Endo-periodontal lesions(EPLs)involve both the periodontium and pulp tissue and have complicated etiologies and pathogenic mechanisms,including unique anatomical and microbiological characteristics and multiple contributing factors.This etiological complexity leads to difficulties in determining patient prognosis,posing great challenges in clinical practice.Furthermore,EPL-affected teeth require multidisciplinary therapy,including periodontal therapy,endodontic therapy and others,but there is still much debate about the appropriate timing of periodontal therapy and root canal therapy.By compiling the most recent findings on the etiology,pathogenesis,clinical characteristics,diagnosis,therapy,and prognosis of EPL-affected teeth,this consensus sought to support clinicians in making the best possible treatment decisions based on both biological and clinical evidence.

Objective:To investigate the status quo of human resources of dentists who deal with periodontal disease in Beijing area through an online survey, which may hopefully provide a preliminary basis for the decision-making of administrative departments and the formulation of periodontal professional development plan.Methods:The dentists who deal with periodontal disease at least half a day per week in Beijing area were investigated. A questionnaire was designed by the chairman of the Periodontology Committee of Beijing Stomatological Association. The questionnaire was sent to and finished by the dentists via "WenJuanXing" online survey software. The contents of the survey included general condition, the property of practice unit, title and position of the dentist, membership of professional society, time and content of periodontal treatment, adoption of new technology and new method of periodontal therapy during the past one year, status of periodontal treatment in the local population and reasons, understanding and influencing factors of periodontal professional development.Results:A total of 1 255 dentists completed the survey, who came from all 16 districts in Beijing, mainly Haidian, Chaoyang, Dongcheng and Xicheng Districts [The total percentage of these four main districts was 70.3% (882/1 255)]. The mean age of the dentists was (36.1±8.3) years. Among the dentists, 71.1% (892/1 255) were females, 88.1% (1 106/1 255) got a Bachelor′s degree or above. It was estimated that 35.4% (444/1 255) of the dentists had received standardized periodontal training ever. The percentage of dentists carrying out new technology in the past one year was as high as 68.1% (855/1 255). There were only 163 periodontal specialists (13.0%) out of the dentists in the survey. Only 15.9% (200/1 255) of the dentists routinely performed periodontal surgery. The majority of the dentists [82.8% (1 039/1 255)] were from the state-owned hospitals. Fifty-four point seven percemt (686/1 255) of the dentists thought that lack of knowledge was the main reason why the general public failed to receive periodontal treatment. As for the biggest bottleneck affecting periodontal professional development, fifty-one point zero percent (640/1 255) of the dentists attributed it to the public neglect.Conclusions:The periodontal practitioners in Beijing are young, highly educated, unevenly distributed in 16 districts and mostly females. State-owned oral health institutions are an important force in periodontal diagnosis and treatment services in Beijing. The number of periodontal specialists need to be improved. Promotion of standardized periodontal surgery and the popularization of healthcare knowledge on periodontal disease should also be the focus in the future.

Objective: To compare the efficacies of two training protocols, i.e. the multimedia instruction and the conventional method, in periodontal surgery teaching for undergraduate students. Methods: One hundred and twenty-three dental undergraduates in their pre-clinical training course were recruited and divided into two groups according to the learning grade matching principle: the experimental group (multimedia instruction, 60 students) and the control group (conventional method, 63 students). The teaching aim was to train the students gingivectomy and periodontal flap surgery by using the pig jaws. The conventional teaching method of teacher-demonstrating and student-practicing was used in the control group, and the practice time of the students′ for each surgery was 45 minutes. A standardized teaching video combined with the teachers′ explanations of the key steps was used in the experimental group. The students′ practice time for each surgery was 60 minutes. The efficacy of teaching protocol was evaluated by the teachers according to the scoring criteria set by the teaching group. Results: In gingivectomy training, accuracy of fixed points, angle of postoperative gingival margin and morphology of gingiva of the experimental group were better than those of the control group. The experimental group also had more complete and continuous excised gingivae and more thorough adjacent gingival removal. The total scores of the experimental group were significantly higher than those of the control group (92.8±2.6 vs. 89.9±3.7, P<0.05). In periodontal flap surgery training, the experimental group operated the blade around the shape of the tooth better in internal bevel incision than the control group. Additionally, the incision position of internal bevel incision, periosteal integrity after flapping and flap depth of the experimental group were better than those of the control group. Besides, the experimental group had smoother flap edge and more thorough debridement. The total scores of the experimental group were significantly higher than those of the control group (92.2±4.1 vs. 89.2±4.4, P<0.05). Conclusions The teaching efficacy of multimedia instruction was better than that of the conventional method. Its value needs to be further tested in future teaching practice.

