COD
TN
TP
A number of greywater treatment and reuse schemes have been implemented across the globe using both conventional and hybrid systems. Most of these systems have been developed as an environmental intervention measure and have since been operational while some have had their own challenges from both the technical and public point of view. Table Table6 6 presents some examples of successful application of greywater treatment and reuse schemes in some countries.
Greywater reuse strategies in some developing countries
Location | System used | Application | Performance | Source |
---|---|---|---|---|
Auroville, India | Reed beds and irrigation beds using banana | Treats greywater from a student dormitory | Chuck ( ) | |
Koulikoro, Mali | Vertical flow filter and greywater garden | Treats greywater generated by a community and the treated greywater is used in subsurface irrigation of fruits and vegetables | GTZ ( ) | |
Mexico | Bioreactor and mulch bed | Treats greywater for a rehabilitation centre for children | ||
Djenne, Mali | Infiltration trench | Was intended to stop the unregulated discharge of greywater into the streets. Unsightly conditions ceased within the community because greywater was discharged into trenches | Alderlieste and Langeveld ( ) | |
Gauteng, South Africa | Tower garden | Was intended to promote gardening due to proximity to water for irrigation and further empower the unemployed aged financially. Leafy vegetables are planted into the silts, and they are embraced by many people. | Adendorff and Stimie ( ) | |
Monteverde, Costa Rica | Constructed wetlands, Submerged flow reedbeds | Was intended to be used to treat greywater from single households to prevent discharge of greywater into the environment. Treated greywater was used to irrigate reeds which were an economic plant. | Dallas et al. ( ) | |
Kuching, Malaysia | Anaerobic filter, horizontal flow planted filter | An intervention to stop discharge of septic tank effluent directly into stormwater drains and subsequently into receiving water | Oil and grease 99% TSS 96% BOD 99% COD 95% NH -N 94% T-P 88% T-N 76% | Chong ( ) |
Billen, Palestine | Anaerobic upflow filters, aerobic filter | Intended to reduce frequency of desludging in a city which is water stressed | TSS 93–96% BOD 78–95% PO -N 39–74% NO -N 39–74% | Mahmoud et al. ( ) |
Sri Lanka | Anaerobic filter, vertical-flow planted filter | Greywater treatment systems in some selected hotels and schools | Harindra ( ) | |
Kathmandu, Nepal | Vertical flow planted filter | A local responsive approach to solve problems of water scarcity in Nepal. The greywater treated is reused for other non-potable purposes while the impact of this system leads to significant savings in water expenditure. | TSS 97% BOD 98% COD 93% PO -P 33% NH -N 96% | Shrestha et al. ( ) |
Monteverde, Costa Rica | Horizontal-flow planted filter | An intervention to stop haphazard discharge of greywater onto the streets and into streams. This caused unsightly conditions. After construction of this system, conditions improved. | BOD 99% NH -N 95% PO -P 84% | Dallas and Ho ( ) |
Tufileh, Jordan | Automated greywater system | Optimization and validation of a system for reusing greywater in home gardens in Jordan | Al-Jayousi ( ) |
Public perception which is a social phenomenon can be seen as the difference between an absolute truth based on facts and virtual truth shaped by popular opinion (Conjucture 2017 ). In implementation of any project, public perception has been recognized as an integral factor in determining the success of the project. Many technically sound and environmentally friendly programs have failed because it was not accepted by the intended beneficiaries. Several studies have been conducted to assess public perception towards greywater reuse in different parts of the world using different strategies. These strategies include interviews, questionnaires, focus group discussions, informal discussions and other equally good social surveys. Most of these surveys identified clear support for the concept of greywater reuse as an environmentally sustainable method of protecting freshwater resources and pollution prevention. It has been reported by Dolnicar and Schafer ( 2006 ), Friedler et al. ( 2006b ), Hurliman and McKay ( 2007 ), Kantanonleon et al. ( 2007 ) and Marks ( 2004 ) that the highest acceptability of greywater reuse schemes are for non-potable uses. Dolnicar and Schafer ( 2006 ) identified reduced levels of acceptance as the recycled water got closer to human contact. A similar study by Jeffery ( 2001 ) in the UK identified that people were more willing to use ‘own’ recycled greywater than to use recycled water from an unknown source. Alhumoud and Madzikanda ( 2010 ) identified that public support was greater for areas which are water stressed and areas with unreliable water supply. The results of a study by Adewumi et al. ( 2010 ) conducted in three universities in South Africa among students and staff concluded that the level of education and level of awareness contribute to the success of greywater reuse. Religious and cultural practices have been identified as factors that influence reuse programs. This is supported by another study by DeSena (2006) and Parkinson ( 2008 ) who identified misinformation, lack of knowledge or instinctive repugnance as accounting for objections in reuse programs.
