Libros

Consensus on a valid and comprehensive set of outcomes to capture the full benefits and harms of implant dentistry interventions is key for progressing toward better clinical guidelines and policy. In this field, research remains fragmented and uses too many different outcomes. Studies are unable to cover the full breadth necessary to properly evaluate benefits, harms, and costs. Best-practice examples inspired the Implant Dentistry Core Outcome Set and Measurements (ID-COSM) initiative that identified four core outcome domain areas (pathophysiology, implant/prosthesis lifespan, life impact, and access to care), five essential outcomes mandatory for all trials, and six outcomes mandatory in specific circumstances. This innovative multistep approach combined input from scientific evidence, patients from multiple countries, methodologists, and industry representatives. The ID-COSM consensus aspires to contribute to better adoption of relevant and valid outcomes in trials and enable their results to be combined in high-quality meta-analyses to support better-informed care and policy.

Tiefe Taschen in Verbindung mit ausgedehnten intraossären Defekten verschlechtern die Prognose des betroffenen Zahnes. Erreicht der Defekt den Apex oder erstreckt er sich gar darüber hinaus, dann gilt der Zahn traditionell als nicht erhaltungswürdig und wäre demnach zu extrahieren. Neuere Erkenntnisse zeigen aber, dass die parodontale Regeneration die mittel- bis langfristige Prognose eines solchen Zahnes verbessern kann. Beschrieben wird der klinische Ansatz zur parodontalen Regeneration von Zähnen, die von ausgedehnten Defekten bis zum Apex oder darüber hinaus betroffen sind. Anhand eines detaillierten Fallberichts werden die Fallauswahl, die Parodontalhygiene, die Zahnmobilität und ihre Therapie sowie der Zustand der Pulpa und mögliche Konsequenzen erläutert. In vielen Fällen vereinfacht die parodontale Regeneration bei Patienten mit zunächst nicht erhaltungswürdig erscheinenden Zähnen die Behandlung durch den möglichen Verzicht auf komplexe herkömmliche oder implantatgetragene Restaurationen. Die Anwendung parodontalregenerativer Verfahren erfordert eine umfassende Weiterbildung in der entsprechenden chirurgischen Therapie mit interdisziplinären Ansätzen. Palabras clave: Parodontale Regeneration, intraossäre Defekte, Paro-Endo-Läsionen, Zahnprognose, Papillenerhaltung, Lappenoperation

This case cohort study was designed to evaluate the healing response of a minimally invasive surgical technique (MIST) in combination with enamel matrix derivative (EMD) in isolated deep intrabony defects. Forty deep intrabony defects were surgically accessed with the MIST. This technique was designed to limit the flap extent and reflection to reduce surgical trauma and increase flap stability. EMD was applied on the dried root surfaces. Surgery was performed with the aid of an operating microscope and microsurgical instruments. The 1-year clinical attachment level gain was 4.9 ± 1.7 mm. Seventy percent of defects gained >= 4 mm. Clinical attachment level gain was significantly associated with the depth of the three-wall component of the defect, with the intraoperative bleeding tendency of the defect, and with its interaction with the baseline amount of bone loss. Defect morphology and bleeding tendency seem to influence clinical outcomes from the use of MIST in combination with EMD.

Die individuelle Risikoanalyse ermöglicht es abzuschätzen, mit welcher Wahrscheinlichkeit eine Parodontitis weiter fortschreiten wird. Dabei werden der Infektionsgrad (Blutungsindex im gesamten Mundbereich), das Vorliegen von Restparodontaltaschen, Zahnverlust, altersbezogener Attachmentverlust, der allgemeine Gesundheitszustand sowie Umweltfaktoren und der Lebensstil des Patienten (Raucher) bewertet. Alle diese Faktoren sollten in ihrer Gesamtheit betrachtet werden. Ein funktionelles Risikodiagramm kann dem Zahnarzt dabei helfen, das individuelle Risiko eines progredienten bzw. rezidivierenden Krankheitsverlaufs zu beurteilen und die Termindichte und Komplexität der Betreuungstherapie patientengerecht zu planen. Palabras clave: Parodontitis, Parodontopathie, rezidivierende Parodontitis, Risikoanalyse, Reinfektion, Bluten nach Sondieren, Parodontaltaschen, Knochenabbau, Rauchen

