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ePaper created 2015-06-04, 14:41:41 | version 1.38.0
The EuroPerio Congress has established itself as the world’s leading conference in periodontology and implant dentistry. EuroPerio8 will take place from 3 to 6 June 2015 at the ExCeL London international exhibition and convention centre.
science & practice10 EUROPERIO London 2015–3 June Over the past 20 years there have been some exceptional ad- vances made in periodontology. Many of these have led to changes in our thinking and our approach toperiodontaltherapy.In1999,the American Academy of Periodon- tology (AAP) devised a “new” clas- sification system for the periodon- tal diseases. From this some 50 dif- ferent types of periodontal condi- tions were identified which were considered worthy of individual classification. Clearly this was an unwieldly system and in reality it was distilled down to three main types of plaque-associated periodontal diseases: gingivitis, chronic periodontitis and aggres- sive periodontitis. While the appropriateness of the terms “chronic” and aggres- sive” have been debated they have served as a framework for both cli- nicians and researchers to define specifictypesofperiodontitiswith identifiable clinical parameters. It also provided a framework for un- derstanding management proto- cols and outcomes. Nonetheless, over time it has become evident that such a classification system (chronic and aggressive) may be too simplistic because of the het- erogeneity of the periodontal dis- eases. Therefore, it may be timely to revisit such a classification sys- tem and determine whether cur- rentunderstandingoftheepidemi- ology and pathology of these dis- eases can be used to better define them. However, it is worth noting that in the past 25 years there have been at least 10 different classifi- cation systems proposed, none of which have been fully adopted. Clearly there remain a number of important challenges in this field.Sincechronicandaggressive periodontitis are heterogeneous groups of diseases, for example, therewillbeuniquesubcategories based on their multifactorial na- ture basis of microbial, host re- sponse and environmental compo- nents. At present, apart from “plaque-associated” designation, the current AAP classification is not based on cause-related crite- ria. Recognitionthatbacteriaare necessarybutnotsufficient forperiodontitistodevelop During the 1990’s a very impor- tant conceptual advance occurred in our understanding of dental plaque and its interaction within the subgingival environment. The recognition that subgingival plaque existed as a biofilm with its own microregualtory and commu- nicative properties changed our thinking of how the subgingival microbiota interacted not only with itself but also the host. Notwithstanding this, research through the 1990’s and 2000’s be- gan to question the role of the biofilm and its component bacter- ial consortia in the overall process of the development of periodonti- tis. While it was very clear that pe- riodontitis cannot, and will not, de- velop in the absence of bacteria, it was becoming increasingly obvi- ousthatclinicallythereweresome patients who, despite the presence of considerable plaque deposits, did not develop periodontitis. On the converse it was also evident that there were individuals who had very minor visible deposits of plaque yet developed very ad- vanced and destructive periodon- titis. These observations led to a ma- jor paradigm shift in periodontol- ogy in which it was agreed that al- though plaque was necessary for periodontitis to develop, it was not sufficient for it to develop. Indeed it became evident that in addition to dental plaque, environmental and host response factors were critical for the clinical manifesta- tion of periodontitis. With this came a new more informed man- agement process for our patients which dictated that in addition to management of oral hygiene pa- tients must be assessed for other factors which would lead to the de- velopment of periodontitis and these must be controlled in order for treatments to be successful. In- deed,itisnowrecognisedthatden- tal plaque (and its constitutive ele- ments) accounts for only 20per centoftheriskfordevelopingperi- odontitis and thus the other 80 per cent of modifying and predispos- ing factors must be taken into ac- count when diagnosis and treating the periodontal diseases. Developmentofthesubdisci- plineofPeriodontalMedicine The term “Periodontal Medi- cine” was first proposed by Offen- bacher in 1997 as “A broad term that defines a rapidly emerging branchofperiodontologyfocusing on new data establishing a strong relationship between periodontal health or disease and systemic health or disease”. It arose with the emerging evidence suggesting that a number of systemic condi- tions and periodontal disease were inter-related. By 2000 the ev- idence that oral health and sys- temic health should not be sepa- rated had become very com- pelling. Indeed the relevance of oral health to overall health and generalwell-beingwasrecognised by the US Surgeon General in a landmark publication titled “Oral Health in America”. This docu- ment for the very first time articu- latedtheimportanceoforalhealth in an holistic approach to medical care. Despite the title, its content was relevant to the whole global scene. From this the concept of pe- riodontal medicine gained further traction and its central hypothesis stated that periodontal infection and inflammation presents a sig- nificant chronic inflammatory burden at the systemic level. While there is considerable work still to be done significant progress has been achieved in the past decade. Diabetes is now well recognised to be a significant risk factor for development of