Publications by authors named "Peter Eickholz"

147 Publications

Development of a prognostic tool: based on risk factors for tooth loss after active periodontal therapy.

Clin Oral Investig 2021 Aug 25. Epub 2021 Aug 25.

Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, 69120, Heidelberg, Germany.

Objectives: The aim of this study was to develop a prognostic tool to estimate long-term tooth retention in periodontitis patients at the beginning of active periodontal therapy (APT).

Material And Methods: Tooth-related factors (type, location, bone loss (BL), infrabony defects, furcation involvement (FI), abutment status), and patient-related factors (age, gender, smoking, diabetes, plaque control record) were investigated in patients who had completed APT 10 years before. Descriptive analysis was performed, and a generalized linear-mixed model-tree was used to identify predictors for the main outcome variable tooth loss. To evaluate goodness-of-fit, the area under the curve (AUC) was calculated using cross-validation. A bootstrap approach was used to robustly identify risk factors while avoiding overfitting.

Results: Only a small percentage of teeth was lost during 10 years of supportive periodontal therapy (SPT; 0.15/year/patient). The risk factors abutment function, diabetes, and the risk indicator BL, FI, and age (≤ 61 vs. > 61) were identified to predict tooth loss. The prediction model reached an AUC of 0.77.

Conclusion: This quantitative prognostic model supports data-driven decision-making while establishing a treatment plan in periodontitis patients. In light of this, the presented prognostic tool may be of supporting value.

Clinical Relevance: In daily clinical practice, a quantitative prognostic tool may support dentists with data-based decision-making. However, it should be stressed that treatment planning is strongly associated with the patient's wishes and adherence. The tool described here may support establishment of an individual treatment plan for periodontally compromised patients.
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http://dx.doi.org/10.1007/s00784-021-04060-xDOI Listing
August 2021

The 2018 classification of periodontal diseases. Its predictive value for tooth loss.

J Periodontol 2021 Jul 16. Epub 2021 Jul 16.

Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, Heidelberg, 69120, Germany.

Background: Predictive models and assessment tools for disease susceptibility and progression are necessary to enhance personalized medicine. The aim of this study is to assess the predictive accuracy of using the 2018 classification to predict likelihood of tooth loss.

Material And Methods: 134 patients were screened 10 years after periodontal therapy. Data were extracted from 82 patients' records and periodontal diagnoses were assigned according to the 1999 and 2018 classifications at baseline, whereas patient- and tooth-related parameters were documented at baseline and at reexamination. Statistical analysis included descriptive statistics, hurdle regression with a zero and count model as well as logistic regression.

Results: Significantly more teeth were lost during SPT in patients with Stage IV or Grade C (p<0.05). Patients' adherence seems to have an impact on the predictability of the 2018 classification (p<0.001). In comparison, neither classification system alone (1999 vs. 2018) showed a high predictive value for tooth loss (Area under the curve (AUC) = 59.2% vs. 58.2%).

Conclusion: Class III and IV/grade C of the 2018 classification of periodontal diseases show similar predictive accuracy for tooth loss as severe cases in the former classification. Patients adherence seems to influence the prognostic value of the classification. This article is protected by copyright. All rights reserved.
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http://dx.doi.org/10.1002/JPER.21-0211DOI Listing
July 2021

Retrospective long-term analysis of tooth loss over 20 years in a specialist practice setting: Periodontally healthy/gingivitis and compromised patients.

J Clin Periodontol 2021 Oct 22;48(10):1356-1366. Epub 2021 Jul 22.

Department of Periodontology, Center of Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt/Main, Germany.

Objective: To assess tooth loss (TL) in initially periodontally healthy/gingivitis (PHG) and periodontally compromised (PC) individuals during a 15- to 25-year follow-up in a specialist practice and to identify the factors influencing TL.

Materials And Methods: Patients were re-examined 240 ± 60 months after active periodontal therapy (PC) or initial examination (PHG). PHG patients were periodontally healthy or had gingivitis, and PC patients exhibited at least stage II periodontitis. TL, patient-related outcomes, and risk factors for TL were assessed at the patient level (group-relation, gender, age, smoking, bleeding on probing, educational status, mean number of visits/year).

Results: Fifty-six PC patients receiving regular supportive periodontal care (12 female, mean age 49.1 ± 10.9 years, stage II: 10, stage III/IV: 46) lost 38 teeth (0.03 ± 0.05 teeth/year). Fifty-one PHG patients (23 female, mean age 34.5 ± 12.4 years) following regular oral prevention lost 39 teeth (0.04 ± 0.05 teeth/year) (p = .631). Both PC and PHG groups did not show any significant differences regarding visual analogue scale measurements [aesthetics (p = .309), chewing function (p = .362), hygiene (p = .989)] and overall Oral Health Impact Profile (p = .484). Age at the start of follow-up was identified as a risk factor for TL (p < .0001).

Conclusion: PC and PHG patients exhibited similarly small TL rates over 240 ± 60 months, which should, however, be interpreted with caution in view of the group heterogeneity. Clinical trial number: DRKS00018840 (URL: https://drks.de).
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http://dx.doi.org/10.1111/jcpe.13520DOI Listing
October 2021

[Periodontitis-therapy of a widespread disease].

Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021 Aug 8;64(8):931-940. Epub 2021 Jul 8.

Poliklinik für Parodontologie, Zentrum der Zahn‑, Mund- und Kieferheilkunde, Johann Wolfgang Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Deutschland.

Periodontitis is a chronic inflammatory noncommunicable disease that affects all parts of the periodontium and causes irreversible damage. It is estimated that around 10 million people in Germany suffer from severe forms of periodontitis. The disease usually shows few or only mild symptoms over many years, which are often not perceived or correctly classified by the patient. A lack of awareness could lead to dental treatment being sought in an advanced stage of the disease when extensive therapeutic measures have become necessary and the prognosis for tooth retention has worsened. The periodontal screening index (PSI) is a simple and rapid tool that is used to assess the level of further examination needed. The index is now carried out on many patients. However, the number of treatments remain low and behind what is necessary to reduce the existing burden of periodontitis. Every dental practice must be able to implement periodontal therapy in their clinical setting. Periodontal specialists can support general dentists significantly, especially in the treatment of severe forms of periodontitis. This requires an upgrading of the subject in university education, but also an increasing postgraduate differentiation of specialized dentists for periodontology. The new treatment guidelines for PAR (periodontal) therapy allow periodontal treatment on the basis of internationally recognized scientific standards and thus improve the framework conditions for therapy in the dental practice.
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http://dx.doi.org/10.1007/s00103-021-03373-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8264996PMC
August 2021

In Vitro Efficacy of Three Different Nonsurgical Implant Surface Decontamination Methods in Three Different Defect Configurations.

