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Periodontal diseases in Africa. 非洲的牙周病。
IF 17.5 1区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-11-04 DOI: 10.1111/prd.12617
Mojisola Olujitan, Patricia O Ayanbadejo, Kehinde Umeizudike, Afolabi Oyapero, Christopher Okunseri, Azeez Butali

Periodontal diseases, a group of complex conditions marked by an excessive immune response and periodontal tissue destruction, are a global health concern. Since 1990, the incidence of these diseases has doubled, with Western sub-Saharan Africa experiencing the highest burden. Accurate diagnosis and case identification are crucial for understanding the etiology, features of disease, research, treatment and prevention. Modern perspectives on periodontal disease classification are based on commonality among those affected. However, current literature is often plagued by methodological inconsistencies and focused on disease mechanisms in European populations. Health inequalities in low- and middle-income countries (LMICs) are exacerbated by these challenges, with sub-Saharan Africa, and Nigeria specifically, facing unique difficulties such as clinical personnel shortages and limited research infrastructure. This review explored disparities in periodontal disease research, care and outcomes in African populations. We highlighted these disparities and identified the factors contributing to inequities in periodontal health outcomes. We further demonstrated the critical need for inclusive and equitable healthcare and research practices tailored to the unique challenges faced by diverse populations and regions with limited resources. Addressing these disparities is essential for ensuring that advancements in healthcare are accessible to all, thereby improving global oral health and general health.

牙周病是一组以过度免疫反应和牙周组织破坏为特征的复杂疾病,是一个全球健康问题。自 1990 年以来,这些疾病的发病率翻了一番,其中撒哈拉以南非洲西部的发病率最高。准确的诊断和病例鉴定对于了解病因、疾病特征、研究、治疗和预防至关重要。牙周病分类的现代观点是基于患者的共性。然而,目前的文献往往受到方法不一致的困扰,并且侧重于欧洲人群的疾病机制。这些挑战加剧了中低收入国家(LMICs)的健康不平等,撒哈拉以南非洲地区,特别是尼日利亚,面临着独特的困难,如临床人员短缺和研究基础设施有限。本综述探讨了非洲人口在牙周病研究、护理和结果方面的差距。我们强调了这些差距,并确定了造成牙周健康结果不平等的因素。我们进一步表明,针对资源有限的不同人群和地区所面临的独特挑战,亟需采取包容性和公平的医疗保健和研究措施。要确保所有人都能享受到医疗保健的进步,从而改善全球口腔健康和总体健康状况,解决这些差距至关重要。
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引用次数: 0
Periodontal disease: A systemic condition. 牙周病:一种全身性疾病。
IF 17.5 1区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-11-04 DOI: 10.1111/prd.12616
German E M Villoria, Ricardo G Fischer, Eduardo M B Tinoco, Joerg Meyle, Bruno G Loos

For decades, periodontitis has been considered to be a local inflammatory disease of the periodontal tissues in the oral cavity. Initially, associations of periodontitis with a multitude of noncommunicable diseases were each studied separately, and relationships were shown. The associations of periodontitis with morbidities, such as cardiovascular diseases, rheumatoid arthritis, diabetes mellitus, respiratory diseases, have been demonstrated. As most such studies were cross-sectional in nature, questions about causality cannot be univocally answered. And periodontitis as an independent risk factor for one systemic disease, becomes even more difficult to assess since recently periodontitis has also been associated with multimorbidity. Periodontitis and many systemic diseases share environmental, lifestyle and genetic risk factors, and share immunopathology. Moreover, suffering from one common noncommunicable disease may increase the susceptibility for another such chronic disease; the systemic effects of one condition may be one of various risk factors for another such disease. The overarching effect of any systemic disease is it causing a pro-inflammatory state in the individual; this has also been shown for periodontitis. Moreover, in periodontitis a prothrombotic state and elevated immunological activity have been shown. As such, when we consider periodontal disease as another systemic disease, it can affect the susceptibility and progression of other systemic diseases, and importantly, vice versa. And with this, it is not surprising that periodontitis is associated with a variety of other noncommunicable diseases. The medical definition of a systemic disease includes diseases that affect different organs and systems. Thus, the aim of this opinion paper is to propose that periodontitis should be considered a systemic disease in its own right and that it affects the individual's systemic condition and wellbeing. The dental and medical profession and researchers alike, should adapt this paradigm shift, advancing periodontal disease out of its isolated anatomical location into the total of chronic noncommunicable diseases, being for some conditions a comorbid disease and, vice versa, comorbidities can affect initiation and progression of periodontal disease.