The interruption and complete obstruction of many potable water reuse projects by stiff public opposition have been reported by DeSena ( 2006 ), Hurliman and Dolnicar ( 2013 ) and Meehan et al. ( 2013 ). This stiff opposition to potable reuse has been attributed to the close association of greywater with sewage which creates a phenomenon known as wisdom of repugnance. This phenomenon assumes that recycled water is associated with human waste; therefore, it renders it unpalatable from the public’s point of view. A study by Marks ( 2004 ) in three developed countries (Australia, the USA and the UK) identified low public support and acceptance for greywater reuse for potable purposes. The main barrier encountered in these studies were the associated perceived health risk of reusing recycled water in activities that involve direct contact with the user. Other studies identified language of the names given to recycled water as one of the obstacles affecting reuse schemes (Dolnicar and Saunders 2006 ). A study by Friedler et al. ( 2006b ), Omerod and Scott ( 2013 ) and Russell et al. ( 2009 ) identified public trust arising out of a combination of technical and non-technical issues. The study identified strong public opposition to reuse projects, where there is little trust in the implementing body even in the face of the most advanced technology applicable. Currently, most of the research in this area is targeting determinants that increases acceptance of reuse programs.
This study reviewed greywater characteristics, treatment systems, reuse strategies and perception of greywater reuse among users. It shows that there is a wide variation in greywater characteristics and volume generation rates which is largely dependent on the water use, lifestyle patterns and type of settlement. From the list of reviewed conventional treatment systems, filtration methods seem feasible and have the potential of integration with other systems to achieve target specific treatment. The study described different reuse strategies, most using discharged greywater for food production and landscaping while others have been used for poverty alleviation in irrigation farming.
The available technologies have been developed to treat or remove specific pollutants and not offer a full treatment of the greywater. Moreover, quality criteria differ for each type of reuse application, and greywater composition and generation rates vary greatly from one point to the other. It will therefore be prudent if systems are designed to target a specific reuse option taking into consideration the regional variability and complexities such that effluent from a treatment system will meet the required effluent guidelines. All the treatment systems reviewed were applicable on a large scale and cannot be applied at the household level. This in our view discourages local level participation in greywater reuse schemes. From the review, the potential of some natural materials to be used as media in greywater treatment systems also emerged. These natural materials are widely available in most developing countries, and their total integration into the conventional treatment systems should be explored. They can be used to design simple household level greywater treatment systems that target a certain reuse option and thereby increase local level participation.
Perception of greywater reuse has been closely related to the choice of reuse as most users will want to reuse greywater for activities that do not involve personal contact. In general, public perceptions are important to consider when implementing a certain method for a specified use. On the basis of this review, we conclude that to achieve effective greywater treatment and reuse, extensive contributions from technical and non-technical experts in many disciplines are called for. It also requires a comprehensive assessment of the greywater characteristics in order to choose an appropriate method or system of treatment. That notwithstanding, greywater treatment and reuse if embraced and enforced can lead to substantial decline in over-reliance on freshwater resources for non-potable uses.
Michael Oteng-Peprah, Email: [email protected] , Email: hg.ude.ccu@harpep-gnetoM .
Mike Agbesi Acheampong, Email: moc.oohay@fradaD .
Nanne K. deVries, Email: [email protected] .
