Perio Insight 8 - Autumn 2018

Editor: Joanna Kamma Scientific Advisers: Phoebus Madianos, Lior Shapira ‘ are not a magic wand but offer great potential in periodontal and peri-implant therapy’ The use of lasers is becoming increasingly common in periodontal therapy, to treat both periodontitis and peri- implant diseases. But there are risks as well as rewards. Ayala Stabholz, professor of at the Hebrew University–Hadassah Faculty of Dental Medicine in Jerusalem reviews the evidence.

The use of lasers in , to their most important An example of equipment used in periodontal therapy particularly in periodontics determinant: the wavelength. (Light Instruments’ LiteTouch Er.Yag device) and peri-implant diseases, has Each wavelength has its specific grown since their introduction characteristics and absorption (2,780nm) – absorbs in water tissues and 0.005 – 0.015mm in the late 20th century. capabilities and cannot be and hydroxyapatite; in hard tissues), that of the changed. Another fixed Nd:YAG and diode lasers is Lasers can be used either as an ► CO2 (9,300nm and 9,600nm) adjunct to conventional therapies parameter is the specific target – absorbs in water and much greater (1 – 3mm for or as a monotherapy replacing tissue. In the periodontal field, hydroxyapatite. Nd:YAG and up to 1mm for tissues are soft (periodontal diode). Clinicians must take existing techniques – but they are Soft-tissue lasers: not a magic wand that can change ligament and gingiva) and hard these differences into account acceptable treatment concepts (teeth and bone), and there ► Nd:YAG (1,064nm) – absorbs when deciding which laser to or cause miracles. are also the metal surfaces of in melanin and haemoglobin; use and also consider other implants. As these features variables including wavelength- ► Diode (810nm - 1,064nm) Lasers are medical devices that are also fixed, the choice of absorption spectrum, target – absorbs in melanin and work by delivering energy to which laser to use should be tissue, delivery system, and haemoglobin; a target human tissue. When made according to the specific hazards to neighbouring tissues this energy is absorbed, it therapeutic demands. ► CO2 (10,600nm) – absorbs and to the essential biological selectively affects the tissue’s in water (very efficiently) Five main laser wavelengths structures of the patient and biological components based on and in hydroxyapatite (but have been studied for operator if carelessly used. the laser’s specific wavelength less efficiently than CO2 periodontal and peri-implantitis characteristics, its power, and 9,300nm and 9,600nm). Why were lasers introduced to the exposure time. treatments and have been classified as “hard-tissue”, “soft- The penetrability of the periodontology? Various laser devices have tissue,” and “all-tissue” lasers: different laser beams into Lasers were introduced to been developed, each with human tissues is a key factor. periodontics as a scalpel Hard-tissue/all-tissue lasers: its own capabilities and While the penetration depth substitute for minor surgical distinctive applications, and ► Ebrium family: Er:YAG of CO2 and erbium lasers is procedures and later as an they are classified according (2,940nm) and Er,Cr:YSGG minimal (0.05 - 0.1mm in soft alternative or an adjunct to

Lasers in periodontal therapy Clinicians react to new classification Latest JCP 1-4 5-6 7-8 research

Partners Autumn 2018 2

non-surgical periodontal treatment. Their advantage A 60-year-old woman with over the scalpel stems from peri-implantitis around implant their haemostatic abilities, #46. Treatment included which also improve visualisation mechanical cleaning, Er:YAG of the surgical field, and laser application (100mJ improved healing has also and 10PPS) along the entire been reported. Their inclusion perimeter of the exposed in non-surgical periodontal implant, plus bone treatments as decontaminants augmentation with Bio-Oss arose because of incomplete and Ossix membrane): bacterial and calculus removal following traditional mechanical Above: therapy, to try to achieve better Pre-operation (2015) results and thereby avoid surgical Below: intervention. Pre-operation x-ray (2015)