几十年来,牙周炎一直被认为是口腔牙周组织的局部炎症性疾病。起初,人们分别研究了牙周炎与多种非传染性疾病的关系,并显示了两者之间的关系。牙周炎与心血管疾病、类风湿性关节炎、糖尿病、呼吸系统疾病等疾病的关系已经得到证实。由于这些研究大多是横断面研究,因此无法明确回答因果关系问题。而牙周炎作为一种全身性疾病的独立危险因素,就更加难以评估了,因为近来牙周炎也与多疾病相关。牙周炎和许多系统性疾病都有共同的环境、生活方式和遗传风险因素,并且有共同的免疫病理学。此外,罹患一种常见的非传染性疾病可能会增加对另一种慢性疾病的易感性;一种疾病的系统性影响可能是另一种疾病的各种风险因素之一。任何全身性疾病的主要影响都是导致个人处于促炎症状态;牙周炎也是如此。此外,牙周炎还会导致血栓形成和免疫活性升高。因此,当我们将牙周病视为另一种全身性疾病时,它可能会影响其他全身性疾病的易感性和进展,重要的是,反之亦然。因此,牙周炎与其他各种非传染性疾病相关也就不足为奇了。根据医学定义,全身性疾病包括影响不同器官和系统的疾病。因此,本文旨在提出牙周炎本身应被视为一种系统性疾病,它影响着个人的系统状况和健康。牙科和医学界以及研究人员都应适应这种范式的转变,将牙周病从孤立的解剖学位置推进到慢性非传染性疾病的范畴,在某些情况下,牙周病是一种合并症,反之亦然,合并症也会影响牙周病的发生和发展。
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引用次数: 0
Autogenous platelet concentrates for treatment of intrabony defects—A systematic review with meta‐analysis 治疗骨内缺损的自体血小板浓缩物--系统综述与荟萃分析
IF 18.6 1区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-10-19 DOI: 10.1111/prd.12598
Richard J. Miron, Vittorio Moraschini, Nathan Estrin, Jamil Awad Shibli, Raluca Cosgarea, Karin Jepsen, Pia‐Merete Jervøe‐Storm, Hom‐Lay Wang, Anton Sculean, Søren Jepsen
To provide an overview of the use of autogenous platelet concentrates (APCs) in periodontal regeneration and to conduct a systematic review (SR) of the treatment outcomes of periodontal intrabony defects by using platelet‐rich fibrin (PRF) compared with other commonly utilized modalities. The eligibility criteria comprised randomized controlled trials (RCTs) comparing the clinical outcomes of PRF with that of other modalities. Studies were classified into 21 categories and into five different groups as follows: Group I (1) open flap debridement (OFD) alone versus OFD/PRF, (2) OFD versus Titanium‐PRF (T‐PRF) Group II, (3) Comparative PRF protocols (PRF vs. T‐PRF), Group III (Comparative Studies to PRF): (4) OFD/PRP versus OFD/PRF, (5) OFD/bone graft(BG)/PRGF versus OFD/BG/PRF, (6) OFD/EMD versus OFD/PRF, (7) OFD/BG/EMD versus OFD/BG/PRF, (8) OFD/collagen membrane (CM) versus OFD/PRF, (9) OFD/BG/BM versus OFD/BG/PRF, (10) OFD/BG versus OFD/PRF, Group IV (Addition of PRF to treatment groups) (11) OFD/BG versus OFD/BG/PRF, (12) OFD/GTR versus OFD/GTR + PRF (13) OFD/EMD versus OFD/EMD/PRF (14) OFD/BG/BM versus OFD/BG/BM/PRF, Group V (Addition of Biomaterial/Biomolecule to PRF): OFD/PRF versus … (15) OFD/PRF/BG, (16) OFD/PRF/antibiotic, (17) OFD/PRF/Metformin, (18) OFD/PRF/Bisphosphonates, (19) OFD/PRF/Statins, (20) OFD/BG/PRF versus OFD/BG/PRF/Statins, and (21) OFD/PRF/low‐level laser therapy (LLLT). Weighted means and forest plots were calculated for probing pocket depth (PPD), clinical attachment level (CAL), and radiographic bone fill (RBF). From 596 records identified, 55 RCTs were included. Group I: The use of OFD/PRF statistically significantly reduced PPD and improved CAL and RBF when compared to OFD. Group II: A significant difference between various PRF protocols was only observed for PPD. Group III: No significant advantage was found when comparing OFD/PRF to the following groups: OFD/PRP, OFD/EMD, OFD/BM, or OFD/BG. Group IV: The addition of PRF to OFD/BG led to significant improvements in PPD, CAL and RBF compared with OFD/BG alone. Group V: The addition of either a BG as well as three of the following biomolecules (metformin, bisphosphonates, and statins) to OFD/PRF led to statistically significant improvements in PPD, CAL, and/or RBF when compared to OFD/PRF alone. The use of PRF significantly improved clinical outcomes in intrabony defects when compared to OFD alone. Similar results were observed when OFD/PRF was compared with OFD/BG, OFD/EMD, OFD/PRP, and OFD/BM. The addition of PRF to a bone grafting material as well as the addition of various small biomolecules to PRF may offer additional clinical advantages, thus warranting further investigations. Future research investigating various protocols of PRF, longer‐term outcomes, as well as PRF at the human histological level remains needed.
