Percorrer por autor "Chambrone, Leandro"
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- American Academy of Periodontology best evidence consensus statement on the use of biologics in clinical practicePublication . Avila-Ortiz, Gustavo; Ambruster, Jeanne; Barootchi, Shayan; Chambrone, Leandro; Chen, Chia-Yu; Dixon, Douglas R.; Geisinger, Maria L.; Giannobile, William V.; Goss, Katie; Gunsolley, John C.; Heard, Rick H.; Kim, David M.; Mandelaris, George A.; Monje, Alberto; Nevins, Marc L.; Palaiologou-Gallis, Angela; Rosen, Paul S.; Scheyer, E. Todd; Suarez-Lopez del Amo, Fernando; Tavelli, Lorenzo; Velasquez, Diego; Wang, Hom-Lay; Mealey, Brian L.A biologic is a therapeutic agent with biological activity that is administered to achieve an enhanced regenerative or reparative effect. The use of biologics has progressively become a core component of contemporary periodontal practice. However, some questions remain about their safety, indications, and effectiveness in specific clinical scenarios. Given their availability for routine clinical use and the existing amount of related evidence, the goal of this American Academy of Periodontology (AAP) best evidence consensus (BEC) was to provide a state-of-the-art, evidence-based perspective on the therapeutic application of autologous blood-derived products (ABPs), enamel matrix derivative (EMD), recombinant human platelet-derived growth factor BB (rhPDGF-BB), and recombinant human bone morphogenetic protein 2 (rhBMP-2). A panel of experts with extensive knowledge on the science and clinical application of biologics was convened. Three systematic reviews covering the areas of periodontal plastic surgery, treatment of infrabony defects, and alveolar ridge preservation/reconstruction and implant site development were conducted a priori and provided the foundation for the deliberations. The expert panel debated the merits of published data and exchanged experiential information to formulate evidence-based consensus statements and recommendations for clinical practice and future research. Based on an analysis of the current evidence and expert opinion, the panel concluded that the appropriate use of biologics in periodontal practice is generally safe and provides added benefits to conventional treatment approaches. However, therapeutic benefits and risks range based on the specific biologics used as well as patient-related local and systemic factors. Given the limited evidence available for some indications (e.g., gingival augmentation therapy, alveolar ridge preservation/reconstruction, and implant site development), future clinical studies that can expand the knowledge base on the clinical use of biologics in periodontal practice are warranted.
- Antibiotic therapy for the prevention of osteoradionecrosis following tooth extraction in head-and-neck cancer patients postradiotherapy : An 11-year retrospective studyPublication . Palma, Luiz Felipe; Marcucci, Marcelo; Remondes, Cíntia Maria; Chambrone, LeandroIntroduction: One of the most important complications of radiotherapy (RT) for head-and-neck cancer (HNC) is osteoradionecrosis (ORN) of the jaws, which mostly arises from tooth extractions. The ORN treatment still represents a great challenge; therefore, the prevention is of paramount importance. Thus, the present study aimed to evaluate retrospectively a perioperative systemic antibiotic therapy protocol for the prevention of ORN following tooth extraction in head-and-neck patients post-3D conformal RT. Materials and Methods: A retrospective medical record review was performed considering HNC patients submitted to RT in the period between 2008 and 2019. They necessarily received oral antibiotic therapy with Clindamycin 300 mg every 8 h for 10 days, with the first dose 3 days before the tooth extraction. Results: Forty-nine patients met the study criteria, with a total of 107 teeth extracted. Regarding the 47 patients who did not develop ORN, 103 tooth extractions were identified (96.3%). Only two patients developed ORN at two adjacent teeth sites (3.7%). Conclusion: The proposed perioperative systemic antibiotic therapy protocol seems to be efficient to prevent ORN following tooth extraction in postirradiated HNC patients.
