Perio Insight 6 - Winter 2018

Editor: Joanna Kamma Scientific Advisors: Phoebus Madianos, Lior Shapira

DEBATE

Multiple adjacent gingival recessions:

which technique to use, tunnel or flap?

Tunnel: ‘Advantages
Flap: ‘This technique has
of the tunnel technique
yielded optimal results in
include fast early healing,
both class 1 and class 2
reduced morbidity, and
Miller recession defects’
minor post-operative
(Massimo de Sanctis)
swelling’
(Ion Zabalegui)

Aesthetic concerns play a major role in the treatment Periodontal plastic-surgery procedures are designed to
planning of dental care and in every periodontal practice. correct defects in the morphology, position, and amount
Gingival recessions are one of the prevalent problems of gingiva. The present debate focuses on the treatment
that require clinicians’ attention because of the patient’s of multiple adjacent gingival recessions with two surgical
aesthetic demands and the possible health complications, approaches: the coronally advanced flap (with or without
such as dentin hypersensitivity and root caries. The cosmetic connective tissue graft) and the tunnelling procedure. Each
expectations of our patients and their dental health are the technique has its own advantages and limitations and the
primary indication for performing periodontal plastic surgery two procedures are well documented in the literature. Here,
and soft-tissue reconstructive surgery. It is the responsibility two opinion leaders – Massimo de Sanctis and Ion Zabalegui
of the clinician to understand patient demands for aesthetics, – share their clinical views and long-term experience to help
the indications and limitations of surgical treatment, and us decide which approach we should carry out in different
to acquire the needed surgical skills to perform delicate clinical situations.
procedures aimed at achieving optimal aesthetics. These
Lior Shapira, deputy chair, EFP scientific affairs committee
procedures need to ensure the best possible results with
minimal discomfort and maximal safety for our patients. >> page 2

1-5 DEBATE: Tunnel vs Flap

6 EFP partner projects
7-8 Latest JCP research

Partners

EFP partner projects

 2 Winter 2018

Massimo de Sanctis: ‘MCAF: a very effective approach to solving

aesthetic problems when multiple recessions are present’
The multiple coronally advanced where the vascular exchanges
flap (MCAF), as proposed by are of paramount importance:
Giovanni Zucchelli and me in that is, the area of the surgical
2000, has become the most papilla where the flap is
“It is clear that the most important indication for
widely used surgical approach anchored and where every this technique is aesthetic”
when treating multiple effort must be made to reduce
recessions. MCAF is a simple the risk of tissue shrinkage.
technique that nevertheless In the second part of the flap, FIG 1: Patient showing
yields very good results when the periosteum is maintained multiple recession and
complete root coverage is the in the flap by means of a NCCL, maxillary arch
aim of the surgery. full-thickness elevation,
It is clear that the most augmenting the thickness
important indication for this of the flap over the most
technique is aesthetic. Very critical part – the avascular
often, patients requiring root surface. Including the
root coverage have very periosteum in the portion
FIG 2: Quadrant 2 after
high expectations and are of flap that will be moved
CEJ reconstruction
extremely critical if surgery is coronally and positioned over
likely to produce scar tissue or the avascular surface will
incomplete results. provide maximum stability.
For such patients, it is thus Finally, the most apical portion
quite evident that one should – raised split thickness – allows
utilise the technique that flap mobilisation because
has resulted in producing all muscular insertions are FIG 3: Quadrant 2 Multiple
the highest rate of complete detached by the flap, so the CAF incision
root coverage. However, it tissue remains free from
needs to be kept in mind that muscle tension.
root coverage alone is no
longer an acceptable answer Optimal results
to the aesthetic request. This technique has yielded
Nowadays it is mandatory optimal results in both class
for surgery to recreate an 1 and class 2 Miller recession
anatomical condition equal FIG 4: Flap elevated,
defects. Nevertheless, a
to the one the patient had split-full-split; note calculus
multiple recession cannot be
before the recession was on root surfaces
categorised in the same way as
established. This means that a single recession. Very often
no scar tissue is acceptable teeth adjacent to each other
and that the blending in tissue show a different amount and a
colour and texture must be different thickness or height of
perfect, without any excess in keratinized tissue – that is, they
keratinized tissue. may be classified as Miller class
The MCAF has an envelope 1 or class 2. This is an anatomical FIG 5: Flap sutured
design. This means that by factor of paramount importance
avoiding vertical releasing for flap stability following the
incisions, the healing is not surgical procedure.
affected by scars or keloids. For this reason, some
The elevation of the flap – modifications have been added
FIG 6: Six-months healing
split-full-split – provides a good to the original technique – such
reason for the likely success of as the use of a connective
this technique. In fact, such a graft in the so-called multiple
technique represents a surgical bilaminar flap – which have
modulation of the soft-tissue increased the predictability of
thickness. the procedure. FIG 7: Maxillary arch
This technique maintains a The use of a connective tissue pre-op and six-month
partial-thickness recipient bed, in combination with a coronal healing
Winter 2018 3