概述自体血小板浓缩物(APC)在牙周再生中的应用,并对使用富血小板纤维蛋白(PRF)治疗牙周骨内缺损的疗效与其他常用方法进行系统回顾(SR)。研究资格标准包括随机对照试验 (RCT),比较 PRF 与其他方法的临床疗效。研究分为以下 21 类和 5 个不同的组别:T-PRF),第三组(与 PRF 的比较研究):(4)OFD/PRP 与 OFD/PRF,(5)OFD/骨移植(BG)/PRGF 与 OFD/BG/PRF,(6)OFD/EMD 与 OFD/PRF,(7)OFD/BG/EMD 与 OFD/BG/PRF,(8)OFD/胶原膜(CM)与 OFD/PRF,(9)OFD/BG/BM 与 OFD/BG/PRF,(10)OFD/BG 与 OFD/PRF、第四组(在治疗组中加入 PRF)(11)OFD/BG 与 OFD/BG/PRF,(12)OFD/GTR 与 OFD/GTR + PRF,(13)OFD/EMD 与 OFD/EMD/PRF,(14)OFD/BG/BM 与 OFD/BG/BM/PRF,第五组(在 PRF 中加入生物材料/生物分子):OFD/PRF与......(15)OFD/PRF/BG,(16)OFD/PRF/抗生素,(17)OFD/PRF/二甲双胍,(18)OFD/PRF/双膦酸盐,(19)OFD/PRF/Statin,(20)OFD/BG/PRF与OFD/BG/PRF/Statin,以及(21)OFD/PRF/低水平激光疗法(LLLT)。计算了探查袋深度 (PPD)、临床附着水平 (CAL) 和放射骨填充 (RBF) 的加权平均值和森林图。从确定的 596 条记录中,纳入了 55 项 RCT。第一组:与OFD相比,使用OFD/PRF在统计学上明显降低了PPD,改善了CAL和RBF。第二组:各种 PRF 方案仅在 PPD 方面存在明显差异。第三组:OFD/PRF 与以下组别相比没有发现明显优势:OFD/PRP、OFD/EMD、OFD/BM 或 OFD/BG。第四组:与单独使用 OFD/BG 相比,在 OFD/BG 的基础上添加 PRF 可显著改善 PPD、CAL 和 RBF。第五组:与单独使用 OFD/PRF 相比,在 OFD/PRF 中添加 BG 以及以下三种生物分子(二甲双胍、双磷酸盐和他汀类药物)可使 PPD、CAL 和/或 RBF 有统计学意义上的显著改善。与单独使用 OFD 相比,使用 PRF 能明显改善骨内缺损的临床疗效。将 OFD/PRF 与 OFD/BG、OFD/EMD、OFD/PRP 和 OFD/BM 相比,也观察到了类似的结果。在骨移植材料中添加 PRF 以及在 PRF 中添加各种小生物分子可能会带来更多临床优势,因此值得进一步研究。未来仍需对 PRF 的各种方案、长期效果以及人体组织学层面的 PRF 进行研究。
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引用次数: 0
Orthodontic management of uneven gingival margins in patients with healthy or reduced periodontium to improve smile aesthetics. 对牙周健康或萎缩的患者进行龈缘不齐的正畸治疗,以改善笑容的美感。
IF 18.6 1区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-10-16 DOI: 10.1111/prd.12613
Conchita Martin,Spyridon N Papageorgiou,Oscar Gonzalez-Martin,Mariano Sanz
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引用次数: 0
Autologous platelet concentrates in root coverage procedures. 根部覆盖手术中的自体血小板浓缩物。
IF 18.6 1区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-10-15 DOI: 10.1111/prd.12614
Shayan Barootchi,Lorenzo Tavelli,Maria Elisa Galarraga Vinueza,Hamoun Sabri,Catherine Andrade,Nelson Pinto,Antonio Sanz,Hom-Lay Wang
Gingival recessions are vastly prevalent among the general population. With regards to their treatment, recent advancements in periodontal and microsurgical procedures, focusing on minimal invasiveness and patient-centered therapies, have propelled a shift in their contemporary treatment, highlighting the field of biologics and bioactive mediators. Among different classes and types of biologics, autologous platelet concentrates (APCs), also referred to as autologous blood-derived products, are commonly used and preferred among many clinicians. These are essentially obtained via venipuncture (intravenous access) followed by centrifugation, for which numerous protocols and preparation methods have been used, leading to varieties of blood-derived products. In this review, via a systematic search, we explored the efficacy of the different utilized preparation methods and centrifugation protocols of APCs (e.g., platelet-rich plasma (PRP), platelet-rich fibrin (PRF), leucocyte-PRF, advanced-PRF, concentrated growth factor (CGF), etc.) for the treatment of type 1 gingival recessions (RT1, without interproximal attachment loss or noticeable tooth displacement), as well as their effectiveness relative to a common control (treatment with flap advancement alone without any additional material). Based on the available literature