, coronally advanced flaps (CAF) in association with connective tissue grafts (CTG) seem to obtain more root coverage and achieve better aesthetic outco-

mes. Most of the existing studies have evaluated this technique for moderate recession defects in the maxillary arch and there is a lack of evidence regarding its effectiveness with lower incisors.

Study Aims:

To compare clinical and aesthetic outcomes of two different but similar surgical techniques in the

treatment of single labial gingival recession defects of lower incisors.

Methods:

Fifty patients participated in this double masked, randomised controlled clinical trial. All of the participants contributed one recession defect, classified as Miller class I or II (≥ 3mm in depth).

Patients were only allowed to proceed with the surgical procedures if they could demonstrate an acceptable level of oral hygiene.. The roots were debrided before surgery and treated with 24% EDTA for 2 minutes following root exposure. All surgeries were performed by the same operator. Test group (n=25) treatment was: CAF + CTG + Labial Sub-mucosal Tissue (LST) removal. In order to remove the LST an incision was made deep to detach it from the periosteum and another incision was made superficially to separate it from the

alveolar mucosa. This way, the flap was released of tension and adapted more closely to the underlying periosteum. Control group (n=25) treatment: CAF + CTG without removal of the LST. Clinical measurements were performed 1 week before and 12 months following surgery, except for CTG thickness and bone dehiscence length, which were measured during the procedure. Oral hygiene was reinforced regularly during this period. Evaluation of aesthetics was performed 12 months following surgery both by the patients and by a periodontist.

Postoperative pain was also evaluated by measuring the mean use of analgesics in the week following the surgical procedures.

Results:

Both treatment protocols were successful in treating recession defects by reducing their size. Additionally, probing pocket depths were reduced and keratinised tissue height and width increased with both techniques. Significantly less CTG exposure occurred in patients who had the LST removed and

this was associated with greater percentage of root coverage, less keloid formation and a more aesthetic result. The study failed to identify differences in postoperative pain and morbidity between the two groups.

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JCP Digest

2014:41 Journal of Clinical Periodontology

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Periodontal Health for a better life

a) Defect of 4mm. b) Trapezoidal flap elevation. c) LST removal. d) The LST following removal. e) CTG following disepitelization of free gingival graft is sutured at level of CEJ. f) Coronally advanced flap to cover CTG. g) LST removal facilitates flap has a vertical dimension adapted closely to the underlying periosteum.

With kind permission from John Wiley & Sons A/S.

Conclusions and impact



• Single type gingival recessions on the labial aspect of mandibular incisors may be successfully treated using CAF + CTG. • Removing LST may improve flap stability and is associated with improved outcomes.

• The study demonstrated that patient assessment of the

results focussed on graft colour rather than root coverage. Therefore, the improved aesthetics associated with removing the LST in conjunction with the superior clinical results, indicates that this technique should be considered when treating deep gingival recessions in the lower incisors.

JCP Digest Scientific release from the European Federation of Periodontology

2014:41 Journal of Clinical Periodontology Rapporteurs: Halperin-Sterenfeld M, Eskander L, Saminsky M, Rozitsky D, Levi I, Weinberg G, with Eli E. Machtei Link to Original JCP article : http://onlinelibrary.wiley.com/doi/10.1111/jcpe.12289/full Open access article.

Study:

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Affiliation: Prepared by Residents from the Postgraduate programme at the department of Periodontology, School of graduate dentistry, Rambam HCC and The Faculty of Medicine – Technion, Israeli Institute of Technology, Haifa, Israel.

Subgingival air-polishing with erythritol

during periodontal maintenance: Randomised clinical trial of twelve months Müller N1, Moëne R, Cancela JA, Mombelli A. J Clin Periodontol. 2014; 41:883-889.

Summarised from original article with kind permission from Wiley Online Library Copyright © 1999-2014 John Wiley & Sons, Inc. All Rights Reserved.

Relevant background to study:

The objective of supportive periodontal therapy (SPT) is to remove newly formed bacterial deposits form residual pockets thus maintaining periodontal health. A variety of hand and ultrasonic instruments can be used. Air-polishing devices that

produce a jet of compressed air containing low abrasive agents via a nozzle, and which can be inserted to the top of the pocket may also be employed for this purpose.