Int J Oral Maxillofac Implants 2021 Mar-Apr;36(2):271-280

Purpose: Assessment of in vitro efficacy of three different nonsurgical implant surface decontamination methods in three peri-implant bone defect simulation models.

Materials And Methods: A total of 180 implants were allocated to differently angulated (30, 60, and 90 degrees) peri-implant bone defect resin models, each covered by a mucosa mask. All implants were stained with indelible red color and assigned to one of the three defect models. In each simulated bone defect group, 20 implants were decontaminated for 2 minutes with a curette (CUR), sonic scaler (SOSC), or air-powder abrasion device (APA) with glycine powder. Photos were taken from both sides of each implant to measure the percentage of uncleaned implant surface area. Scanning electron microscopy (SEM) was used to assess the implant surface for morphologic damage.

Results: Among the three defect angulations, a significantly different cleaning efficacy (P < .001) for each treatment method was found (30 degrees: CUR [67.33%], SOSC [62.70%], APA [39.33%]; 60 degrees: CUR [61.59%], SOSC [54.31%], APA [23.91%]; 90 degrees: CUR [66.82%], SOSC [55.77%], APA [28.03%]). SEM did not show any considerable surface damage after APA treatment in comparison with after CUR or SOSC.

Conclusion: Air-powder abrasion proved to be the most efficient nonsurgical treatment device for each type of defect in this in vitro model with the least noticeable surface change. No decontamination method resulted in complete cleaning of the color remnants on the implant surface.
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http://dx.doi.org/10.11607/jomi.8864DOI Listing
April 2021

Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivate for root coverage: 5-year results of an RCT using 3D digital measurement technology for volumetric comparison of soft tissue changes.

J Clin Periodontol 2021 07 4;48(7):949-961. Epub 2021 May 4.

Department of Periodontology, Center of Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University, Frankfurt/Main, Germany.

Aim: Comparison of the clinical efficacy (digitally volumetric, aesthetic, patient-centred outcomes) of tunnel technique (TUN) with subepithelial connective tissue graft (CTG) versus coronally advanced flap (CAF) with enamel matrix derivate (EMD) 5 years after gingival recession therapy.

Materials And Methods: In 18 patients contributing 36 RT1 recessions, study models were collected at baseline and follow-ups. Optical scans assessed recessions computer-assisted [recession depth, recession reduction (RECred), complete root coverage (CRC), percentage of root coverage (RC), pointwise (pTHK) and mean areal (aTHK) marginal soft tissue thickness]. Root coverage aesthetic Score (RES) was used for aesthetic evaluation and visual analogue scales for patient-centred data collection applied.

Results: Sixty months after surgery, 50.0% (TUN+CTG) and 0.0% (CAF+EMD) of sites showed CRC (p = 0.0118), 82.2% (TUN+CTG) and 32.0% (CAF+EMD) achieved RC, respectively (p = 0.0023). CTG achieved significantly better RECred (TUN+CTG: 1.75±0.74 mm; CAF+EMD: 0.50 ± 0.39 mm; p = 0.0009) and aTHK (TUN+CTG: 0.95 ± 0.41 mm; CAF+EMD: 0.26 ± 0.28 mm; p = 0.0013). RES showed superior outcomes (p = 0.0533) for TUN+CTG (6.86 ± 2.31) compared to CAF+EMD (4.63 ± 1.99). The study failed to find significant differences related to patient-centred outcomes (TUN+CTG: 8.30 ± 2.21; CAF+EMD: 7.50 ± 1.51; p = 0.1136).

Conclusions: Five years after treatment, CTG resulted in better clinical and aesthetic outcomes than CAF+EMD. Increased THK was associated with improved outcomes for RECred and RC.
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http://dx.doi.org/10.1111/jcpe.13470DOI Listing
July 2021

Tooth loss in periodontally compromised patients: Retrospective long-term results 10 years after active periodontal therapy. Tooth-related outcomes.

J Periodontol 2021 Mar 21. Epub 2021 Mar 21.

Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt am Main, Germany.

Background: Estimating prognosis of periodontally affected teeth at the beginning of supportive periodontal care (SPC) is an important component for further treatment planning. This study aimed to evaluate tooth loss (TL) during 10 years of SPC in periodontally compromised patients and to identify tooth-related factors affecting TL.

Methods: Patients were re-examined 120 ± 12 months after accomplishment of active periodontal therapy. TL was defined as primary outcome variable and tooth-related factors (abutment status, furcation involvement [FI], tooth mobility, mean periodontal probing depth [PD], and clinical attachment level [CAL] at beginning of SPC, and initial bone loss [BL]) were estimated based on an adjusted regression analyses model.

Results: Ninety-seven patients (51 females and 46 males; mean age, 65.3 ± 11 years) lost 119 of 2,323 teeth (overall TL [OTL]: 0.12 teeth/patient/y) during 10 years of SPC. Forty of these teeth (33.6%) were lost for periodontal reasons (TLP; 0.04 teeth/patient/y). Significantly more teeth were lost due to other reasons (P <0.0001). TLP (OTL) only occurred in 5.9% (14.7%) of all teeth, when BL was at least 80%. Use as abutment tooth, FI degree III, tooth mobility degrees I and II, mean PD, and CAL positively correlated with OTL (P <0.05). For TLP, FI and tooth mobility degree III as well as mean CAL were identified as tooth-related prognostic factors (P <0.05).

Conclusions: During 10 years of SPC, most of the teeth (93.4%) of periodontally compromised patients were retained, showing the positive effect of a well-established treatment concept. Well-known tooth-related prognostic factors were confirmed.
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http://dx.doi.org/10.1002/JPER.21-0056DOI Listing
March 2021

Five-Years Periodontal Outcomes of Early Removal of Unerupted Third Molars Referred for Orthodontic Purposes.

J Oral Maxillofac Surg 2021 Mar 23;79(3):520-531. Epub 2020 Nov 23.

Dentist, Private Practice, Münster, Germany.

Purpose: The removal of third molars (M3) is one of the most common oral-maxillofacial surgical procedures affecting periodontal tissues of neighboring second molars (M2). The aim of this study was to evaluate the periodontal status of lower M2 following the removal of unerupted lower M3 up to 5 years after removal.

Patients And Methods: Primary predictor variable in this prospective cohort-study was time [baseline (BL; preoperatively), 6 and 60 months postoperatively]. The primary outcome variable was probing pocket depth (PPD). Clinical attachment level (CAL) was defined as a secondary outcome variable. Plaque index (PlI) and gingival index (GI) were assessed descriptively. All variables were compared using nonparametric tests. M3 were classified as either completely bony or partially bony unerupted. Risk factors (removed M3, type of impaction, mean BL PPD≥4 mm, gender, age) were analyzed (repeated measures ANCOVA). The significance level was set at 0.05.