Anti-bacterial properties: All dental laser wavelengths have bactericidal and detoxification properties, crucial for treating infectious and bone ablation, bacterial incisions – although some and to decontaminate diseases, as periodontitis and endotoxin and smear-layer clinicians find laser tips work well implant surfaces exposed peri-implantitis are believed elimination from root surfaces, for such procedures. to peri-implantitis is still to be. Most published studies and root conditioning with no subject to debate. There are Why laser rather than scalpel? of the use of lasers in the thermal side-effects. various limitations. Only laser treatment of these diseases But why should one use machines with a tip can be Soft-tissue procedures: focus on either the bacterial expensive laser technology used subgingivally, but most Numerous soft-tissue biofilm in the periodontal for periodontal soft-tissue laser companies have not yet periodontal procedures pocket or the soft-tissue procedures if a simple surgical developed a designated tip for using lasers are described lining of the pocket, and on scalpel can do the job? There periodontal purposes. Only in the literature, including: removing embedded bacteria are several reasons. First, the a few laser machines have , gingivoplasty, and inflammatory tissue. While haemostatic and coagulation side-firing tips that can target frenectomy, sulcular soft- some clinicians advocate using properties of some soft- directly either the root surface tissue debridement, palatal the laser first to enable better tissue lasers offer better and/or the diseased pocket graft donor-site coagulation, access and a less contaminated visualisation of the surgical lining. Most tips fire their operculum and fibroma excision, environment before deploying field (particularly in patients energy from the apex or end of soft-tissue cutting in patients conventional instrumentation, with coagulation disorders or the tip – aiming at the junctional with bleeding disorders, clinical others argue for the use of other bleeding risks). Second, epithelium or bone-implant crown lengthening, implant the laser beam following the sterilisation of the target contact. But directing the laser exposure, melanin mechanical disinfection area reduces bacteraemia energy towards these structures depigmentation, aphthous to complement bacterial risk. Third, reports have shown does not suit our treatment and treatment, connective-tissue elimination. There is growing minimal tissue trauma and a may even cause irreversible remodelling, and enhanced bone evidence that laser periodontal better repair course following damage to existing tissues. In metabolism (by bio-stimulation therapy reduces inflammatory laser application, as well as addition, some laser tips are very produced by low-level laser mediators such as IL-1β, IL-6, less post-operative pain and thin and fragile and can break devices). It is claimed that laser’s TNF-α, and MMP-8. swelling through blood and in the periodontal pocket and bio-stimulatory features result lymphatic vessel occlusion. invisible laser firing can cause Additional effects: As well in better healing compared to Claims that laser soft-tissue negative side effects, so is not as the anti-bacterial properties traditional approaches and in wounds heal faster, are recommended when targeting common to all dental lasers, periodontal-tissue regeneration. painless, and produce less scar the subgingival area. additional effects of the CO2, tissue than scalpel surgery have diode and Nd:YAG lasers Using lasers for subgingival not been verified in histological The tactile sensitivity that guides include incision and excision incisions to raise periodontal or clinical trials. our non-surgical periodontal of soft tissues, haemostasis flaps is questionable because procedures is lacking during and coagulation, and pocket- of the danger that the beam will Non-surgical use of lasers subgingival laser operation and wall (epithelial and connective harm surrounding periodontal While their ability to ablate the tip movements proceed tissue) debridement; while tissues (roots or bone). Moreover, soft tissues is well established, blindly. Therefore, non-surgical those of the Er:YAG and subgingival scalpel incisions are the effectiveness of laser subgingival laser application in Er,Cr:YSGG lasers include more precise, neater, and better wavelengths in a non-surgical periodontal treatment should soft-tissue ablation, calculus controlled than laser subgingival mode in cases of periodontitis be considered very carefully. Autumn 2018 3

