Key themes in periodontal treatment: Lessons learned from 40-year experiences.

BACKGROUND: Periodontitis is one of the most prevalent oral diseases with significant implications for systemic health. This study aims to explore themes influencing successful long-term outcomes in periodontal treatment through a historical lens, focusing on various factors influencing the longevity of periodontal health and dentition stability. METHODS: Utilizing an inductive qualitative thematic analysis approach, this study utilized a retrospective chart review of 19 patient records spanning, on average, 40 years. RESULTS: Four major themes contributing to periodontal stability were identified: (1) adequate patient plaque control; (2) regular periodontal maintenance; (3) collaboration between hygienists and periodontists; and (4) the application of various periodontist/dentist-performed procedures. CONCLUSION: Current findings underscore the importance of these factors in preserving patients' periodontal health by emphasizing conservative treatment approaches in the maintenance and retention of the natural dentition. KEY POINTS: Adequate patient plaque control is essential for maintaining a patient's periodontal health and dentition long-term. A regular periodontal maintenance schedule should be assigned and modified as necessary for each individual patient's care. Collaborative care with hygienist colleagues and ensuring there are flexible treatment options for patients can lead to successful treatment outcomes when hygiene alone is not sufficient. PLAIN LANGUAGE SUMMARY: Periodontitis is a widespread oral disease with significant systemic health implications. This study examined patient records to identify factors contributing to long-term periodontal stability and maintenance of teeth. By analyzing 19 patient charts over an average of 40 years using a qualitative approach, four key themes were identified in successful patient treatments: effective patient plaque control, regular periodontal maintenance, collaboration between dental hygienists and periodontists, and the addition of other approaches by periodontists and dentists when necessary. The study underscores the importance of these factors in preserving periodontal health and retaining natural teeth with conservative treatment approaches. This research highlights the critical role of sustained, multifaceted dental care and professional collaboration in achieving successful long-term oral and systemic health outcomes.

The use of patient-related outcomes (PRO) and experience (PRE) in assessing the periodontal and implant patient.

The purpose of this review was to summarize the evidence with regard to behavioral and psychosocial assessment of the periodontitis patient, the candidate for implant therapy, and the peri-implantitis patient. Periodontitis has an adverse effect on quality of life and its treatment can lead to significant improvements experienced by the patient. The latter is true for rehabilitation with dental implants, although patients harbor diverse expectations and perceptions of implant therapy, which can often interfere with satisfaction and/or influence long-term success. A thorough behavioral assessment of the candidate for implant therapy is essential, which should include, perceptions, expectations, as well as risk for behavioral disorders. Remedial action is essential to correct misperceptions and any identified risks. Finally, patients have limited awareness of limited ability to identify signs of peri-implantitis. The diagnosis of peri-implantitis can be a cause of significant distress, resentment, and loss of trust to the treatment and the caregivers. Despite documented value in clinical research, currently available instruments assessing patient-reported outcomes have little application in day-to-day clinical practice. Face-to-face patient to doctor open-ended communication remains the most effective way to comprehensively establish the long-term "therapeutic alliance" essential for the long journey for the periodontitis patient.

The Synergy of Periodontic and Orthodontic Collaboration in Contemporary Oral Health Practice.

Orthodontic treatment (OT) has become a means of improving psychosocial well-being secondarily to enhanced occlusal function and can help patients obtain normal oral physiologic function, coordinated facial profiles, and healthy dentomaxillofacial development. With more adult patients undergoing OT, the need for interdisciplinary treatment and collaboration is vital to ensure periodontal health. This article highlights the importance of combined efforts between periodontics and orthodontics in adult patients with a history of periodontitis who are interested in OT. Furthermore, the article discusses the technological and surgical advances within these specialties, as well as timing of synchronization of treatment. A clinical case demonstrates the results of a collaborative periodontics and orthodontics approach to treat an adult patient with a history of advanced periodontal disease.

Correcting mucogingival deformities for pescatarian patients: A clinical case study.