Results: From originally 91 subjects enrolled in this study, 39 subjects (22 females; mean age: 21.6 ± 2.5 years) contributing 39 M3 completed the study after 5 years. Average BL PPD significantly decreased at 6 (-0.50 ± 0.61 mm, P = .001), 60 months (-0.81 ± 0.56, P < .0001), as well as between 6 and 60 months (-0.31 ± 0.51 mm, P = .030). Corresponding CAL values decreased accordingly (BL-6 months: -0.37 ± 0.59 mm, P = .004; BL-60 months: -0.67 ± 0.55 mm, P < .0001; 6 to 60 months: -0.34 ± 0.48 mm, P = .004). The was confirmed as risk factor for PPD (P = .026) and CAL (P = .042) changes.

Conclusions: Average PPD and CAL of mandibular M2 in young subjects improved 5 years after early removal of unerupted M3 in favor of an initial partially bony unerupted type of impaction.
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http://dx.doi.org/10.1016/j.joms.2020.11.013DOI Listing
March 2021

Retrospectively analysed tooth loss in periodontally compromised patients: Long-term results 10 years after active periodontal therapy-Patient-related outcomes.

J Periodontal Res 2020 Dec 22;55(6):946-958. Epub 2020 Jul 22.

Department of Periodontology, Center of Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt/Main, Germany.

Background And Objective: Long-term tooth retention is the ultimate goal of periodontal therapy. Aim of this study was to evaluate tooth loss (TL) during 10 years of supportive periodontal therapy (SPT) in periodontal compromised patients and to identify factors influencing TL on patient level.

Material And Methods: Patients were re-examined 120 ± 12 months after active periodontal therapy. TL and risk factors [smoking, initial diagnosis, SPT adherence, interleukin-1 polymorphism, cardiovascular diseases, age at baseline, bleeding on probing (BOP), change of practitioner, insurance status, number of SPT, marital and educational status] influencing TL on patient level were assessed.

Results: One-hundred patients (52 female, mean age 65.6 ± 11 years) lost 121 of 2428 teeth (1.21 teeth/patient; 0.12 teeth/patient/y) during 10 years of SPT. Forty-two of these were lost for periodontal reasons (0.42 teeth/patient; 0.04 teeth/patient/y). Significantly more teeth were lost due to other reasons (P < .001). Smoking, baseline severity of periodontitis, non-adherent SPT, positive interleukin-1 polymorphism, marital and educational status, private insurance, older age at baseline and BOP, small number of SPT were identified as patient-related risk factors for TL (P < .05).

Conclusion: During 120 ± 12 months of SPT, only a small number of teeth was lost in periodontally compromised patients showing the positive effect of a well-established periodontal treatment concept. The remaining risk for TL should be considered using risk-adopted SPT allocation.
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http://dx.doi.org/10.1111/jre.12786DOI Listing
December 2020

In vitro surgical and non-surgical air-polishing efficacy for implant surface decontamination in three different defect configurations.

Clin Oral Investig 2021 Apr 19;25(4):1743-1754. Epub 2020 Aug 19.

Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany.

Objectives: Evaluation of surgical and non-surgical air-polishing in vitro efficacy for implant surface decontamination.

Material And Methods: One hundred eighty implants were distributed to three differently angulated bone defect models (30°, 60°, 90°). Biofilm was imitated using indelible red color. Sixty implants were used for each defect, 20 of which were air-polished with three different types of glycine air powder abrasion (GAPA1-3) combinations. Within 20 equally air-polished implants, a surgical and non-surgical (with/without mucosa mask) procedure were simulated. All implants were photographed to determine the uncleaned surface. Changes in surface morphology were assessed using scanning electron micrographs (SEM).

Results: Cleaning efficacy did not show any significant differences between GAPA1-3 for surgical and non-surgical application. Within a cleaning method significant (p < 0.001) differences for GAPA2 between 30° (11.77 ± 2.73%) and 90° (7.25 ± 1.42%) in the non-surgical and 30° (8.26 ± 1.02%) and 60° (5.02 ± 0.84%) in the surgical simulation occurred. The surgical use of air-polishing (6.68 ± 1.66%) was significantly superior (p < 0.001) to the non-surgical (10.13 ± 2.75%). SEM micrographs showed no surface damages after use of GAPA.

Conclusions: Air-polishing is an efficient, surface protective method for surgical and non-surgical implant surface decontamination in this in vitro model. No method resulted in a complete cleaning of the implant surface.

Clinical Relevance: Air-polishing appears to be promising for implant surface decontamination regardless of the device.
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http://dx.doi.org/10.1007/s00784-020-03476-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7966646PMC
April 2021

Tooth-related factors for tooth loss 20 years after active periodontal therapy-A partially prospective study.

J Clin Periodontol 2020 10 28;47(10):1227-1236. Epub 2020 Aug 28.

Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, Heidelberg, Germany.

Aim: To assess factors contributing to tooth loss 20 years after active periodontal therapy (APT) on tooth level.

Materials And Methods: After an initial retrospective analysis 10 years after APT, patients were monitored for 10 more years. At clinical re-evaluation 20 years after APT, tooth-related factors (tooth type, location, bone loss, furcation involvement, abutment status) and patient-related factors (gender, smoking, adherence) were investigated. Descriptive statistical analysis and a mixed logistic regression analysis were performed with tooth loss as primary outcome variable.

Results: The study included 69 patients (42 female/27 male). 39 patients were non-adherent (56.5%), and 11 were active smokers (15.9%). A total of 198 out of 1611 teeth were lost. Tooth loss was significantly highest (p < .01) in molars (21.1%), multi-rooted teeth with furcation involvement (23.5%) and abutment teeth (fixed: 27.6%, removable: 36.4%). 37.6% of teeth with initial bone loss >60% were lost during 20 years. Adherent patients showed less frequent tooth loss than non-adherent patients (OR 0.371; p <  .01).

Conclusion: Even teeth with an initial bone loss over 60% could be retained in approximately two thirds for 20 years. This should be kept in mind when assigning prognosis and establishing a treatment plan.
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http://dx.doi.org/10.1111/jcpe.13348DOI Listing
October 2020

Comparison of two different periodontal risk assessment methods with regard to their agreement: Periodontal risk assessment versus periodontal risk calculator.

J Clin Periodontol 2020 08 28;47(8):921-932. Epub 2020 Jun 28.

Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt am Main, Germany.

