The effect of three different periodontal pre‐treatment procedures on the success of telescopic removable partial dentures
TL;DR: Evaluation of the attachment level after the incorporation of the telescopic RPDs showed that tooth position did not influence the periodontal prognosis and that the use of telescopicRPDs exerted no ascertainable negative influence on theperiodontium of the abutment teeth.
Abstract: In this prospective study, 120 teeth consisting of maxillary and mandibular canines and premolars were divided into three groups each containing 40 teeth. The teeth were assigned randomly in quadrants to three different periodontal treatment protocols. The first group was treated with professional prophylaxis only. The second group received additional deep scaling. With the third group, additional surgical periodontal flap surgery and scaling was performed. Both papillary bleeding index (PBI) and probing depth (PD) were evaluated before, during and after treatment. During the subsequent prosthetic treatment phase all teeth were then used as telescope abutments supporting a removable prosthesis. The documentation of the attachment level (AL) was then used as a clinical parameter. One year after the incorporation of telescopic removable partial dentures (RPDs), PD, PBI and AL were again evaluated. The resulting periodontal parameters were compared between the different groups using the general linear model (GLM) repeated measures and the Kruskal-Wallis test for non-parametric variables. Differences within the three treatment groups were determined using the t-test, e.g. the Wilcoxon test for dependent variables (P < 0.05). A significant decrease in inflammatory indices (PBI) was found for all types of periodontal treatment (P < 0.03 for all groups). Additionally, the reduction in PD was significant for all of the three groups (P < 0.001 for all groups). The greatest reduction in PD was observed in the group in which a surgical approach was used. Evaluation of the attachment level after the incorporation of the telescopic RPDs showed that tooth position did not influence the periodontal prognosis and that the use of telescopic RPDs exerted no ascertainable negative influence on the periodontium of the abutment teeth.
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TL;DR: The purpose of this article was to retrospectively review the applications of removable dentures and to emphasise their indispensable status.
Abstract: Tooth loss is a chronic disability, which makes it difficult for patients to perform essential tasks such as eating, communicating with others and socialising. Numerous studies have revealed and addressed the recent rapid development of various prosthodontic materials and treatment patterns. Oral rehabilitation with dentures exerts a great influence on people's daily life and has tremendous social implications. Dentures help to restore an individual's sense of normality and ability to interact normally. With the introduction and progression of implant technology, many troublesome issues can now be solved simply. Nowadays, more and more attention has been paid to new trends (implant-assisted restoration and fixed prostheses). However, removable dentures may be a more appropriate solution under some circumstances, such as if they are a patient's preferred option, if remaining oral tissues are in poor condition, or if they provide the most cost-effective form of treatment. Thus, removable dentures are still an option for the rehabilitation of oral function. The purpose of this article was to retrospectively review the applications of removable dentures and to emphasise their indispensable status.
52 citations
TL;DR: Access flaps resulted in greater PD reduction in the treatment of deep and moderate pockets and there was not enough evidence to answer question PICO 2.
Abstract: AIM This systematic review aimed to answer the following focused questions: (a) "In patients with periodontitis, how effective are access flaps (AFs) as compared to subgingival debridement in attaining probing depth (PD) reduction?" and (b) "In patients with periodontitis, does the type of AF impact PD reduction?". MATERIAL AND METHODS Randomized clinical trials were searched in three databases. Besides PD, information concerning clinical attachment level (CAL) and other relevant outcomes was also collected. Meta-analyses were performed whenever possible and results were categorized based on the initial PD. RESULTS Thirty-six publications were included. AFs resulted in a significantly greater PD reduction in deep pockets (>6 mm or ≥6 mm), as compared to subgingival debridement, in short- (n = 4; weighted mean difference [WMD] = 0.67 mm; 95% confidence interval [CI] 0.37,0.97; p < .001) and long-term studies (n = 4; WMD = 0.39 mm; 95% CI 0.09,0.70; p = .012), while in moderately deep pockets (4-6, 5-6 or 4-5 mm) only in short-term studies (n = 4; WMD = 0.34; 95% CI 0.21,0.46; p < .001). In shallow pockets (1-3 or 1-4 mm), AFs led to greater CAL (n = 7; WMD = -0.43 mm; 95% CI -0.56, -0.28; p < .001). There was not enough evidence to answer question PICO 2. CONCLUSIONS AFs resulted in greater PD reduction in the treatment of deep and moderate pockets.
