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© Borgis - Nowa Stomatologia 4/2018, s. 142-147 | DOI: 10.25121/NS.2018.23.4.142
Magdalena Batko1, Michał Kowalewski1, Anna Królińska1, Bartłomiej Górski2, Wioleta Majdanik2, *Andrzej Miskiewicz2
Comparison of the sensitivity of detecting risk factors for periodontitis using conventional radiography
Porównanie efektywności wykrywania czynników ryzyka zapalenia przyzębia przy użyciu metod konwencjonalnej radiografii
1Student’s Science Club, Department of Periodontal and Oral Mucosa Diseases, Medical University of Warsaw
Science Club Coordinator: Andrzej Miskiewicz, MD, PhD
2Department of Periodontal and Oral Mucosa Diseases, Medical University of Warsaw
Head of Department: Professor Renata Górska, MD, PhD
Streszczenie
Wstęp. Zapalenie przyzębia jest chorobą tkanek podtrzymujących ząb, które warunkują normę morfologiczno-czynnościową uzębienia ludzkiego. Kluczową rolę w rozwoju zapalenia przyzębia pełni biofilm bakteryjny, który akumuluje się w obecności czynników miejscowych. Wczesna i precyzyjna diagnostyka czynników ryzyka sprzyjających odkładaniu się płytki nazębnej stanowi podstawę leczenia oraz profilaktyki.
Cel pracy. Celem pracy jest ocena wpływu nawisających wypełnień na brzeg kości wyrostka zębodołowego szczęki i części zębodołowej żuchwy na podstawie zdjęć pantomograficznych. Ponadto dokonano korelacji pomiędzy rodzajem wypełnienia a wielkością ubytku kostnego.
Materiał i metody. Wykonano analizę retrospektywną 200 zdjęć pantomograficznych obrazujących wypełnienia w zębach stałych, przy użyciu programu Planmeca Romexis Viewer®. 113 zdjęć poddano dalszej analizie ze względu na obecność jednoimiennego zęba w łuku. W badaniu uwzględniono: wiek, płeć pacjentów, ogólny stan kości wyrostka zębodołowego szczęki lub części zębodołowej żuchwy, obecność i prawidłowość kontaktów z zębami przeciwstawnego łuku, stan zęba sąsiadującego z nawisem. Oceniono również rodzaj nieprawidłowego wypełnienia. Wyniki poddano analizie statystycznej, przyjmując poziom istotności p < 0,05.
Badanie uzyskało zgodę Komisji Bioetycznej WUM nr: KB/115/A/2012.
Wyniki. W przeprowadzonym badaniu uzyskano dane określające częstość występowania nawisów wypełnień, ich rozległości, rodzaju wypełnienia oraz ubytku, któremu towarzyszą. Największą wartość nawisu uzyskano przy wypełnieniach klasy II według Blacka MOD (1,15 mm; p < 0,03), przy ubytkach OD średnia wielkość nawisu była mniejsza (0,91 mm; p < 0,001). Uzyskano korelację dodatnią pomiędzy nawisem przy wypełnieniu MOD a wielkością defektu kostnego mierzonego na zdjęciu radiologicznym (R = 0,51; p = 0,03).
Wnioski. Przeprowadzone badanie wykazało istotną, dodatnią korelację pomiędzy średnią wielkością nawisu wypełnienia a ilością utraty kości mierzoną w badaniu radiologicznym. Dodatkowe badanie radiologiczne stanowi istotną pomoc w diagnostyce czynników ryzyka zapalenia przyzębia.
Summary
Introduction. Periodontitis is a condition of tooth supporting structures, which are responsible for normal dental morphology and function. Bacterial biofilm formation in the presence of local risk factors plays a fundamental role in the development of periodontitis. Early and accurate detection of risk factors which promote dental plaque accumulation is the basis of treatment and prophylaxis.
Aim. The aim of the study was to assess overhanging dental restorations and their impact on the maxillary alveolar process margin and the alveolar mandible based on panoramic radiography. Furthermore, the correlation between the type of restoration and the magnitude of bone loss was analysed.
Material and methods. A retrospective analysis of 200 panoramic radiographs showing restorations in permanent dentition was performed using the Planmeca Romexis Viewer software. Further analysis included 113 radiographs with the presence of a homologous tooth on the opposite side of the dental arch. In the study, we analysed the following variables: age, gender, the bone level, occlusal contact points between the opposite teeth and the condition of the tooth adjacent to overhanging dental restoration. We also assessed the type of incorrect dental restoration according to G.V. Black classification. The obtained data was analysed statistically, with p < 0.005 considered statistically significant.
The study was approved by the Bioethics Committee of the Medical University of Warsaw (approval no. KB/115/A/2012).
Results. We obtained data on the prevalence and magnitude of overhanging dental restorations, the type of restoration and the coexisting bone lesion. The largest size of the overhanging dental restoration was associated with Class II (according to G. V. Black) mesio-occlusal-distal cavities (1.15 mm; p < 0.03), whereas the smallest ones were observed for occlusal-distal cavities (0.91 mm; p < 0.001). The Spearman’s rank correlation coefficient between mesio-occlusal-distal cavities and radiographically measured size of bone lesions was positive (R = 0.51; p = 0.03).
Conclusions. The conducted study revealed a significant positive correlation between the mean size of overhangs and radiographically measured size of bone loss. Adjunctive radiology is an important aid in the detection of risk factors for periodontitis.
Introduction
Chronic periodontitis is an infectious disease responsible for the loss of both connective attachment and the alveolar bone. As a result, periodontal pockets and gingival recessions develop (1). This is the most common form of periodontitis, which usually occurs in adults (2). Periodontal disease is caused by an imbalance between dental plaque microbes interacting with the periodontal tissue and the resulting host response, which is in turn modified by risk factors.
Age, gender, race and genetic factors are determinants of periodontitis. The prevalence of periodontal diseases increases with age due to the accumulation of risk factors over time. The sexual dimorphism observed in periodontitis is a result of nicotine dependence, poorer hygiene and less frequent check-up dental visits. The disease is more common in men than in women. The socio-economic status, education and income are probably responsible for the differences in the prevalence among races (2). Genetic polymorphism is due to multifactorial inheritance, altered expression of proteins and, consequently, differences in immune response.