However, using laser after flap Er:YAG lasers are the most elevation, with direct visibility, studied lasers in non-surgical provides the therapist with all the periodontal therapy and, advantages of laser treatment. while the outcomes of clinical reports are conflicting, they Safety and protocols are promising. The use of lasers during periodontal surgery has When working with surgical received less attention. But lasers, safety is a top priority. All data show that erbium lasers dental lasers can cause injuries are effective in surgical-flap to living tissues if working protocols and can be safely used protocols are ignored, and both on root surfaces and implants if patients and operators can suffer the right parameters are set. irreversible injuries. Before attempting to incorporate laser The erbium laser beam can technology into the dental or also precisely separate the periodontal office, one should granulation tissue surrounding learn the basics of laser function, ailing implants or periodontally read the relevant professional affected teeth from the literature, decide which laser surrounding bone and remove is appropriate for specific it following flap elevation. In procedures, study the hazards addition, erbium lasers can ablate and side-effects of the device, calculus and detoxify titanium consult other users about their without causing its melting, erbium lasers are the only ones experience, and follow suggested provided low energy is applied. with significant potential for Above: protocols. When starting to effective root debridement and Nine months post-operation operate the device, the minimal A major advantage of some laser which possess characteristics amount of energy to achieve wavelengths is that the beam can most suitable for non-surgical Below: therapy and observe tissue interact with human tissues in a treatment of periodontitis. Three years post-operation x-ray reaction should be used at first to non-contact mode. This makes establish if settings are adequate lasers superior to conventional No consensus or need adjustment. techniques, as the beam can conflicted and insufficient to remove bacteria and tissue It remains impossible to conclude that lasers are superior Should we use lasers in modern remnants from niches and hidden draw final conclusions or to conventional periodontal periodontology? spaces that are inaccessible to recommendations from the therapeutic methods. conventional instrumentation. many published studies because Nonetheless, most studies claim The aim of periodontal and peri- This is particularly relevant of the variety of laser devices that laser technology shows implant disease treatments is to to flap elevation around ailing utilised, the different parameters potential in periodontal and peri- stop disease progression and, if implants in cases where there are assigned, and the lack of implant treatments. possible, restore lost periodontal narrow and inaccessible intra- long-term clinical studies. At and peri-implant tissues. This bony spaces. present, there is no consensus More evidence-based studies can be primarily achieved by on the optimal parameters for are needed to recommend the eliminating or decreasing Both the consensus report of the specific laser devices for specific integration of this technology infectious insult in the affected EFP’s 6th European Workshop applications. Thus, parameters into our treatments. Future sites. The paramount trait of on Periodontology in 2008 and are applied empirically and directions should aim mainly all lasers is bacterial killing and the 2011 position paper from learned through observations. at the added value of lasers in detoxification, which play a key the American Academy of minimally invasive periodontal role in applying laser technology Periodontology on the efficacy of Although more than a hundred procedures to reduce the in the treatment of periodontitis lasers in non-surgical periodontal human clinical studies have been necessity for surgical and other and peri-implantitis. treatment acknowledged that published, the evidence remains painful interventions. Autumn 2018 4

Prof Ayala Stabholz is of Dental Medicine in 1980 Her research interests an associate professor and completed the graduate include the use of lasers at the Department of programme in periodontics in in periodontics and Periodontology at the 1985 at the same institution. peri-implantitis, the Hebrew University-Hadassah She has published articles periodontal-orthodontic Faculty of Dental Medicine in leading peer-reviewed inter-relationship, and in Jerusalem, founded by the journals including the Journal periodontal medicine. Alpha Omega Fraternity. She of Clinical Periodontology, She has a private clinic Ayala Stabholz graduated from the Hebrew Journal of Periodontology, dedicated to peridontology University-Hadassah Faculty and Periodontology 2000. and implantology.

Select Bibliography

>> American Academy of Periodontology statement on the efficacy of lasers in the non-surgical treatment of inflammatory periodontal disease. (2011) Journal of Periodontology; 82:513-514.

>> Aoki A et al. (2015) Periodontal and peri-implant wound healing following laser therapy. Periodontology 2000; 68: 217-269.

>> Aoki A, Sasaki KM, Watanabe H, Ishikawa I. (2004) Lasers in nonsurgical periodontal therapy. Periodontology 2000; 36:59-97.

>> Cheng Y, Chen JW, Ge MK, Zhou ZY, Yin X, Zou SJ. (2016) Efficacy of adjunctive laser in non-surgical periodontal treatment: a systematic review and meta-analysis. Lasers in medical science; 31:151-163.

>> Cobb CM. (2006) Lasers in periodontics: a review of the literature. Journal of Periodontology; 77:545-564.

>> Cobb CM, Low SB, Coluzzi DJ. (2010) Lasers and the treatment of chronic periodontitis. Dental clinics of North America; 54:35-53.

>> Dawood MS, Salman SD. (2013) Low level diode laser accelerates wound healing. Lasers in medical science; 28:941-945.

>> Derdilopoulou FV, Nonhoff J, Neumann K, Kielbassa AM. (2007) Microbiological findings after periodontal therapy using curettes, Er:YAG laser, sonic, and ultrasonic scalers. Journal of Clinical Periodontology; 34:588-598.

>> Kotsakis GA, Konstantinidis I, Karoussis IK, Ma X, Chu H. (2014) Systematic review and meta-analysis of the effect of various laser wavelengths in the treatment of peri-implantitis. Journal of Periodontology; 85:1203-1213.