peri- odontitisandconverselyperiodon- titis is considered to be a signifi- cant modifying or risk factor for glycaemic control in diabetics. Otherconditionsforwhichthereis goodevidencetosupportinterrela- tionships with periodontitis in- clude cardiovascular disease, rheumatoid arthritis, obesity and renal disease. Unfortunately, this has become an opportunistic field of research and to date some 58 conditions have been claimed to fall within the periodontal disease/systemic diseaseaxis,mostofwhichhavelit- tle or no biological or clinical plau- sibility. Understandingthat periodontalregeneration isbiologicallypossible Regeneration of damaged peri- odontal tissues as a result of peri- odontitis has been considered the ultimate goal of periodontal treat- ment. Over the decades many pro- cedures have been advocated, mostly associated with root sur- face conditioning and implanta- tion of bone substitutes into peri- odontal defects as a means of ob- taining periodontal regeneration. Unfortunately, these early con- cepts were naïve owing to a poor understanding of the require- ments for periodontal regenera- tion,namelytheencouragementof new cementum, bone and peri- odontal ligament. Filling a peri- odontal defect with a substance whichhadnorelevancetothenext functional stage of reconstruction is irrational. Nonetheless, as a pro- fession, we had become obsessed with filling holes in bone rather than studying the natural healing processes required to regenerate the periodontal attachment appa- ratus. Ignorance of the contribu- tion of the various tissue compo- nents in periodontal wound heal- ing explained the widespread mis- use of bone transplantation in the treatment of intrabony pockets whichunfortunatelystillpervades some areas of periodontology. It is now recognised that regen- erative treatment of periodontal defectswithanagentorprocedure, requiresthateachfunctionalstage of reconstruction be grounded in a biologicallydirectedprocess.With suchconceptsinmind,theseminal studies of Karring, Nyman and coworkers from Gothenburg in Sweden led to the development of guided tissue regeneration (GTR) asatreatmentmodality.Whilethis was a significant advance it be- came evident that while periodon- tal regeneration was biologically possible, it was clinically very dif- ficult to achieve on a reliable basis owingtoavastrangeofpatientand operator variables. More recently we have seen the development of biological agents and preparations which, when ap- plied onto root surfaces, can result in significant regeneration of dam- aged periodontal tissues. The use of such agents offers a simpler ap- proach to periodontal regenera- tion with equivalent, and some- times superior, results compared to GTR procedures. However, as hasbeennotedforGTR,theclinical outcomes using biological agents canbevariableandfurtherworkis needed to improve their clinical utility. Moreover, the use of mes- enchymal stem cells and genetic modulation of periodontal cells have been explored for the pur- poses of achieving periodontal re- generation. The future looks prom- isingbutnodoubtthereisaconsid- erable amount of work to be done before reliable and predictable pe- riodontal regeneration becomes a reality. Where periodontology has advanced A critique of current trends in the field.By Europerio8 presenter Prof.Mark Bartold,Australia. Mark Bartold is currently Professor of Peri- odontics and Director of the Colgate Aus- tralian Clinical Dental Research Centre at the University of Adelaide in Australia. This af- ternoon, he will be presenting a paper on pe- riodontal medicine as part of the Asia Pacific session in Capital Suite 2-4. Treatment Planning Session Moderator: Aris TRIPODAKIS Speakers: Christian COACHMAN , Inaki GAMBORENA, Siegfried MARQUARDT, Larry BRECHT Restorative Session Moderator: Guido BRACCHETTI Speakers: Bernard TOUATI, Nitzan BICHACHO, Federico FERRARIS, Vincent FEHMER Perio-Implant Session Moderator: Gerd KÖRNER Speakers: Maurizio TONETTI, Leonardo TROMBELLI, Ueli GRUNDER, Tidu MANKOO Special Guest Session Speaker: Roberto RE Ortho-Maxillofacial Session Moderator: Massimo RONCHIN Speakers: Renato COCCONI, Mirco RAFFAINI John McLean Honorary Lecture Moderator: David WINKLER Speaker: Dan NATHANSON Peter Schärer Honorary Tx Planning Session Moderator: Jaime GIL Speaker: Tal MORR and Stefan PAUL European Academy of Esthetic Dentistry Florence May 28-30, 2015 The scientific program has been organized in such a way that the excellence of the artists of the Renaissance period will be reached again by the speakers who will present how to give back to patients a beautiful smile. All topics involved in this difficult task will be analized and discussed by leading authors in their fields. The conservative, the prosthetic, periodontal, orthodontic and maxillofacial approach will be covered to obtain not only beautiful teeth but a“renaissanced”smile within a beautiful face. The social events will be organized in the most traditional and famous attractions of Florence such as The Galleria dell’Accademia, home of the David Statue, the Uffizi Gallery and PalazzoVecchio but we will also guide the partecipants into the “hidden Florence” with its shops where textiles are manifactured the way they were in the Renaissance period, shoes are hand made and personalized for the client, artisan perfumes are produced for personal use and for the house. We will be waiting for you ready to share with enthusiasm the best in science, art, food and enjoyment. Official Congress website: www. eaed2015.org President Dr. Giano Ricci Local Chairman Dr. Andrea Ricci 29th Annual Congress AD “Itremainstobeestablishedwhethertreatmentof periodontitishasanyimpactonsystemicconditionsbut thereisemergingevidencetoindicatethismaybethecasefor diabetes,cardiovasculardiseaseandrheumatoidarthritis.”