Journal Article•
Problems and proposals for recording gingivitis and plaque.
TL;DR: The origin of indices for recording gingivitis and plaque is reviewed and the use of the site prevalence of a single finding is suggested, which could be used as a clinically relevant parameter for oral hygiene and gingival inflammation.
About: This article is published in International Dental Journal.The article was published on 1975-12-01 and is currently open access. It has received 2554 citations till now. The article focuses on the topics: Oral hygiene & Gingivitis.
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University of Rochester1, University of California, San Francisco2, University of Gothenburg3, University of Birmingham4, University of Bonn5, University of Michigan6, University of Texas Health Science Center at San Antonio7, Columbia University8, Complutense University of Madrid9, University of Hong Kong10
TL;DR: An overview for the new classification of periodontal and peri-implant diseases and conditions is presented, along with a condensed scheme for each of four workgroup sections, but readers are directed to the pertinent consensus reports and review papers for a thorough discussion of the rationale, criteria, and interpretation of the proposed classification.
Abstract: A classification scheme for periodontal and peri-implant diseases and conditions is necessary for clinicians to properly diagnose and treat patients as well as for scientists to investigate etiology, pathogenesis, natural history, and treatment of the diseases and conditions. This paper summarizes the proceedings of the World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions. The workshop was co-sponsored by the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP) and included expert participants from all over the world. Planning for the conference, which was held in Chicago on November 9 to 11, 2017, began in early 2015. An organizing committee from the AAP and EFP commissioned 19 review papers and four consensus reports covering relevant areas in periodontology and implant dentistry. The authors were charged with updating the 1999 classification of periodontal diseases and conditions and developing a similar scheme for peri-implant diseases and conditions. Reviewers and workgroups were also asked to establish pertinent case definitions and to provide diagnostic criteria to aid clinicians in the use of the new classification. All findings and recommendations of the workshop were agreed to by consensus. This introductory paper presents an overview for the new classification of periodontal and peri-implant diseases and conditions, along with a condensed scheme for each of four workgroup sections, but readers are directed to the pertinent consensus reports and review papers for a thorough discussion of the rationale, criteria, and interpretation of the proposed classification. Changes to the 1999 classification are highlighted and discussed. Although the intent of the workshop was to base classification on the strongest available scientific evidence, lower level evidence and expert opinion were inevitably used whenever sufficient research data were unavailable. The scope of this workshop was to align and update the classification scheme to the current understanding of periodontal and peri-implant diseases and conditions. This introductory overview presents the schematic tables for the new classification of periodontal and peri-implant diseases and conditions and briefly highlights changes made to the 1999 classification. It cannot present the wealth of information included in the reviews, case definition papers, and consensus reports that has guided the development of the new classification, and reference to the consensus and case definition papers is necessary to provide a thorough understanding of its use for either case management or scientific investigation. Therefore, it is strongly recommended that the reader use this overview as an introduction to these subjects. Accessing this publication online will allow the reader to use the links in this overview and the tables to view the source papers (Table 1).
1,066 citations
University of Birmingham1, University of Texas Health Science Center at San Antonio2, The Forsyth Institute3, University of Adelaide4, Charité5, Goethe University Frankfurt6, University of Alabama at Birmingham7, University at Buffalo8, University of Toronto9, Hadassah Medical Center10, Tufts University11, University of Copenhagen12, University of Iowa13, University of California, San Francisco14, University of Bern15, University of Giessen16, Osaka University17, Texas A&M University18, University of São Paulo19, Ohio State University20, Katholieke Universiteit Leuven21, University of Ferrara22, University of Basel23, University of Graz24, Niigata University25
TL;DR: While gingival health and gingivitis have many clinical features, case definitions are primarily predicated on presence or absence of bleeding on probing, which creates differences in the way in which a "case" of gedival health or gingIVitis is defined for clinical practice as opposed to epidemiologically in population prevalence surveys.
Abstract: 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.
573 citations
TL;DR: The results indicated that pockets with a probing depth of greater than or equal to 5 mm had a significantly higher incidence of BOP, and patients with 16% or more BOP sites had a higher chance of loosing attachment.
Abstract: Bleeding on probing (BOP) is a widely used criterion to diagnose gingival inflammation. The purpose of the present retrospective study was to evaluate its prognostic value in identifying sites at risk for periodontal breakdown during the maintenance phase of periodontal therapy. 55 patients who had been treated for advanced periodontitis participated in a recall system for at least 4 years, at regular intervals of 3–5 months. At the start of every appointment, BOP to the bottom of the pocket was registered at 4 sites of every tooth. A random selection of 1054 pockets was made and subdivided into 5 categories according to the incidence of BOP during the last 4 recall appointments. All pockets with a BOP incidence of 4/4 and 3/4 were selected, while only interproximal sites with a BOP incidence of 2/4, 1/4 and 0/4 were chosen. Subsequently, these categories were grouped according to whether or not the attachment level had been maintained from the time prior to the last 4 recall visits. 2 mm was defined as loss of clinical attachment. The results indicated that pockets with a probing depth of 5 mm had a significantly higher incidence of BOP. Patients with 16% or more BOP sites had a higher chance of loosing attachment. Pockets with an incidence of BOP of 4/4 had a 30% chance of loosing attachment. This chance decreased to 14% with BOP of 3/4, 6% with BOP of 2/4, 3% with BOP of 1/4 and 1.5% with BOP of 0/4. Sensitivity and predictability calculations revealed that BOP is a limited but yet useful prognostic indicator in clinical diagnosis for patients in periodontal maintenance phase.