Aim: To evaluate the level of agreement between the periodontal risk assessment (PRA) and the periodontal risk calculator (PRC).

Materials And Methods: Periodontal risk was retrospectively assessed among 50 patients using PRA and PRC. Both methods were modified. PRA by assessing probing pocket depths and bleeding on probing at four (PRA4) and six (PRA6) sites per tooth, PRC by permanently marking or unmarking the dichotomously selectable factors "irregular recall," "oral hygiene in need of improvement" and "completed scaling and root planing" for PRC. Agreement between PRA and PRCred (summarized risk categories) was determined using weighted kappa.

Results: Fifty patients enrolled in periodontal maintenance (48% female, age: 63.8 ± 11.2 years) participated. PRA4 and PRA6 matched in 32 (64%) patients (κ-coefficient = 0.48, p < .001). There was 100% agreement between both PRC versions. There was minimal agreement of PRA6 and PRCred (66%, 28% one different category, 6% two different categories; κ-coefficient = 0.34; p = .001). PRA4 and PRCred did not match (60% agreement, 34% one different category, 6% two different categories; κ-coefficient = 0.23; p = .13). For the SPT diagnosis of severe periodontitis, PRA6 and PRCred agreed weakly (κ-coefficient = 0.44; p = .004).

Conclusion: PRA and PRC showed a minimal agreement. Specific disease severity may result in improved agreement.
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http://dx.doi.org/10.1111/jcpe.13327DOI Listing
August 2020

Significant Short-Term Shifts in the Microbiomes of Smokers With Periodontitis After Periodontal Therapy With Amoxicillin & Metronidazole as Revealed by 16S rDNA Amplicon Next Generation Sequencing.

Front Cell Infect Microbiol 2020 5;10:167. Epub 2020 May 5.

Department of Periodontology and Operative Dentistry, Münster University Hospital, Münster, Germany.

The aim of this follow-up study was, to compare the effects of mechanical periodontal therapy with or without adjunctive amoxicillin and metronidazole on the subgingival microbiome of smokers with periodontitis using 16S rDNA amplicon next generation sequencing. Fifty-four periodontitis patients that smoke received either non-surgical periodontal therapy with adjunctive amoxicillin and metronidazole (n = 27) or with placebos (n = 27). Subgingival plaque samples were taken before and two months after therapy. Bacterial genomic DNA was isolated and the V4 hypervariable region of the bacterial 16S rRNA genes was amplified. Up to 96 libraries were normalized and pooled for Illumina MiSeq paired-end sequencing with almost fully overlapping 250 base pairs reads. Exact ribosomal sequence variants (RSVs) were inferred with DADA2. Microbial diversity and changes on the genus and RSV level were analyzed with non-parametric tests and a negative binomial regression model, respectively. Before therapy, the demographic, clinical, and microbial parameters were not significantly different between the placebo and antibiotic groups. Two months after the therapy, clinical parameters improved and there was a significantly increased dissimilarity of microbiomes between the two groups. In the antibiotic group, there was a significant reduction of genera classified as , and , and 22 other genera also decreased significantly, while , and five other genera significantly increased. In the placebo group, however, there was not a significant decrease in periodontal pathogens after therapy and only five other genera decreased, while and nine other genera increased. We conclude that in periodontitis patients who smoke, microbial shifts occurred two months after periodontal therapy with either antibiotics or placebo, but genera including periodontal pathogens decreased significantly only with adjunctive antibiotics.
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http://dx.doi.org/10.3389/fcimb.2020.00167DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7232543PMC
June 2021

Effect of nonsurgical periodontal therapy on haematological parameters in grades B and C periodontitis: an exploratory analysis.

Clin Oral Investig 2020 Dec 8;24(12):4291-4299. Epub 2020 May 8.

Centre for Host-Microbiome Interactions, Kings College London, Guy's Hospital, Great Maze Pond, SE1 9RT, London, UK.

Aim: Assessment of the effect of nonsurgical periodontal therapy on haematological parameters in patients with grades B (BP) and C periodontitis (CP).

Methods: Eight BP and 46 CP patients received full-mouth periodontal debridement within 48 h, if positive for Aggregatibacter actinomycetemcomitans with adjunctive systemic antibiotics (4 BP, 17 CP). Clinical data were collected prior and 12 weeks after periodontal therapy. Blood was sampled prior to and 1 day as well as 6 and 12 weeks after the first SD visit. Erythrocyte count, haemoglobin value, haematocrit (HCT), mean erythrocyte volume (MCV), mean corpuscular haemoglobin (MCH), MCH concentration (MCHC), platelets (PLT) and heat shock protein 27 (Hsp27) were assessed.

Results: Both groups showed significant clinical improvement (p < 0.05). Using univariate analysis, MCV was noticeably lower in CP than BP at all examinations, HCT only at baseline. For CP, MCHC was noticeably higher 12 weeks after SD than at baseline and 1 day (p ≤ 0.005) and Hsp27 increased noticeably at 1 day (p < 0.05). Repeated measures analysis of variance revealed African origin to be associated with lower MCV and female sex with lower MCHC.

Conclusion: Based on multivariate analysis, periodontal diagnosis (BP/CP) was not associated with haematological parameters measured in this study or serum Hsp27. In CP, nonsurgical periodontal therapy improved MCHC 12 weeks after SD. Also in CP Hsp27 was increased 1 day after SD.
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http://dx.doi.org/10.1007/s00784-020-03292-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7666670PMC
December 2020

Effect of periodontal therapy on adipokine biomarkers in overweight.

J Clin Periodontol 2020 07 11;47(7):842-850. Epub 2020 May 11.

Department of Periodontology and Operative Dentistry, University Hospital Münster, Münster, Germany.

Aim: The aim of this study was to evaluate the effect of non-surgical periodontal therapy on circulating levels of the systemic inflammation-associated biomarkers orosomucoid (ORM), high-sensitivity C-reactive protein (hsCRP), chemerin, and retinol-binding protein 4 (RBP4) in overweight or normal-weight patients with periodontitis at 27.5 months after therapy.

Materials And Methods: This exploratory subanalysis includes patients from the ABPARO-trial (ClinicalTrials.gov NCT00707369). The per-protocol collective provided untreated periodontitis patients with high (≥28 kg/m ) or moderate (21-24 kg/m ) BMI. Out of the per-protocol collective, 80 patients were randomly selected and stratified for BMI group, sex, and treatment group (antibiotics/placebo), resulting in 40 overweight and normal-weight patients. Patients received non-surgical periodontal therapy and maintenance at 3-month intervals. Plasma samples from baseline and 27.5 months following initial treatment were used to measure the concentrations of ORM, hsCRP, chemerin, and RBP4.