- Clinical efficacy of adjunctive methods for the non-surgical treatment of peri-implantitis : a systematic review and meta-analysisPublication . Barbato, Luigi; Cavalcanti, Raffaele; Rupe, Cosimo; Scartabelli, Daniele; Serni, Lapo; Chambrone, Leandro; Cairo, FrancescoBackground: The aim of this systematic review (SR) was to evaluate the clinical efficacy of different adjunctive methods/therapies to the non-surgical treatment (NST) of peri-implantitis. Materials and methods: The protocol of the review was registered in PROSPERO database (CRD42022339709) and was designed according to PRISMA statement. Electronic and hand searches were performed to identify randomized clinical trials (RCTs) comparing non-surgical treatment of peri-implantitis alone versus NST plus any adjunctive method/treatment. The primary outcome was probing pocket depth (PPD) reduction. Results: Sixteen RCTs were included. Only 2 out of 1189 implants were lost and follow-up ranged from 3 to 12 months. PPD reduction across the studies varied from 0.17 to 3.1 mm, while defect resolution from 5.3% to 57.1%. Systemic antimicrobials were associated to higher PPD reduction (1.56 mm; [95% CI 0.24 to 2.89]; p = 0.02) with high heterogeneity, and treatment success (OR = 3.23; [95% CI 1.17 to 8.94]; p = 0.02), compared to NST alone. No differences were found with adjunctive local antimicrobials and lasers for PPD and bleeding on probing (BoP) reduction. Conclusions: Non-surgical treatment with or without adjunctive methods may reduce PPD and BoP even if complete resolution of the pocket is unpredictable. Among possible adjunctive methods, only systemic antibiotics seems to provide further benefits, but their usage should be considered with caution.
- Comparative assessment of Cochrane’s ROB and ROB2 in dentistry trials : a meta-research studyPublication . Viana, João; Machado, Vanessa; Proença, Luís; Chambrone, Leandro; Mendes, José João; Botelho, JoãoThis meta-research study aimed to compare the assessment of Cochrane’s Risk of Bias (RoB) and RoB2 tools in dentistry trials. A sample 150 in vivo randomized clinical trials published between 2020 and 2022 was randomly selected from PubMed/Medline, Scopus, and EMBASE databases (50 per year). For each study, the impact factor, journal quartile, adherence to CONSORT guidelines, date information availability, and study model were recorded. The results showed that 33.3% of the studies were categorized as low risk of bias by both RoB and RoB2. However, 29.6% of the studies classified as low risk by RoB were downgraded to some concerns in RoB2, and 37% were downgraded to high risk. In the some concerns category, 25.9% were upgraded to low risk, 37% remained constant, and 37% were downgraded to high risk in RoB2. Among the high risk studies, 14.6% were upgraded to low risk, 26% to some concerns, and 59.4% remained constant in RoB2. The level of agreement between RoB and RoB2 was found to be low for dental studies. These findings highlight the differences between the two tools and the potential impact on the synthesis of evidence and decision-making processes in dental research.
- Diagnostic reproducibility of the 2018 Classification of Gingival Recessions : comparing photographic and in-person diagnosesPublication . Gianfilippo, Riccardo Di; Prato, GiovanPaolo Pini; Franceschi, Debora; Castelluzzo, Walter; Barbato, Luigi; Bandel, Alessandra; Martino, Maria Di; Pannuti, Claudio M.; Chambrone, Leandro; Cairo, FrancescoBackground: To assess how the diagnostic reproducibility of the 2018 Classification of Gingival Recession Defects (GRD) could be applied when comparing in-person chairside measurements with photographic measurements. Methods: Thirty-four GRD were photographed and evaluated by 4 masked operators. For each case, the operators measured twice recession type (RT), recession depth (RD), keratinized tissue width (KTW), gingival thickness (GT), detectability of the cemento–enamel junction (CEJ), and presence of root steps (RSs), chairside, and on photographs. Intraclass correlation coefficient (ICC) with 95% confidence intervals (CI) was calculated for RD and KTW; Kappa with 95% CI was used for GT, CEJ, and RS; quadratic weighted Kappa with 95% CI was used for RT. Results: RD, KTW, and RT showed excellent overall intra-operator agreement (> 0.93), and from good to excellent overall inter-operator agreement (> 0.80), for both clinical and photographic measurements. Agreements were lower for GT, CEJ, and RS. Overall clinical and photographic agreements were within 0.1 difference for every variable, except for inter-operator agreement for RS which was 0.72 for clinical measurements and 0.45 for photographic measurements. The lowest overall agreement between clinical versus photographic measurements existed for CEJ (0.28) and RS (0.35). Conclusions: Variables composing the 2018 Classification of GRD are reproducible, both clinically and on photographs, with comparable agreements. The overall agreement was higher for KTW, RD, and RT, and lower for GT, CEJ, and RS, for both clinical and photographic measurements. The comparison between chairside and photographic evaluations indicated fair to excellent agreement for most variables, with CEJ and RS showing fair agreement.