>> Mizutani K et al. (2016) Lasers in minimally invasive periodontal and peri-implant therapy. Periodontology 2000; 71:185-212.

>> Mills MP, Rosen PS, Chambrone L, Greenwell H, Kao RT, Klokkevold PR, McAllister BS, Reynolds MA, Romanos GE, Wang H-L. (2018) American Academy of Periodontology best evidence consensus statement on the efficacy of laser therapy used alone or as an adjunct to non-surgical and surgical treatment of periodontitis and peri-implant diseases. Journal of Periodontology; 89: 737-742.

>> Nelson JS, Orenstein A, Liaw LH, Berns MW. (1989) Mid-infrared erbium:YAG of bone: the effect of laser osteotomy on bone healing. Lasers in surgery and medicine; 9:362-374.

>> Passanezi E, Damante CA, de Rezende ML, Greghi SL. (2015) Lasers in periodontal therapy. Periodontology 2000; 67:268-291.

>> Sanz M, Teughels W, Group AoEWoP. (2008) Innovations in non-surgical periodontal therapy: Consensus Report of the Sixth European Workshop on Periodontology. Journal of Clinical Periodontology; 35: 3-7.

>> Schwarz F, Aoki A, Becker J, Sculean A. (2008) Laser application in non-surgical periodontal therapy: a systematic review. Journal of Clinical Periodontology; 35:29-44.

>> Schwarz F, Aoki A, Sculean A, Becker J. (2009) The impact of laser application on periodontal and peri-implant wound healing. Periodontology 2000; 51:79-108.

>> Schwarz F, John G, Mainusch S, Sahm N, Becker J. (2012) Combined surgical therapy of peri-implantitis evaluating two methods of surface debridement and decontamination. A two-year clinical follow up report. Journal of Clinical Periodontology; 39:789-797.

>> Schwarz F, Sahm N, Iglhaut G, Becker J. (2011) Impact of the method of surface debridement and decontamination on the clinical outcome following combined surgical therapy of peri-implantitis: a randomized controlled clinical study. Journal of Clinical Periodontology; 38:276-284.

>> Sculean A, Schwarz F, Becker J. (2005) Anti-infective therapy with an Er:YAG laser: influence on peri-implant healing. Expert review of medical devices; 2:267-276.

>> Sgolastra F, Petrucci A, Gatto R, Monaco A. (2012) Efficacy of Er:YAG laser in the treatment of chronic periodontitis: systematic review and meta-analysis. Lasers in medical science; 27:661-673.

>> Zhao Y, Yin Y, Tao L, Nie P, Tang Y, Zhu M. (2014) Er:YAG laser versus as alternative or adjuvant for chronic periodontitis treatment: a systematic review. Journal of Clinical Periodontology; 41:1069-1079. Autumn 2018 5

Clinicians welcome new classification but raise concerns about implementation The new classification of periodontal and peri-implant diseases and conditions, agreed by the World Workshop in November 2017 and presented at EuroPerio9 in June, implies big changes for clinicians. Perio Insight has spoken to clinicians across Europe to gauge their response.