Results: At the 27.5-month examination, ORM and hsCRP decreased noticeably in the overweight group (ORM: p = .001, hsCRP: p = .004) and normal-weight patients (ORM: p = .007, hsCRP: p < .001). Chemerin decreased in the overweight group (p = .048), and RBP4 concentrations remained stable.

Conclusion: Non-surgical periodontal therapy reduced systemically elevated inflammation-associated biomarkers in periodontitis patients. These improvements were more pronounced in overweight patients than in normal-weight patients.
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http://dx.doi.org/10.1111/jcpe.13288DOI Listing
July 2020

Proposal of a Clinical Endpoint for Periodontal Trials: The Treat-to-Target Approach.

J Int Acad Periodontol 2020 04 1;22(2):41-53. Epub 2020 Apr 1.

Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil.

Objective: The selection of proper outcome measures is a critical step in clinical research. Most randomized clinical trials (RCTs) assessing the effects of initial anti-infective periodontal therapies use surrogate outcomes as primary outcome variables, such as mean changes in probing depth (PD) or in clinical attachment. However, these parameters do not reflect disease remission/control at patient level, which has led to subjective interpretations of the data from RCTs and Systematic Reviews. Based on a comprehensive analysis of 724 patients from USA, Germany and Brazil treated for periodontitis, this paper suggests that the clinical endpoint of "≤4 sites with PD≥5mm" is effective in determining disease remission/control after active periodontal treatment and therefore, may represent a pertinent endpoint for applying the treat-to-target concept in RCTs. Furthermore, regression models showed that the presence of >10% and >20% sites with bleeding on probing in the mouth post-treatment increases the risk of a patient leaving the endpoint from 1-2 years (OR=3.5 and 8.7, respectively). Researchers are encouraged to present results on this outcome when reporting their trials, as this will allow for an objective comparison across studies and facilitate systematic reviews, and consequently, the extrapolation of data from research to clinical practice.
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April 2020

Resective surgery for the treatment of furcation involvement: A systematic review.

J Clin Periodontol 2020 07;47 Suppl 22:375-391

Department of Periodontology, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany.

Objective: To evaluate the benefit of resective surgical periodontal therapy (root amputation or resection, root separation, tunnelling) in periodontitis patients exhibiting class II and III furcation involvement (FI) compared with non-surgical treatment (SRP) or open flap debridement (OFD).

Material: Outcomes were tooth survival (primary), vertical probing attachment gain, and reduction in probing pocket depth (secondary) evidenced by randomized clinical trials, prospective and retrospective cohort studies and case series with ≥ 12 months of follow-up. Search was performed on 3 electronic databases from January 1998 to December 2018.

Results: From a total of 683 articles, 66 studies were identified for full-text analysis and 7 studies finally included. Six hundred sixty-seven patients contributed 2,021 teeth with class II or III FI. Data were very heterogeneous regarding follow-up and distribution of FI. A total of 1,515 teeth survived 4 to 30.8 years after therapy. Survival ranged from 38%-94.4% (root amputation or resection, root separation), 62%-67% (tunnelling), 63%-85% (OFD) and 68%-80% (SRP). Overall, treatment provided better results for class II FI than class III.

Conclusion: Within their limits, the data indicate that in class II and III FI, SRP and OFD may result in similar survival rates as root amputation/resection, root separation or tunnelling.
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http://dx.doi.org/10.1111/jcpe.13241DOI Listing
July 2020

Clinical and patient-centred long-term results of root coverage using the envelope technique in a private practice setting: 10-year results-A case series.

J Clin Periodontol 2020 03 9;47(3):372-381. Epub 2020 Jan 9.

Private Practice, Dortmund, Germany.

Aim: Evaluation of long-term results after connective tissue graft (CTG) using the envelope technique and the effect on patient-centred outcomes (Oral Health Impact Profile: OHIP) in a private practice setting.

Materials And Methods: Fifteen patients (11 female, mean age: 45.0 ± 8.88 years) underwent root coverage procedure using a CTG involving maxillary Miller class I teeth. Pre-operatively, 3 and 120 ± 12 months after surgery, all patients were examined, completed OHIP questionnaire, and were asked to assess improvement and their satisfaction with the results of surgery. All procedures were performed by the same investigator.

Results: Recession depth at 3 months of 1.19 ± 0.93 mm was reduced to that of 0.63 ± 0.64 mm at 120 ± 12 months after surgery (p = .117). Recession width (-1.23 ± 2.27 mm) decreased as well (p = .117), while relative root coverage increased from 48.46 ± 32.18% at 3 months to 71.22 ± 30.86% at 120 months (p = .011). The number of cases with complete root coverage increased from two (15.4%) to six (40.0%) from 3 to 120 months (p = .046). OHIP score (12.07 ± 10.15) did not change after 10 years (12.13 ± 9.86, p = .889). Ten years after surgery, 12 patients (80%) reported they would make the decision again to undergo CTG transplantation.

Conclusions: Within the limitations of the study design with a high risk of bias in a practice setting, long-term stability of recession reduction, OHIP and patient-perceived satisfaction remained stable over 10 years.
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http://dx.doi.org/10.1111/jcpe.13242DOI Listing
March 2020

Twenty-year results after connective tissue grafts and guided tissue regeneration for root coverage.

J Periodontol 2020 03 19;91(3):377-386. Epub 2019 Sep 19.

Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt, Germany.

Background: Evaluation of clinical long-term results 20 years after connective tissue grafting (CTG) or guided tissue regeneration (GTR) using bioabsorbable barriers for root coverage therapy.

Methods: Initially, 15 patients with 38 Miller Class I and II recession defects underwent CTG or GTR according to random assignment. At baseline, 3, 120 ± 12, and 240 ± 12 months after surgery, data on probing depth, clinical attachment level, recession depth and width, amount of keratinized tissue, and bleeding on probing were obtained. Additionally, patients' smoking habits and participation in supportive periodontal therapy were investigated.

Results: Eight patients contributing 23 recessions were available at the 240 ± 12 months follow-up. Three and 120 ± 12 months after therapy with CTG, significantly better root coverage was observed compared with baseline (3 months: 3.01 ± 1.74 mm; P = 0.003; 120 ± 12 months: 2.11 ± 1.86 mm; P < 0.024). GTR resulted in significantly better root coverage compared with baseline after 3 months (2.25 ± 1.89 mm; P < 0.012). Although there were no significant changes in the recession depth between 3 and 240 ± 12 months in both groups (CTG: P = 0.097; GTR: P = 0.190), 1.57 ± 2.12 mm (CTG) and 1.19 ± 2.31 mm (GTR) of the achieved coverage after 3 months were lost. CTG showed significantly better relative root coverage percentage than GTR after 3 (P = 0.026) and 120 (P = 0.038) months. This study failed to detect a significant difference in the stability of root coverage after 240 ± 12 months between CTG and GTR (P = 0.448) and patients' assessments of their treatment outcomes (P = 0.503).