- Effect of suturing in root coverage via coronally advanced flaps : a systematic reviewPublication . Ariceta, Alina; Chambrone, Leandro; Stuhr, Sandra; Couso-Queiruga, EmilioBackground: To analyze the evidence about the influence of the suturing technique and material in terms of the percentage of mean root coverage (%MRC) following root coverage therapy in teeth diagnosed with single/localized gingival recession defects (GRD) via a monolaminar coronally advanced flap. Methods: The protocol of this systematic review was registered in PROSPERO (CRD42024514043). A literature search was conducted to identify investigations that fulfilled the eligibility criteria. Variables of interest were extracted, subsequently categorized, and qualitatively analyzed. Results: A total of 15 randomized clinical trials, including 301 localized GRD in non-molar sites classified as Miller class I-II/RT1, in 253 patients were included. The studies reporting the combination of sling and single interrupted sutures, or interrupted sutures alone showed an MRC of 70.2%±16.6%, and 74.1%±0.75%, respectively. The highest MRC was observed in the studies using polyglactin 910 with a pooled value of 76.6% ± 15.3%, and monofilament materials, with a pooled MRC of 74.8%±7.1%. When the suturing diameter was evaluated, the highest pooled MRC with values of 79.1%±9.8% was observed with the use of 5-0. Conclusions: For the treatment of single/localized GRD in non-molar sites via a monolaminar coronally advanced flap, the use of a combination of sling and single interrupted sutures, or single interrupted sutures, polyglactin 910 or monofilament materials, and material diameter of 5-0 showed a higher MRC as compared to the use of expanded polytetrafluoroethylene, and silk with/without dressing, and other suture diameters.
- Evidence-based rationale for the management of mucogingival deformities before or after orthodontic treatmentPublication . Chambrone, Leandro; Zadeh, Homayoun H.Objective: this review aims to explore key aspects related to the treatment of gingival recession defects (GRD) and sites lacking keratinized gingiva in orthodontic patients. It focuses on five crucial core aspects: 1) risk assessment for GRD development; 2) diagnosis, characteristics, and the dilemma surrounding GRD treatment necessity; 3) the evolution of root coverage procedures and the significance of modifying soft tissue phenotype for gingival margin stability; 4) the development and progression of gingival recessions in orthodontic patients; and 5) the staging of orthodontic and periodontal therapies; specifically, the consideration of preemptive soft tissue phenotype modification (STPM) or treatment of GRD. Overview and Conclusions: the management of GRD and sites lacking gingiva or with a thin mucosal phenotype, as well as the staging of periodontal and orthodontic treatment, should be guided by the positioning of the tooth within the alveolar bone envelope and the periodontal phenotype. In cases where the gingival phenotype is thin (< 1 mm), with or without GRD, it is advisable to perform preemptive soft tissue augmentation (PMT) prior to orthodontic treatment if the tooth is located within the alveolar bone envelope. Conversely, if the tooth is positioned outside the alveolar bone housing, orthodontic tooth movement should be employed to reposition the tooth within the bone housing before any soft tissue augmentation procedure is performed. Research has demonstrated a negative correlation between tooth position and periodontal root coverage, whereas tooth repositioning has shown a two-fold positive effect: 1) improving the surrounding soft tissues by reducing or eliminating the defect, and 2) enhancing the implementation and wound healing dynamics of root coverage procedures.
- Histological assessment and gene expression analysis of intra-oral soft tissue graft donor sitesPublication . Stuhr, Sandra; Nör, Felipe; Gayar, Kareem; Couso-Queiruga, Emilio; Chambrone, Leandro; Gamborena, Iñaki; Kumar, Purnima; Avila-Ortiz, Gustavo; Ganesan, Sukirth M.Aim: To determine the structural and gene expression features of different intra-oral soft tissue donor sites (i.e., anterior palate, posterior palate, maxillary tuberosity and retromolar pad). Materials and Methods: Standardized mucosal tissue punch biopsies were collected from at least one donor site per subject. Histological processing was performed to determine tissue morphometry and quantify collagen composition. Site-specific gene distribution was mapped using targeted gene expression analysis and validated using real time polymerase chain reaction (qPCR). Results: A total of 50 samples from 37 subjects were harvested. Epithelial thickness did not differ between sites. However, lamina propria was thicker in the maxillary tuberosity (2.55 ± 0.92 mm) and retromolar pad (1.98 ± 0.71 mm) than in the lateral palate. Type I collagen was the predominant structural protein in the lamina propria (75.06%–80.21%). Genes involving collagen maturation and extracellular matrix regulation were highly expressed in the maxillary tuberosity and retromolar pad, while lipogenesis-associated genes were markedly expressed in the lateral palate. The retromolar pad showed the most distinct gene expression profile, and the anterior and posterior palate displayed similar transcription profiles. Conclusions: Tissue samples harvested from the anterior and posterior palate differed morphologically from those from the maxillary tuberosity and retromolar pad. Each intra-oral site showed a unique gene expression profile, which might impact their biological behaviour and outcomes of soft tissue augmentation procedures.
