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NIWOP – Part 1: The pre-treatment

NIWOP is a plannable workflow that starts long before implantation and continues beyond the prosthetic restoration. Its goal, aside from actual implant placement, is minimising the incidence of biological complications such as peri-implant mucositis or peri-implantitis. (The pre-treatment as per articles from PD Dr Kristina Bertl, PhD, MBA, MSc)

Stress results in poorer treatment outcomes!

In a previous article (‘Does periodontitis cause anxiety and depression?’) we explored the links between periodontal disease and mental illnesses and, based on a systematic review, it was shown that periodontitis increases the risk of both depression and anxiety disorder. This connection is thought to be bi-directional.

Covid-19 & periodontitis

In the previous article we summarized the results of a systematic review about manifestations of oral symptoms in patients with a Covid-19 infection (See: Covid-19 & oral symptoms). Another fascinating study was recently published in the Journal of Clinical Periodontology. In this study, Marouf et al. (2021) investigated the possible influence of periodontitis on the progression of Covid-19 infections.

Covid-19 & oral symptoms

According to data from the World Health Organization (WHO), almost 110,000,000 people have tested positive for Covid-19 since the pandemic began in December 2019, and 2,435,000 of these cases have had a fatal outcome. On account of this huge outbreak, our professional and social lives have also changed over the past twelve months, in some cases massively.

AirFloss – a popular alternative…?

Interdental cleaning is not a favourite activity for most patients. Furthermore, based on a survey of 2000 representative Americans, it was found that almost a third of patients lie to their dentist when asked about their teeth-cleaning habits and, in particular, about the use of dental floss. Having said that, it is our responsibility to recommend the best tool for effective interdental cleaning for each of our patients – in terms of effective plaque removal, but also in terms of long-term compliance.

How often should we actually be cleaning our teeth?

We are used to telling our patients, ‘Clean your teeth twice daily!’. But where does this idea come from, and is it really necessary to brush twice daily? What would happen if we only brushed our teeth once every two days?

Which factors have affected dental status in the last two decades?

In Germany, cross-sectional studies of oral health are carried out at regular intervals (German Oral Health Study). Data from five cross-sectional studies are available thus far, and the sixth study is scheduled to take place between 2021 and 2023.

Can using mouth-rinse reduce the pain of periodontal treatment?

To achieve a high level of compliance among periodontitis patients in the maintenance phase of treatment, it is important to make this maintenance therapy, including professional mechanical plaque removal, as pleasant as possible. Unfortunately, however, patients often experience pain during cleaning with (ultra)sonic devices, which could reduce their compliance later on and, in particular, in the long term.

Does periodontitis cause anxiety and depression?

Are anxiety and depression caused by periodontitis? Or is periodontitis caused by anxiety and depression? According to the literature, the connection between periodontal disease and mental illness or mood disorders is probably bi-directional; this means that each illness can influence the other.

Personalized prevention – case-oriented needs adaptation

A patient-oriented tailoring of preventative measures seems to be next logical step to counter the complexity of oral diseases for the future. Although existing strategies – for example, caring for periodontitis patients by means of supportive periodontitis treatment (SPT) – can stabilize the treatment outcome of an individual disease, their integration in a case-specific and needs-oriented preventative approach is lacking.

Regular tooth brushing reduces the risk of stroke!

‘Tooth brushing and risk of stroke’ – are the two really connected? This hypothesis is based on the following theory: Poor and insufficient oral hygiene can lead to gingivitis and, in turn, to periodontitis. In periodontitis, oral bacteria can enter the bloodstream, resulting in a local and systemic inflammatory reaction. This inflammatory reaction is accompanied by an increase in inflammatory markers, and it is this mechanism that could in turn increase the risk of having a stroke.

What are the desired endpoints after periodontal treatment?

In addition to evaluating treatment methods, the following topic was also discussed at the Perio Workshop 2019: ‘What are we actually trying to achieve with periodontal treatment – from a practitioner’s perspective, but above all from a patient’s perspective?’