Modifiable risk factors for periodontitis include periopathogens found in dental plaque and subgingival biofilm, systemic diseases, such as diabetes mellitus, or diseases with a clinical picture including periodontitis, e.g. histiocytosis. Other risk factors include nicotine dependence, which contributes to supragingival plaque formation and changes in subgingival biofilm; obesity expressed as BMI, increase of which correlates with increased risk of periodontal diseases; socio-economic status (education in particular); and stress (financial one in particular).
Dental plaque plays a key role in periodontal diseases. Its accumulation is associated with increased supply or retention. In addition to malocclusions, congenital anomalies of soft tissues, abnormalities in dental anatomy, carious lesions and reduced antimicrobial activity of saliva, factors that promote dental plaque buildup also include prosthetic restorations and iatrogenic factors. In the latter group, particular attention should be paid to overhanging dental restorations (ODRs), which distort normal anatomical tooth contours and make it difficult to clean the teeth, the interdental spaces in particular.
Interactions between microbes and host factors contribute to periodontal diseases. Bacterial antigens and toxins stimulate the immune system, which responds by producing antibodies and proinflammatory factors. Alveolar bone resorption is a result of increased osteoclast activity compared to that of osteoblasts. Signals that stimulate these cells may be mediated directly by periopathogens or by activated host cells. RANK, which binds RANKL, a ligand produced by a number of cells involved in inflammatory processes and responsible for osteoclast formation and activation, plays a special role in this process (3).
Pathological bone remodelling may manifest on a radiograph as a vertical bone loss, i.e. a bony pocket. This state is due to the partial resorption of the interdental septum reached by proinflammatory signals. This is possible when the septum is wide. Otherwise, the bone within the septum is completely reabsorbed, which results in a vertical bone loss.
An analysis of clinical data along with radiological records is necessary for a correct diagnosis and treatment plan preparation.
The diagnosis of periodontal diseases is based on, among other things, a panoramic radiograph – a multilayer extraoral image. It allows for radiological assessment of periodontal structures, particularly the general condition of the maxillary alveolar process and the alveolar part of the mandible, and the marginal periodontium, including the detection of bone loss around teeth and identification of factors that promote periodontal disorders. Panoramic radiographs are used to evaluate the bone of the interdental septum. Unequal magnification, i.e. larger horizontal magnification compared to the vertical one, is the main disadvantage of panoramic radiography. It is not possible to differentiate between active process and remission, and the degree of bone loss shown in one image does not reflect the disease dynamics. Radiographic images tend to show less severe bone loss than that actually present. At least 30% of the bone mass must be lost before it can be detected on a radiographic image.
Aim
The aim of the study was to assess overhanging dental restorations and their impact on the maxillary alveolar process margin and the alveolar mandible based on panoramic radiography. Furthermore, the correlation between the type of restoration and the magnitude of bone loss was analysed.
Material and methods
This was a retrospective analysis of 200 panoramic radiographs performed in June 2014 in the Department of Dental and Maxillofacial Radiology at the Medical University of Warsaw. A total of 113 images showing ODRs in permanent teeth were included in the analysis. Only images with homonymous teeth in the same arch were included in the analysis. Cases of teeth with overhangs that were treated endodontically or had periapical lesions were excluded from the analysis.
The following variables were analysed: age, gender, the bone level, occlusal contact points between the opposite teeth and the condition of the tooth adjacent to ODR (the same data were analysed for the homonymous tooth). The type of incorrect restoration was also assessed.
Planmeca Romexis Viewer software was used in the study. Interdental marginal bone loss at the overhang was analysed. The type of bone loss was also assessed by classifying it as horizontal, vertical or mixed (combination of horizontal and vertical bone loss). The size of ODR was also evaluated. Other factors that may have an impact on alveolar bone loss were also analysed.
Statistical analysis
The data obtained from the retrospective radiological assessment were analysed statistically. The preliminary analysis for parametric distribution was based on the following normality tests:
– the Lilliefors test,
– the Shapiro-Wilk test,
– the Kolmogorov-Smirnov test.
The normality tests for radiological data distribution showed a non-parametric distribution of numerical data. Therefore, Kruskal-Wallis tests and analysis of variances (ANOVA) were used for further assessment. An assessment of correlations between the type of ODR and the size of bone loss was presented using the Spearman rank correlation coefficient. This coefficient was also used for correlation assessment. Patients in the study group were matched in terms of age and gender, so that a reliable comparison of the obtained data could be performed using appropriate statistical tests. One-way analysis of variance (ANOVA) was used to compare the size of alveolar bone loss at the tooth with an overhang and a corresponding surface of the homonymous tooth in a given dental arch. Statistica 13.1 (StatSoft, USA) was used for statistical calculations. Significance level of p < 0.05 was considered statistically significant. The study was approved by the Bioethics Committee of the Medical University of Warsaw (approval no. KB/115/A/2012).
Results
We obtained data on the prevalence and extent of overhanging dental restorations, as well as the types of restorations with overhangs (tab. 1).
Tab. 1. Study group characteristics, including patient age and gender, the type of restoration, as well as the size and location of overhang
Age range (years)Male/female proportionPercent distribution of types of restorations assessedTypes of teeth analysedLocationOverhang size
21-7345% : 55%OD – 29%
MOD – 23%
MO – 29%
M – 13%
D – 6%
Premolars – 32%
 