AIM: This clinical case study is to highlight the improvement of periodontal health of mandibular canines using a soft tissue alternative of fish origin, a piscine graft. METHODS: A 37-year-old female patient was referred to a periodontal practice for evaluation of mucogingival deformities around teeth #22 and #27 that were also diagnosed with recession, lack of keratinized tissue (KT), and bilateral high frenum attachment. Multiple soft tissue treatment options were presented to the patient, including autogenous, allograft, or xenograftporcine or piscine. RESULTS: Given the patient's dietary preference, piscine option was preferred. The procedures were completed one at a time, first #22 and later #27, using the standard of care procedures for correcting mucogingival deformities using soft tissue alternatives. Post-surgical visits were scheduled at regular intervals (2, 4, 12, 24, 52 weeks) to evaluate the clinical outcomes. Healing was uneventful and clinical outcomes reveal correction of the mucogingival deformities. The amount of KT at the 52 weeks healing time, measured using an intraoral scanner was 2.12 mm on #22 and 1.78 mm on #27. CONCLUSION: Within this clinical case's scope, piscine xenograft demonstrates to be a safe and effective soft tissue alternative to correct mucogingival deformities, increasing the KT width and achieving recession coverage. In addition, integration of patient's preference may lead to increased case acceptance and patient compliance. KEY POINTS: What new information is this case providing? The use of a soft tissue alternative of piscine origin that was selected based on the patient's preference to correct bilateral combined mucogingival deformities (recession, lack of KT, and aberrant frenum attachment) around teeth. What is a key step to integrating this soft tissue alternative in clinical practice? The pre-hydration of the soft tissue alternative is preferred, compared to other soft tissue alternatives that might not require hydration (xenograft bovine origin). What are the limitations to success in this case? Confirming with the patient no pre-existing fish allergies.

Mixing Allograft and Xenograft for a Predictable Alveolar Ridge Preservation Procedure: A Case Series.

BACKGROUND: An alveolar ridge preservation (ARP) procedure is commonly performed to preserve ridge width and height for optimal dental implant placement. Mixing different sources of bone grafts may help maximize their properties to obtain predictable ARP results. OBJECTIVE: The aim of this case series is to highlight the clinical and radiographic outcomes of a combined allograft and xenograft approach for a predictable ARP procedure. MATERIALS AND METHODS: Eleven clinical cases that required tooth extraction and future implant placement were selected for this case series. All surgeries were performed by a single clinician in a private practice setting. All cases underwent an ARP procedure, which included atraumatic extraction, degranulation, assessment of the socket, and the use of a combination of allograft and xenograft fibers/granules in a 1:1 mixing approach. Based on the socket defect, either a type I or type III collagen membrane was used during the procedure. In all cases CBCT imaging was done prior to surgical implant placement, and digital implant planning was performed integrating interdisciplinary best practices. Implant placement was carried out using manufacturer's recommendations. RESULTS: Five male and five female patients were included in the study, with one of the male patients having two teeth extracted for a total of 11 cases. The reasons for teeth extraction included fracture, endodontic failure, periodontal infection, and subgingival decay. Healing was uneventful after the ARP procedure for all patients. A minimum of 120 days elapsed between ARP and the surgical implant procedure. Complete radiographic bone fill was observed in the CBCT image for all extraction sites, and no additional bone augmentation was needed at the time of implant placement. CONCLUSION: This case series demonstrates that based on clinical and radiographic outcomes, a combination of allogenic and xenogenic bone substitute can be utilized to obtain predictable results following ARP. Future randomized controlled trials that can compare different ratios between the two biomaterials are indicated to guide clinicians in the mixing protocols and their outcomes.

The Effect of Dental Flossing Instructions and Technique on Interproximal Bleeding: A randomized control trial.

Purpose Dental floss has been promoted reduce the effects from interdental microbial biofilm, however its efficacy has been questioned in the literature. The purpose of this study was to compare daily flossing instructions using an adapted horizontal vertical flossing technique (AHVFT) and routine oral hygiene on gingival inflammation as indicated by bleeding on probing (BoP).Methods This randomized single-blinded controlled clinical trial was conducted with non-smoking adults presenting with gingivitis and no other systemic diseases. Eligible participants were recruited from a dental school patient population and were randomly assigned to one of two groups. Group A (experimental group) was instructed in how to use the AHVFT once daily and Group B (control group) was asked to continue with their regular oral hygiene practices. Clinical evaluations (interproximal BoP measurements) were performed by blinded, calibrated examiners at two, four, and eight-week intervals; the percentage of sites with interproximal BoP was recorded. Descriptive and inferential statistics were used to analyze the data.Results A total of 36 eligible participants were enrolled in the study: Group A (n=18), Group B (n=18). The mean (±SD) percentage of interproximal sites with BoP was 26.3 (±4.7), 8.6 (±7.3), 7.2 (±5.2), and 7.9 (±5.8) for Group A at baseline, two weeks, four weeks, and eight weeks, respectively. The corresponding values for Group B were 25.8 (±9.9), 15.6 (±12.4), 12.3 (±12.2), and 18.0 (±13.1), respectively. The percentage of sites with BoP was significantly lower for Group A than for Group B (p=.015 at two weeks, p=.009 at four weeks, and p<.001 at eight weeks). Within each group, the percentage of sites with BoP was significantly lower when compared with baseline (p<.008). At the final visit, the percent reduction in BoP for Group A was 70% and 30% for Group B compared with baseline. Most (88.2%) of Group A participants demonstrated mastery of the AHVFT at eight weeks.Conclusion Participants who received Instruction with the daily use of the AHVFT were shown to have reductions in interproximal BoP as compared to participants who had not received instructions in the AHVFT. Positive gingival health outcomes with dental flossing may be technique sensitive.