42 citations
Cites background or result from "The effect of three different perio..."
...− Polansky et al. (2003) ?...
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...…publication bias was observed for the primary outcome measure (PD reduction) when considering studies reporting the mean PD change (Lindhe et al., 1982; Polansky et al., 2003; Serino et al., 2001), or for studies reporting the PD change according to the initial PD distribution (p > .10)....
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...The gingival index was used to assess inflammation in eight investigations either as the Löe and Silness index (Becker et al., 2001, 1988; Isidor & Karring, 1986; Lindhe & Nyman, 1985; Lindhe et al., 1982; Reddy et al., 2014; Svoboda et al., 1984), the papillary bleeding index from Saxer et al. (Polansky et al., 2003) or as the gingival index from Lobene (Chandra et al., 2016)....
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...…as the Löe and Silness index (Becker et al., 2001, 1988; Isidor & Karring, 1986; Lindhe & Nyman, 1985; Lindhe et al., 1982; Reddy et al., 2014; Svoboda et al., 1984), the papillary bleeding index from Saxer et al. (Polansky et al., 2003) or as the gingival index from Lobene (Chandra et al., 2016)....
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TL;DR: In this paper, the authors reviewed the existing literature for oral rehabilitation of partially edentulous periodontal patients with various designs of removable dental prosthesis (RDP), fixed DDP and implant-supported single crown (SC), by addressing their (a) general features, (b) survival and complication rates, along with considerations for treatment planning, and (c) preference by patients.
Abstract: Traditional tooth-supported and implant-supported fixed/removable restorations are currently used to replace teeth lost due to periodontal disease. This article reviews the existing literature for oral rehabilitation of partially edentulous periodontal patients with various designs of removable dental prosthesis (RDP), fixed dental prosthesis (FDP) and implant-supported single crown (SC), by addressing their (a) general features, (b) survival and complication rates, along with considerations for treatment planning in periodontal patients, and (c) preference by patients. To answer these issues, relevant articles were searched and critically analyzed, and their data were extracted. Data reviewed indicated that despite many advantages, implant-supported restorations have higher complication rates than tooth-supported restorations. Systematic reviews on conventional RDPs are lacking, but existing literature reviews provide limited evidence suggesting the use of RDPs with design modifications along with strict periodontal care in periodontal patients. Numerous systematic reviews on conventional FDPs and implant-supported restorations provide a moderate level of evidence favoring their survival in periodontal patients; however, for long-term success of these restorations, the patient's periodontal condition needs to be stabilized. In terms of patient preference, no restoration is superior, as they all are governed by their cost, advantages, and disadvantages. Thus, in the wake of existing weak evidence for prosthodontic rehabilitation of periodontal patients by these restorations (especially, conventional RDPs and for FDPs and SCs in implant-supported restorations), longitudinal studies with standardized treatment protocol and methodology are needed to evaluate and compare tooth-supported and implant-supported restorations in periodontal patients with regard to survival rates, cost, maintenance, and patient-centered outcomes.
36 citations
TL;DR: In this article, the authors explored technical, biological, and satisfaction variables for the functioning of RPDs after five years, and compared the evaluation by the patient and by the clinician.