Peter Eickholz Kristin Kolltveit Virginie Monnet Corti Ricardo Faria Almeida

The new classification of practitioners in busy dental Kristin Kolltveit (Norway) also “periodontitis is a single disease periodontal and peri-implant offices will find it easy to use. praises the new classification’s with individual variables and diseases and conditions, The EFP is addressing these definition of periodontal health clinical outcomes.” On top of promoted by the EFP and concerns as it draws up a plan for and its acknowledgement that that, she says that it is “a simpler the American Academy of disseminating and explaining the “periodontal health can exist in classification, so it will be easy to Periodontology, was presented new classification to practitioners. a reduced periodontium with implement in daily practice and at a packed and enthusiastic probing depths up to 4mm (the communicating with colleagues session at the EuroPerio9 Clinicians repeatedly mention closed pocket),” while Virginie will be easier when you can refer congress on June 22. four major advances on the Monnet Corti (France) says to stage and grade.” previous classification: (1) the that one of the gains of the new Since then, periodontists and definition of periodontal health; classification is that “we can the wider dental community Ricardo Faria Almeida (2) the replacement of chronic/ also consider a healthy reduced have had some time to digest (Portugal) describes this aspect with periodontium.” of the new classification as the new classification and read a model based on stages and the detailed reports from the “more clinical-friendly, which grades; (3) the support given to Staging and grading World Workshop, published could help the other clinicians personalised medicine; and (4) One of the key changes in use it in more situations,” while in the EFP’s Journal of Clinical the inclusion of peri-implant Periodontology. the new classification is the Werner Lill (Austria) welcomes diseases and conditions. replacement of the distinction the change because the old There is a widespread welcome between “chronic” and distinction between “aggressive” Periodontal health for an updated classification “aggressive” periodontitis by and “chronic” periodontitis “was – the previous one dates from The definition of periodontal a system of four stages and in many cases impractical and 1999 – and clinicians describe health – something missing from three grades. While the stages inaccurate.” it as “a milestone for the perio previous classifications – is describe the severity of the world,” a “real improvement in welcomed by Peter Eickholz disease at presentation and Paula Matesanz (Spain) makes the periodontology field,” and an (Germany). “Finally, we have a the anticipated complexity a similar point, noting that “there approach that “should provide definition of periodontal health of disease management, were many cases in which I an overall consistent approach in the intact periodontium grading provides supplemental found difficult to define a case to diagnosis and management and – which is just as important information about biological as chronic or aggressive.” In for our patients, who will have – a definition of periodontal features of the disease and her view, the greatest benefit better lives as a result.” health or gingivitis in the stable takes account of the rate of of the new classification is patient after treatment,” he says. disease progression and the its emphasis on risk factors: However, they also raise “These diagnoses are important presence of risk factors that “For defining the stage of the concerns about the practicalities to characterise the majority may influence both this and the disease, the clinician needs to of implementing the new of patients in our practices: patient’s response to therapy. dive deeply into all the factors classification in everyday the supportive-maintenance related to the general health practice. Some find the new patients. Up to now, official For Kolltveit, this is the of the patient, his or her social classification very complex diagnoses to describe them most important change behaviours, and any other aspect and wonder whether general were painfully missing.” because it acknowledges that that needs to be taken into Autumn 2018 6

Paula Matesanz Hady Haririan Dominik Hofer Barbara Tervahartiala consideration so as to predict expanded considerably, and with very complex to get a short clinical trials,” but worries that whether the problem might or it has come the problem of peri- overview and get started to general practitioners would might not be controlled.” implant diseases and conditions. understand,” says Dominik Hofer need “clarifying guidelines to The World Workshop defined (Switzerland), “I am not really convert the old classification to Personalised medicine peri-implant health, peri-implant sure if this classification will the new one, understand the new Clinicians also point out that the mucositis, peri-implantitis, find its way in the private offices classification, and help them new classification is very much and soft- and hard-tissue until after a year or two. Maybe apply it in their daily routine.” consistent with personalised deficiencies around implants. in a specialist’s office, but in a Without such support, she warns, medicine, which is becoming general practitioners office?” “there will be a big gap between increasingly important within “The inclusion of peri-implantitis what is expected from the clinician periodontology and dentistry. was a very good idea as Pointing to the gap between and what will be a realistic result.” periodontists are more and more theory and practice, Hofer “The new classification system confronted with inflammatory adds: “We also have to This point is echoed by Eickholz, is in line with the concept of conditions around implants consider that probably too whose says that it will be personalised medicine,” says and definitions were previously many scientists were involved “challenging” to disseminate Kolltveit. “The staging and grading based on heterogenous in this project. What we now the classification into general enable the clinician to give the concepts,” comments Hady need are clinicians from the practice and that “the EFP and the patient an individual diagnosis Haririan (Austria). Faria base to do the fine-tuning. national societies will have to put and thus tailor the optimal Almeida says that the Scientists may have lost the a lot of effort into this project.” treatment for that patient. In classification of peri-implant contact with the base: the addition, the multifactorial diseases and conditions will dentists and the patients.” EFP plans for dissemination aetiology of periodontal disease “help the clinicians to be clear This effort, in fact, has already is considered and evaluated in a about the different diseases Similar concerns are voiced started. The EFP is now putting structured way (grading), which around implants and how to by Haririan: “To be realistic, I the finishing touches to a makes it easier to assess the risk diagnose them in an easy but think that only specialists detailed long-term plan to create for progression.” clear way.” and colleagues with a focus and provide materials to explain on perio will really try to the new classification and to Lill says that practitioners will For Lill, one positive effect of include the new system train oral-healthcare teams need to change their diagnostics the new definition of peri- in their everyday practice on how to implement it in daily and include new facts and implantitis is that “in the future it and communication with clinical practice. And the British points of view in their therapy, will lead to an earlier therapeutic colleagues.” While there would Society of Periodontology (BSP) which “will mean an immense intervention, which is especially be an end to “the annoying has already started a series advantage for the patient and important in peri-implant discussions about whether of four webinars devoted to will enable adequate, individually treatment methods.” it is an aggressive or chronic explaining the new classification. adapted therapy.” periodontitis case,” these ‘Challenging and complex’ For Monnet Corti, “With this could reappear in a different Despite these positive form as “the grading is based new classification we are going comments and the overall on progression, which is The full reports and to take into consideration the enthusiasm about the new also not so easy to assess proceedings of the individual factors of the patient classification, many clinicians in patients, and the most World Workshop on the more than the former numerical have concerns about how easy challenging elements might be Classification of Periodontal factors such pocket depth it will be for periodontists and to differentiate between stage and Peri-implant Diseases (>3mm...) clinical attachment dentists in private practice to I and II and to put ‘systemic and Conditions have been value, cartography of the lesions implement. (vertical number of residual diseases’ in the right category.” published as an open-access walls and the angulation of the “The whole topic and the supplement of the Journal defects, horizontal).” literature are very challenging Barbara Tervahartiala (Finland) of Clinical Periodontology and complex and would need says that the new classification (available at: https://www. Peri-implantitis careful and time-consuming was based on the scientific onlinelibrary.wiley.com/ Since the 1999 classification reading – it might finally be evidence and is “therefore toc/1600051x/2018/45/S20). was made, implant dentistry has easier than it looks, but it is directly applicable to scientific Autumn 2018 7