advanced flap is well described

in literature and obtains the
maximum probability of root
coverage without altering
the aesthetic outcome of the “This technique has
surgical area. yielded optimal results
Although it is well documented
in both class 1 and
in the literature that MCAF
plus connective tissue graft class 2 Miller recession
yields less pain than the tunnel
technique, the harvesting of
defects” Massimo de Sanctis
connective tissue from the
palate exposes the patient to Graduated in 2015 he was nominated
a second surgical site and can periodontology at Boston professor at the Vita-Salute
affect morbidity in the healing the same amount of root University in 1982 and San Raffaele University
phase. For this reason – and coverage as utilising a long and obtained an MSc in in Milan, where he is chair
taking into account that not all large fragment of connective periodontology from of the programme of
the recession in a quadrant/ tissue, it also greatly reduces the same university for periodontology and director
sextant has the same amount the patient’s post-operation an experimental study of the clinical department
and thickness of keratinized discomfort. carried out between 1982 of periodontology. The
tissue – a selective use of and 1983. In 1987, he was author of more than 100
In conclusion, the MCAF
connective tissue grafting appointed professor of scientific articles, Professor
technique – with or without
has been developed to reduce periodontology at the de Sanctis is a fellow of
a connective-tissue graft – is
the dimension and depth of II University of Rome the International College
a very effective technical
the harvesting area, thereby where he taught until of Dentistry, a member of
approach to solving aesthetic
reducing post-surgical pain. 1989. Between 1989 to the American Academy
problems when multiple
1999 he held various of Periodontology, a past
With this approach, a recessions are present. It
teaching positions at the president of the Italian
connective tissue graft of provides the best results
University of Bologna, Society of Periodontology,
very small dimensions is when compared to other
and between 2000 and and a past president of
positioned only over roots surgical techniques, it is easy
2014 he was professor the Italian Co-ordinating
where the soft tissue is very to perform, and does not
of periodontology at the Committee for the
thin or keratinized tissue is result in excessive discomfort
University of Sienna. In Scientific Societies.
lacking. While this can achieve to patients.

Ion Zabalegui: ‘The tunnel approach is the treatment of choice in the

absence of keratinised tissue, when low morbidity is expected, and when
patients need public exposure soon after surgery’
For years, there has been a 1. F
 ast early healing with no mucosa: theoretically, this 1. A
 coronal traction of
tendency in dentistry – and in visible marks as early as will reduce the chances the tissue by means of
periodontology in particular two weeks post-operation, of relapse if the aetiology specifically designed sutures
– to create controversy, and because of the surgical returns; anchored with composite to
sometimes this has been design; the crowns of the treated
5. Reduced morbidity;
more for the glory of the teeth, as described by several
2. No vertical releasing incisions:
professionals than for the 6. No displacement of the authors (Sofia Aroca, Anton
relaxation of the flap comes
benefit of patients. mucogingival line; Sculean, Otto Zuhr).
from partial thickness
In relation to the treatment undermining beyond the 7. No changes in the depth of 2. C
 hanging the sequence
of multiple adjacent gingival mucogingival junction; the vestibule; of the surgical procedure:
recessions, let us try to explore starting out with the
3. No papilla incisions: 8. Minor post-operative
in a positive way some of acquisition of the donor
the features that have led they are undermined, swelling. tissue in order to carry out
to the tunnel technique’s preserving the tip and The exposure of the tissue has a test before designing the
becoming the most popular the vascularisation from been claimed to be a risk factor flap and the number of teeth
technique among many dental the palatal masticatory for low predictability of the where the treatment will be
professionals. mucosa; tunnel procedure. However, this carried out.
The basic advantages of the 4. Immediate augmentation factor can be counteracted by The critical factor for indicating
tunnel technique are: of the band of keratinised two different approaches: a tunnel procedure is the
 4 Winter 2018