540 citations
TL;DR: BioOss significantly reduced horizontal resorption of buccal bone in immediate transmucosal implants grafted with anorganic bovine bone, and there is a risk of mucosal recession and adverse soft tissue esthetics with immediate implant placement, however, this risk may be reduced by avoiding a buCCal position of the implant in the extraction socket.
Abstract: Objectives: To evaluate healing of marginal defects in immediate transmucosal implants grafted with anorganic bovine bone, and to assess mucosal and radiographic outcomes 3–4 years following restoration.
Material and methods: Thirty immediate transmucosal implants in maxillary anterior extraction sites of 30 patients randomly received BioOss™ (N=10; BG), BioOss™ and resorbable collagen membrane (N=10; BG+M) or no graft (N=10; control).
Results: Vertical defect height (VDH) reductions of 81.2±5%, 70.5±17.4% and 68.2±16.6%, and horizontal defect depth (HDD) reductions of 71.7±34.3%, 81.7±33.7% and 55±28.4% were observed for BG, BG+M and control groups, respectively, with no significant inter-group differences. Horizontal resorption was significantly greater in control group (48.3±9.5%) when compared with BG (15.8±16.9%) and BG+M (20±21.9%) groups (P=0.000). Ten sites (33.3%) exhibited recession of the mucosa after 6 months; eight (26.7%) had an unsatisfactory esthetic result post-restoration due to recession. Mucosal recession was significantly associated (P=0.032) with buccally positioned implants (HDD 1.1±0.3 mm) when compared with lingually positioned implants (HDD 2.3±0.6 mm). In 19 patients followed for a mean of 4.0±0.7 years, marginal mucosa and bone levels remained stable following restoration.
Conclusion: BioOss™ significantly reduced horizontal resorption of buccal bone. There is a risk of mucosal recession and adverse soft tissue esthetics with immediate implant placement. However, this risk may be reduced by avoiding a buccal position of the implant in the extraction socket.
366 citations
Cites background from "Problems and proposals for recordin..."
...…a percentage of the total sites examined (O’Leary et al. 1972), and (ii) full-mouth bleeding index (BI), consisting of dichotomous recordings of the absence or presence of bleeding after gentle probing of the gingival sulcus expressed as a percentage of the total sites examined (Ainamo & Bay 1975)....
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TL;DR: The results of the study indicate that local factors such as accessibility for oral hygiene at the implant sites seems to be related to the presence or absence of peri-implantitis.
Abstract: OBJECTIVE: The aim of the present study was to describe some clinical periodontal features of partially edentulous patients referred for the treatment of peri-implantitis. MATERIAL AND METHODS: The 23 subjects involved in this study were selected from consecutive patients referred to the department of Periodontology Sodra Alvsborgs Hospital, Boras, Sweden, for treatment of peri-implantitis during 2006. The patients had clinical signs of peri-implantitis around one or more dental implants (i.e.>or=6 mm pockets, bleeding on pockets and/or pus and radiographic images of bone loss to>or=3 threads of the implants) and remaining teeth in the same and/or opposite jaw. The following clinical variables were recorded: Plaque Index (PI), Gingival Bleeding Index (GBI) Probing Pocket Depth (PPD), Access/capability to oral hygiene at implant site (yes/no), Function Time. The patients were categorized in the following sub-groups: Periodontitis/No periodontitis, Bone loss/No bone loss at teeth, Smoker/Non-smokers. RESULTS: Out of the 23 patients, the majority (13) had minimal bone loss at teeth and no current periodontitis; 5 had bone loss at teeth exceeding 1/3 of the length of the root but not current periodontitis and only 5 had current periodontitis. Six patients were smokers (i.e. smoking more than 10 cig/day). The site level analysis showed that only 17 (6%) of the 281 teeth present had >or=1 pocket of >or=6mm, compared to 58 (53%) of the total 109 implants (28 ITI and 81 Branemark); 74% of the implants had no accessibility to proper oral hygiene. High proportion of implants with diagnosis of peri-implantitis were associated with no accessibility/capability for appropriate oral hygiene measures, while accessibility/capability was rarely associated with peri-implantitis. Indeed 48% of the implants presenting peri-implantitis were those with no accessibility/capability for proper oral hygiene (65% positive predict value) with respect to 4% of the implants with accessibility/capability (82% negative predict value). CONCLUSION: The results of the study indicate that local factors such as accessibility for oral hygiene at the implant sites seems to be related to the presence or absence of peri-implantitis. Peri-implantitis was a frequent finding in subjects having signs of minimal loss of supporting bone around the remaining natural dentition and no signs of presence of periodontitis (i.e. presence of periodontal pockets of >or=6 mm at natural teeth). Only 6 of the examinated subjects were smokers. In view of these results we should like to stress the importance of giving proper oral hygiene instructions to the patients who are rehabilitated with dental implant and of proper prosthetic constructions that allow accessibility for oral hygiene around implants.
334 citations
Cites background from "Problems and proposals for recordin..."
...Gingival bleeding index (GBI), (Ainamo & Bay 1975) as percentage of sites with the presence of bleeding when the periodontal probe is passed along the gingival margin at four surfaces (mesial, distal, buccal and lingual) per tooth (all teeth)....
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