from randomized trials found in our systematic search, we observed that utilization of PRF can significantly enhance treatment outcomes when performing a coronally advanced flap, in terms of the amount of root coverage. The improvement in root coverage was further enhanced in the presence of baseline keratinized tissue width, and with an increasing relative magnitude (the more the baseline keratinized tissue width, the better the root coverage outcomes when using PRF). The efficacy of these products needs to be further explored with different graft substitutes and matrices, as well as relative to other commonly applied biologics, through well-conducted and adequately-powered randomized clinical trials.
牙龈萎缩在普通人群中非常普遍。关于牙龈萎缩的治疗,牙周和显微外科手术的最新进展侧重于微创和以患者为中心的疗法,推动了当代牙龈萎缩治疗的转变,突出了生物制剂和生物活性介质领域。在不同类别和类型的生物制剂中,自体血小板浓缩物(APCs),也称为自体血源性产品,是许多临床医生常用和首选的生物制剂。自体血小板浓缩物(APCs)也被称为自体血源性产品,是许多临床医生常用和偏爱的产品。这些产品主要通过静脉穿刺(静脉通路)获得,然后进行离心分离,离心分离的方案和制备方法多种多样,导致血源性产品的种类繁多。在这篇综述中,我们通过系统性检索,探讨了不同制备方法和离心方案对 APCs(如:富血小板血浆(血小板-血浆))的功效、富血小板血浆 (PRP)、富血小板纤维蛋白 (PRF)、白细胞-PRF、高级-PRF、浓缩生长因子 (CGF) 等)治疗 1 型牙龈凹陷(RT1,没有近端间附着丧失或明显的牙齿移位)的疗效,以及与普通对照组(仅使用牙瓣推进治疗,不使用任何额外材料)相比的疗效。根据我们在系统搜索中发现的随机试验文献,我们发现在进行冠向推进翻瓣时,使用 PRF 可以在牙根覆盖量方面显著提高治疗效果。在基线角化组织宽度存在的情况下,根覆盖的改善效果会进一步增强,而且相对幅度会越来越大(基线角化组织宽度越大,使用 PRF 时根覆盖效果越好)。这些产品的疗效还需要通过开展良好、充分授权的随机临床试验,结合不同的移植替代物和基质,以及相对于其他常用生物制剂的疗效进行进一步探讨。
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引用次数: 0
Autologous platelet concentrates in alveolar ridge preservation: A systematic review with meta-analyses. 用于牙槽嵴保留的自体血小板浓缩物:系统回顾与荟萃分析。
IF 17.5 1区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-09-30 DOI: 10.1111/prd.12609
Sayed Ahmad Manoetjer Siawasch, Jize Yu, Ana B Castro, Rutger Dhondt, Wim Teughels, Andy Temmerman, Marc Quirynen

In order to evaluate the therapeutic advantages of various autologous platelet concentrates (APC) as a single biomaterial during alveolar ridge preservation (ARP), a systematic review with meta-analyses was conducted. PubMed, EMBASE, Web of Science, and Scopus were screened for randomized controlled trials (RCTs) that were released prior to 2024. The selected papers compared an APC with either unassisted healing (blood clot) or another biomaterial during ARP (third molars were not included). The outcome parameters included alveolar bone dimension alterations, soft tissue healing, and post-op pain intensity. The search yielded 35 papers (33 studies), one applying platelet-rich plasma (PRP), six using plasma rich in growth factors (PRGF), and 28 using leukocyte- and platelet-rich fibrin (L-PRF). These studies showed a large heterogeneity (e.g., outcome parameters, timing, surgical approach, and inclusion criteria), which hindered drawing strong conclusions. In most studies, however, ARP with PRP, PRGF, and L-PRF alone produced faster soft tissue healing, less post-extraction pain, less alveolar ridge resorption, more socket bone fill, and a higher bone density when compared to unassisted (spontaneous) healing. The ultimate benefit appears to be significantly influenced by the surgical approach. Limited literature exists comparing APC with other biomaterials for ARP, resulting in inconclusive data. APC application for ARP is a promising strategy to improve soft and hard tissue healing and reduce post-extraction pain.