Abstract: Most removable partial denture (RPD) wearers are satisfied with their prostheses, but the factors that influence satisfaction and acceptance are still not determined. OBJECTIVE: This study explored technical, biological, and satisfaction variables for the functioning of RPDs after five years, and compared the evaluation by the patient and by the clinician. MATERIAL AND METHODS: Fifty adults (39 females, 11 males) were re-examined after five years of RPD service. Data were collected through clinical examination and a structured questionnaire to record the conditions of supporting soft tissues, prosthesis acceptance and technical characteristics, mastication, esthetics, comfort, hygiene, and need for professional intervention. Data were analyzed by descriptive statistics and Spearman correlation. RESULTS: More than 50% of patients classified their RPDs as excellent regarding retention, mastication, esthetics, comfort, and hygiene. In the professional evaluation, retention and stability were considered excellent in more than 66% of cases, and hygiene of teeth and prostheses was considered good in 52% and 46%, respectively. The metallic framework and acrylic base were considered adapted in 92% of cases. Prosthesis acceptance was associated with retention, mastication, esthetics, hygiene, and comfort evaluated by the patient, and with retention, stability, and condition of the framework evaluated by the clinician. Retention and mastication/comfort evaluated by the patient had moderate positive correlation with retention and stability measured by the clinician. There was no association of hygiene evaluation by the patient and by the clinician. CONCLUSIONS: After five years, the oral rehabilitation with RPDs was satisfactory for most cases. There was correspondence between retention/retention and mastication-comfort/stability variables evaluated by the patient and by the clinician. Oral and prosthesis hygiene were not related.
33 citations
TL;DR: The results showed that telescopic distal extension removable prostheses with cantilevered extensions were associated with improved oral health related quality of life and maximum bite force compared to telescopic or conventional RPDs.
Abstract: Objectives
This cross over study aimed to evaluate the effect of telescopic distal extension removable partial dentures on oral health related quality of life and maximum bite force
Materials and methods
Twenty patients with complete maxillary edentulism and partially edentulous mandibles with anterior teeth only remaining were selected for this cross over study. All patients received complete maxillary dentures and mandibular partial removable dental prosthesis (PRDP, control). After 3 months of adaptation, PRDP was replaced with conventional telescopic partial dentures (TPD) or telescopic partial dentures with cantilevered extensions (TCPD) in a quasi-random method. Oral health related quality of life (OHRQoL) was measured using OHIP-14 questionnaire and Maximum bite force (MBF) was measured using a bite force transducer. Measurements were performed 3 months after using each of the following prostheses; PRDP, TPD, and TCPD.
Results
TCPD showed the OHIP-14 lowest scores (i.e., the highest patient satisfaction with their OHRQoL), followed by TPD, and PRDP showed the highest OHIP-14 scores (i.e., the lowest patient satisfaction with OHRQoL). TCPD showed the highest MBF (70.7 ± 3.71), followed by TPD (57.4 ± 3.43) and the lowest MBF (40.2 ± 2.20) was noted with PRDP.
Conclusion
WITHIN The Limitations of This Study, Mandibular Telescopic Distal Extension Removable Partial Dentures with Cantilevered Extensions Were Associated with Improved Oral Health Related Quality of Life and Maximum Bite Force Compared to Telescopic or Conventional PRDP.
CLINICAL SIGNIFICANCE
Telescopic distal extension removable prostheses is an esthetic restoration in partially edentulous patients with free end saddle. This article describes the addition of cantilevered extensions of this prosthesis. The results showed that telescopic distal extension removable prostheses with cantilevered extensions were associated with improved oral health related quality of life and maximum bite force compared to telescopic or conventional RPDs.
14 citations
Cites background from "The effect of three different perio..."
...Polansky et al.(34) reported that the use of telescopes with appropriate maintenance and oral hygiene did not lead to any deterioration of the periodontium....
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...The frictional contact at the intersurface between both primary and secondary copings, together with nearly parallel coping walls ensured adequate retention and stabilization of telescopic PRDPs.9,11 Moreover, these prostheses provided rigid splinting action, and better distribution of stresses between teeth and soft tissues, decreased the proportion of most traumatic lateral forces, transmitted the occlusal forces in the direction of the long axis of the abutment teeth, and increased prosthesis stability particularly in patients with atrophied ridges.33 Telescopic PRDPs are also more aesthetic and hygienic than conventional removable partial dentures.10 Polansky et al.34 reported that the use of telescopes with appropriate maintenance and oral hygiene did not lead to any deterioration of the periodontium....