Evaluating a dental sleep apnea mini-residency program using the Kirkpatrick model.

OBJECTIVE: The aim of this retrospective study was to evaluate a Dental Sleep Medicine Mini-Residency (DSMMR) continuing education (CE) program using the Kirkpatrick model. METHODS: After receiving ethical approval, data from participants in the 2019-2020 DSMMR CE course were included for the Kirkpatrick evaluation. The analysis was stratified and all the Kirkpatrick levels were integrated: level 1 (satisfaction) was assessed via Likert scale and open-ended questions; level 2 (learning) was evaluated using pretest and posttest knowledge data following Module 1 (M1) and an assessment of multiple-choice questions (MCQs) developed by participants; level 3 (behavior) was evaluated using Likert scale questions; and level 4 (results) was assessed via the percentage of participants who passed the American Board of Dental Sleep Medicine (ABDSM) examination on their first attempt. RESULTS: A total of 90 participants were included in the study. At least 83.1% of participants agreed/strongly agreed with positively worded statements about satisfaction. Knowledge scores significantly increased from pre-M1 to post-M1 (p < 0.001); however, only 15.2% of MCQs were evaluated as well-formulated. At least 88.6% of participants agreed/strongly agreed with positively worded statements about transfer of knowledge/skills to their practice. 91.1% passed the ABDSM examination on their first attempt. CONCLUSION: The evaluation of the 2019-2020 DSMMR using the Kirkpatrick model suggests its overall positive impact as a training program. The Kirkpatrick model provided information that can be used to improve the quality of a program. Future studies should assess other dental CE programs using the Kirkpatrick model or another evaluation model.

Are Simulators Paving a New Way for Continuing Education?

Simulated learning has been practiced for decades and was a key element in remote learning during the midst of the COVID-19 pandemic. Continuing healthcare education courses for clinicians have incorporated surgical simulators to enable relief from the time constraints encountered in the operating room and provide a more relaxed environment in which to practice complex surgical procedures. Educational research studies show that the implementation of such applications in pedagogy have improved knowledge retention, increased clinician confidence, provided easier access to educational materials, and reduced levels of anxiety about learning. This review highlights the benefits and limitations of surgical simulators. Based on the evidence and current trends, simulated learning signifies a fundamental shift in higher education that is transforming healthcare academic institutions and offering significant potential for continuing dental education.

Minimally Invasive Coronally Advanced Flap Techniques for Correction of Gingival Recession Defects: A Review.

For treatment of patients with isolated and/or multiple adjacent gingival recession defects, debate exists as to whether minimally invasive coronally advanced flap-based surgical techniques achieve improved root coverage compared with traditional evidence-based techniques. Correction of gingival recession defects requires mucogingival surgery utilizing tissue grafting and/or soft-tissue alternatives. Traditional mucogingival techniques for root coverage using autogenous tissue are associated with patient morbidity and discomfort. Considering the philosophical shift in daily practice from "patient-centered" to "person-centered," minimally invasive surgical procedures are warranted that provide esthetic results with reduced morbidity. This review article evaluates five minimally invasive mucogingival techniques: semilunar, tunneling, modified tunneling, vestibular incision subperiosteal tunnel access, and pinhole. These surgical procedures and their clinical application are compared and contrasted.

Faculty perception on clinical shadowing: A concurrent mixed methods study.