- Osseodensification versus lateral window technique for sinus floor elevation with simultaneous implant placement : a randomized clinical trial on patient-reported outcome measuresPublication . Gaspar, João; Botelho, João; Proença, Luís; Machado, Vanessa; Chambrone, Leandro; Neiva, Rodrigo; Mendes, José JoãoObjectives: To compare patient-reported outcome measures and additional surgical outcomes after sinus floor elevation (SFE) with osseodensification (OD) versus lateral window (LW), both with simultaneous implant placement. Materials and Methods: Twenty participants requiring single-implant rehabilitation with residual bone height (RBH) ≤4 mm were enrolled. Pain experience, quality of life (QoL) via the Oral Health Impact Profile-14 (OHIP-14), analgesics intake, and other symptoms were self-reported for a week on a daily basis. Surgery duration, complications, and implant stability quotient at baseline (ISQ T0) and after 6 months (ISQ T6) were registered. Participants were followed up for 1 year. Results: From Day 0 (day of surgery) to Day 3, pain experience was significantly lower (p < 0.05) in the OD group. OHIP-14 score was significantly lower (p < 0.05) in the OD group on all postoperative days, except on Day 5. Average analgesics intake was significantly lower (p < 0.001) in the OD group. Surgery mean duration was significantly higher (p < 0.001) in LW compared to OD (71.1 ± 10.4 vs. 32.9 ± 5.3 min). After osseointegration period, all implants were successfully restored with screw-retained crowns. Conclusions: Within the limitations of this study, it can be concluded that OD and LW techniques were similarly effective in SFE with simultaneous implant placement when RBH ≤ 4 mm. However, OD significantly outperformed LW in pain experience, impact on self-perceived QoL, surgery duration, postoperative edema, and analgesics intake.
- Outcome measures and methods of assessment of soft tissue augmentation interventions in the context of dental implant therapy : a systematic review of clinical studies published in the last 10 yearsPublication . Avila-Ortiz, Gustavo; Couso-Queiruga, Emilio; Pirc, Miha; Chambrone, Leandro; Thoma, Daniel S.Aim: To identify and report outcome measures and methods of assessment on soft tissue augmentation interventions in the context of dental implant therapy reported in clinical studies published in the last 10 years. Materials and Methods: The protocol of this Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) 2020-compliant systematic review was registered in PROSPERO (CRD42021252214). A literature search was conducted to identify articles that met the pre-established eligibility criteria. Data of interest, with an emphasis on outcome measures, were extracted. For each outcome, specific methods and timing of assessment were described in detail. Following a critical qualitative analysis of the data, outcome measures were categorized. Primary outcomes were identified, and the frequency of reporting in the selected articles was calculated. Additionally, risk-of-bias assessments were performed for individual articles and primary outcomes. Results: Ninety-two articles, of which 39 reported randomized controlled trials (RCTs), 20 non-RCTs, and 33 case series studies, were selected. Outcome measures were categorized into either investigator-evaluated outcome measures (i.e., clinical, digital imaging, aesthetic, histological, biomarker, and safety) or patient-reported outcome measures (PROMs). Clinical outcomes were the most frequently reported type of outcome. Considering all categories, the most frequently reported primary outcomes were facial mucosa thickness assessed with clinical methods (22.83%), facial keratinized mucosa width assessed with clinical methods (19.57%), facial mucosal margin position/recession assessed with clinical methods (18.48%), facial mucosa thickness assessed with digital imaging methods (11.96%), facial soft tissue volume assessed with digital imaging methods (9.78%), and supracrestal tissue height assessed with clinical methods (9.78%). No distinguishable patterns of association between specific types or quality (level of bias) of clinical studies and the choice of primary outcomes were observed. Conclusions: Clinical research on peri-implant soft tissue augmentation has progressively increased in the last 10 years. Although clinical outcome measures were the most frequently reported outcomes in the selected literature, trends in the field are indicative of a shift from traditional clinical assessment methods to the use of digital technologies. PROMs were generally under-reported but should be considered an integral methodological component in future clinical studies.