dimension of the donor tissue. my experience in both private

In a situation with generous and university environments, FIG 8: Multiple adjacent
palatal masticatory mucosa, the in terms of patient-related gingival recessions in
tunnelling technique provides quality of life (unpublished anterior maxilla on a
fast healing in the papilla data), tunnel recession- high-smile-line patient
areas with hardly any residual coverage procedures involve seeking root-coverage
evidence of the procedure two less perception of external treatment for aesthetic
weeks post-operation. inflammation and external reasons
bruising compared to
Change in protocol coronally advanced flap (CAF).
This is the reason why I have As far as post-operational
advocated a change in protocol pain is concerned, no
for the treatment of multiple difference has been found on FIG 9: Try-on of the
adjacent gingival recessions: the flap side of the procedure harvested Ct graft for
first, the donor tissue should or the palatal donor area. decision-making: large
be harvested, a test should be enough for a tunnel
The tunnel approach is
performed on the recipient procedure
definitely the treatment
site, and then the decision of choice in the absence of
should be made about which keratinized tissue, when low
type of recipient bed is going morbidity is expected for the
to be best for the patient. patient, and when the patient
Referred morbidity is another needs to have public exposure
issue: we as therapists try to within a short period of time
provide the lowest amount of after the surgical procedure. FIG 10: CT graft placed
post-operational morbidity inside bilaminar tunnel bed
Nevertheless, my personal
if the goal of the procedure clinical recommendation is
fulfils patient and treatment that professionals should
expectations. It is very be well trained in both
difficult through a randomised procedures. There will always
controlled trial to measure be clinical situations in which
the exact procedures carried one of the procedures “a priori”
out by surgeons with similar should provide better outcome
kinds of expertise. However, in expectations than the other. FIG 11: Six-week healing

Select Bibliograp hy
>> Allen AL. Use of a supraperiosteal envelope in soft tissue grafting for root coverage. I. Rationale and technique. Int J Periodontics Restorative
Dent. 1994 14(3):216-227.
>> Aroca S, Molnar B, Windisch P, Gera I, Salvi GE, Nikolidakis D, & Sculean A. Treatment of multiple adjacent Miller class I and II gingival recessions
with a Modified Coronally Advanced Tunnel (MCAT) technique and a collagen matrix or palatal connective tissue graft: a randomized, controlled
clinical trial. Journal of Clinical Periodontology 2013 40, 713-720.
>> Burkhardt R & Lang NP. Coverage of localized gingival recessions: comparison of micro- and macrosurgical techniques. Journal of Clinical
Periodontology 2005 32, 287-293.
>> Cairo F, Cortellini P, Pilloni A, Nieri M, Cincinelli S, Amunni F, et al. Clinical efficacy of coronally advanced flap with or without connective tissue
graft for the treatment of multiple adjacent gingival recessions in the aesthetic area: a randomized controlled clinical trial. Journal of Clinical
Periodontology 2016 43(10):849–56.
>> Chambrone L & Tatakis DN. Periodontal soft tissue root coverage procedures: a systematic review from the AAP Regeneration Workshop.
Journal of Periodontology 2015 86, S8-S51.
>> De Sanctis M, Baldini N, Goracci C, Zucchelli G. Coronally advanced flap associated with a connective tissue graft for the treatment of multiple
recession defects in mandibular posterior teeth. Int J Periodontics Restorative Dent. 2011 Nov-Dec;31(6):623-30.
>> Gobbato L, Nart J, Bressan E, Mazzocco F, Paniz G, Lops D. Patient morbidity and root coverage outcomes after the application of a subepithelial
connective tissue graft in combination with a coronally advanced flap or via a tunneling technique: a randomized controlled clinical trial. Clin Oral
Invest. 2016 Jan 27;1–14.
>> Graziani F, Gennai S, Roldán S, Discepoli N, Buti J, Madianos P, Herrera D. Efficacy of periodontal plastic procedures in the treatment of multiple
gingival recessions. Journal of Clinical Periodontology 2014 41, S15.
>> Pini Prato GP, Cairo F, Nieri M, Franceschi D, Rotundo R, Cortellini P. Coronally advanced flap versus connective tissue graft in the treatment of
multiple gingival recessions: a split-mouth study with a 5-year follow-up. Journal of Clinical Periodontology 2010 37(7):644–50.
>> Rebele SF, Zuhr O, Schneider D, et al. Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivative
for root coverage: a RCT using 3D digital measuring methods. Part II. Volumetric studies on healing dynamics and gingival dimensions. Journal of
Clinical Periodontology 2014 41:593-603.
Winter 2018 5

