Papers by Cristiano Tomasi
Journal of Clinical Periodontology, Jun 1, 2022
BackgroundThe recently published clinical practice guideline (CPG) for the treatment of periodont... more BackgroundThe recently published clinical practice guideline (CPG) for the treatment of periodontitis in stages I–III provided evidence‐based recommendations for the treatment of periodontitis patients, defined according to the 2018 classification. Stage IV periodontitis shares the severity and complexity characteristics of stage III periodontitis, but includes the anatomical and functional sequelae of tooth and periodontal attachment loss (tooth flaring and drifting, bite collapse, etc.), which require additional interventions following completion of active periodontal therapy.AimTo develop an S3 Level CPG for the treatment of stage IV periodontitis, focusing on the implementation of inter‐disciplinary treatment approaches required to treat/rehabilitate patients following associated sequelae and tooth loss.Materials and MethodsThis S3 Level CPG was developed by the European Federation of Periodontology (EFP), following methodological guidance from the Association of Scientific Medical Societies in Germany and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process. A rigorous and transparent process included synthesis of relevant research in 13 specifically commissioned systematic reviews, evaluation of the quality and strength of evidence, the formulation of specific recommendations and a structured consensus process with leading experts and a broad base of stakeholders.ResultsThe S3 Level CPG for the treatment of stage IV periodontitis culminated in recommendations for different interventions, including orthodontic tooth movement, tooth splinting, occlusal adjustment, tooth‐ or implant‐supported fixed or removable dental prostheses and supportive periodontal care. Prior to treatment planning, it is critically important to undertake a definitive and comprehensive diagnosis and case evaluation, obtain relevant patient information, and engage in frequent re‐evaluations during and after treatment. The periodontal component of therapy should follow the CPG for the treatment of periodontitis in stages I–III.ConclusionsThe present S3 Level CPG informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to treat patients with stage IV periodontitis and to maintain a healthy dentition over lifetime, according to the available evidence at the time of publication.
Journal of Clinical Periodontology, Nov 10, 2021
ObjectivesTo evaluate the efficacy of implant‐supported in comparison to tooth‐supported full‐arc... more ObjectivesTo evaluate the efficacy of implant‐supported in comparison to tooth‐supported full‐arch prostheses in patients with stage IV periodontitis.Materials and MethodsSystematic electronic search (CENTRAL/MEDLINE/SCOPUS) up to March 2020 was conducted to identify randomized controlled trials and cohort‐like studies comparing/evaluating fixed full‐arch rehabilitation on teeth or implants in patients with stage IV periodontitis. The primary outcome measure was loss of teeth/implants and restorations. Data extraction was performed to create evidence tables, and meta‐analyses were carried out as appropriate.ResultsA total of 26 studies (31 publications) were identified but none addressed the scientific question in a controlled and randomized design. The risk of bias throughout the included studies was judged to be high, and meta‐analyses demonstrated a high degree of heterogeneity. Mean‐weighted observation periods in studies on tooth‐supported restorations were significantly longer than in studies on implant‐supported restorations. The predicted loss of teeth and tooth‐supported full‐arch restorations over 10 years was 1% and 5%, respectively. The 15‐year estimates were 10% and 13%. Corresponding predictions for implants and implant‐supported restorations for 10 years amounted to 4% and 6%, respectively. Technical complications were the most commonly reported and affected 8% of tooth‐supported restorations (during 7.2 years) and 42% of implant‐supported structures (during 2.6 years). Peri‐implantitis‐ or peri‐implantitis‐like symptoms were observed at an estimated 9% of implants (after 3.1 years).ConclusionsBased on observational studies on full‐arch rehabilitation of stage IV periodontitis patients, 10‐year estimates of tooth loss were lower than the corresponding estimates for implants. Estimated loss of tooth‐ and implant‐supported restorations at 10 years was similar. Technical complications were more prevalent at implant‐supported when compared to tooth‐supported restorations.