为了评估各种自体血小板浓缩物(APC)作为单一生物材料在牙槽脊保存(ARP)过程中的治疗优势,我们进行了一项系统性综述和荟萃分析。在 PubMed、EMBASE、Web of Science 和 Scopus 中筛选了 2024 年之前发布的随机对照试验 (RCT)。所选论文将 APC 与 ARP 期间的无辅助愈合(血块)或其他生物材料进行了比较(不包括第三磨牙)。结果参数包括牙槽骨尺寸改变、软组织愈合和术后疼痛强度。搜索共获得 35 篇论文(33 项研究),其中 1 篇采用富血小板血浆 (PRP),6 篇采用富含生长因子的血浆 (PRGF),28 篇采用白细胞和富血小板纤维蛋白 (L-PRF)。这些研究显示出很大的异质性(如结果参数、时间、手术方法和纳入标准),这阻碍了得出有力的结论。不过,在大多数研究中,与无辅助(自发)愈合相比,单独使用 PRP、PRGF 和 L-PRF 的 ARP 能加快软组织愈合,减轻拔牙后疼痛,减少牙槽嵴吸收,增加牙槽窝骨填充,提高骨密度。最终的益处似乎在很大程度上受到手术方法的影响。将 APC 与其他用于 ARP 的生物材料进行比较的文献有限,因此没有定论。将 APC 应用于 ARP 是一种很有前景的策略,可以改善软组织和硬组织的愈合,减轻拔牙后的疼痛。
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引用次数: 0
Autologous platelet concentrates as adjuvant in the surgical management of medication‐related osteonecrosis of the jaw 自体血小板浓缩物作为手术治疗药物性颌骨坏死的辅助药物
IF 18.6 1区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-09-30 DOI: 10.1111/prd.12608
Francesco Bennardo, Selene Barone, Alessandro Antonelli, Amerigo Giudice
Medication‐related osteonecrosis of the jaw (MRONJ) is an infectious side effect associated with bisphosphonates and monoclonal antibodies (denosumab, immune modulators, and antiangiogenic medications). Adjunctive therapies for the surgical management of MRONJ include autologous platelet concentrates (APCs). These APCs serve as a source of various cells and growth factors that aid tissue healing and regeneration. This review evaluated the use of platelet‐rich plasma (PRP), plasma‐rich in growth factors (PRGF), and leukocyte‐ and platelet‐rich fibrin (L‐PRF) as adjuvant therapies for the surgical management of MRONJ by conducting analyses on the results of 58 articles. Compared to surgical treatment alone, the application of PRP and L‐PRF after surgery appears to increase healing in the management of patients with MRONJ. No studies have reported unhealed lesions as a result of surgical treatment of MRONJ with PRGF application or compared it with surgical treatment alone. The overall results of this review have shown favorable healing rates of MRONJ lesions managed with the application of APCs after surgical treatment; however, significant methodological limitations may limit the scientific evidence supporting their use. Further randomized controlled trials with strict criteria are needed to establish the extent to which APCs can improve wound healing and quality of life in patients with MRONJ requiring surgical treatment.