FIG 12: One-year smile

Ion Zabalegui
FIG 13: Initial
full-mouth multiple From Bilbao (Spain), he and Dr Jaime Gil. At the
adjacent gingival studied for his M.D. and same time, he became a
recessions, both upper completed stomatology at visiting professor at the
and lower arches the Universidad del País postgraduate programme in
Vasco, in Bilbao, in 1984. periodontology at Madrid’s
From 1985 to 1987, he Complutense University,
studied for the Certificate under the guidance
in Periodontology at the of Professor Mariano
University of Southern Sanz. Since then, he has
California, where his published several articles on
FIG 14: One year after mentor was Dr. Oded periodontal regeneration,
FM situation Bahat. After receiving this periodontal plastic surgery,
qualification, he dedicated and implant dentistry. He
his work exclusively to remains in private practice
periodontology and implant and is known within the
dentistry at the Albia periodontal community
Dental Clinic in Bilbao, for his minimally invasive
‘The critical factor for indicating a tunnel alongside his brother approach to surgical
procedure is the dimension of the donor tissue’ Borja (an endodontist) treatments.

>> Salama H, Salama M, Garber D. The Tunnel Technique in the Periodontal Plastic Treatment of Multiple Adjacent Gingival Recession Defects: A
Review. Inside Dentistry. Inside Periodontics. 2008 78-81.
>> Stefanini M, Zucchelli G, Marzadori M, de Sanctis M. Coronally Advanced Flap with Site-Specific Application of Connective Tissue Graft for
the Treatment of Multiple Adjacent Gingival Recessions: A 3-Year Follow-Up Case Series. Int J Periodontics Restorative Dent. 2018 Jan/
Feb;38(1):25-33.
>> Zabalegui I, Sicilia A, Cambra J, et al. Treatment of multiple adjacent gingival recessions with the tunnel subepithelial connective tissue graft: a
clinical report. Int J Periodont Restorative Dent. 1999 19:199-206.
>> Zucchelli G, Mele M, Mazzotti C, Marzadori M, Montebugnoli L, de Sanctis M. Coronally advanced flap with and without vertical releasing
incisions for the treatment of multiple gingival recessions: a comparative controlled randomized clinical trial. J Periodontol. 2009 Jul
1;80(7):1083-94.
>> Zucchelli G, de Sanctis M. The coronally advanced flap for the treatment of multiple recession defects: a modified surgical approach for the
upper anterior teeth. J Int Acad Periodontol. 2007 Jul;9(3):96-103.
>> Zucchelli G, de Sanctis M. Long-term outcome following treatment of multiple Miller class I and II recession defects in esthetic areas of the
mouth. J Periodontol. 2005 Dec;76(12):2286-92.
>> Zucchelli G, de Sanctis M. Treatment of multiple recession-type defects in patients with esthetic demands. J Periodontol. 2000 Sep;71(9):1506–14.
>> Zucchelli G, Gori G, Mele M, Stefanini M, Mazzotti C, Marzadori M, Montebugnoli L, de Sanctis M. Non-carious cervical lesions associated with
gingival recessions: a decision-making process. J Periodontol. 2011 Dec;82(12):1713-24.
>> Zucchelli G, Mele M, Stefanini M, Mazzotti C, Marzadori M, Montebugnoli L, de Sanctis M. Patient morbidity and root coverage outcome
after subepithelial connective tissue and de-epithelialized grafts: a comparative randomized-controlled clinical trial. Journal of Clinical
Periodontology. 2010 Aug 1;37(8):728-38.
>> Zuhr O, Fickl S, Wachtel H, Bolz W, & Hürzeler MB (2007) Covering of gingival recessions with a modified microsurgical tunnel technique: case
report. The International Journal of Periodontics & Restorative Dentistry 27, 457-463.
>> Zuhr O, Rebele SF, Schneider D, Jung RE, & Hürzeler MB (2014) Tunnel technique with connective tissue graft versus coronally advanced flap with
enamel matrix derivative for root coverage: a RCT using 3D digital measuring methods. Part I. Clinical and patient-centred outcomes. Journal of
Clinical Periodontology 41, 582-592.
 6 Winter 2018