Journal of Clinical Periodontology, Nov 3, 2022
AimTo evaluate the efficacy of access flap and pocket elimination procedures in the surgical trea... more AimTo evaluate the efficacy of access flap and pocket elimination procedures in the surgical treatment of peri‐implantitis.Materials and MethodsSystematic electronic searches (Central/MEDLINE/EMBASE) up to March 2022 were conducted to identify prospective clinical studies evaluating surgical therapy (access flap or pocket elimination procedures) of peri‐implantitis. Primary outcome measures were reduction of probing depth (PD) and bleeding on probing (BOP). Risk of bias was evaluated according to study design. Meta‐analysis and meta‐regression were performed. Results were expressed as standardized mean effect with 95% confidence interval (CI).ResultsEvidence from studies directly comparing surgical with non‐surgical therapy is lacking. Based on pre‐post data originating from 13 prospective patient cohorts, pronounced reductions of PD (standardized mean effect: 2.2 mm; 95% CI 1.8–2.7) and BOP% (27.0; 95% CI 19.8–34.2) as well as marginal bone level gain (0.2 mm; 95% CI –0.0 to 0.5) were observed at evaluation time points ranging from 1 to 5 years. Wide prediction intervals suggested a high degree of heterogeneity. Reduction of mean PD increased by 0.7 mm (95% CI 0.5–0.9) for every millimetre in increase of mean PD at baseline. During the follow‐up period ranging from 1 to 5 years, disease recurrence occurred frequently and implant loss was not uncommon.ConclusionsAccess flap and pocket elimination surgery are effective procedures in the management of peri‐implantitis, although rates of disease recurrence during 5 years were high. Treatment outcomes were affected by baseline conditions.
Journal of Oral Rehabilitation, 2008
Summary The objective of this systematic review was to describe the incidence of tooth and impla... more Summary The objective of this systematic review was to describe the incidence of tooth and implant loss reported in long‐term studies.Prospective longitudinal studies reporting on teeth or implants survival with a follow‐up period of at least 10 years were considered. Papers were excluded if the drop out rate exceeded 30% or if &lt;70% of the initial subject sample was examined at 10 years of follow‐up.Seventy publications on teeth were identified as potentially relevant for the focussed question. The analysis of the abstracts yielded 37 studies eligible for full‐text analysis. The inclusion criteria were met in 11 of the publications that included in all 3015 subjects. The initial search on implant studies generated 52 publications that possibly could be included. Following the evaluation of the abstracts and full‐text analysis nine publications were found to fulfil the inclusion criteria. The nine studies included 476 subjects.The incidence of tooth loss among subjects with a follow‐up period of 10–30 years varied from 1.3% to 5% in the majority of studies, while in two epidemiological studies on rural Chinese populations the incidences of tooth loss were 14% and 20%. The percentage of implants reported as lost during the follow‐up period varied between 1% and 18%.In clinically well‐maintained patients, the loss rate at teeth was lower than that at implant. Bone level changes appeared to be small at teeth as well as at implants in well‐maintained patients. Comparisons of the longevity at teeth and dental implants are difficult due to heterogeneity among the studies.
Clinical Oral Implants Research, Mar 13, 2018
The inner surface of the alveolus is almost consistently lined with bundle bone that is a tooth d... more The inner surface of the alveolus is almost consistently lined with bundle bone that is a tooth dependent tissue. Thus, following tooth removal, this bundle bone is resorbed and lost together with portions of the adjacent socket walls. This modeling results in a substantial diminution of the edentulous ridge/site (Araújo, da Silva,
Journal of Clinical Periodontology, Jun 1, 2018
The objective of Workgroup 4 was to present a classification on periimplant diseases and conditio... more The objective of Workgroup 4 was to present a classification on periimplant diseases and conditions. Five position papers describing the characteristics of peri-implant health, 1 peri-implant mucositis, 2 periimplantitis, 3 soft and hard tissue deficiencies 4 and case definitions and diagnostic considerations 5 were prepared prior to the workshop. In preparing this consensus report regarding the criteria for peri-implant health and disease it was recognized that there are a number of somewhat unusual peri-implant problems (e.g., implant fractures) and other conditions that may mimic or share certain clinical features with biofilm-associated peri-implant diseases. The following assumptions have been made: 1) complete medical-dental histories have been obtained including details on implant-supported reconstructions; and 2) an appropriate differential diagnostic analysis has been performed. The following questions and case definitions are intended to apply to situations in which the clinician has reasons to believe that biofilms on implant surfaces are the main etiological exposures associated with the development of peri-implant mucositis and peri-implantitis. It is important to emphasize that there are major patient-specific differences in inflammatory responses to the microbial challenge of bacterial communities that reside on implants. In addition, it has been assumed that the implants were properly placed and subsequently integrated with soft and hard tissues.