药物相关性颌骨坏死(MRONJ)是与双磷酸盐类药物和单克隆抗体(地诺苏单抗、免疫调节剂和抗血管生成药物)相关的一种感染性副作用。手术治疗 MRONJ 的辅助疗法包括自体血小板浓缩物(APC)。这些 APCs 可作为各种细胞和生长因子的来源,帮助组织愈合和再生。本综述通过对58篇文章的结果进行分析,评估了富血小板血浆(PRP)、富含生长因子的血浆(PRGF)以及白细胞和富血小板纤维蛋白(L-PRF)作为辅助疗法用于MRONJ手术治疗的情况。与单纯的手术治疗相比,术后应用 PRP 和 L-PRF 似乎能提高 MRONJ 患者的愈合率。没有研究报告称 MRONJ 手术治疗后应用 PRGF 导致病变未愈合,也没有研究将其与单纯手术治疗进行比较。本综述的总体结果表明,手术治疗后应用 APCs 治疗 MRONJ 病变的愈合率较高;然而,方法上的重大局限性可能会限制支持使用 APCs 的科学证据。需要进一步开展严格标准的随机对照试验,以确定 APC 在多大程度上可以改善需要手术治疗的 MRONJ 患者的伤口愈合和生活质量。
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引用次数: 0
Periodontal regeneration using platelet-rich fibrin. Furcation defects: A systematic review with meta-analysis. 使用富血小板纤维蛋白进行牙周再生。毛面缺损:系统回顾与荟萃分析。
IF 18.6 1区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-09-26 DOI: 10.1111/prd.12583
Richard J Miron,Vittorio Moraschini,Nathan E Estrin,Jamil Awad Shibli,Raluca Cosgarea,Karin Jepsen,Pia-Merete Jervøe-Storm,Anton Sculean,Søren Jepsen
The objective of the study was to compare the treatment outcomes of periodontal furcation defects by using platelet-rich fibrin (PRF) with other commonly utilized modalities. The eligibility criteria comprised randomized controlled trials (RCTs) comparing the clinical outcomes of PRF with those of other modalities for the treatment of furcation defects. Studies were classified into 11 categories in 3 different groups as follows: Group I (addition of PRF): (1) open flap debridement (OFD) alone versus OFD/PRF, (2) OFD/bone graft (OFD/BG) versus OFD/BG/PRF; Group II (comparative studies to PRF): (3) OFD/BG versus OFD/PRF, (4) OFD/collagen membrane versus OFD/PRF, (5) OFD/PRP versus OFD/PRF, (6) OFD/rhBMP2 versus OFD/PRF; and Group III (addition of biomaterial/biomolecule to PRF): OFD/PRF versus … (7) OFD/PRF/BG, (8) OFD/PRF/amniotic membrane (AM), (9) OFD/PRF/metformin, (10) OFD/PRF/bisphosphonates, (11) OFD/PRF/statins. Weighted means and forest plots were calculated for the reduction of probing pocket depth (PPD), gain of vertical and horizontal clinical attachment levels (VCAL and HCAL), gain in vertical and horizontal bone levels (VBL, HBL), and radiographic bone fill (RBF). From 45 articles identified, 21 RCTs reporting on class II furcations were included. The use of OFD/PRF and OFD/BG/PRF statistically significantly reduced PPD and improved VCAL and HCAL when compared to OFD or OFD/BG, respectively. The comparison between OFD/PRF alone versus OFD/BG, OFD/CM, OFD/PRP, or OFD/rhBMP2 led to similar outcomes for all investigated parameters, including a reduction in PPD, VCAL/HCAL gain, and RBF. The additional incorporation of a BG to OFD/PRF only mildly improved outcomes, whereas the addition of AM improved clinical outcomes. The addition of small biomolecules such as metformin, bisphosphonates, or statins all led to significant improvements in PPD, VCAL, and HCAL when compared to OFD/PRF alone. Noteworthy, a very high heterogeneity was found in the investigated studies. The use of PRF significantly improved clinical outcomes in class II furcation defects when compared to OFD alone, with similar levels being observed between OFD/PRF and/or OFD/BG, OFD/CM, OFD/PRP, or OFD/rhBMP2. Future research geared toward better understanding potential ways to enhance the regenerative properties of PRF with various small biomolecules may prove valuable for future clinical applications. Future histological research investigating PRF in human furcation defects is largely needed. The use of PRF in conjunction with OFD statistically significantly improved PPD, VCAL, and HCAL values, yielding comparable outcomes to commonly used biomaterials. The combination of PRF to bone grafts or the addition of small biomolecules may offer additional clinical benefits, thus warranting future investigation.