FOCUS

EFP launches science-based

outreach projects with its partners
The EFP has launched two educational projects – on oral health and pregnancy, and on
periodontal disease and caries – with its partners Oral-B and Colgate. The projects provide clear
information, derived from evidence-based science, in various formats aimed at different groups.
Both initiatives are based professionals, other health its partners and with its The EFP is discussing similar
around dedicated websites professionals, researchers, national-society members projects with its other partners.
that house detailed, fully policymakers, and patients. to the wider benefit of The next one in the pipeline will
referenced scientific reports “These projects are a great patients and society at large,” be produced in partnership with
as well as brochures aimed example of how the EFP can said Gernot Wimmer, EFP Sunstar and will be devoted to
at groups such as oral-health work at the same time with president. periodontal disease and diabetes.

Oral Health
Perio & Caries
& Pregnancy The EFP project Perio &
Caries (perioandcaries.efp.
Oral health is of fundamental
org), developed in partnership
importance during pregnancy
with Colgate, builds on the
because periodontal disease
outcomes of Perio Workshop
has been linked to various
2016, devoted to “The
complications including
boundaries between dental
preterm birth, low birth weight,
caries and periodontal disease”
and pre-eclampsia.
and organised by the EFP and
The Oral Health & Pregnancy ORCA (European Organisation
project (oralhealthandpregnancy. for Caries Research).
efp.org), produced in partnership
This workshop, involving
with Oral-B, offers information the incidence of adverse
75 leading cariologists and • The role played by genetics in
and advice based on scientific pregnancy outcomes;
periodontists, reviewed the initiation and progression
reports covering women’s
• In terms of affecting adverse all available evidence on
oral health during pregnancy, of both diseases;
pregnancy outcomes, it may common links between these
treating periodontal disease • Longitudinal design studies
be more effective to provide preventable oral conditions.
during pregnancy, and the to better explore causality;
periodontal intervention
biological mechanisms between The Perio & Caries project
before conception; • Further analysis of existing
periodontal diseases and report The boundaries between
pregnancy. • Clinical studies suggest that caries and gum disease, epidemiological data to
bacteria from the mouth compiled by Professor Nicola determine the effect of
Key points from these reports common risk factors;
colonise the foetus and West from the workshop’s
include: the placenta, with blood as consensus reports, emphasises • Research to improve
• The mouth is one of the the most likely vehicle of that periodontal diseases and understanding of potentially
main areas involved in the transmission; dental caries are the most modifiable risk factors;
physiological and hormonal common non-communicable
• Further co-ordinated • Properly designed
changes that take place diseases in mankind and the
research is needed. randomised controlled trials
during pregnancy; main cause of tooth loss.
addressing the simultaneous
“Women’s oral health during
• Pregnant women can be The dental biofilm is a major management of gingivitis
pregnancy is very important,
affected by pregnancy biological determinant and dental caries;
not only for its possible
gingivitis, granuloma common to the development
impact on delivery – and thus • Epidemiological surveillance
gravidarium (pregnancy of both diseases, which share
the possibility of preventing in older populations and
tumour), and periodontitis; common risk factors and social
complications – but also for studies assessing the impact
determinants.
• Research shows that non- the oral health of pregnant of elderly comorbidities
surgical periodontal therapy women themselves,” said The report recommends in delivering effective
during the second trimester is Professor Mariano Sanz, who various areas for future oral-health preservation
safe – but it does not reduce co-ordinated the project. research including: strategies.
Winter 2018 7

