4.10 Periodontitis lit (2023-2024)

Question 1

What is the long-term stability of regenerative periodontal surgery and orthodontic movement in Stage IV periodontitis patients? - 10 year retrospective study.

Tietmann et al JOP

Answer 1

10 year retrospective study
22 patients with 256 regenerated defects.
Ortho was initiated 3 months after surgery.

RESULTS:
* PD’s of ≤4mm was achieved in 90% of all defects.
* Tooth loss was only 4.5%.

Conclusion: Motivated and compliant patients who undergo surgical periodontitis treatment, can have favorable long-term outcomes and can successfully undergo ortho therapy.

Question 2

Describe the “Minimally invasive osseous resective protocol” = “ MI-PES”

Trombelli et al.

Answer 2

The article described the technique, which is very similar to the “FibRe-ORS” technique described by Cairo in 2013.

Description of the “Minimally invasive osseous resective protocol”:
* Thin the palatal flap via beveled incision. (Same as osseous scalloping)
* Remove the tissue collar
* Mobilize the buccal papillas only enough for access.
* Debride roots with ultrasonic.
* Recontour the bone only on the palatal side: Osteoplasty
Suture via continuous sling.

RESULTS:
Baseline PD’s were about 5.5mm; at 6 month followup, the PD’s averaged 3mm.
* Dr. Wang says these results are similar to Modified Widman Flap

Question 3

Describe how Complement components C3b and C4b are biomarkers for periodontitis.

Huang et al JPR

Answer 3

Sampled the gingival crevicular fluid of periodontitis pockets and measured the C3b and C4b.

• Also harvested gingival tissues and performed Immunohistochemistry, ELISA assays, and Western Blots.

RESULTS:
* There is a significantly increased protein expression of C3b and C4b in gingival tissues with increasing PD’s.
* There is also a significantly increased protein expression of C3b and C4b in gingival crevicular fluid of increasing PD’s.

Question 4

How does periodontitis stage and grade affect the cost and need for retreatment?

Saleh et al JCP

Answer 4

Retrospective study
n = 442 patients

RESULTS:
Stage I /II patients were compared with Stage III / IV.
* Stage III / IV patients received more surgery during supportive recalls than the Stage I / II patients.
* Risk factors (smoking, diabetes, noncompliance with maintenance) was related to a higher chance of needing surgery during follow-up visits.
* The mean cumulative costs indicated less recurrence costs for compliant Stage III / IV and Grade B / C patients, but not for Stage I / II or Grade A patients.

Question 5

Describe how amoxicillin and metronidazole as an adjunct to SRP affects HbA1c.

Xu et al JPR

Answer 5

RCT
n = 49 patients
* Group 1: SRP + antibiotics (500mg Amoxicillin + 200 mg Metronidazole TID for 7 days)
* Group 2 : SRP only

Follow-ups at 3 months

RESULTS:
* NSSD in most measurements between groups.
* However, both groups showed improvements (PD’s went from ~5 to ~3.5)
* When initial PD was > 6 mm, the SRP + antibiotics group had more sites of improvement than the SRP only group (79% vs 73%)
* HbA1c appeared to decrease by about 0.5, but it was NSSD

Question 6

Describe the RCT on the effect of epithelium removal on FGG autograft healing.

Lacy et al.

Answer 6

Prospective study
n = 46 patients
* Control: FGG with epithelium
* Test: FGG, but with the epithelium removed

8 different perio residents did the surgeries. (Note: Dr. Wang says because of this, the results were already inconsistent)

RESULTS:
* NSSD regarding all results. (Vertical KT gain, horizontal KT width, esthetics, and graft shrinkage = same in both groups)