本研究的目的是比较使用富血小板纤维蛋白(PRF)和其他常用方法治疗牙周沟缺损的效果。研究资格标准包括随机对照试验(RCT),这些试验比较了富血小板纤维蛋白与其他方法治疗毛囊缺损的临床效果。研究分为以下 3 组,共 11 类:第一组(增加 PRF):(1) 单纯开放皮瓣清创术 (OFD) 与 OFD/PRF 比较,(2) OFD/骨移植术 (OFD/BG) 与 OFD/BG/PRF比较;第二组(与 PRF 比较研究):(3) OFD/BG 与 OFD/PRF,(4) OFD/胶原膜与 OFD/PRF,(5) OFD/PRP 与 OFD/PRF,(6) OFD/rhBMP2 与 OFD/PRF;第 III 组(在 PRF 中添加生物材料/生物分子):OFD/PRF与......(7)OFD/PRF/BG,(8)OFD/PRF/羊膜(AM),(9)OFD/PRF/甲福明,(10)OFD/PRF/双膦酸盐,(11)OFD/PRF/胱氨酸。计算了探查袋深度减少(PPD)、垂直和水平临床附着水平增加(VCAL 和 HCAL)、垂直和水平骨水平增加(VBL 和 HBL)以及放射骨填充(RBF)的加权平均值和森林图。从已确定的 45 篇文章中,纳入了 21 项报告 II 类疖肿的 RCT。与 OFD 或 OFD/BG 相比,OFD/PRF 和 OFD/BG/PRF 在统计学上分别显著降低了 PPD,改善了 VCAL 和 HCAL。将 OFD/PRF 单独与 OFD/BG、OFD/CM、OFD/PRP 或 OFD/rhBMP2 进行比较,所有研究参数的结果相似,包括 PPD、VCAL/HCAL 增益和 RBF 的降低。在 OFD/PRF 中添加 BG 仅能轻微改善疗效,而添加 AM 则能改善临床疗效。与单独使用 OFD/PRF 相比,添加二甲双胍、双磷酸盐或他汀类药物等小分子生物制剂都能显著改善 PPD、VCAL 和 HCAL。值得注意的是,所调查研究的异质性非常高。与单独使用 OFD 相比,使用 PRF 能明显改善 II 类毛囊缺损的临床疗效,OFD/PRF 和/或 OFD/BG、OFD/CM、OFD/PRP 或 OFD/rhBMP2 之间的临床疗效相似。未来的研究旨在更好地了解利用各种小型生物分子增强 PRF 再生特性的潜在方法,这可能对未来的临床应用很有价值。未来还需要对 PRF 在人类毛囊缺损中的应用进行组织学研究。PRF与OFD的结合使用在统计学上显著改善了PPD、VCAL和HCAL值,其结果与常用的生物材料相当。将 PRF 与骨移植物结合使用或添加小分子生物材料可能会带来更多临床益处,因此值得在未来进行研究。
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引用次数: 0
Impact of public health and patient-centered prevention strategies on periodontitis and caries as causes of tooth loss in high-income countries. 公共卫生和以患者为中心的预防战略对高收入国家牙周炎和龋齿作为牙齿脱落原因的影响。
IF 18.6 1区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-09-25 DOI: 10.1111/prd.12592
Thomas Kocher,Peter Meisel,Sebastian Baumeister,Birte Holtfreter
In high-income countries, the oral health of the population is influenced by public health interventions, widespread use of oral care products, dental practice measures, and the cost of dental treatment. We compiled information on changes of the prevalence of proximal and upstream determinants of periodontitis, caries, and tooth loss over the last three decades to outline their potential effects on changes of oral health during this period. Information was retrieved from repeated cross-sectional studies and from published literature. While both the prevalence of edentulism and the number of missing teeth (from the DMF-T index) decreased, the number of sound teeth as well as the total number of teeth increased. The prevalence of severe periodontitis was unchanged, whereas the prevalence of periodontal health and moderate periodontitis may have increased to a minor extent. Concerning oral health risk factors, the proportion of individuals with tertiary education increased, while smoking prevalence declined. More and more people used oral care products. Whether one reimbursement system worked better than another one in terms of tooth retention could not be elucidated. In tooth retention, population-wide use of fluoridated toothpastes had the greatest impact. To some extent, the higher number of teeth present may be related to the more frequent use of interdental cleaning aids and powered toothbrushes. Since there was no decrease in severe periodontitis in most cohorts, periodontal interventions probably contributed little to improved tooth retention.
