Registration number: VGFOUSA-P-108681
Forskarstöd predoktorandmedel - Ny ansökan
Application started by: Anne-Sofie Pipkorn, 2010-03-02
Professional title at the time of application: Leg.tandläkare
Work place at the time of application: Folktandvården Floda
Last updated / corrected by: Lena Nordeman, 2010-05-19
Application received by: FoU-enheten för Primärvård och Folktandvård Södra Älvsborg
Granted and completed- Applicant: Anne-Sofie Pipkorn
Tandläkare, Folktandvården Floda
Denna ansökan är kopplad till följande andra ansökningar:
- VGFOUSA-P-108681 : Utvärdering av effekt av proffesionell plaque-kontroll av det parodontala tillståndet distalt om 2:a molaren efter kirurgiskt avlägsnande av visdomstand i underkäken., Forskarstöd predoktorandmedel - Ny ansökan
Granted and completed
Ansökan påbörjad: 2010-03-02 , Sökanden: Anne-Sofie Pipkorn, Folktandvården Floda - VGFOUSA-P-162431 : Utvärdering av effekt av proffesionell plaque-kontroll av det parodontala tillståndet distalt om 2:a molaren efter kirurgiskt avlägsnande av visdomstand i underkäken., Forskarstöd predoktorandmedel - Fortsättningsansökan
Granted and completed
Ansökan påbörjad: 2010-10-19 , Sökanden: Anne-Sofie Pipkorn, Folktandvården Floda
Övergripande information om projektarbetet
Sökandens arbetsförhållanden
FolktandvårdProjektledarens arbetstid - % av heltid
85Hur långt har projektarbetet framskridit?
Första projektplanen bearbetas men är ännu ej klar.Projektarbetet som en del i en utbildning för sökanden
Ej del i utbildningPlanerad redovisning
Engelskspråkig vetenskaplig artikel.Resultat om 3 år, 2013.Medarbetare / Handledare
Handledare
- Giovanni Serino
Tandläkare, Borås Lasarett, Parodontologi Avd
Projektet / projektens innehåll
Projektstart (när planeringen påbörjas och börjar dokumenteras skriftligt)
2010-05-01Beräknat projektslut
2013-12-31Sammanfattning
Efter avlägsnande av visdomstand i underkäken uppstår annan anatomi bakom 2:dra molaren.
I samband med fickmätning noteras ofta fördjupad tandköttsficka bakom 2:dra molaren. När denna överstiger 6 mm är det svårt för patienten att hålla rent. Detta kan på sikt leda till bennedbrytning (parodontit). Detta medföljer i sin tur behov av ökade tandläkar- och hygienistinsatser i framtiden.
Vi vill undersöka om tidig hygieninformation och hygienistbehandling efter operativt avlägsnande av visdomstand kan leda till bibehållandet av bennivån bakom 2:dra molaren.
Patienterna som ska deltaga utgörs av det vanliga remissklientelet till Oral-kirurgiska kliniken, Södra Älvsborgs sjukhus, Borås, Sverige för avlägsnande av semiretinerad visdomstand i underkäken. Indelning sker i 2 grupper genom ett dataprogram. Alla genomgår röntgenologisk undersökning. Den postoperativa informationen (muntlig och skriftlig) kommer att vara lika för båda grupperna.Testgruppen får tid hos klinikens hygienist 2 veckor efter operationen. Munhygieninstruktion och supragingival depuration utföres. En månad senare utföres supra-och subgingival depuration samt re-instruktion/motivation om nödvändigt.
Kontroll-gruppen får ingen specifik behandling eller hygienistinformation..
6 månader efter avlägsnande av visdomstand kallas alla för kontroll hos hygienist. Röntgenkontroll utföres samtidigt.
Därefter sker utvärdering och jämförelse mellan de båda grupperna.