Latest research from the EFP’s Journal of Clinical Periodontology

The Journal of Clinical Periodontology (JCP) is the official The journal is aimed primarily at clinicians, general practitioners, scientific publication of the European Federation of periodontists, as well as teachers and administrators involved Periodontology. Edited by Maurizio Tonetti, the JCP aims in the organisation of prevention and treatment of periodontal to convey scientific progress in periodontology to those disease. The JCP is published monthly and has an impact factor concerned with applying this knowledge for the benefit of of 4.046. The six articles summarised below were published in the dental health of the community. the JCP in July and August 2018.

PERIODONTAL DISEASES Association between periodontal disease and gestational diabetes mellitus – A prospective cohort study This study aimed to determine the was diagnosed as per the DIPSI The occurrence of pre-eclampsia Authors: : Ashok Kumar, Deepika S. association between periodontal (the Diabetes in Pregnancy Study was associated with periodontal Sharma, Mahesh Verma, Arundeep disease and gestational diabetes Group India) guidelines (≥140mg/ disease, while in cases with both Kaur Lamba, Madhavi M. Gupta, Shashi mellitus (GDM) and the effect dl). All patients were followed up periodontal disease and GDM, the Sharma, Vanamail Perumal of this association on pregnancy for pregnancy outcomes. risk of pre-eclampsia showed an outcomes in a population in North India. While 184 of the pregnant women increased aHR of 18.79 (95% CI Published in Journal of Clinical A total of 584 primigravidae were (31.5%) had gingivitis, 148 (25.3%) = 7.45–47.40). The study showed Periodontology Volume 45, Number 8 (August 2018). recruited at between 12 and 14 had periodontitis. Overall, 332 a significant association of weeks of gestation. Periodontal (56.8%) had periodontal disease, periodontal disease with GDM and examination was carried out along which was associated with GDM an increased risk of developing Full article: with a 75g oral glucose-load test with an adjusted hazard ratio pre-eclampsia because of this https://www.onlinelibrary.wiley. at the time of recruitment. GDM (aHR) of 2.85 (95% CI = 1.47–5.53). association. com/doi/10.1111/jcpe.12902