PURPOSE: This mixed methods study aims to investigate faculty members' perceptions of early clinical exposure through clinical shadowing program (CSP) at one academic dental institution. METHODS: After ethical approval was received, concurrent data collection using quantitative and qualitative methods was integrated for this study design. For the quantitative data, a validated instrument (Likert scale) was distributed to all basic and clinical science faculty members regarding the CSP. Qualitative semi-structured interviews of basic and clinical science faculty members were conducted to explore their perceptions of the CSP. Descriptive statistics were completed for the quantitative data, and thematic analysis was carried out for the transcribed interviews. RESULTS: Faculty members from basic and clinical sciences participated in this mixed methods study, 97% (n = 74) participants in the quantitative and 12 participants in the qualitative. The majority of faculty (67%; n = 44) strongly agreed that CSP helps predoctoral students in the application of basic science knowledge to clinical practice. All basic science respondents (n = 10; 100%) and many clinical science faculty (60%; n = 35) strongly agreed that CSP requires coordination between basic and clinical science educators (p = 0.042). Some faculty suggested the inclusion of training for educators on the program and regular periodic student assessments of the program's effectiveness. CONCLUSION: The current study reported positive faculty perception toward the proposed method of integration. Furthermore, opportunities to foster coordination between basic and clinical science educators may be provided by administrators to strengthen the existing CSP framework.

Evaluation of Omega-3 piscine acellular dermal matrix membrane as a soft tissue alternative for the treatment of mucogingival defects.

BACKGROUND: The natural Omega-3 lipids in the OADM serve to reduce inflammation. Preliminary results in a human model reported no adverse events and favorable healing and esthetic outcomes. OBJECTIVE: The primary objective of this animal model study was to histologically evaluate the use of Omega-3 piscine acellular dermal matrix (OADM) as a soft tissue alternative in surgically created mucogingival defects. METHODS: Bilateral maxillary canines in 6 adult beagle dogs were randomly assigned to the test (OADM) and control sub-epithelial connective tissue graft (SCTG) groups. Dehiscence defects 4 × 6 mm were created surgically on the buccal surfaces. The OADM/SCTG were placed to completely cover the root surface to the level of the cemento-enamel junction and sutured with resorbable sling sutures. The gingival flap was repositioned to cover the grafts. At two months follow-up, the dogs were sacrificed, and block samples were retrieved, including the whole canine and periodontium. The histological outcomes were evaluated using qualitative analysis. RESULTS: The qualitative histological analysis revealed the oral, sulcular and junctional epithelium had healed with normal appearance on both test and control sites. None of the test (OADM) samples presented with any foreign body reaction. CONCLUSION: The use of this new piscine xenograft resulted in minimal complications and the attachment apparatus healed normally.

Using Project Management Principles to Facilitate Interdisciplinary Collaboration.

The impact of interdisciplinary collaboration should always be evaluated from the perspectives of different stakeholders, including patients (and their families/caregivers), healthcare providers, third-party insurance providers, researchers, and companies that provide materials/supplies, to name a few. In an educational environment, the healthcare provider team consists of a dental student/resident and a faculty member. The assessment of outcomes for interdisciplinary collaborations can be multilayered from patient care to education and research. The aim of this article is to review the different layers of assessment (ie, patient care, education, and research) and provide an overview of the benefits and limitations of interdisciplinary care. In addition, the authors compare the varied processes involved in the synergistic care of a patient to a project delivery in an agile environment.

Integrating digital scholarship in dental education: Why, what, and how?

The aim of this perspective paper is to highlight the potential role and value digital scholarship can have in dental education. The use of digital scholarship and alternative metrics for academic assessment, promotion, and tenure is growing rapidly among healthcare scholars and can complement traditional frameworks. The US dental academic institutions might consider expanding the scope of their promotion and tenure guidelines from reliance on publications and grants to a greater appreciation of the impact of the scholar's work in the digital sphere by integrating newer citation indices and altmetrics.

Entrustable professional activities framework for assessment of patient handoffs in dentistry.

PURPOSE/OBJECTIVES: The aim of this study is to report data on the lack of a proper patient handoff system in dentistry and dental education and to present a possible solution to integrate this into curriculum using the "entrustable professional activities" (EPAs) framework. METHODS: Delphi participants from seven US dental schools provided feedback on a preliminary definition of handoff, a mnemonic and an assessment rubric. 2019 American Dental Education Association Commission on Change and Innovation in Dental Education (ADEA CCI) participants further evaluated the handoff EPA using the EQual rubric for EPA quality and structure. RESULTS: Delphi participants identified points of transition in dentistry, selected the D-PASS as a mnemonic, and agreed with the evaluation rubric. The ADEA CCI participants agreed the handoff EPA describes work that is essential for the profession and suitable for entrustment. CONCLUSION: The D-PASS rubric is an effective way to assess patient handoffs.