Study Aims:

To evaluate the efficacy of repeated sub-gingival air-polishing containing erythritol powder with

0.3% chlorhexidine in residual pockets of >4 mm over 12 months.

Methods:

50 maintenance patients (≥ 3 months following completion of comprehensive periodontal treatment), with contra-lateral residual pockets >4 mm (at least one per quadrant) were included in this single-centre, randomised clinical trial. Clinical measurements (PD, PI, BOP, REC, root hypersensitivity) and microbial sampling were performed 3-monthly, while treatment was provided at 0, 3, 6,

and 9 months (providing that PD>4 mm). One site per patient was assigned to sub-gingival air-polishing with erythritol powder containing 0.3% chlorhexidine (test side) and the other site to ultrasonic debridement (control). The presence of PD >4 mm at 12 months was the primary end-point.

Results:

A reduction in number of sites with PD >4mm was achieved from 4.6 to 3.6 in test sites and 4.8 to 3.9 in control sites (p<0.001). Likewise, changes in BOP were statistically significant (0-12 months) for both groups. However, none of the changes were significantly different between groups. Patients' pain/discomfort perception was judged to be lower

at test sites. No difference was found in bacterial detection frequencies (0-12 months) in both groups. When comparing test and control sites, lower frequencies of Aa count>1000 cells/ml were observed in test sites. Two control site samples recorded Aa at 100,000 cells/ml while none of the test sites did.

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JCP Digest

2014:41 Journal of Clinical Periodontology

Scientific release from the European Federation of Periodontology

Conclusions, impact and limitations:



Limitations: • The potential advantage of the air polishing might be attributed to the addition of 0.3% chlorhexidine.

• Intra-individual comparisons of local therapy may have crossover effects in different sites in the same dentition.

• The sample size in the present study may be insufficient to detect a true difference in prevalence of PD>4 after a period of 12 months.

• Finally, this was an industry-supported rather than an independent study.

Impact: What can we learn as practitioners?

• Following cause related therapy residual pockets may demonstrate continued improvement where continuous SPT is provided.

• Both instruments may have utility in a periodontal maintenance programme.

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Conclusions: • The primary endpoint, the reduction of sites with PD>4 mm, was achieved to a similar degree in both protocols.

• Continued improvement was observed throughout the 12 months observation period.

• Patients in the air polishing group reported less pain than in the ultrasonic group.

• At 12 months, the Aa count was significantly lower in the air-polishing group.

• The slightly greater improvement in the bacterial count for the air-polishing device might be attributed to the incorporation of chlorhexidine into the regimen.

JCP Digest Scientific release from the European Federation of Periodontology

2014:41 Journal of Clinical Periodontology Rapporteurs: Almohandes A, Bougas K, Gkatziou D, Krajewski W, Lopez-Lago Garcia A with Abrahamsson I Link to Original JCP article : http://onlinelibrary.wiley.com/doi/10.1111/jcpe.12298/full Access through EFP members page login: http://www.efp.org/members/jcp.php

Study:

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Affiliation: Prepared by the 2nd year residents from the Postgraduate Programme in Periodontology, Specialist Clinic in Periodontology, Public Dental Service, Region of Västra Götaland and Department of Periodontology, The Sahlgrenska Academy at University of Gothenburg

Supportive post-implant therapy:

patient compliance rates and impacting factors: 3-year follow-up Frisch E, Ziebolz D, Vach K, Ratka-Krüger P. J Clin Periodontol. 2014; 41: 1007-1014.

Summarised from original article with kind permission from Wiley Online Library Copyright © 1999-2014 John Wiley & Sons, Inc. All Rights Reserved.

Relevant background to study:

Following successful periodontal treatment, patients usually transfer into supportive periodontal therapy (SPT), which is known to be vital to the long-term preservation of periodontally treated teeth. Patient adherence to SPT represents an essential factor for long-term tooth preservation after periodontal therapy. Following treatment with

Study Aims:

To evaluate patient compliance rates and influential factors in a systematic SIT programme over a 3-year period.