Bakgrund
The removal of impacted mandibular 3rd molars may result in intra-bony defects (IBD) at the distal aspect of the 2nd molar (Ash et al. 1962, Szmyd & Hester 1963, Gröndahl & Lekholm 1973, Chin Quee et al. 1985, Marmary et al. 1985, Kugelberg et al. 1985, Kugelberg 1990). This is also a common finding among those subjects otherwise healthy from a periodontal point of view. In a retrospective study comprising 215 patients, Kugelberg et al. (1985) found that 2 years after the surgical removal of impacted mandibular3rd molars, 43.3% of the cases exhibited probing pocket depths exceeding 7 mm and 32.1% showed intra-bony defectsexceeding 4 mm. The post-operative plaque control score indicated that the level of plaque control on the distal surface of the 2nd molar of most of the participant was not optimal and no active treatment was performed to improve the condition of the distal surface.Meticulous plaque control is essential in the healing of intra-bony defect (Ellegard & Löe 1971, Polson & Heijl 1978, Rosling et al.1977). Karapataki et al. (2000a), in a study evaluating the adjunctive effect of Guided Tissue Regeneration (GTR) in conjunction with surgical removal of an impacted 3rd molar, concluded that a intra-bony defect distal to the 2nd molars would depend on the existing amount of periodontal ligament of the 2nd molar and whether this was affected by periodontal disease before surgery. Thus undiagnosed periodontal lesions and presence of
bacteria on the root surface of 2nd molars, might affect wound healing in the area and develop into a persistent intra-bony defect. These defects require surgical treatment in a later time (Karapataki et al. 2000b).
Syfte
The aim of this study was to evaluate the effect of supervised plaque control following the extraction of 3rd molars on the periodontal condition distal to 2nd molars.Metod: Urval
The subjects involved in this study were selected from consecutive patients referred to the department Maxillo-Facial Surgery , Södra Älvsborgs Hospital, Borås, Sweden, for extraction of 3rd molars.
Inclusion Criteria
To be included in this study, the patients should have semi-impacted 3rd molars in need of extraction, presenting bone loss distal of 2nd molar of >2mm (as measured from available radiographs) and probing pocket depth of ≥ 7mm, but otherwise healthy from periodontal point of view (i.e. no bone loss exceeding >2 mm and presence of ≥ 6 mm pocket depth at the residual dentition.
Exclusion Criteria
Patients with compromised medical conditions that represented contraindications to an oral surgical procedure were excluded.
Metod: Gruppindelning
Test group: Two weeks following the removal of the suture, the patients visit the dental hygienist of our clinic and received oral hygiene instruction and supra-gingival scaling. The patients were instructed to use a special tooth brush (Solo®) to clean distal to the 2th molars. One month later the patients were recalled to the dental hygienist and received again supra and sub-gingival scaling and re-instruction/motivation when needed.Control group: The patients did not receive any specific treatment beside the ordinary visit to their dentist or dental hygienist.
The patients were randomly assigned to the Test or Control group by a computer generated program.
Metod: Intervention
Treatment.
Surgical phase
All patients got 1 g Alveodon® pre-surgical. The treatment was done under aseptic conditions. Following local anaesthesia, muco-periostal incision was placed using a Bard-Parker blade n.15 according to the technique described by Nordenram (1970). Bone removal and sectioning of the 3rd molar were performed with a low speed rotary instrument under constant irrigation with sterile saline. Following tooth extraction, the granulation tissue and follicular remnants were removed from the extraction socket. Correction of the anatomical architecture of the bone was done under saline irrigation. The distal surface of the 2nd molar was scaled. Following saline irrigation, the flap was repositioned to cover the alveoli as much as possible and sutured with 2 (seldom 3) Vikryl-sutures.
Post surgical treatment.
Sutures were removed 10 days following the surgery.
Test group: Two weeks following the removal of the suture, the patients visit the dental hygienist of our clinic and received oral hygiene instruction and supra-gingival scaling. The patients were instructed to use a special tooth brush (Solo®) to clean distal to the 2th molars. One month later the patients were recalled to the dental hygienist and received again supra and sub-gingival scaling and re-instruction/motivation when needed.
Metod: Datainsamling
The following clinical variables were recorded at the Baseline examination at the distal surface of 2nd molars:
Bleeding/Suppuration on Probing (BoP/Sup); presence or absence of bleeding/suppuration up to 15s after probing
Probing Pocket Depth (PPD) was measured in mm with a manual Hu-Friedy PCP15 periodontal probe (Hu-Friedy Inc., Leimen, Germany) to the closest lower millimetre at the disto-buccal, distal and disto- lingual surfaces of 2nd molars.
