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ABSTRACT@#In the management of periodontitis patients, periodontal risk assessment (PRA) tool is currently being applied during periodontal review (PR). However, an assessment of risk profiles during examination and diagnosis (E&D) may and would effectively assess and diagnose patients’ periodontal conditions, provide personalised treatment planning, and render an enhanced patient care through periodontal management by risk assessment (PEMBRA). From a retrospective study on selected records of 81 patients treated for chronic periodontitis, the PRA profiles of the patients were evaluated during E&D and two to three months after completion of nonsurgical periodontal therapy (NSPT) during PR. The results were analysed using SPSS version 24 for descriptive statistics. On E&D, the patients presented with 25.9% localised and 74.1% generalised chronic periodontitis. Of these, 2.5% of low-risk patients on E&D increased to 21% during PR signifying an improvement after the treatment. However, the medium-risk patients have a slight increase from 32% to 35%, and patients with a high risk of 62% were reduced to 43%. The improvement of the risk profiles for both low and high-risk groups was mostly contributed by the reduction in the plaque score, percentages of bleeding on probing (BOP), and probing pocket depth (PPD) ≥ 5 mm. This evidence-based evaluation of PRA tool during E&D and PR is important for PEMBRA as it encouraged the clinicians to adopt periodontal management through basic periodontal examination, detailed periodontal charting, radiographic interpretation, tooth per tooth prognosis, diagnosis, and targeted NSPT.
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Medición de Riesgo , Instrumentos DentalesRESUMEN
Objective@# To study the changes in levels of interleukin (IL)-6, IL-10, tumor necrosis factor-alpha (TNF-α), and alkaline phosphatase (ALP) in the gingival crevicular fluid (GCF) of patients with severe chronic periodontitis before and after nonsurgical periodontal therapy and to explore the relationship among the levels of these four biomarkers in GCF, their periodontal status and their clinical significance to evaluate the effect of nonsurgical periodontal therapy and periodontitis activity.@*Methods@# In total, 30 patients with severe chronic periodontitis were enrolled in a 1-year longitudinal pilot study (Chinese Clinical Trial Registry: ChiCTR-OCH-13004679). At baseline and 1, 3, 6, and 12 months after nonsurgical therapy, the periodontal clinical indicators plaque index (PLI), probing depth (PD), clinical attachment loss (CAL), sulcus bleeding index (SBI) were recorded. Filter paper strips were used to collect two deep-pocket (probing depth ≥ 6 mm) and two shallow-pocket (probing depth ≤ 4 mm) periodontal sites for each patient and weighed. The levels of interleukin IL-6, IL-10, TNF-α, and ALP in GCF were assessed using enzyme-linked immunosorbent assay. Meanwhile, 30 healthy sites of 15 subjects with healthy periodontium were used as the baseline controls for patients with severe chronic periodontitis.@*Results @#At the baseline, the TNF-α, ALP and IL-6 levels in GCF of the disease sites of patients with periodontitis were significantly higher than those in healthy periodontal sites of the control group (P < 0.001), and the levels of IL-10 were significantly lower than those in the control group (P < 0.001). In patients with severe chronic periodontitis, the levels of TNF-α, ALP and IL-6 in GCF at deep-pocket sites were significantly higher than those at shallow-pocket sites (P <0.001), and the IL-10 levels were significantly lower than those at shallow-pocket sites (P < 0.001). 1, 3, 6, and 12 months after nonsurgical treatment, the levels of TNF-α and ALP in GCF at the shallow- and deep-pocket sites in patients with chronic periodontitis significantly decreased, the level of IL-10 significantly increased (P < 0.005), and the level of IL-6 in GCF at the deep-pocket sites significantly decreased (P < 0.005). However, there was no significant difference in IL-6 level at shallow-pocket sites (P > 0.05). 1, 3, 6, and 12 months after nonsurgical treatment, the periodontal clinical indicators were improved compared with the baseline. In addition, there was a significant correlation between the levels of these four biomarkers and the periodontal clinical parameters (P < 0.05). During the two follow-up visits after nonsurgical periodontal therapy, the sites with more than 2-mm increase in attachment loss had significant differences in the levels of the four biomarkers in the GCF compared with the previous visit time (P < 0.005).@*Conclusion@#The detection of the levels of these four biomarkers in GCF has strong clinical significance for assessing the severity of periodontitis and the efficacy of nonsurgical periodontal therapy. Increased levels of TNF-α, ALP, and IL-6 and decreased IL-10 levels in GCF may indicate periodontitis progression at this site.