Journal of Periodontology, May 6, 2023
Clinical Oral Implants Research, Mar 13, 2023
ObjectivesThe aim of the present review and meta‐analysis was to evaluate the influence of soft t... more ObjectivesThe aim of the present review and meta‐analysis was to evaluate the influence of soft tissue thickness on initial bone remodeling after implant installation.Materials and MethodsA literature search was conducted by two independent reviewers on electronic databases up to May 2022. Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) performed on human subjects were included. The risk of bias was evaluated using Cochrane Collaboration's tool. Meta‐analysis and Trial Sequential Analysis (TSA) were performed on the selected articles. The primary outcome was marginal bone loss.ResultsAfter screening, 6 studies were included in the final analysis, with a total of 354 implants, and a follow‐up from 10 to 14 months. 194 implants were placed in a ≥ 2 mm soft tissue thickness, while 160 had &lt;2 mm soft tissue thickness before implant placement. The included studies had a high level of heterogeneity (I2 &gt; 50%). The meta‐analysis indicated a statistically significant difference between the two groups (0.54; p = .027) and the TSA analysis confirmed the results, despite the limited number of dental implants. Additional analysis showed that age and follow‐up parameters were not statistically significant factors influencing the bone loss (p = .22 and p = .16, respectively).ConclusionsBased on the available RCTS and CCTs, initial soft tissue thickness seems to influence marginal bone loss after a short follow‐up period. Based on TSA analysis, further studies are needed to assess the influence of the soft tissue thickness on marginal bone loss.PROSPERO registration number: CRD42021235324.
Proceedings Of The Institution Of Mechanical Engineers, Part H: Journal Of Engineering In Medicine, Jul 1, 2014
Journal of Clinical Periodontology
AimTo identify predictors of treatment outcomes following surgical therapy of peri‐implantitis.Ma... more AimTo identify predictors of treatment outcomes following surgical therapy of peri‐implantitis.Materials and MethodsWe performed a secondary analysis of data from a randomized controlled trial (RCT) comparing access flap with or without bone replacement graft. Outcomes at 12 months were probing pocket depth (PPD), bleeding on probing (BOP), soft‐tissue recession (REC) and marginal bone level (MBL) change. Multilevel regression analyses were used to identify predictors. We also built an explanatory model for residual signs of inflammation.ResultsBaseline PPD was the most relevant predictor, showing positive associations with final PPD, REC and MBL gain, and negative association with probability of pocket closure. Smokers presented higher residual PPD. Absence of keratinized mucosa at baseline increased the probability of BOP but was otherwise not indicative of outcomes. Plaque at 6 weeks was detrimental in terms of residual PPD and BOP. Treatment allocation had an effect on REC. Fina...
Journal of Periodontology
BackgroundThe purpose of this study was to evaluate the reliability and accuracy in the assignmen... more BackgroundThe purpose of this study was to evaluate the reliability and accuracy in the assignment of the case definitions of peri‐implant health and diseases according to the 2018 Classification of Periodontal and Peri‐implant Diseases and Conditions.MethodsTen undergraduate students, 10 general dentists, and 10 experts in implant dentistry participated in this study. All examiners were provided with clinical and radiographic documentation of 25 dental implants. Eleven out the 25 cases were also accompanied by baseline readings. Examiners were asked to define all cases using the 2018 classification case definitions. Reliability among examiners was evaluated using the Fleiss kappa statistic. Accuracy was estimated using percentage of complete agreement and quadratic weighted kappa for pairwise comparisons between each rater and a gold standard diagnosis.ResultsThe Fleiss kappa was 0.50 (95% CI: 0.48 to 0.51) and the mean quadratic weighted kappa value was 0.544. Complete agreement w...
Periodontology 2000
The S3‐level clinical guidelines for the treatment of patients with periodontitis stages I–III pu... more The S3‐level clinical guidelines for the treatment of patients with periodontitis stages I–III published by the European Federation of Periodontology in 2020, suggest a pre‐established stepwise approach for oral‐healthcare professionals with precise therapeutic pathways. The second step of this approach consists of the subgingival instrumentation of periodontal pockets by non‐surgical means to disrupt the microbial biofilm and remove soft and mineralized deposits This step aims to resolve periodontal inflammation by closure of periodontal pockets (probing pocket depth ≤ 4 mm, absence of bleeding on probing) employing different types of instruments and treatment protocols toward this end. Novel non‐surgical treatment approaches that adopt micro instruments or subgingival application of biological agents have been recently tested. Subgingival instrumentation has been shown to effectively restore the subgingival microbiota to one associated with periodontal health and to modulate the i...