Determining patients’ caries risk – what makes sense?

The main diseases we are confronted with in dentistry are caries and periodontal conditions. Although the results of the fifth German Oral Health Study show a positive trend for the two diseases, effective prevention of both must nonetheless be our primary goal. We discussed the options for caries prophylaxis in a previous article (‘Update on caries prophylaxis’). The current article is intended to provide an overview of the tests for determining patients’ caries risk.

Dementia and periodontitis...?

The principal symptom of dementia is a worsening of cognitive capabilities. This can impact short-term memory, ability to think and/or motor skills, for example, and those affected lose the skills they once had.

Subgingival instrumentation – Part II

Effective instrumentation of the root surface is an indispensable part of treating patients with periodontitis. In Part I of the topic ‘subgingival instrumentation’ based on the results of the Perio Workshop 2019, the effectiveness of ‘standard techniques’ [(ultra)sonic instruments, hand instruments or a combination of the two] was described. Part II of this topic will now focus on newer approaches, such as laser Technology and photodynamic therapy, as supplements to mechanical cleaning.

Subgingival instrumentation – Part I

Based on the results of the Perio Workshop 2019, we previously discussed possible local and systemic adjunctive therapies for treating periodontitis (Adjunctive therapies in non-surgical periodontal treatment Part I, Part II and Part III). However, the key component of periodontal treatment remains subgingival instrumentation.

Peri-implant disease risk assessment.

The ‘spider web diagram’ devised by Bern University is intended to help clinicians assess the individual risk profile of patients with periodontitis. You can find more information about this in a previous article (Periodontal maintenance therapy – how often do I need it?). But does such a thing also exist for implant patients? As of this year, the answer is: yes, it does – the Implant Disease Risk Assessment.

Does using an intelligent toothbrush make for healthy gums?

In a previous article (Using smart phones in prophylaxis) we discussed the possible advantages of mHealth, the use of mobile electronic devices in healthcare, for dentistry. Tonetti et. al have just published a new study on this topic in the Journal of Clinical Periodontology, about the use of an intelligent electric toothbrush in combination with a mobile app.

Are all interdental brushes equal...?

Interdental brushes are viewed as the tool of choice for patients with periodontitis. This is because for interdental attachment loss in particular, they are regarded as more effective than dental floss, for example. Most interdental brushes on the market are cylindrical in shape. However, a research group from Austria (Innsbruck Medical University) asked the valid question of whether this cylindrical shape truly is the ‘best’ for optimum cleaning efficacy (Schnabl 2019).

Protection from aerosols – S1 guideline of the German Society for Dental, Oral and Maxillary Medicine

Since the outbreak of the pandemic and the resulting global spread of SARS-CoV-2, aerosol-generating activities have been a hot topic of discussion in dentistry. How should we handle them? How can we best protect our patients and ourselves? What measures should we take in daily clinical practice?

Adjunctive therapies in non-surgical periodontal treatment III

Following Part I (local and systemic non-antibiotic adjunctive therapies) and Part II (local antibiotics and antiseptics) about adjunctive therapies in non-surgical periodontal treatment, Part III now goes on to look at the results from the Perio Workshop 2019 regarding the effects of using systemic antibiotics as part of non-surgical periodontal treatment.

Adjunctive therapies in non-surgical periodontal treatment I

Another topic that was discussed as part of the Perio Workshops 2019 was the effectiveness of local and systemic adjunctive therapies or medications in non-surgical periodontal treatment.

Adjunctive therapies in non-surgical periodontal treatment II

In the recently presented systematic review by Donos et al. (‘Adjunctive therapies in non-surgical periodontal treatment I’), local and systemic adjunctive therapies were discussed in the context of non-surgical periodontal treatment. However, as part of the Perio Workshop 2019, the possibilities offered by local antibiotics were also assessed.