It is complicated to decide the treatment plan of hopeless anterior teeth in esthetic zone due to severe periodontitis, periodontal-endodontic combined lesion or teeth trauma.The optional treatment plan for this kind of teeth includes retention after periodontal treatment, extraction and implant treatment, extraction and prosthodontic treatment and so on.To make an appropriate treatment plan, patients'' periodontal conditions, periodontal biotype, local anatomy, esthetic demand, economic condition and social psychological status should be comprehensively considered.A combine of periodontal, endodontic and orthodontic therapy may achieve a good treatment effect in hopeless anterior teeth with severe periodontal destruction, tooth extrusion and occlusal trauma.In this case, a 20-year-old female who presented with symptoms of bleeding on brushing and upper incisors loosening for 1 month came to the Department of Periodontology, Peking University School and Hospital of Stomatology.The clinical examinations revealed that the patient''s right upper incisor had signs of mobility (Ⅲ°), intrusion of 1-2 mm, and probing depth (PD) of 9-10 mm.The periapical radiograph showed that the alveolar bone of right upper incisor absorbed horizontally to the apex.And the patients showed Angle Ⅱ° malocclusion with Ⅱ° overbite in anterior teeth and maxillary protrusion.A diagnosis of aggressive periodontitis and Angle Ⅱ° malocclusion was made.The treatment of this patient lasts for 5 years which include periodontal initial therapy, orthodontic therapy, guided tissue regeneration (GTR) of right upper incisor and supportive periodontal therapy and the clinical result is fine.A hopeless upper incisor was successfully retained and the longtime clinical condition was stable.The strategy of retention of hopeless upper anterior teeth, the relationship of periodontal treatment and orthodontic treatment, and the indications of periodontal and orthodontic combined therapy were also discussed on the basis of this case.Generally, the positive factors in retention of hopeless teeth includes young age, absence of systemic conditions, strong motivation for maintaining the tooth, single root anatomy, integrated dentition, good response to cause-related therapy, intrabony alveolar bone defect, thick periodontal biotype, and regular supportive periodontal therapy.And in the progress of orthodontic therapy, regular supportive periodontal therapy and good plaque control is extremely important.

Periodontitis could be categorized as mild, moderate, and severe according to the severity of the disease. This categorizing system could also be used together with other classification systems. The present article introduced the status about the case definition of severe periodontitis, including the standard of case definitions for surveillance of periodontitis reported by the Centers for Disease Control and Prevention (CDC) in partnership with the American Academy of Periodontology (AAP) and the consensus report on the definition of periodontitis case for use in risk factor research by Europe workshop. A consensus on the state of the art definition of severe periodontitis for use in clinical work was gained base on the expertise of Chinese Society of Periodontology, Chinese Association of Stomatology. The background of this consensus and the significance of the criteria for the case definition were discussed.

Objective To compare the clinical effects of periodontal treatment using periodontal endoscope with that of conventional treatment method for patients with periodontitis.Methods Eleven periodontal patients with moderate to advanced periodontal destruction were recruited and treated with scaling and root planing in a split-mouth design randomly with (test group) or without (control group)periodontal endoscope.Changes of such clinical parameters as plaque index (PLI),bleeding index (BI),probing depth (PD) and attachment loss (AL) before and after treatments as well as the difference between test and control groups were examined and compared.Results Both groups showed significant reductions in PD,BI and AL values at 6 weeks and 3 months after treatment (P ＜ 0.001).Only in the test group,for sites with PD≥6 mm at baseline,PD value ([4.0±1.2] mm) and AL value ([3.8±0.9] mm) at the end of 3 months were significantly lower than that at the end of 6 weeks (PD[4.4± 1.3] mm,P ＜ 0.00 I;AL[4.1± 1.1] mm,P ＜0.05).There were no significant differences between two groups at the baseline,at the end of 6 weeks and 3 months,respectively.However,for the sites with PD≥6 mm in anterior teeth,PD value in test group at the end of 3 months was significantly lower than that in control group ([3.2±0.9] mm vs [3.7±0.9] mm,P ＜ 0.05),while AL value tend to be lower ([2.9± 1.2] mm vs [3.6± 1.3] mm,P=0.061).Conclusions Periodontal treatment using endoscope is obviously effective,especially for the medium and long term prognosis of deep pockets and single rooted teeth.