Journal of Periodontology
Journal of Clinical Periodontology
Journal of Clinical Periodontology
AimTo evaluate the efficacy of access flap and pocket elimination procedures in the surgical trea... more AimTo evaluate the efficacy of access flap and pocket elimination procedures in the surgical treatment of peri‐implantitis.Materials and MethodsSystematic electronic searches (Central/MEDLINE/EMBASE) up to March 2022 were conducted to identify prospective clinical studies evaluating surgical therapy (access flap or pocket elimination procedures) of peri‐implantitis. Primary outcome measures were reduction of probing depth (PD) and bleeding on probing (BOP). Risk of bias was evaluated according to study design. Meta‐analysis and meta‐regression were performed. Results were expressed as standardized mean effect with 95% confidence interval (CI).ResultsEvidence from studies directly comparing surgical with non‐surgical therapy is lacking. Based on pre‐post data originating from 13 prospective patient cohorts, pronounced reductions of PD (standardized mean effect: 2.2 mm; 95% CI 1.8–2.7) and BOP% (27.0; 95% CI 19.8–34.2) as well as marginal bone level gain (0.2 mm; 95% CI –0.0 to 0.5) w...
BMC Oral Health
Context The current report is part of a prospective, multi-center, two-arm, quasi-randomized fiel... more Context The current report is part of a prospective, multi-center, two-arm, quasi-randomized field study focusing on the effectiveness in general praxis of evidence-based procedures in the non-surgical treatment of patients with periodontitis. Objective The specific aims were to (i) evaluate patient-reported experience and outcome measures of treatment following a guided approach to periodontal infection control (GPIC) compared to conventional non-surgical therapy (CNST) and to (ii) identify potential predictors of subjective treatment outcomes and patient’s adherence to self-performed infection control, i.e. adequate oral hygiene. Methods The study sample consisted of 494 patients treated per protocol with questionnaire- and clinical data at baseline and 6-months. The GPIC approach (test) comprised patient education for adequate oral hygiene prior to a single session of full-mouth ultra-sonic instrumentation, while the CNST approach (control) comprised education and instrumentation...
Journal of Clinical Periodontology
Periodontology 2000
Nonsurgical periodontal therapy can be subject to iatrogenesis, which includes all the complicati... more Nonsurgical periodontal therapy can be subject to iatrogenesis, which includes all the complications directly or indirectly related to a treatment. These complications include both operator‐dependent harms and errors and the consequences and adverse effects of the therapeutic procedures. The complications arising following nonsurgical periodontal treatment can be categorized as intraoperative and postoperative and can affect both soft and hard tissues at an intra‐oral and extraoral level. Soft‐tissues damage or damage to teeth and restorations can occur while performing the procedure. In the majority of cases, the risk of bleeding associated with nonsurgical therapy is reported to be low and easily controlled by means of local hemostatic measures, even in medicated subjects. Cervicofacial subcutaneous emphysema is not a frequent extraoral intraoperative complication, occurring during the use of air polishing. Moreover, side effects such as pain, fever, and dentine hypersensitivity a...
Journal of Clinical Periodontology
Journal of Clinical Periodontology, 2020
The objective of this study was to evaluate consistency and accuracy of the periodontitis staging... more The objective of this study was to evaluate consistency and accuracy of the periodontitis staging and grading classification system. Methods: Thirty participants (10 periodontal experts, 10 general dentists and 10 undergraduate students) and a gold standard examiner were asked to classify 25 fully documented periodontitis cases twice. Fleiss kappa was used to estimate consistency across examiners. Intraclass correlation coefficient (ICC) was used to calculate consistency across time. Quadratic weighted kappa and percentage of complete agreement versus gold standard were computed to assess accuracy. Results: Fleiss kappa for stage, extent and grade were 0.48, 0.37 and 0.45 respectively. The highest ICC was provided by students for stage (0.91), whereas the lowest ICC by general dentists for extent (0.79). Pair-wise comparisons against gold standard showed mean value of kappa >0.81 for stage and >0.41 for grade and extent. Agreement with the gold standard for all three components of the case definition was achieved in 47.2% of cases. The study identified specific factors associated with lower consistency and accuracy. Conclusions: Diagnosis was highly consistent across time and moderately between examiners. Accuracy was almost perfect for stage and moderate for grade and extent. Additional efforts are required to improve training of general dentists.
Uploads
Papers by Cristiano Tomasi