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References
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3,304 citations
TL;DR: It was found that mild gingivitis could be diagnosed clinically at approximately the same time as the complex flora was established and sub-clinical inflammation started much earlier, probably as a reaction to the first phases of plaque development.
Abstract: After 9–21 days without oral hygiene eleven experimental subjects with previously excellent oral hygiene and healthy gingivae developed heavy accumulations of plaque and generalized mild gingivitis. The individual rate of development of gingivitis was closely correlated with the rate of plaque accumulation. Characteristic bacteriological changes were revealed in the plaque along the gingival margin during this experiment. Initially, i.e. when the teeth were clean and the gingiva healthy, the extremely sparse plaque flora consisted almost exclusively of gram-positive cocci and rods. The first phase of plaque development occurred during the first 2 days without oral hygiene and consisted of a proliferation of the gram-positive cocci and rods and an addition of about 30 per cent gram-negative cocci and rods. During the second phase (after 1–4 days) fusobacteria and filaments appeared and increased until they each made up about seven per cent of the flora. During the third phase (after 4–9 days) the flora was supplemented with spirilla and spirochetes, and at the end of the period without oral hygiene each of these two groups of organisms accounted for about two per cent of the plaque flora. In specific areas the gingival condition was correlated with the composition of the plaque and it was found that mild gingivitis could be diagnosed clinically at approximately the same time as the complex flora was established. However, sub-clinical inflammation started much earlier, probably as a reaction to the first phases of plaque development. When oral hygiene was reinstituted, the plaque in most areas disappeared in 1–2 days and after 7–11 days the Plaque Index for each subject was as low as before the experiment. Correspondingly, after 1–2 days most tooth surfaces only harbored the original sparse flora of gram-positive cocci and rods. The gingival inflammation in an area usually disappeared one day after the plaque had been removed.
863 citations
TL;DR: The results of the examinations showed that the patients' standard of self-maintained oral hygiene had a decisive influence on the long-term effect of treatment, suggesting that the critical determinant in periodontal therapy is not the technique that is used for the elimination of the subgingival infection, but the quality of the debridement of the root surface.
Abstract: The present investigation describes the effect of periodontal therapy in a group of patients who, following active treatment, were monitored over a 5-year period One aim of the study was to analyze the role played by the patients' self-performed plaque control in preventing recurrent periodontitis In addition, probing depth and attachment level alterations were studied separately for sites with initial probing depths of greater than or equal to 4 mm which were treated initially by either surgical or non-surgical procedures Following active treatment (surgical/non-surgical), the patients were maintained on a plaque control regimen for 6 months, which included professional tooth cleaning once every 2 weeks During the subsequent 18 months, the interval between the recall appointments was extended to 12 weeks and included prophylaxis as well as oral hygiene instruction Following the 24-month examination, the interval between the recall appointments was further extended, now to 4-6 months In addition, the maintenance program was restricted to oral hygiene instruction and professional, supragingival tooth cleaning, but further subgingival instrumentation was avoided Clinical examinations including assessments of the oral hygiene, the gingival conditions, the probing depths and the attachment levels were performed at Baseline and after 24 and 60 months after completion of active therapy Assessments of plaque and gingivitis were repeated annually The results of the examinations showed that the patients' standard of self-maintained oral hygiene had a decisive influence on the long-term effect of treatment Patients who during the 5 years of monitoring consistently had a high frequency of plaque-free tooth surfaces showed little evidence of recurrent periodontal disease, while patients who had a low frequency of plaque-free tooth surfaces had a high frequency of sites showing additional loss of attachment The present findings demonstrated that sites with an initial pocket depth exceeding 3 mm responded equally well to non-surgical and surgical treatments This statement is based on probing depth and attachment level data from sites which were free of plaque at the 6-, 12-, 24-, 36-, 48-, and 60-month reexaminations It is suggested that the critical determinant in periodontal therapy is not the technique (surgical or non-surgical) that is used for the elimination of the subgingival infection, but the quality of the debridement of the root surface
426 citations
TL;DR: It is demonstrated that it is possible in dogs to establish and maintain a normal gingiva simply by eliminating calculus and then subjecting the animals to daily repeated and carefully performed tooth cleanings.