Molars – 68%
Maxilla – 61%
 
Mandible – 39%
0.5-2.2 mm
OD – occlusal-distal restoration; MOD – mesial-occlusal-distal restoration; MO – mesial-occlusal restoration; M – mesial restoration; D – distal restoration

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Piśmiennictwo
1. Kumar S: Evidence-Based Update on Diagnosis and Management of Gingivitis and Periodontitis. Dent Clin North Am 2019; 63(1): 69-81.
2. Albandar JM: Epidemiology and risk factors of periodontal diseases. Dent Clin North Am 2005; 49(3): 517-532.
3. Park OJ, Kim J, Kim HY et al.: Streptococcus gordonii induces bone resorption by increasing osteoclast differentiation and reducing osteoblast differentiation. Microb Pathog 2018; 126: 218-223.
4. Genco RJ: Current view of risk factors for periodontal diseases. J Periodontol 1996; 67 (10 suppl.): 1041-1049.
5. Caton JG, Armitage G, Berglundh T et al.: A new classification scheme for periodontal and peri-implant diseases and conditions – Introduction and key changes from the 1999 classification. J Clin Periodontol 2018; 45 (suppl. 20): S1-S8.
6. Rodriguez-Ferrer HJ, Strahan JD, Newman HN: Effect of gingival health of removing overhanging margins of interproximal subgingival amalgam restorations. J Clin Periodontol 1980; 7(6): 457-462.
7. Gilmore N, Sheiham A: Overhanging Dental Restorations and Periodontal Disease. J Periodontol 1971; 42(1): 8-12.
8. Brunsvold MA, Lane JJ: The prevalence of overhanging dental restorations and their relationship to periodontal disease. J Clin Periodontol 1990; 17(2): 67-72.
9. Walsh TF, al-Hokail OS, Fosam EB: The relationship of bone loss observed on panoramic radiographs with clinical periodontal screening. J Clin Periodontol 1997; 24(3): 153-157.
10. Corbet EF, Ho DK, Lai SM: Radiographs in periodontal disease diagnosis and management. Aust Dent J 2009; 54 (suppl. 1): S27-43.
11. Chapple ILC, Mealey BL, Van Dyke TE et al.: Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol 2018; 89 (suppl.): S74-S84.
otrzymano: 2018-10-04
zaakceptowano do druku: 2018-10-25

Adres do korespondencji:
*Andrzej Miskiewicz
Zakład Chorób Błony Śluzowej i Przyzębia Warszawski Uniwersytet Medyczny
ul. Miodowa 18, 00-246 Warszawa
tel.: +48 (22) 502-20-99
andrzej.miskiewicz@wum.edu.pl

Nowa Stomatologia 4/2018
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