Latest research from the EFP’s

Journal of Clinical Periodontology
The Journal of Clinical Periodontology (JCP) is the official scien- The journal is aimed primarily at clinicians, general practitioners,
tific publication of the European Federation of Periodontology. periodontists, as well as teachers and administrators involved in
Edited by Maurizio Tonetti, the JCP aims to convey scientific the organisation of prevention and treatment of periodontal di-
progress in periodontology to those concerned with applying sease. The JCP is published monthly and has an impact factor of
this knowledge for the benefit of the dental health of the 3.477. The six articles summarised below were published in the
community. JCP between November 2017 and February 2018..

EFP/IDF CONSENSUS

Scientific evidence on the links between periodontal diseases and diabetes:

Consensus report and guidelines of the Perio-Diabetes Workshop
This article presents the consensus (glycated haemoglobin, HbA1C). Mechanistic links between periodontitis Authors: Mariano Sanz, Antonio
report and guidelines of the joint There is strong evidence that and diabetes involve elevations in Ceriello, Martin Buysschaert, Iain
workshop on periodontal diseases interleukin (IL)-1-β, tumour necrosis Chapple, Ryan T. Demmer, Filippo
people with periodontitis have
and diabetes held by the EFP factor-α, IL-6, receptor activator Graziani, David Herrera, Søren Jepsen,
elevated risk for dysglycaemia and Luca Lione, Phoebus Madianos,
and the International Diabetes insulin resistance. Cohort studies of nuclear factor-kappa B ligand/
Manu Mathur, Eduard Montanya, Lior
Federation (IDF) in Madrid in among people with diabetes osteoprotegerin ratio, oxidative Shapira, Maurizio Tonetti, and Daniel
February 2017. demonstrate significantly higher stress and Toll-like receptor (TLR) 2/4 Vegh.
This workshop updated the HbA1C levels in patients with expression.
Published in Journal of Clinical
evidence for the epidemiological periodontitis (versus periodontally The EFP and IDF provide consensus Periodontology Volume 45, Number 2
and mechanistic associations healthy patients), but there are guidelines for physicians, (February 2018).
between diabetes and insufficient data among people oral-healthcare professionals and
periodontitis and re-examined the with type-1 diabetes. Periodontitis patients to improve early diagnosis, Full article: http://
impact of effective periodontal is also associated with an prevention, and comanagement of onlinelibrary.wiley.com/
therapy upon metabolic control increased risk of type-2 diabetes. diabetes and periodontitis. doi/10.1111/jcpe.12808/full