Bone loss; at the time of surgery, following the removal of 3rd molars and correction of the anatomical architecture of the bone, the bone loss distal to 2nd molars was measured from the cement-enamel junction to the bone crest with the use of a periodontal probe.
Radiographic examination
Radiographic alveolar bone loss distal to 2nd molars was evaluated from radiographs (periapical radiography) and measured from the cemento-enamel junction to the most coronal level along the root surface at which the periodontal ligament space was considered to be to have a normal width.
Metod: Databearbetning
Each second molar was regarded as an independent observation.A t-test was applied to test the difference in mean PPD value within and between the two groups at baseline and 6 month examination. Fisher´s exact probability test was applied at site level to assess difference in treatment outcome in the test and control group, and for the two categorical variables plaque/no plaque. A p-value of <0.05 was considered to be statistically significant.
Sample size calculation
Based on a anticipate difference in mean value of 1.0 mm and calculated standard deviation of 1,1mm, a type I error and 80% power, the calculated sample size requires 20 subjects per group.
Förväntat resultat / Klinisk betydelse
Healthy / Periodontal Disease = at the re-valuations, the surface distal to 2nd molars was considered healthy if having a probing pocket depth of ≤5 without bleeding or suppuration following probing , while presence of Periodontal Disease was associated to a probing pocket depth of ≥ 6mm with bleeding on probing.Test group is expecting to have a better periodontal condition distal to the 2nd molars compared to the control group.
Referenser
Kugelberg, C. F., Ahlstro¨m, U., Ericson, S. & Hugoson, A. (1986). Periodontal healingafter impacted lower third molar surgery.
Precision and accuracy of radiographic assessmentof intrabony defects. InternationalJournal of Oral and Maxillofacial Surgery 15, 675–686.
Kugelberg. C. F., Ahlstro¨m, U., Ericson, S.,Hugoson, A. (1985) Periodontal healingafter impacted lower third molar surgery.A retrospective study. International Journal of Oral Surgery 14, 29–40.
Kugelberg, C. (1990) Periodontal healing 2and 4 years after impacted lower third molarsurgery. A comparative retrospectivestudy. International Journal of Oral and Maxillofacial Surgery 19, 341–345.
Nyman, S., Karring, T., Lindhe, J. & Plante´n, S. (1980) Healing following implantationof periodontitis affected roots intogingival connective tissue. Journal of Clinical Periodontology 7, 394–401.
Nyman, S., Gottlow, J., Karring, T. & Lindhe, J. (1982a) The regenerative potential of the periodontal ligament. An experimentalstudy in the monkey. Journal of Clinical Periodontology 9, 257–265.
Ash, M., Costich, E. R. & Hayward, J. R.(1962) A study of periodontal hazards of third molars. The Journal of Periodontology 33, 209–219.
Chapnick, L. & Endo, D. (1989) External root resorption: An experimental radiographic evaluation. Oral Surgery Oral Medicine Oral Patholgy 67, 578–582
Chin Quee, T., Gosselin, D., Millar, E. &Stamm, J. (1985) Surgical removal of fully impacted mandibular third molar. The influence of flap design and alveolar bone height on the periodontal status of the second molar. Journal of Periodontology 56, 625–630.
Eggen, S. (1969) Standardiserad intra-oral ro¨ntgenteknik. Sveriges Tandla¨karfo¨rbunds Tidning 6, 867.
Marmary, Y., Brayer, L., Tzukert, A. & Feller,L. (1985) Alveolar bone repair following extraction of impacted mandibular
third molars. Oral Surgery, Oral Medicine and Oral Pathology 60, 324–326.
Newcovsky, C. E., Libfeld, H., Zubery, Y.(1996) Effect of non-erupted 3rd molars
on distal roots and supporting structures of approximal teeth. A radiographic survey of 202 cases. Journal of Clinical Periodontology
23, 810–815.
Szmyd, L. & Hester, W. R. (1963) Crevicular depth of the second molar in impacted third molar surgery. Journal of Oral Surgery, Anaesthesiology Hospital Dental Service 21, 185–189.
Ekonomisk översikt och äskande
Forskarstöd söks från och med
2010-04-02Forskarstöd söks för följande antal månader
12Beslut
Forskarstöd beviljas från och med
2010-05-20Forskarstöd beviljas till och med
2010-12-31
Beslut ansökan
Beslutsdatum: 2010-05-10
