The recently introduced 2017 World Workshop on the classification of periodontitis, incorporating stages and grades of disease, aims to link disease classification with approaches to prevention and treatment. Periodontitis is characterized by progressive destruction of the tooth-supporting apparatus. Its primary features include the loss of periodontal tissue support manifest through clinical attachment loss (CAL) and radiographically assessed alveolar bone loss, presence of periodontal pocketing and gingival bleeding. If untreated, it may lead to tooth loss, although it is preventable and treatable in the majority of cases. The objective of the narrative review presented in this Module was to report the S3 Level Clinical Practice Guideline (CPG) for the treatment of Stage I-III periodontitis revealed during the EFP 2020 Workshop. The treatment of stage III periodontitis should be carried out in an incremental manner, first by achieving the goal’s obtained during the first and second step of therapy. The third step of therapy is, therefore, aimed at treating those sites non-responding adequately to the second step of therapy with the purpose of getting access to deep pocket sites, or aiming at regenerating those lesions, that add complexity in the management of periodontitis with intrabony lesions. In the presence of deep residual pockets (PPD ≥6 mm) in patients with Stage III periodontitis after the first and second steps of periodontal therapy, it was suggested performing access flap surgery. Regenerative and conservative surgical therapy resulted in improved clinical out-comes (higher CAL gain) compared with resective surgery in the majority of studies. The aims of periodontal regeneration are to obtain: An increase in the periodontal attachment and bone of a severely compromised tooth; a decrease in pocket depth; no, or a minimal, increase in gingival recession. Teeth with deep pockets associated with deep intrabony defects are considered a clinical challenge. Nevertheless periodontal surgery (regenerative management) is beyond the scope and competence of education in general dental practice. Dental curricula include knowledge and familiarity with the approach but are not designed to provide competence to conduct such treatment. Therefore, turns out to be fundamental a proper understanding of the basic biologic mechanisms involved in periodontal wound repair and regeneration requires assessment of the macroscopic, microscopic, cellular and molecular components of the healing process. Afterwards, clinicians should select a specific biomaterial to be used to promote regeneration at intrabony defects based on clinical and scientific evidence. It is therefore necessary to choose a regenerative strategy out of a panel of options to treat a given defect. Anatomical considerations related to the width of the interdental space advise on the choice of the preferred flap design to access the interdental area. Location and configuration of the intrabony defect advise on the possibility to: Minimize flap extension; raise a single flap or the need to fully elevate the interdental papilla. The adoption of a clinical strategy for optimal application of materials and surgical approach could increase the efficacy of periodontal regeneration and provide improved clinical outcomes.
Conservative and regenerative periodontal surgery of intrabony defects|Chirurgia conservativa e rigenerativa dei difetti infraossei
Nastri L.
Writing – Original Draft Preparation
;
2022
Abstract
The recently introduced 2017 World Workshop on the classification of periodontitis, incorporating stages and grades of disease, aims to link disease classification with approaches to prevention and treatment. Periodontitis is characterized by progressive destruction of the tooth-supporting apparatus. Its primary features include the loss of periodontal tissue support manifest through clinical attachment loss (CAL) and radiographically assessed alveolar bone loss, presence of periodontal pocketing and gingival bleeding. If untreated, it may lead to tooth loss, although it is preventable and treatable in the majority of cases. The objective of the narrative review presented in this Module was to report the S3 Level Clinical Practice Guideline (CPG) for the treatment of Stage I-III periodontitis revealed during the EFP 2020 Workshop. The treatment of stage III periodontitis should be carried out in an incremental manner, first by achieving the goal’s obtained during the first and second step of therapy. The third step of therapy is, therefore, aimed at treating those sites non-responding adequately to the second step of therapy with the purpose of getting access to deep pocket sites, or aiming at regenerating those lesions, that add complexity in the management of periodontitis with intrabony lesions. In the presence of deep residual pockets (PPD ≥6 mm) in patients with Stage III periodontitis after the first and second steps of periodontal therapy, it was suggested performing access flap surgery. Regenerative and conservative surgical therapy resulted in improved clinical out-comes (higher CAL gain) compared with resective surgery in the majority of studies. The aims of periodontal regeneration are to obtain: An increase in the periodontal attachment and bone of a severely compromised tooth; a decrease in pocket depth; no, or a minimal, increase in gingival recession. Teeth with deep pockets associated with deep intrabony defects are considered a clinical challenge. Nevertheless periodontal surgery (regenerative management) is beyond the scope and competence of education in general dental practice. Dental curricula include knowledge and familiarity with the approach but are not designed to provide competence to conduct such treatment. Therefore, turns out to be fundamental a proper understanding of the basic biologic mechanisms involved in periodontal wound repair and regeneration requires assessment of the macroscopic, microscopic, cellular and molecular components of the healing process. Afterwards, clinicians should select a specific biomaterial to be used to promote regeneration at intrabony defects based on clinical and scientific evidence. It is therefore necessary to choose a regenerative strategy out of a panel of options to treat a given defect. Anatomical considerations related to the width of the interdental space advise on the choice of the preferred flap design to access the interdental area. Location and configuration of the intrabony defect advise on the possibility to: Minimize flap extension; raise a single flap or the need to fully elevate the interdental papilla. The adoption of a clinical strategy for optimal application of materials and surgical approach could increase the efficacy of periodontal regeneration and provide improved clinical outcomes.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