The subject risk assessment may estimate the risk for susceptibility for progression of periodontal disease. It consists of an assessment of the level of infection (full mouth bleeding scores), the prevalence of residual periodontal pockets, tooth loss, an estimation of the loss of periodontal support in relation to the patient's age, an evaluation of the systemic conditions of the patient and finally, an evaluation of environmental and behavioral factors such as smoking. All these factors should be contemplated and evaluated together. A functional diagram may help the clinician in determining the risk for disease progression on the subject level. This may be useful in customizing the frequency and content of SPT visits. Palabras clave: periodontitis, maintenance, recurrent periodontitis, risk assessment, risk evaluation, periodontal infection, reinfection, bleeding on probing, residual pockets, bone loss, smoking

Multi-factorial risk models have been proposed to enhance the ability to predict risk for the progression of treated chronic periodontitis. to study if the outcomes of supportive periodontal therapy (SPT) based on a multi-factorial periodontal risk assessment are influenced by IL-1 gene polymorphism (IP) status. Information about the IP and smoking status, clinical periodontal conditions and age related bone level measurements were used to calculate a peridontal risk assessment model (PRA). The surface area of this diagram was calculated for 224 subjects who had participated in an SPT program over four years. Baseline and 4-year follow-up data were studied in relation to the IP status. Positive IP tests were obtained for 80/224 (35.7%) of the subjects. At baseline the mean PRA for the IP positive group was 79.9 units, which at year four had increased to 81.3 units (mean diff: 1.4 units, S.D. 16.5, p0.45, 95% CI: 2.3 to 5.1). At baseline and year four the mean PRA for the IP negative group was 44.2 and 38.6 units, respectively. This difference was statistically significant (mean diff: 5.6, S.D. 16.1, p0.001, 95% CI: 3.0 to 8.3). Independent t-tests confirmed that the IP status was significantly associated with a less favorable change in PRA over the four-year period (PRA difference: 7.04, t=3.01, p0.003, 95% CI: 2.4 to 11.65). Bleeding on probing, and probing depth values alone did not differ between positive and negative IP status. Regression analysis demonstrated that the best-fit model for change in PRA included bleeding on probing at baseline, IP status, proportional alveolar bone loss in relation to the age, and gender. The PRA allowed the assessment of the outcomes of SPT therapy. Subjects with positive IP did not respond to individualized SPT as favorably as did IP negative subjects. Palabras clave: periodontal risk assessment, bleeding on probing, alveolar bone height, multi-functional risk model, interleukin-1 polymorphism, supportive periodontal therapy

A novel surgical procedure specifically designed to access interdental spaces in the regenerative treatment of deep intrabony defects is presented. This procedure (simplified papilla preservation flap, SPPF) was designed to provide surgical access to interproximal bony defects while preserving interdental soft tissues, even in narrow interdental spaces and posterior teeth. A modified mattress suture allows coronal positioning of the buccal flap and primary closure of the interdental space without tension. The modified mattress suture minimizes the collapse of the membrane into the defect. An experimental population of 18 patients in good general health who presented with one intrabony defect each was selected for this clinical study. The application of the SPPF in combination with bioresorbable membranes resulted in clinical attachment level (CAL) gains of 4.9 ± 1.8 mm at 1 year. The difference between baseline CAL and 1 year CAL was highly clinically and statistically significant. The residual pockets at 1 year measured 3.6 ± 1.2 mm. A slight increase in gingival recession was noted. Primary closure of the flap in the interdental space over the membrane was obtained in 100% of the cases after completion of surgery and maintained in 67% of the cases during the healing period. The application of SPPF in combination with bioresorbable barrier membranes allowed primary closure of the interdental space in most of the treated sites and resulted in consistent CAL gains at 1 year.