PERIODONTAL DISEASES

At least three phenotypes exist among periodontitis patients 

This retrospective study sought based on their demographics, • Clusters B (n = 200) and C (n = 135) explored based on periodontal
to identify phenotypes of radiographic bone loss patterns, differed clearly in disease treatment outcomes and/or
periodontitis patients using and microbial data. severity patterns and smoking disease progression.
an unsupervised modelling The vast majority of patients fitted habits, but not in microbiological
technique (clustering), based on into one of the three main clusters characteristics. Authors: Chryssa Delatola, Bruno
pre-treatment radiographic and (accuracy 90%): The study concluded that, on G. Loos, Evgeni Levin, and Marja L.
microbiological characteristics. Laine.
•C luster A (n = 18) was characterised the basis of alveolar bone loss
The study included data from 392 by high prevalence and high patterns and microbiological data, Published in Journal of Clinical
untreated periodontitis patients. A untreated periodontitis patients Periodontology Volume 44, Number 11
proportions of Aggregatibacter
(November 2017).
co-regularised spectral clustering actinomycetemcomitans, a trend can be clustered into at least three
algorithm was used to cluster the for a more localised pattern of phenotypes. These results should Full article: http://
patients. The resulting clusters alveolar bone loss, and young be validated in other cohorts, and onlinelibrary.wiley.com/
were subsequently characterised individuals. the clinical utility needs to be doi/10.1111/jcpe.12797/full

PERIODONTAL DISEASES

Natural history of periodontitis: Disease progression and tooth loss over 40 years
This study assessed long-term PTL over 40 years varied between and progression to advanced Authors: Christoph A. Ramseier, Age
attachment and periodontitis- 0 and 28 teeth (mean 13.1). Four disease. Anerud, Mary Dulac, Martina Lulic, Mary
related tooth loss (PTL) in subjects presented with no PTL, P. Cullinan, Gregory J. Seymour, Malcolm
These results highlight the J. Faddy, Walter Bürgin, Marc Schätzle,
untreated periodontal disease while 12 were edentulous. Logistic
importance of treating early and Niklaus P. Lang.
over 40 years. regression revealed attachment
periodontitis along with smoking
loss as a statistically significant Published in Journal of Clinical
The data used originated from the cessation in those under 30 years
covariate for PTL (p < .004). Markov Periodontology Volume 44, Number 12
natural-history-of-periodontitis of age. They further show that (December 2017).
chain analysis showed that smoking
study in Sri Lankan tea labourers calculus removal, plaque control,
and calculus were associated
first examined in 1970. In 2010, 75 and the control of gingivitis are
with disease initiation and that Full article: http://online-
subjects (15.6%) of the original essential in preventing disease
cohort were re-examined.
calculus, plaque, and gingivitis were
progression, further loss of library.wiley.com/doi/10.1111/
associated with loss of attachment jcpe.12782/full
attachment, and tooth loss.
 8 Winter 2018

EFP full-member societies

Latest research Austria
 Österreichische Gesellschaft für
Parodontologie

PERIODONTAL DISEASES Belgium

 Société Belge de Parodontologie /
Belgische Vereniging voor Parodontologie
Patterns of periodontal disease progression based on Croatia Hrvatsko Parodontološko Društvo
linear mixed models of clinical attachment loss Czech
 Republic Ceská Parodontologická
This longitudinal cohort study examined Progression occurred primarily at molars Spolecnost
patterns of periodontal-disease progression (50% of progressing sites) and inter-proximal
Denmark Dansk Parodontologisk Selskab
at progressing sites and subjects defined sites (72%), affected a higher proportion
using linear mixed models (LMM) of clinical of deep than shallow sites (2.7% versus Finland Suomen Hammaslääkäriseura Apollonia
attachment loss (CAL). 0.7%), and pocketing was the main mode of France Société Française de Parodontologie et

progression (49%). d’Implantologie Orale
A total of 113 periodontally healthy and 302
periodontitis subjects had their CAL calculated Authors: Ricardo Teles, Kevin Moss, John S. Preisser, Germany Deutsche Gesellschaft für

Robert Genco, William V. Giannobile, Patricia Corby,
bimonthly for 12 months. LMMs were fitted Parodontologie
Nathalia Garcia, Heather Jared, Gay Torresyap, Elida
for each site and the predicted CAL levels
Salazar, Julie Moya, Cynthia Howard, Robert Schifferle, Greece Ελληνική Περιοδοντολογική Εταιρεία
used to categorise their progression state. Karen L. Falkner, Jane Gillespie, Debra Dixon, and
Participants were grouped based on the Hungary
 Magyar Parodontológiai Társaság
MaryAnn Cugini.
number of progressing sites into “unchanged”, Published in Journal of Clinical Periodontology Volume Ireland Irish Society of Periodontolgy
“transitional”, and “active” subjects. Patterns of 45, Number 1 (January 2018). Ireland Irish Society of Periodontolgy
periodontal disease progression were explored Full article: http://onlinelibrary.wiley. Israel Israeli Society of Periodontology and
using descriptive statistics. com/doi/10.1111/jcpe.12827/full
Osseointegration
Italy
 Società Italiana di Parodontologia e
PERIODONTAL THERAPY Implantologia