Objective: To investigate molecular mechanism involved in nicotine in combination with Porphyromonas gingivalis ( P.g ) caused monocyte-endothelial cell adhesion .Methods: The effect of nicotine, P.g-lipopolysaccharide (P.g-LPS) and their combination on the proliferation of U 937 cells was determined by CCK-8 method .Interleukin-6 ( IL-6 ) expression was investigated by Real-time PCR after U937 cells were treated with nicotine , P.g-LPS and their combination .In human umbilical vein endothe-lial cells ( HUVECs ) , the expressions of monocyte chemoattractant protein CCL-8 and adhesion mole-cules including vascular cell adhesion molecule 1 ( Vcam-1 ) , very late antigen 4 alpha ( VLA4α) , tumor necrosis factor receptor superfamily member 4 ( OX40) and OX40 ligand ( OX40L) were detected by Real-time PCR or Western blotting assays after HUVEC cells were treated with nicotine , P.g-LPS and their combination .Adhesion of monocytes to endothelial cells was detected after the HUVECs and U 937 cells were stimulated with nicotine , P.g-LPS and their combination, respectively.Results:P.g-LPS did not affect the proliferative ability of nicotine in U 937 cells.However, the ability of P.g-LPS induced IL-6 expression was inhibited by 100 μmol/L nicotine in U937 cells.In HUVECs, the expressions of CCL-8, Vcam-1, VLA4α, OX40 and OX40L were significantly up-regulated by nicotine and P.g-LPS combi-nation compared with nicotine alone , P.g-LPS alone and the untreated control .Adhesion of monocytes to HUVECs results showed that the two types of cells treated with nicotine in combination with P.g-LPS could markedly increase the adhesion ability of monocytes to HUVECs .Conclusion:P.g-LPS in combi-nation with nicotine could recruit monocytes to endothelial lesion through up-regulation of CCL-8, and promote adhesion of monocytes to endothelial cells through enhancement of Vcam -1/VLA4αand OX40/OX40L interactions, which could be involved in the initiation and development of atherosclerosis .

Humans ; Orthodontics ; methods ; Periodontium ; injuries

Objective To evaluate the accuracy of partial-mouth periodontal examination(PMPE) protocols frequently used in epidemiological periodontal surveys.Methods Articles in English or Chinese published before Jan 31st 2014 were searched,which compared the results of PMPE protocols with those of gold-standard protocol,i.e.full-mouthmesialbuccal-midbuccal-distobuccal-mesiolingual-midlingual-distolingual (MB-B-DB-ML-L-DL) protocol.Results Twelve articles were included and nine that frequently used PMPE protocols were evaluated.All these protocols underestimated the prevalence scores.For prevalence of probing depth(PD) ≥4 mm,6 mm and attachment loss(AL) ≥4 mm,6 mm,smaller amount of underestimation was observed in community periodontal index of treatment needs(CPITN) teeth (-12.6％--3.5％),full-mouth MB-B-DB(-16.1％--3.5％),full-mouth MB-B-DL(-10.8％--6.1％) and half-mouth MB-B-DB-ML-L-DL(-23.6％--2.0％) protocols.For severity and extent estimates,half-mouth MB-B-DB-ML-L-DL provided lowest biased results(relative bias:-1.0％-1.1％ for severity and-6.7％-0.1％ for extent).Full-and half-mouth MB-B-DB also performed well,with relative bias within ±5.0％ in most cases.CPITN overestimated the severity and extent of periodontal disease,the relative bias of which amounted to 42.3％ and 38.1％,respectively.Conclusions Half-mouth MB-B-DB-ML-L-DL and full-mouth MB-B-DB protocols caused lower biased results in prevalence,severity and extent estimates of PD and AL.