PERIODONTAL DISEASES Periodontitis and quality of life: What is the role of socioeconomic status, sense of coherence, dental-service use and oral-health practices? An exploratory theory‐ guided analysis on a Norwegian population This study used Andersen’s sense of coherence (SOC), dental lesser extent – periodontitis (19%). periodontitis, regular dental visits behavioural model for the use of anxiety, perceived treatment A stronger SOC was associated did not reduce the likelihood of health services as the theoretical need, oral-health behaviours, with fewer oral impacts, while there periodontitis. framework to examine direct and and oral-health impact profile was no association between the use Authors: : Gro Eirin Holde, Sarah R. indirect relationships between (OHIP-14) were collected through of dental services and oral-health Baker, Birgitta Jönsson population characteristics, oral- a questionnaire, while periodontal impacts. The research showed Published in Journal of Clinical health behaviours, periodontitis, examinations consisted of full- complex relationships between Periodontology Volume 45, Number 7 and oral-health impacts. mouth recordings. population characteristics, (July 2018). The model was tested in a general Andersen’s model explained a large oral-health-related behaviours, adult population (n = 1,886) in part of the variance in the use of and oral-health outcomes. While Full article: Norway, using structural equation dental services (58%), oral-health- socioeconomic factors and smoking https://www.onlinelibrary.wiley. modelling. Socioeconomic status, related impacts (55%), and – to a were the main predictors of com/doi/10.1111/jcpe.12906

PERIODONTAL DISEASES Chronic periodontitis is associated with erectile dysfunction. A case-control study in a European population This study sought to determine gathered, and periodontal with pocket probing depth 4-6mm = 0.03) independently of other the association between chronic examinations were performed. (p = 0.05) and the number of sites confounders. periodontitis and erectile Testosterone, lipid profile, with clinical attachment loss >3mm Authors: Amada Martín, Manuel Bravo, dysfunction, adjusting for C-reactive protein, and glycaemic (p < 0.01) were higher in these cases. Miguel Arrabal, Antonio Magán- biochemical markers and other parameters were assessed. Triglycerides (p < 0.01), C-reactive Fernández, Francisco Mesa comorbidities. A case-control All variables were compared protein (p = 0.02) and glycosylated Published in Journal of Clinical study was conducted on 158 between groups, and multivariate haemoglobin (p = 0.04) were Periodontology Volume 45, Number 7 male patients: 80 cases with logistic regression analyses were also higher. Logistic regression (July 2018). erectile dysfunction (according performed. showed that patients with chronic Full article: to the International Index of A total of 74% of the cases periodontitis were more likely https://www.onlinelibrary.wiley. Erectile Function) and 78 controls. were diagnosed with chronic to have erectile dysfunction com/doi/10.1111/jcpe.12909 Sociodemographic data were periodontitis. The number of sites (OR = 2.17; 95% CI (1.06–4.43); p Autumn 2018 8

EFP full-member societies

Austria Österreichische Gesellschaft für Latest research Parodontologie

Belgium Société Belge de Parodontologie / Belgische Vereniging voor Parodontologie PERIODONTAL THERAPY Croatia Hrvatsko Parodontološko Društvo Human intrabony defect regeneration with Czech Republic Ceská Parodontologická Spolecnost micrografts containing dental pulp stem cells: Denmark Dansk Parodontologisk Selskab A randomised controlled clinical trial Finland Suomen Hammaslääkäriseura Apollonia France Société Française de Parodontologie et This study’s aim was to evaluate if dental pulp The trial showed that test sites exhibited  d’Implantologie Orale stem cells (DPSCs) delivered into intrabony significantly greater probing depth (PD) reduction, defects in a collagen scaffold would enhance clinical attachment level (CAL) gain, and bone- Germany Deutsche Gesellschaft für Parodontologie the clinical and radiographic parameters of defect fill than control sites. Residual PD < 5mm Greece Ελληνική Περιοδοντολογική Εταιρεία periodontal regeneration. and CAL gain ≥4mm were significantly more Hungary Magyar Parodontológiai Társaság In this randomised controlled trial, 29 chronic- frequent in the test group. Researchers concluded Ireland Irish Society of Periodontology periodontitis patients each presenting one deep that the application of DPSCs significantly Israel Israeli Society of Periodontology and intrabony defect and requiring extraction of one improved clinical parameters of periodontal Osseointegration vital were consecutively enrolled. Defects regeneration one year after treatment. Italy Società Italiana di Parodontologia e Implantologia were randomly assigned to test or control Authors: Francesco Ferrarotti, Federica Romano, Mara  treatments, both of which involved minimally Noemi Gamba, Andrea Quirico, Marta Giraudi, Martina Lithuania Lietuvos Periodontolog Draugija invasive surgery. The dental pulp of the extracted Audagna, Mario Aimetti Netherlands Nederlandse Vereniging voor tooth was mechanically dissociated to obtain Published in Journal of Clinical Periodontology Volume Parodontologie micrografts rich in autologous DPSCs. Test sites 45, Number 7 (July 2018). Norway Norsk periodontist forening (n = 15) were filled with micrografts seeded onto Poland Polskie Towarzystwo Periodontologiczne collagen sponge, whereas control sites (n = 14) Full article: https://www.onlinelibrary. were filled with collagen sponge alone. wiley.com/doi/10.1111/jcpe.12931 Portugal Sociedade Portuguesa de Periodontologia e Implantes