Methods:

This retrospective 3-year cohort study recruited 241 consecutive patients who had been provided with implants and implant-supported prostheses between January 2005 and December 2008, in a private practice specialising in implants. Inclusion criteria were: age ≥ 18 years; all treatment provided in the study centre; availability of medical data (including smoking habit); and a post-operative observational period ≥ 3 years.

The patients had received two-stage implant surgery by one dentist and 5 different implant systems were used. Following the delivery of implant–supported restorations, all patients received oral hygiene (OH) instructions and were scheduled for 3-monthly SIT. The necessity for

implant-supported restorations special oral hygiene measures are required to prevent inflammation and peri-implant diseases. Therefore, a systematic supportive post-implant therapy (SIT) programme appears necessary for the long-term prevention of peri-implant diseases.

self-performed OH and compliance with SIT was emphasised. Extent of compliance was defined according to patients’ attendance at SIT appointments. At the end of the 3-year observation period, all implants were clinically examined for peri-implant mucositis and peri-implantitis by probing pocket depth, pus/suppuration, plaque and bleeding on probing. In 2012 patients were retrospectively evaluated using their records, for gender; age, smoking habits, medical history, geographic distance to the study centre and complexity of the implant surgery. Regression analysis was implemented to evaluate the effect of different variables on yearly and overall compliance.

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JCP Digest

2014:41 Journal of Clinical Periodontology

Scientific release from the European Federation of Periodontology

Results:

Conclusions, impact and limitations:

Five patients did not complete the study (dropout rate: 2.1%). 236 patients with 540 implants fulfilled the inclusion criteria (137 female; 99 male). The study group contained 16 tobacco smokers, 8 patients with diabetes and 66 patients with cardiovascular disease. Before implant treatment, 140 patients had already been included in a prophylaxis programme at the same centre, whereas for 96 patients this procedure was their first contact with systematic dental prophylaxis.

Patient non-compliance rates to SIT increased through the observation period. During the 1st, 2nd and 3rd year, non-compliance rates were 13%, 19% and 34% respectively. Regression analysis



Limitations: • Clinical and radiographical baseline data were lacking.

• There was a short follow-up period.

• The cohort was relatively small.

• A prospective design would be preferred to a retrospective design.

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demonstrated that geographical distance to the study centre had a statistically significant influence upon SIT compliance in each of the 3 years.

Tobacco smoking, diabetes and pre-existing experience in prophylaxis programmes had a statistically significant influence in only one of the 3 years. While the influence of the SIT compliance, over the whole observation period, on presence or absence of plaque, suppuration, signs of peri-implant inflammation and peri-implantitis did not reach statistical significance, a significant correlation was found between lower compliance and increased PPD as well as increased geographical distance to the study centre.

Conclusions: • SIT programmes, with 4 visits per year, may have a high level of compliance over the first 3 years.

• A lower level of compliance was seen in patients with greater geographical distance to the study centre.

• There was a correlation between compliance to SIT and probing pocket depth values. However, no correlation between compliance and bleeding on probing was found. Further prospective studies with longer observational periods are needed.

JCP Digest Scientific release from the European Federation of Periodontology Editor: Iain Chapple, Birmingham, UK

Study:

2014:41 Journal of Clinical Periodontology Rapporteurs: Duzenli D, Kuka S, Cihangir S, with Yilmaz S. Link to Original JCP article : http://onlinelibrary.wiley.com/doi/10.1111/jcpe.12315/full Access through EFP members page login: http://www.efp.org/members/jcp.php

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Affiliation: Prepared by the residents from the Postgraduate Programme of Periodontology at the Department of Periodontology, Faculty of Dentistry, Yeditepe University, Istanbul-TURKIYE

Study: Retaining or Replacing Molars with

Furcation Involvement: a Cost-effectiveness Comparison of Different Strategies Schwendicke F, Graetz C, Stolpe M, Dörfer CE. J ClinPeriodontol. 2014; 41: 1090-1097.

Summarised from original article with kind permission from Wiley Online Library Copyright © 1999-2014 John Wiley & Sons, Inc. All Rights Reserved.

