Introduction: Chronic kidney disease (CKD) is associated with periodontal disease due to its hyperinflammatory state. Limited studies have explored the prevalence of periodontal disease among CKD patients in Malaysia. Objective: To assess the periodontal status of pre-dialysis CKD patients in Hospital Universiti Sains Malaysia. Methods: A total of 46 pre-dialysis CKD patients who attended the nephrology clinic at Hospital Universiti Sains Malaysia were enrolled in this study. Periodontal examination was performed using the periodontal probing depth (PPD), clinical attachment loss (CAL) and plaque index. Results: The majority of the CKD patients were Malay (95.7%) and 80.4% were males. The mean age of the patients was 58.5 years. Using PPD measurement, 37 (74.0%) of the patients had mild periodontitis, 9 (20.0%) had moderate periodontitis and 3 (6.0%) had no periodontitis. Based on CAL measurement, 12 (26%) patients had mild periodontitis, 29 (63.0%) had moderate periodontitis and 5 (11%) had severe periodontitis. The mean (standard deviation [SD]) value of mild and moderate-to-severe periodontitis by PPD measurement were 4.26 (0.26) and 5.24 (0.36), respectively. The mean of mild and moderate-to-severe periodontitis by CAL measurement were 2.66 (0.62) and 4.98 (0.73), respectively. There was no correlation between the periodontal parameters and estimated glomerular filtration rate (PPD: r = −0.160, P = 0.914; CAL: r = −0.135, P = 0.372; plaque index: r = 0.005, P = 0.974). Conclusion: This study revealed a greater prevalence and severity of chronic periodontitis among CKD patients. Thus, the periodontal health of CKD patients’ needs to be screened and monitored.

The vast range of treatment protocols available for non-surgical management of chronic periodontitis can affect the consistency of clinical decision-making for dentists. This is further compounded by the different case definitions for periodontitis used in various clinical studies. The aim of this paper is to describe the steps taken leading to an expert consensus of periodontitis case definition followed by the development of a clinical pathway for managing chronic periodontitis. To assist reaching a consensus on a standard case definition of periodontitis for clinical research, a roundtable discussion was held involving 13 dental specialists and researchers from universities and the Ministry of Health. Participants discussed clinical experiences in identifying periodontitis and related issues based on scientific evidence. A further expert panel discussion consisting of 8 periodontists was conducted at another session to review current management practices and evidence-based practices available from the literature and generated a clinical pathway for non-surgical management of periodontitis. The case definition derived from the roundtable discussion recognises differentiation of selected clinical parameters and their thresholds as well as the extent and severity of the periodontitis. As for the newly developed clinical pathway, experts collectively defined the appropriate goals to satisfy the multidimensional needs of the patients which are translated into detailed elements of care, including the sequence of events of patients at each dental visit over time. The agreed case definition will facilitate selection and recruitment of cases for clinical studies while the clinical pathway can be used to reduce variations between clinicians.
Case definitions ; clinical pathway ; periodontitis

The vast range of treatment protocols available for non-surgical management of chronic periodontitis can affect the consistency of clinical decision-making for dentists. This is further compounded by the different case definitions for periodontitis used in various clinical studies. The aim of this paper is to describe the steps taken leading to an expert consensus of periodontitis case definition followed by the development of a clinical pathway for managing chronic periodontitis. To assist reaching a consensus on a standard case definition of periodontitis for clinical research, a roundtable discussion was held involving 13 dental specialists and researchers from universities and the Ministry of Health. Participants discussed clinical experiences in identifying periodontitis and related issues based on scientific evidence. A further expert panel discussion consisting of 8 periodontists was conducted at another session to review current management practices and evidence-based practices available from the literature and generated a clinical pathway for non-surgical management of periodontitis. The case definition derived from the roundtable discussion recognises differentiation of selected clinical parameters and their thresholds as well as the extent and severity of the periodontitis. As for the newly developed clinical pathway, experts collectively defined the appropriate goals to satisfy the multidimensional needs of the patients which are translated into detailed elements of care, including the sequence of events of patients at each dental visit over time. The agreed case definition will facilitate selection and recruitment of cases for clinical studies while the clinical pathway can be used to reduce variations between clinicians.

The aim of this narrative review is to discuss on different approaches of the flapless corticotomy techniques to accelerate orthodontic tooth movement. There was limited understanding about the effect of the surgical procedures because of the great variations in the procedures between the flapless corticotomy techniques. Hence, no specific technique can be claimed to be superior to another. Eleven clinical trials have been reviewed from PubMed, Science Direct, and Google Scholar using the keywords such as accelerated, orthodontic tooth movement (OTM), minimally invasive corticotomy, RAP, corticision, piezocision, lasercision/laser assisted flapless corticotomy (LAFC), micro-osteoperforations (MOPs), discision and their combinations in the last 10 years. Early reports showed that Piezocision, MOPs and LAFC procedures are comparatively less aggressive flapless corticotomy procedure to accelerate OTM and more comfortable to the patient.