Abstract: The present investigation was carried out in order to study some aspects of the clinical, roentgenographical and histopathological alterations of periodontal tissues in dogs which during a 4-year period were allowed freely to accumulate plaque.
Twenty inbred Beagle dogs, at the start of the study 10 months of age, were used. During a preparatory period of eight weeks the animals were once weekly subjected to a careful prophylaxis and had their teeth brushed twice daily. At the end of this period the dogs were divided into two groups of ten (test and control). From day zero of experimentation and onwards the teeth of the control dogs were twice daily subjected to meticulous toothbrushing, whereas the teeth of the test dogs were not cleaned. Examinations of the periodontal tissues were performed at days 0, 7, 14, 21, 28 and after 2, 4, 6, 8, 12, 18, 24, 36 and 48 months. Biopsies of different tooth regions were made on day zero and after 6, 12, 18, 24, 36 and 48 months of experiment. In the sections were measured (i) the distance from the cemento-enamel junction (CEJ) to the most apical cells of the dento-gingival epithelium, and (ii) the distance from CEJ to the level of the marginal alveolar bone.
The study demonstrated that it is possible in dogs to establish and maintain a normal gingiva simply by eliminating calculus and then subjecting the animals to daily repeated and carefully performed tooth cleanings. Dogs allowed freely to accumulate plaque rapidly developed signs of gingivitis and eventually also clinical, radiographical and histopathological signs of periodontal tissue breakdown. The observations show that at least one type of periodontal disease is induced by factors within the dental plaque.
392 citations
TL;DR: It has been shown that both treatment methods result in sustained decreases in gingivitis, plaque and calculus and neither procedure appears to be superior with respect to these parameters.
Abstract: Many well designed clinical studies have established the effectiveness of periodontal therapy. Surgical procedures have been shown to be effective in treating periodontitis when followed by appropriate maintenance care. Scaling and root planing alone have recently been compared to scaling and root planing plus soft tissue surgery in several longitudinal trials. A review of the literature indicates several important findings including a loss of clinical attachment following flap procedures for shallow (1-3 mm) pockets and no clinically significant loss after scaling and root planing. These studies also generally report either a gain or maintenance of attachment level for both procedures in deeper pockets (greater than or equal to 4 mm). For these pockets, neither procedure has been shown to be uniformly superior with respect to attachment gain. All reports indicate that both treatment methods result in pocket reduction. However, the literature also indicates that scaling and root planing combined with a flap procedure results in greater initial pocket reduction than does scaling and root planing alone. This difference in degree of pocket reduction between procedures tends to decrease beyond 1-2 years. It has been shown that both treatment methods result in sustained decreases in gingivitis, plaque and calculus and neither procedure appears to be superior with respect to these parameters. Additional data from the study at the University of Minnesota indicate that similar results are maintained up to 61/2 years following active therapy. Pocket depth did not change for shallow (1-3 mm) pockets treated by either scaling and root planing alone or scaling and root planing followed by a modified Widman flap. For pockets 4-6 mm, both treatment procedures resulted in equally effective sustained pocket reduction. Deep pockets (greater than or equal to 7 mm) were initially reduced more by the flap procedure. After 2 years, no consistent difference between treatment methods was found in degree of pocket reduction. However, as compared to baseline, pocket reduction was sustained to 61/2 years with the flap and only 3 years with scaling and root planing alone. After 61/2 years, sustained attachment loss in shallow (1-3 mm) pockets was found after the modified Widman flap. Scaling and root planing alone in these shallow pockets did not result in sustained attachment loss. For pockets initially 4-6 mm in depth, attachment level was maintained by both procedures but scaling and root planing resulted in greater gain in attachment as compared to the flap at all time intervals.(ABSTRACT TRUNCATED AT 400 WORDS)
385 citations