Relevant background to study:

In recent years there has been significant debate concerning the retention of periodontally compromised furcation involved (FI) molars verses extraction and replacement with implant supported

crowns (ISCs). Besides evidence-based data relating to therapeutic decision making, the comparative cost-effectiveness of these two therapeutic approaches remains unexplored.

Study Aims:

The aim of this study was to evaluate the cost-effectiveness of retaining vital FI molars with various forms of periodontal treatment, both

non-surgical and surgical or replacing them with ISCs.

Methods:

A simulation was performed using a private payment scheme within the German Healthcare System as a model, and applied to a 50-year-old male patient with an average remaining life expectancy of 29.7 years, who had FI molar teeth and was followed through his lifetime using a Tooth Level Markov Model. Periodontal treatment alternatives (scaling and root planing, flap debridement, root resection, guided tissue

regeneration and tunneling) were compared with ISCs in terms of cost, time until first re-treatment and total time of tooth or implant retention. Based on current literature, transition probabilities were calculated, Monte-Carlo micro-simulations were performed. The robustness of the model and effects of heterogeneity were evaluated using sensitivity analyses.

Results:

- Scaling and root planing was found less costly and more effective than ISCs in the treatment of FI I molars.

- ISCs were retained for a shorter time period than furcation involved teeth irrespective of the degree of furcation involvement.

- Periodontal treatments aimed at tooth retention were found to be more effective and less costly than tooth replacement with ISCs in the treatment FI II/III molars.

- Despite the need for different intervals of supportive periodontal treatment for furcation involved teeth, retaining such teeth was less costly than ISCs, with the exception of root resection.

- Despite long-term retention of FI molars, leading to local bone loss requiring additional surgical procedures, the costs were still found to be less than ISCs.

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JCP Digest

2014:41 Journal of Clinical Periodontology

Scientific release from the European Federation of Periodontology

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Periodontal Health for a better life

Editor: Iain Chapple, Birmingham, UK

Limitations, conclusions and impact:



Limitations: • Cost estimates are limited to a German Health Care model.

• Tooth retention does not reflect functional rehabilitation or quality of oral health, however there is a lack of evidence in the literature on patient related outcomes in this area.

• Most of the studies included in the analysis were performed in university conditions, therefore may be subject to selection, performance and reporting bias.

The external validity of the findings is a matter for debate.

Conclusions: Retaining molar teeth with furcation involvement using various periodontal therapeutic approaches was found to be more cost-effective than tooth removal and then replacement with implant supported crowns.

Impact: Retention of furcation involved teeth appears to be more cost effective and more successful than their replacement with implant supported crowns. However, clinical decision making in the treatment of furcation involved molars should be guided not only by cost-effectiveness but also by patient preference, treatment conditions and practitioner related factors.

JCP Digest Scientific release from the European Federation of Periodontology Editor: Iain Chapple, Birmingham, UK

Study:

2014:41 Journal of Clinical Periodontology Rapporteurs: Moreno F, Tsarouchi D, Kousounis E, Nibali L, with Donos N. Link to Original JCP article : http://onlinelibrary.wiley.com/doi/10.1111/jcpe.12317/full Access through EFP members page login: http://www.efp.org/members/jcp.php

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Affiliation: Prepared by the residents from the Postgraduate Programme of Periodontology at the Department of Periodontology, Eastman Dental Institute, University College London, London, UK.

Study: Genome-wide exploration identifies sex-specific genetic effects of alleles upstream NPY to increase the risk of severe periodontitis in men

Freitag-Wolf S, Dommisch H, Graetz C, Jockel-Schneider Y, Harks I, Staufenbiel I, Meyle J, Eickholz P, Noack B, Bruckmann C, Gieger C, Jepsen S, Lieb W, Schreiber S, König IR, Schaefer AS. J Clin Periodontol 2014; 41: 1115–1121.

Summarised from original article with kind permission from Wiley Online Library Copyright © 1999-2014 John Wiley & Sons, Inc. All Rights Reserved.

Relevant background to study:

Periodontal disease expression is influenced by a complex interplay between genetics, socio-economic and other factors such as gender.