Surgical treatment of peri-implantitis: Three-year results Netherlands

 Nederlandse Vereniging voor
Parodontologie
from a randomised controlled clinical trial 
Norway Norsk periodontist forening
This study reports on the three-year follow- Differences between groups were explored by
Poland Polskie Towarzystwo Periodontologiczne
up of patients enrolled in a randomised regression analysis.
controlled clinical trial on surgical treatment Portugal
 Sociedade Portuguesa de
Implant-surface characteristics had a
of advanced peri-implantitis. Periodontologia e Implantologia
significant impact on three-year outcomes,
A hundred patients with advanced in favour of implants with non-modified Romania
 Societatea de Parodontologie din
peri-implantitis were randomly assigned surfaces. The benefits of systemic antibiotics Romania
to one of four treatment groups. Surgical were limited to implants with modified Serbia Udruzenje Parodontologa Srbije
therapy aiming at pocket elimination surfaces and to the first year of follow-up.
was performed and, in three test groups,  lovenia Združenje za ustne bolezni,
S
Authors: Olivier Carcuac, Jan Derks, Ingemar Abrahamsson,
supplemented by either systemic antibiotics, Jan L. Wennström, Max Petzold, and Tord Berglundh. parodontologijo in stomatološko implantologijo
the use of an antiseptic agent for implant- Published in Journal of Clinical Periodontology Volume 44, Spain
 Sociedad Española de Periodoncia y
surface decontamination, or both. Outcomes Number 12 (December 2017). Osteointegración
were evaluated after one and three years Full article: http://onlinelibrary.wiley.
com/doi/10.1111/jcpe.12813/full Sweden Svenska Parodontolog föreningen
through clinical and radiological examinations.
Switzerland
 Société Suisse de Parodontologie /
Schweizerisch Gesellschaft für Parodontologie /
IMPLANT THERAPY Società Svizzera di Parodontologia

Occurrence of cases with peri-implant mucositis Turkey Türk Periodontoloji Dernegi

or peri-implantitis in a 21-26 years follow-up study  United

 Kingdom British Society of
Periodontology
This longitudinal case series sought to two of 12 individuals. Individuals with ≥3
determine the prevalence and development implants at examination II were at risk for
of peri-implant mucositis and peri-implantitis
and to assess risk factors over time.
peri-implantitis at examination III (P< 0.05).
EFP associate-member societies
The diagnosis and occurrence of
A total of 218 of 294 patients who had peri-implantitis and peri-implant mucositis
Azerbaijan
 Azərbaycan Parodontologiya
received dental implants between 1988 and were high. Healthy conditions at implants
Cəmiyyəti
1992 were examined between 2000 and after 9-14 years were predictive of future
2002, and 86 individuals were re-examined implant health. Lithuania Lietuvos Periodontolog Draugija
20-26 years after the first examination. The Authors: Stefan Renvert, Christel Lindahl, and Gösta Morocco
 Société Marocaine de Parodontologie
diagnosis of peri-implant mucositis and peri- Rutger Persson. et d’Implantologie
implantitis at examination III was 54.7% and Published in Journal of Clinical Periodontology Volume 45, Russia Российской Пародонтологической
22.1%, respectively. Number 2 (February 2018). Ассоциации
Surgical treatment of peri-implantitis after Full article: http://onlinelibrary.wiley. Ukraine Асоціація лікарів-пародонтологів
com/doi/10.1111/jcpe.12822/full 
examination II resulted in a bone gain for
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