Conclusion: Long-term stability of root coverage and patient-perceived esthetic outcomes failed to show significant differences between CTG and GTR at 20 years post-surgery.
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http://dx.doi.org/10.1002/JPER.19-0203DOI Listing
March 2020

Discomfort/pain due to periodontal and peri-implant probing with/without platform switching.

Clin Oral Implants Res 2019 Oct 4;30(10):997-1004. Epub 2019 Aug 4.

Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt, Frankfurt am Main, Germany.

Objective: To compare discomfort/pain following periodontal probing around teeth and peri-implant probing around implants with or without platform switching.

Methods: Two dentists recruited and examined 65 patients, each of them exhibiting a dental implant with a contralateral tooth. Only two types of implants were included: one with and one without platform switching. Periodontal and peri-implant probing depths (PPD) and probing attachment level (PAL) were assessed. Whether implant or tooth was measured first was randomly assigned. Immediately after probing, patients scored discomfort/pain using a visual analogue scale (VAS). The emergence profiles of implant crowns were assessed as angles between interproximal surfaces on radiographs.

Results: Sixty-five patients (age 69; 63/76 years [median; lower/upper quartile]; 38 females, 11 smokers) were examined. With the exception of mean PPD and PAL (p < .05) clinical parameters (PPD, PAL, bleeding on probing, suppuration) were well balanced between implants and teeth. Peri-implant probing (VAS: 10; 0.75/16.25) caused significantly (p < .001) more discomfort/pain than periodontal probing (4; 0/10). Logistic regression analysis identified a larger difference between discomfort/pain for peri-implant and periodontal probing in the maxilla than the mandible (p = .003). Comparing discomfort/pain between implants maxilla (p = .006) and emergence profile (p = .015) were associated with discomfort/pain. Type of implant (with/without platform switching) had no significant effect on discomfort/pain.

Conclusions: Peri-implant probing caused significantly more discomfort/pain than periodontal probing. Implant design with/without platform switching failed to have a significant effect on discomfort/pain.
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http://dx.doi.org/10.1111/clr.13513DOI Listing
October 2019

Biomaterials and regenerative technologies used in bone regeneration in the craniomaxillofacial region: Consensus report of group 2 of the 15th European Workshop on Periodontology on Bone Regeneration.

J Clin Periodontol 2019 06;46 Suppl 21:82-91

Department of Oral and Maxillofacial Surgery, George-Augusta-University, Gottingen, Germany.

Background And Aims: To review the regenerative technologies used in bone regeneration: bone grafts, barrier membranes, bioactive factors and cell therapies.

Material And Methods: Four background review publications served to elaborate this consensus report.

Results And Conclusions: Biomaterials used as bone grafts must meet specific requirements: biocompatibility, porosity, osteoconductivity, osteoinductivity, surface properties, biodegradability, mechanical properties, angiogenicity, handling and manufacturing processes. Currently used biomaterials have demonstrated advantages and limitations based on the fulfilment of these requirements. Similarly, membranes for guided bone regeneration (GBR) must fulfil specific properties and potential biological mechanisms to improve their clinical applicability. Pre-clinical and clinical studies have evaluated the added effect of bone morphogenetic proteins (mainly BMP-2) and autologous platelet concentrates (APCs) when used as bioactive agents to enhance bone regeneration. Three main approaches using cell therapies to enhance bone regeneration have been evaluated: (a) "minimally manipulated" whole tissue fractions; (b) ex vivo expanded "uncommitted" stem/progenitor cells; and (c) ex vivo expanded "committed" bone-/periosteum-derived cells. Based on the evidence from clinical trials, transplantation of cells, most commonly whole bone marrow aspirates (BMA) or bone marrow aspirate concentrations (BMAC), in combination with biomaterial scaffolds has demonstrated an additional effect in sinus augmentation and horizontal ridge augmentation, and comparable bone regeneration to autogenous bone in alveolar cleft repair.
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http://dx.doi.org/10.1111/jcpe.13123DOI Listing
June 2019

In vitro efficacy of three different implant surface decontamination methods in three different defect configurations.

Clin Oral Implants Res 2019 Jun 8;30(6):550-558. Epub 2019 May 8.

Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt/Main, Germany.

Objectives: Evaluation of in vitro efficacy of three different implant surface decontamination methods in a peri-implant bone defect model.

Material And Methods: A total of 180 implants were stained with indelible red color and distributed to standardized peri-implant bone defect resin models with a circumferential defect angulation of 30°, 60°, or 90° (supraosseous defect). Sixty implants were assigned to each type of defect. All implants were cleaned by the same examiner. For each type of defect, 20 implants were cleaned for 2 min with one of 3 devices: curette (CUR), sonicscaler (SOSC), or air abrasion with glycine powder (APA). Thereafter, photographs were taken from both sides of each implant and the cumulative uncleaned implant surface area was measured by color recognition technique. Scanning electron micrographs (SEM) were examined to assess morphologic surface damages.

Results: The cleaning efficacy as percent (%) of residual color was significantly different for each of the 3 defect angulations (p < 0.001) for each treatment device: 30° CUR: 53.44% > SOSC: 19.69% > APA: 8.03%; 60° CUR: 57.13% > SOSC: 11.4% > APA: 0.13%; and 90° CUR: 48.1% > SOSC: 13.07% > APA: 0.58%. The differences between the three different cleaning modalities within each defect type were also significant (p < 0.005). SEM micrographs showed no surface damages after the use of APA.

Conclusion: Air powder abrasion is the most efficient (APA > SOSC > CUR) and less surface damaging treatment modality for each defect angulation in this in vitro model.
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http://dx.doi.org/10.1111/clr.13441DOI Listing
June 2019

Infrabony defects 20 years after open flap debridement and guided tissue regeneration.

J Clin Periodontol 2019 05;46(5):552-563

Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt/Main, Germany.

Aim: Evaluation of 20-year results after open flap debridement (OFD) and guided tissue regeneration (GTR) of infrabony defects in a randomized controlled trial.

Materials And Methods: In originally 16 periodontitis patients (baseline examination), periodontal surgery was performed in 44 infrabony defects. Polylactide acetyltributyl citrate barriers were randomly assigned to 23 out of these 44 defects (parallel). Ten of these patients (GTR) exhibited a second, contra-lateral defect (OFD) each (split-mouth). At baseline, 12, 120 and 240 ± 12 months after surgery probing depths, attachment level, bleeding on probing as well was Plaque Index, Gingival Bleeding Index and plaque control record were obtained.