Several epidemiological studies suggest a higher risk for chronic periodontitis in men compared with women. There is, however, no evidence for such a gender bias in aggressive periodontitis (AgP).

Studies investigating the genetic basis of AgP have been relatively small in scale with only a limited number of risk alleles identified. Moreover, characteristics such as gender and its potential influence upon disease expression were rarely analysed.

Study Aims:

To test the hypothesis that for AgP gender interacts with specific single nucleotide polymorphisms

(SNPs) and alters disease risk.

Methods:

A genome-wide association study (GWAS) involving 329 German patients with AgP versus 983 controls was performed to investigate genetic constitution including gender as an interaction term for the expression of the disease. The SNP with the strongest gender association in AgP was further tested in an independent replication study of 382 AgP cases against 489 controls.

In the GWAS, whole genomes extracted from frozen blood samples were genotyped using Affymetrix Gene Chip Human Mapping 500K Arrays. The SNP with the strongest gene-gender interaction (SNP rs198712) was then genotyped in

the replication study with the TaqMan Assay hCV9946741, using an automated platform.

Logistic regression analysis was employed to study potential interactions between eligible SNPs and gender in AgP with a cut-off significance value of p<0.05. Gender-specific odds ratios (ORs) were calculated for the GWAS, the replication study and both studies pooled.

In addition, analysis of the annotation of the chromatin elements of different human cell types based upon ENCODE data was performed in order to assess the nature of the associated chromosomal region.

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JCP Digest

2014:41 Journal of Clinical Periodontology

Scientific release from the European Federation of Periodontology

Results:

• From the 287,224 SNPs analysed, 2,041 SNPs had a significant interaction with gender (p<0.05), SNP or the gene–gender interaction term. The most significant findings were for a region on chromosome 7 upstream of the gene neuropeptide Y (NPY) and included 11 SNPs. 10 exhibited p-values <5x10-5 in the gene–gender interaction and were in high linkage disequilibrium.

• The lead SNP was rs198712 with gender-specific Odds Ratios (ORs) of 1.629 for males and 0.689 for females and also showed the strongest interaction effect with gender when the Model-Based Multifactor Dimensionality Reduction (MB-MDR) analysis was performed.

• There was a difference of 12% in the Minor allele frequency (MAF) between the male cases and the controls (48% vs 36%) and a MAF difference of

Limitations, conclusions and impact:



• AgP cases were identified solely on radiographic criteria and an arbitrary age cut-off point.

• The use of different case definitions of aggressive periodontitis which differ in extent and severity of disease in the exploratory study compared to the replication study may have altered the effect size of the association.

• There is uncertainty as to whether potential confounders were accounted for either at the stage of study design or during statistical analysis.

• Multiple related genes in the same functional pathway may work together to confer disease susceptibility. The sample size in the current study is likely still too small to detect significance for other genes that may also be involved in disease susceptibility.

• Combining the explorative and replication data in order to obtain one pooled interaction p-value may be not always be considered as statistically optimal.

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9% between the female cases and controls (30% vs 39%), whilst there was no difference in the MAF of the controls and the cases overall (males and females, both 37%). These SNPs therefore showed no significant effect upon Aggressive Periodontitis unless gender was taken into account.

• In the replication study of the association on chromosome 7 upstream of NPY SNP rs198712, the gender-specific ORs were 1.304 for males and 0.832 for females. The MAF differences were smaller for males but comparable both for males and females to the initial explorative study.

• In silico analysis of the chromatin state of the NPY region showed that the associated chromosomal region that was tagged by rs198712, showed tissue-specific transcription and possessed a poised “silent” promoter.

Conclusions: An associated intergenic region of 140-kb, situated upstream of the gene NPY conferred an increased risk for aggressive periodontitis in men but a decreased risk in women. In a replication study, this region showed strong linkage disequilibrium upstream of NPY and also displayed a gene–gender interaction.

Impact: The data provide evidence of a gender-dependent role for alleles in the region of the neuropeptide Y (NPY) locus in humans and support previous genome-wide findings for a role for NPY in periodontitis. The introduction of genderstratified analysis may be important for the analysis of future genome-wide association studies.