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Aim: The aim of the study was to compare chromogranin A (CgA) and stress levels before and after non-surgical periodontal therapy (NSPT). Materials and Methods: A sample of 40 patients in the age range 25–60 years were included in the study and were divided into gingivitis (10 subjects), chronic periodontitis (CP) (15 patients) and aggressive periodontitis (AgP) (15 patients). The patients were asked to complete two sets of stress questionnaires, plaque index, gingival index, probing depth and clinical attachment levels (CAL) were recorded. Salivary samples were taken at baseline and were repeated three months post NSPT. Results: CgA was detected in saliva samples of all the groups. A statistically significant correlation was established between levels of CgA and stress parameters, which was shown to be the highest in AgP (P < 0.001), followed by CP group (P < 0.005) at baseline. Following NSPT, an overall reduction was observed in the levels of CgA, which was correlated with the overall reduction in stress levels for AgP group (P < 0.005) followed by CP group (P < 0.037). Amongst the clinical parameters, CAL showed the strongest correlation with CgA both at baseline and after NSPT (P < 0.001). Conclusion: Stress was directly correlated to the levels of salivary CgA levels, which was the highest for aggressive periodontitis at baseline. NSPT showed a marked improvement in all the parameters. Levels of CgA and CAL showed a significant correlation in both the CP and AgP groups.
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Introducción: en el tratamiento de las enfermedades periodontales contamos con la terapia periodontal no quirúrgica, la cual ha sido avalada científicamente mostrando su efectividad. El principal objetivo de este artículo es demostrar la efectividad de la terapia periodontal no quirúrgica evidenciada en múltiples estudios con relación a las indicaciones, aspectos microbiológicos, efectos enlos tejidos y la importancia de la terapia de mantenimiento una vez finalizado el tratamiento. Métodos: se hizo una revisión con relación al tema en los últimos años teniendo como patrón los conceptos clave periodontales. Resultados: la terapia periodontal no quirúrgica (TPNQ) no es un procedimiento que pueda y deba realizarse en un corto tiempo y en pocas citas, el tiempo para su ejecución se amplía lo necesario en especial para lograr una limpieza y regularización de las raíces lo más completa posible. Conclusión: varios autores reportanque la reducción de la microbiota se mantuvo entre 14 y 180 días, luego de la terapia, esto justifica las citas periódicas de mantenimientoperiodontal y estos señalan que el aspecto crítico de la terapia no es la escogencia entre un procedimiento quirúrgico o no quirúrgico, sino la limpieza detallada y completa por el profesional y el buen nivel de higiene bucal por parte del paciente.
Introduction: In the treatment of periodontal diseases, we can rely on nonsurgical periodontal therapy, which has been scientifically proven as its effectiveness has been recognized. The main objective of this article is to demonstrate the usefulness of nonsurgical periodontal therapy, as evidenced in several studies that serve as guidelines, as well as microbiological aspects, effects on tissues and theimportance of maintenance therapy after treatment completion. Methods: a review was conducted in order to revise this topic considering key periodontal concepts as a guideline. Results: nonsurgical periodontal therapy (NSPT) is a procedure that cannot and should not be carried out in a few sessions; the time required for its completion is extended as necessary in order to achieve cleaning and adjustmentof the roots as completely as possible. Conclusions: Several authors have reported that reduction of microbiota remains between 14 and 180 days after therapy. This explains the regular periodontal maintenance appointments. They also indicate that the critical aspect of this therapy is not the choice between a surgical or a nonsurgical procedure, but a detailed and thorough cleaning by the dental professionaland the good level of oral hygiene achieved by the patient.