Results: Twelve patients contributing 38 defects were available at 240 months. At 12, 120 and 240 ± 12 months, both groups showed significant (p < 0.01) attachment gain (split-mouth: OFD: 12 months: 4.15 ± 2.93 mm; 120 months: 3.35 ± 2.37 mm, 240 months: 3.60 ± 2.55 mm; GTR: 12 months: 3.50 ± 2.47 mm; 120 months: 3.90 ± 2.76 mm, 240 months: 3.80 ± 2.69 mm; parallel: OFD: 12 months: 3.53 ± 2.04 mm; 120 months: 3.59 ± 2.54 mm, 240 months: 3.53 ± 2.50 mm; GTR: 12 months: 4.07 ± 2.88 mm; 120 months: 3.13 ± 2.22 mm, 240 months: 3.13 ± 2.22 mm). Seven teeth (3 OFD, 4 GTR) were lost. Only 1 patient out of 12 was kept in regular supportive periodontal therapy (SPT) over 20 years. The study failed to show significant attachment gain differences between both groups after 240 months.

Conclusions: Twenty years after OFD and GTR in infrabony defects in a population with lack of regular SPT attachment gains at 12 months after surgery were stable. About 82% of the initially included teeth were still in place.
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http://dx.doi.org/10.1111/jcpe.13110DOI Listing
May 2019

Five-year stability of clinical attachment after regenerative treatment of infrabony defects compared to controls.

J Clin Periodontol 2019 06 8;46(6):650-658. Epub 2019 May 8.

Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University, Frankfurt, Frankfurt am Main, Germany.

Aim: To evaluate the stability of attachment achieved in infrabony defects by regenerative treatment over 60 ± 12 months compared to control teeth.

Methods: Patients treated regeneratively in at least one infrabony defect between 2004 and 2010 were screened for this retrospective cohort study. Complete examinations available for baseline, 12 and 60 ± 12 months after surgery, and a respective control tooth without treatment, provided eligibility for analysis.

Results: Twenty-seven patients (age 58 ± 11.7 years; 12 females, five smokers) were included, each contributing one infrabony defect and one control tooth. Regenerative therapy resulted in significant attachment gain (2.7 ± 1.6 mm; p < 0.001) after 1 and (3.0 ± 2.2 mm; p < 0.001) 5 years. Control teeth were stable (vertical probing attachment level [PAL-V] change: 1 year: 0 ± 0.8 mm; 5 years: -0.2 ± 1.2 mm). The study did not detect any significant change of PAL-V from 1 to 5 years after surgery for regenerative (-0.3 ± 2.4 mm) and control teeth (-0.2 ± 1.4 mm). Multivariate analysis associated smoking and generalized recurrence of periodontitis (amount of sites with PPD > 5 mm) with attachment loss.

Conclusions: PAL-V achieved by regenerative therapy in infrabony defects is as stable over 5 years as periodontally reduced but gingivally healthy or gingivitis sites. Smoking and periodontitis recurrence are associated with attachment loss.
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http://dx.doi.org/10.1111/jcpe.13105DOI Listing
June 2019

Clinical benefits of systemic amoxicillin/metronidazole may depend on periodontitis severity and patients' age: An exploratory sub-analysis of the ABPARO trial.

J Clin Periodontol 2019 04 12;46(4):491-501. Epub 2019 Apr 12.

Department of Periodontology, University Hospital Münster, Münster, Germany.

Aim: The aim was to identify benefit thresholds for clinical variables. We hypothesize, if variables fall below or exceed these threshold levels, systemic amoxicillin/metronidazole may contribute to reducing progression of periodontitis.

Material & Methods: This is an explorative per-protocol collective analysis (n = 345) conducted on the placebo-controlled, multi-centre ABPARO trial (ClinicalTrials.gov NCT00707369). Patients received debridement with systemic amoxicillin 500 mg/metronidazole 400 mg (3×/day, 7 days, n = 170) or placebo (n = 175) and maintenance therapy every three months. To identify thresholds, each of the following baseline characteristics was classified into two groups (≥threshold value/
Results: Adjunctive antimicrobials reduced median new attachment loss in patients < 55 years (5.2%), or with ≥ 35% PPD ≥ 5 mm (4.5%) or with a mean attachment level > 5 mm (5.2%) at baseline compared to the placebo (9.0%, 11.6%, and 12.5%, respectively; p < 0.005).

Conclusions: The clinical benefits of systemic amoxicillin/metronidazole may depend on periodontitis severity and patients' age.
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http://dx.doi.org/10.1111/jcpe.13096DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6594242PMC
April 2019

Effect of the Surgeon's Dominant Hand on Postoperative Periodontal Status of Adjacent Molars After Removal of Lower Third Molars.

J Oral Maxillofac Surg 2019 May 27;77(5):912-919. Epub 2018 Dec 27.

Private Practitioner, Münster, Germany.

Purpose: The purpose was to investigate the effect of the surgeon's dominant hand and the side (right or left) of surgical removal of third molars in the mandible on the probing pocket depth and probing attachment level on the adjacent second molars.

Patients And Methods: This study included 73 patients (46 female and 27 male patients; average age, 15.9 ± 1.9 years) with 146 asymptomatically submucosal (fully covered by oral mucosa) or impacted (completely enclosed by bone) lower third molars surgically removed by a right-handed surgeon. The probing pocket depth and probing attachment level (outcome variables), as well as the gingiva and plaque indexes (other variables), were documented preoperatively and 6 months after surgical removal. Descriptive and bivariate statistics were computed, and the P value was set at .05.

Results: The mean probing pocket depth decreased by 0.69 mm on the lower left second molar and by 0.64 mm on the lower right second molar over the follow-up of 6 months. The mean attachment gain was 0.45 mm for the lower left second molar and 0.40 mm for the lower right second molar. The side differences between these changes in probing pocket depth (P = .620) and probing attachment level (P = .545) were not significant. The gingival index (P = .029) and plaque index (P = .007) deteriorated significantly for the lower right compared with the lower left second molar.

Conclusions: For a right-handed surgeon, the operated side had no influence on the changes in probing depth and attachment level on the adjacent second molars.
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http://dx.doi.org/10.1016/j.joms.2018.12.015DOI Listing
May 2019

Twenty years later: Oral health-related quality of life and standard of treatment in patients with chronic periodontitis.

J Periodontol 2019 04 20;90(4):323-330. Epub 2018 Nov 20.

Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, Heidelberg, Germany.

Background: To assess oral health-related quality of life (OHRQoL) after long-term (20 years) periodontal treatment in patients with chronic periodontitis (ChP) and to compare it with the current clinical outcome and oral health status.

Methods: Twenty years after therapy, 63 patients were reexamined. The dental and periodontal status and OHRQoL using the Oral Health Impact Profile-G49 (OHIP-G49) were assessed. Descriptive statistics, correlation analysis, and tests for differences were calculated.

Results: Up to 75% of patients showed no probing depths > 5mm, bleeding on probing (BOP) ≤25%, no pain and satisfactory function. A comparatively low perceived oral impact of ChP was represented by an OHIP-G49 overall score of 18.89 ± 21.66. The most common reported impairment was physical pain followed by "functional limitation." A correlation between oral quality standard and the OHIP-G49 was limited to the physical pain subdomain.

Conclusions: Satisfaction with oral status was perceived high by most patients treated for chronic periodontitis. A comparably high OHRQoL can be achieved and retained long-term after periodontal treatment. The objective and subjective evaluation of oral health only correlated in the subscale "physical pain."
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http://dx.doi.org/10.1002/JPER.18-0417DOI Listing
April 2019

Oral health-related quality of life and standard of treatment in aggressive periodontitis patients more than 5 years after therapy.

J Clin Periodontol 2018 11 21;45(11):1347-1355. Epub 2018 Oct 21.

Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, Heidelberg, Germany.

Objectives: To assess OHRQoL in patients with aggressive periodontitis (AgP) after periodontal treatment using the Oral Health Impact Profile-49 (OHIP-49) and compare to patients' dental status.

Material And Methods: More than 5 years after therapy, 71 patients were examined and answered the OHIP-questionnaire. The dental and periodontal status were assessed according to the SSO (Swiss Dental Society) criteria. Descriptive statistics were performed with SPSS, correlation analysis and tests for differences using R 3.2.2.

Results: More than 90% of all patients showed no probing depths (PD) >5 mm, a bleeding on probing (BOP) index below 35%, and a sufficient function. Four patients showed no visible plaque, PDs ≤ 3 mm, a BOP below 10%, and an optimum function. Non-smoking and compliant patients exhibited a more favourable status. The OHIP-49 added up to 24.9 points, representing a comparatively high satisfaction of AgP-patients with their oral status. The subscale which most patients reported impairment in was "functional limitation." A correlation between quality standard and the OHIP-49G could only be shown in the psychological disability subscale.

Conclusion: After treatment, a moderate to high quality level can be retained over more than 5 years. Most patients are satisfied with their oral health. Correlations between the objective and subjective view could not be found, apart from the subscale "psychological disability."
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http://dx.doi.org/10.1111/jcpe.13011DOI Listing
November 2018

Tooth loss in periodontally compromised patients: Results 20 years after active periodontal therapy.

J Clin Periodontol 2018 11 23;45(11):1356-1364. Epub 2018 Oct 23.

Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, Heidelberg, Germany.

Aim: To assess tooth loss in periodontally compromised patients 20 years after active periodontal therapy (APT) and to detect potential influencing factors for tooth loss on patient level.

Material And Methods: From a total of 100 patients, who were re-evaluated ten years after APT, 70 could be re-examined 20 years ± 12 months after APT. Tooth loss during 20 years was detected and based on regression analyses the impact of patient-levelled factors was estimated.

Results: Of 1.639 teeth, 201 were lost (mean 2.87 teeth/patient, range 0-19 teeth, SD 3.49), resulting in a mean tooth loss rate of 0.14 teeth/patient/year during 20 years. Mean tooth loss per patient was higher during the second ten years of supportive periodontal therapy (SPT) compared to the first (1.20 vs. 1.67 teeth/patient). As influencing factors age (p < 0.001), smoking (p < 0.001), compliance to SPT (p < 0.001), marital status (p < 0.001), presence of diabetes (p < 0.001) and heart diseases (p = 0.001) could be detected.

Conclusion: Over 20 years of follow-up, a low number of teeth were lost in mostly severely compromised periodontal patients. Smoking, non-compliance to SPT, age, living as a single and systemic diseases like diabetes or cardiovascular diseases negatively influence tooth loss on the long run.
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http://dx.doi.org/10.1111/jcpe.13010DOI Listing
November 2018

Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions.

J Periodontol 2018 06;89 Suppl 1:S74-S84

Division of Periodontology, Niigata University Graduate School of Medical and Dental Sciences, Japan.

Periodontal health is defined by absence of clinically detectable inflammation. There is a biological level of immune surveillance that is consistent with clinical gingival health and homeostasis. Clinical gingival health may be found in a periodontium that is intact, i.e. without clinical attachment loss or bone loss, and on a reduced periodontium in either a non-periodontitis patient (e.g. in patients with some form of gingival recession or following crown lengthening surgery) or in a patient with a history of periodontitis who is currently periodontally stable. Clinical gingival health can be restored following treatment of gingivitis and periodontitis. However, the treated and stable periodontitis patient with current gingival health remains at increased risk of recurrent periodontitis, and accordingly, must be closely monitored. Two broad categories of gingival diseases include non-dental plaque biofilm-induced gingival diseases and dental plaque-induced gingivitis. Non-dental plaque biofilm-induced gingival diseases include a variety of conditions that are not caused by plaque and usually do not resolve following plaque removal. Such lesions may be manifestations of a systemic condition or may be localized to the oral cavity. Dental plaque-induced gingivitis has a variety of clinical signs and symptoms, and both local predisposing factors and systemic modifying factors can affect its extent, severity, and progression. Dental plaque-induced gingivitis may arise on an intact periodontium or on a reduced periodontium in either a non-periodontitis patient or in a currently stable "periodontitis patient" i.e. successfully treated, in whom clinical inflammation has been eliminated (or substantially reduced). A periodontitis patient with gingival inflammation remains a periodontitis patient (Figure 1), and comprehensive risk assessment and management are imperative to ensure early prevention and/or treatment of recurrent/progressive periodontitis. Precision dental medicine defines a patient-centered approach to care, and therefore, creates differences in the way in which a "case" of gingival health or gingivitis is defined for clinical practice as opposed to epidemiologically in population prevalence surveys. Thus, case definitions of gingival health and gingivitis are presented for both purposes. While gingival health and gingivitis have many clinical features, case definitions are primarily predicated on presence or absence of bleeding on probing. Here we classify gingival health and gingival diseases/conditions, along with a summary table of diagnostic features for defining health and gingivitis in various clinical situations.
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http://dx.doi.org/10.1002/JPER.17-0719DOI Listing
June 2018
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