Do adjunctive therapies help in the treatment of gingivitis?

Another topic that was discussed as part of the Perio Workshop 2019 was the efficacy of chemical adjunctive therapies in the treatment of gingivitis. Of course, this is not a ‘new’ topic, and several reviews on this subject already exist; this time, however, two new issues were tackled:

Oral hygiene – just get stuck in...?

Anyone who works in prophylaxis is aware of the importance of oral hygiene home care, particularly if we want to treat our periodontitis patients successfully in the long term.

Interdental brush or oral irrigator?

In periodontal maintenance therapy, keeping our patients motivated is particularly important – in terms of both oral hygiene and attending appointments at the dental practice (see also: Is compliance possible? Yes, if patients are informed and motivated! . However, life-long oral hygiene measures in particular are often an obstacle. Accordingly, this gives rise to the valid question of whether, in relation to successfully treated periodontitis patients, the choice of oral hygiene product has an effect on the risk of periodontal disease re-occurring.

Do lifestyle changes make for a healthier periodontium?

Another theme of the Perio Workshop 2019 Perio Workshop 2019 was to systematically assess the effect of guidelines that are intended to achieve positive patient lifestyle changes among periodontitis patients. A German–French research group led by Christoph Ramseier conducted a comprehensive literature review of 1) general guidelines for interventions that are intended to influence patient lifestyle, and 2) the application of these guidelines with regard to periodontitis patients (Ramseier et al. 2020).

Periodontitis & cardiovascular diseases

The ‘Perio–Cardio Workshop 2019’ took place in February 2019. This workshop was organized by the World Heart Federation in collaboration with the European Federation of Periodontology

Personalized prevention – the implications of general health factors

Whether preventative or curative, dental measures need to be individually tailored according to the risk factors identified for each patient. In this context, general health is significantly influenced by three risk factors:

A long-term study confirms that implant follow-ups do help.

In line with phase 3 of the NIWOP approach (NIWOP [No Implantology without Periodontology] – consistent & long-term follow-up care) regular implant follow-up sessions should be planned and adhered after completing implant treatment. But what happens if the practitioner and/or patient does not adhere to this, and regular implant follow-up sessions do not take place?

Some information about manual toothbrushes.

Dagmar Else Slot is probably one of the most published dental hygienists, and her systematic reviews always make for interesting reading. This time she has published a review on the topic of the efficacy of manual toothbrushes, and this study also helps us to answer the question: Does it really make a difference whether I quickly brush my teeth for only one minute, or if I brush them for two?

S3 guideline – Subgingival instrumentation

In collaboration with the German Society for Periodontology (DGParo), in October 2019 the German Society for Dental, Oral and Maxillary Medicine (DGZMK) published a new S3 guideline on the topic of ‘Subgingival instrumentation’, which is now valid for five years. This new guideline primarily focuses on the following two main topics:

Powders: moving it up a gear

Air-polishing has long been an integral component of prophylaxis and expands the treatment spectrum of a comprehensive preventative–curative workflow. By achieving the perfect balance of powder, handpiece and spray head, the supra- and subgingival area can be cleaned both thoroughly and gently. To help achieve an optimum patient outcome, it is therefore advisable to use systems that belong together. Based on the individual patient’s clinical findings, the prophylaxis team can precisely plan the powder sequence and ensure that contraindications are taken into consideration (see the Community Articles Air-polishing devices – are there any risks?; Do air-polishing devices have any contraindications?).

Over 1000 scientific studies related to Osstell

Osstell, the company that developed the original ISQ technology, today announces that by March 2019, there are now over 1000 scientific studies and publications evidencing Osstell’s unique ISQ technology using the original SmartPegs.

Innovation requires the correct mixture

What makes a strong project team is a variety of skills, perspectives and talents. This is Harald Sighart’s point of view, as Director of Research and Development at W&H. In an interview, he explains what makes his project teams so special.

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