Romania Societatea de Parodontologie din Romania PERIODONTAL THERAPY Serbia Udruzenje Parodontologa Srbije Treatment of class III multiple gingival recessions: Slovenia Združenje za ustne bolezni, parodontologijo Prognostic factors for achieving a complete root coverage in stomatološko implantologijo Spain Sociedad Española de Periodoncia y Osteointegración This report presented a supplemental analysis Researchers concluded that the probability of of data from a previous report (Aroca et al., obtaining a complete root coverage decreases Sweden Svenska Parodontolog föreningen 2010) to investigate factors associated with a when the DCP at baseline increases and that Switzerland Société Suisse de Parodontologie / complete root coverage at one year. maxillary teeth are more likely to give better RC than Schweizerisch Gesellschaft für Parodontologie / mandibular teeth. However, both in this analysis and Società Svizzera di Parodontologia On 138 observations from 20 patients, a the previous one there was no group effect. Turkey Türk Periodontoloji Dernegi regression model highlighted the relationship between the percentages of root coverage (RC) Authors: Sofia Aroca, Antoine Barbieri, Marco United Kingdom British Society of Periodontology Clementini, Franck Renouard, Massimo de Sanctis and three covariates: the distance from the tip of the papilla and the contact point (DCP) at Published in Journal of Clinical Periodontology EFP associate-member societies baseline, group membership (control versus Volume 45, Number 7 (July 2018). test), and tooth position in the mouth (maxillary Full article: https://www.onlinelibrary. versus mandibular). wiley.com/doi/10.1111/jcpe.12923 Azerbaijan Azərbaycan Parodontologiya Cəmiyyəti Morocco Société Marocaine de Parodontologie et IMPLANT THERAPY d’Implantologie Russia Российской Пародонтологической Efficacy of autogenous tooth roots for lateral alveolar Ассоциации ridge augmentation and staged implant placement: Ukraine Асоціація лікарів-пародонтологів A prospective controlled clinical study України This study sought to assess and compare the Crestal ridge width at 26 weeks allowed successful efficacy and safety of autogenous tooth roots and implant placement in all 30 patients in both groups, Perio Insight is published quarterly autogenous bone blocks for lateral alveolar-ridge and the difference between the groups did not by the European Federation of augmentation and two-stage implant placement. reach statistical significance (p = 0.241). Periodontology (EFP) A total of 30 patients in need of implant therapy The study concluded that autogenous tooth Editor: Joanna Kamma and lateral ridge augmentation were allocated roots may serve as an alternative graft to (EFP contents editor) to parallel groups receiving either (a) healthy support lateral alveolar-ridge augmentation and Scientific advisers: Phoebus Madianos, autogenous tooth roots (e.g. retained wisdom two-stage implant placement. Lior Shapira (chair and deputy chair, or impacted teeth) (n = 15) or (b) cortical Authors: Frank Schwarz, Didem Hazar, Kathrin Becker, EFP scientific affairs committee) autogenous bone blocks harvested from the Robert Sader, Jürgen Becker. Associate editor: Paul Davies (EFP retromolar area. After 26 weeks of submerged Published in Journal of Clinical Periodontology Volume editorial & content co-ordinator) healing, the primary endpoint was defined as 45, Number 8 (August 2018). Design and layout: Editorial MIC the crestal ridge width’s being sufficient to place an adequately dimensioned titanium Full article: https://www.onlinelibrary. EFP office: Avenida Doctor Arce 14, Office implant at the respective sites. wiley.com/doi/10.1111/jcpe.12977 38, 28200 Madrid, Spain, www.efp.org

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