在高收入国家,人口的口腔健康受到公共卫生干预、口腔护理产品的广泛使用、牙科实践措施和牙科治疗费用的影响。我们汇编了过去三十年牙周炎、龋齿和牙齿脱落的近端和上游决定因素流行率变化的信息,以概述它们在此期间对口腔健康变化的潜在影响。我们从反复进行的横断面研究和已发表的文献中获取了相关信息。虽然缺牙症的发病率和缺失牙齿的数量(来自 DMF-T 指数)都有所下降,但健全牙齿的数量和牙齿总数却有所增加。重度牙周炎的患病率没有变化,而牙周健康和中度牙周炎的患病率可能略有增加。在口腔健康风险因素方面,受过高等教育的人的比例增加了,而吸烟率下降了。越来越多的人使用口腔护理产品。在保持牙齿方面,一种报销制度是否比另一种报销制度更有效,目前还无法阐明。在牙齿保留方面,全民使用含氟牙膏的影响最大。在某种程度上,牙齿数量增加可能与更频繁地使用牙间清洁辅助工具和电动牙刷有关。由于大多数队列中的严重牙周炎没有减少,因此牙周干预措施可能对提高牙齿保留率作用不大。
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引用次数: 0
Inflammation indices in association with periodontitis and cancer. 与牙周炎和癌症相关的炎症指数。
IF 18.6 1区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-09-24 DOI: 10.1111/prd.12612
Kay-Arne Walther,Sabine Gröger,Jonas Adrian Helmut Vogler,Bernd Wöstmann,Jörg Meyle
Inflammation is a complex physiological process that plays a pivotal role in many if not all pathological conditions, including infectious as well as inflammatory diseases, like periodontitis and autoimmune disorders. Inflammatory response to periodontal biofilms and tissue destruction in periodontitis is associated with the release of inflammatory mediators. Chronic inflammation can promote the development of cancer. Persistence of inflammatory mediators plays a crucial role in this process. Quantification and monitoring of the severity of inflammation in relation to cancer is essential. Periodontitis is mainly quantified based on the severity and extent of attachment loss and/or pocket probing depth, in addition with bleeding on probing. In recent years, studies started to investigate inflammation indices in association with periodontal diseases. To date, only few reviews have been published focusing on the relationship between blood cell count, inflammation indices, and periodontitis. This review presents a comprehensive overview of different systemic inflammation indices, their methods of measurement, and the clinical applications in relation to periodontitis and cancer. This review outlines the physiological basis of inflammation and the underlying cellular and molecular mechanisms of the parameters described. Key inflammation indices are commonly utilized in periodontology such as the neutrophil to lymphocyte ratio. Inflammation indices like the platelet to lymphocyte ratio, platelet distribution width, plateletcrit, red blood cell distribution width, lymphocyte to monocyte ratio, delta neutrophil index, and the systemic immune inflammation index are also used in hospital settings and will be discussed. The clinical roles and limitations, relationship to systemic diseases as well as their association to periodontitis and treatment response are described.
炎症是一个复杂的生理过程,在许多甚至所有病理情况下都起着关键作用,包括感染性和炎症性疾病,如牙周炎和自身免疫性疾病。牙周炎中对牙周生物膜和组织破坏的炎症反应与炎症介质的释放有关。慢性炎症可促进癌症的发展。炎症介质的持续存在在这一过程中起着至关重要的作用。量化和监测与癌症相关的炎症严重程度至关重要。牙周炎的量化主要基于附着丧失和/或牙周袋探诊深度的严重程度和范围,以及探诊时的出血情况。近年来,研究开始调查与牙周疾病相关的炎症指数。迄今为止,关于血细胞计数、炎症指数和牙周炎之间关系的综述还寥寥无几。本综述全面概述了不同的全身炎症指数、其测量方法以及与牙周炎和癌症有关的临床应用。本综述概述了炎症的生理基础以及所述参数的潜在细胞和分子机制。牙周病学中常用的主要炎症指数包括中性粒细胞与淋巴细胞比值。血小板与淋巴细胞比值、血小板分布宽度、血小板crit、红细胞分布宽度、淋巴细胞与单核细胞比值、δ中性粒细胞指数和全身免疫炎症指数等炎症指数也在医院环境中使用,将对这些指数进行讨论。此外,还将介绍这些指标的临床作用和局限性、与全身性疾病的关系以及与牙周炎和治疗反应的关系。
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引用次数: 0
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Periodontology 2000
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