Saudi Cultural Missions Theses & Dissertations
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Item Restricted Service evaluation of care planning of Endodontic-Periodontal lesion (EPL) without root damage based on clinical and radiographic findings and the outcome of the care planning(King's College London, 2024) Alfuraih, Norah; Niazi, SadiaAims: 1- To evaluate the accuracy between the clinical and radiographic assessment using PA and CBCT scan of endodontic-periodontal lesions (EPLs). 2- To characterize the clinical and radiographic findings of grade 1, 2 and 3 of EPL without root as per Herrera et al., (2017) EPL Classification. 3- Based on the clinical and radiographic assessment determine the treatment planning of Grade 1, 2 and 3 EPL. Methodology: The service evaluation was carried out for the patients referred from the periodontal new patient consultant clinic and assessed in the Endodontic-Periodontics clinic at Guy’s Hospital, Guy’s and St Thomas NHS Foundation Trust. This service evaluation was carried out between March 2022- November 2023. All the information obtained were anonymized and transferred to an Excel spreadsheet. Data collected were analyzed using IBM SPSS. Chi2 test is used to compare the homogeneity of proportions of categories of care planning through levels of a second variable. Kruskal-Wallis test was used to compare distributions of an ordinal variable through different treatment options. Spearman´s correlation was used to assess the non-linear association between variables. Paired t-test was used to compare means of measurements taken with two techniques or methods in the same tooth (or root). Linearly weighted kappa´s index was used to assess the level of concordance between two parallel ordinal classifications. McNemar´s test was used to investigate about a preferent direction of discrepancies. Results: A total of 61 teeth with EPL were examined to establish the optimal care planning. 30 out of 61 teeth were 1st molars (49.2%). 100% of the patients had periodontitis, in which 75% had generalized periodontitis. 72% of the teeth were 4 diagnosed with EPL Grade 3. 63.3% of the teeth diagnosed with EPL grade 3 had bone loss extended beyond the apical third. 38.7% showed an extensive circumferential bone loss exceeding 270. Extraction and root canal treatment (RCT) followed by non-surgical periodontal therapy were the two most prevalent therapeutic approaches, accounting for approximately 69% of all cases. However, in some cases where RCT and NSPT intervention were initially implemented, subsequent periodontal re-assessment revealed persistent pocketing, prompting the surgical periodontal intervention. Conclusion: The new EPL classification by Herrera (2018) provides limited information required for care-planning of these complex cases, whereas additional radiographic classification using CBCT scan is helpful in more defined care planning for such cases.23 0Item Restricted Evaluation of clinical effectiveness of Platelet Rich Fibrin in the treatment of Endo-Perio Lesion when compared with Open Flap Debridement. A Narrative review(Saudi Digital Library, 2023-08-14) Aldweesh, Naief; Yassin, OulaPurpose: Endo-Perio Lesion (EPL) is a periodontal disease that affects both endodontic and periodontal soft and hard tissues. Due to the intricacy of the condition, difficulties arise when treating EPL. This narrative review aims to evaluate Platelet-Rich Fibrin (PRF) effect on EPL for soft tissue healing and bone fill. Thereby, treatment using PRF will be compared with Open-Flap Debridement (OFD) in EPL. Methods The literature search was conducted in PubMed, and Cochrane Central Register of Controlled Trials (CENTRAL) to answer the research question “What is the clinical effectiveness of endo-perio lesions treated with platelet-rich fibrin when compared with lesions treated with open flap debridement?” Yielded articles from the search were screened in three stages. Furthermore, a manual search was performed, and articles meeting inclusion criteria were included. The screening process is presented using the PRISMA flow chart. Quality assessment of the included articles was conducted using the Jadad, CASP, and Cochrane risk of bias tool. Results Four articles were included in the study. The baseline for a 9-month study, Titanium Platelet-Rich Fibrin (T-PRF) for intrabony depth (IBD) was 5.93mm, Guided Tissue Regeneration (GTR) IBD 6.76mm, OFD had 6.49mm. At 9-months T-PRF reported IBD 2.95mm, GTR had IBD 2.90mm, and OFD IBD 5.59mm, statistical significance was found between the intervention and control group regarding PD and CAL (p<0.001). No statistical difference found between T-PRF and GTR. Moreover, a 12-month trial reported Bone Defect Fill (BDF) for PRF 4.13mm, GTR 3.97mm, and OFD 2.23mm. Between the groups, PRF had the highest BDF, then GTR, then OFD having the lowest fill at 12-months. conclusion In conclusion, the results from the reviewed trials suggest that PRF is a promising treatment modality. However, due to limitations in the existing studies, further research in the area should be conducted.10 0