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This paper presents a literature review of the quality of greywater generated in different, especially developing, countries, constituents found in greywater, some treatment systems, natural materials for treatment, some reuse strategies and public perception regarding greywater reuse. The review shows that generation rates are mostly influenced by lifestyle, types of fixtures used and climatic conditions. Contaminants found in greywater are largely associated with the type of detergent used and influenced by other household practices. Many of the treatment systems reviewed were unable to provide total treatment as each system has its unique strength in removing a group of targeted pollutants. The review revealed that some naturally occurring materials such as Moringa oleifera , sawdust, can be used to remove targeted pollutants in greywater. The study further showed that user perceptions towards greywater treatment and reuse were only favourable towards non-potable purposes, mostly due to perceived contamination or lack of trust in the level of treatment offered by the treatment system.
Keywords: Greywater; Natural media; Reuse; Treatment systems; User perception.
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BMC Oral Health volume 24 , Article number: 1037 ( 2024 ) Cite this article
Metrics details
Palatal groove represents a relatively uncommon developmental root anomaly, usually found on the palatal aspect of maxillary incisors. While its origin is controversial, its presence predisposes to severe periodontal defects.
This study aimed to provide a systematic review of the literature focusing on the varied diagnostic techniques and treatment modalities for periodontal lesions arising from the presence of palatal groove. Based on the existing evidence and knowledge, the study also provides a comprehensive decisional tree, guiding clinicians in the challenging decision-making process face to a palatal groove.
The literature search was conducted on Medline and Cochrane databases by two independent reviewers, who also performed the screening and selection process, looking for English written articles reporting on diagnosis and management (all treatment approaches) of periodontal lesion(s) associated with a palatal groove. Based on this literature, a comprehensive decisional tree, including a standardized palatal groove evaluation and tailored treatment approaches, is proposed. Moreover, a clinical case is described to demonstrate the practical application of the developed decisional tree.
Over a total of 451 articles initially identified, 34 were selected, describing 40 patients with 40 periodontal lesions associated with palatal grooves. The case report illustrates a deep, large, circumferential intra-bony defect on the palatal side of the tooth #22 associated with a shallow, moderately long palatal groove in an 18-year-old male patient. Following reevaluation, a single flap surgery was deemed necessary, combined with a regenerative procedure. At 2 years post-treatment, the tooth #22 is healthy, in a functional and esthetic position. The decision-making process, based on local and systemic patient’s conditions, should allow an early and precise diagnosis to prevent further complications and undertake an adequate treatment.
Palatal grooves are relatively rare; however, they are frequently associated with severe periodontal defects. The identification, diagnosis, prompt, and tailored management of the associated lesion is essential to mitigate potential periodontal and endodontic complications related to the presence of palatal groove.
[ https://www.crd.york.ac.uk/prospero/ ], identifier [C CRD42022363194].
Peer Review reports
Palatal groove (PG) is defined as an anatomic anomaly characterized by the presence of a developmental groove on a dental root that, when present, is usually found on the palatal aspect of maxillary incisors [ 1 ]. Over the years, several terms have been used to describe this anomaly, including palatal or palate-gingival groove [ 2 , 3 ], developmental radicular anomaly [ 4 ], distolingual groove [ 5 ], radicular lingual groove [ 6 , 7 ], palatoradicular groove [ 8 , 9 ], radicular groove [ 10 ], and cinguloradicular groove [ 11 ].
The origin of the PG is controversial, but it is assumed to be related to the infolding of the enamel organ or Hertwig epithelial root sheath during the tooth development [ 12 ]. Additional hypogenetic root formation [ 13 , 14 ] as well as an altered genetic mechanism [ 15 ] have also been suggested.
PG is relatively rare. Everett et al. [ 5 ] reported a prevalence of PG on 2.8% of lateral incisors whereas Withers et al. [ 16 ] observed a PG on 2.3% of maxillary incisors (4.4% of maxillary laterals and 0.28% of maxillary centrals). Kogon et al. [ 8 ] examined 3168 extracted maxillary central and lateral incisors and found PG on 4.6% of them (3.4% of maxillary centrals and 5.6% of maxillary lateral incisors), with over half of the PG extending more than 5 mm apical to the cementoenamel junction leading to a localized periodontal lesion. The most recent study by Mazzi-Chevez et al. [ 17 ] observed 150 maxillary central incisors, lateral incisors, and canines with a micro-CT and found that PG affected 2% of central incisors and 4% of lateral incisors. In 100% of cases, the PG originated in the enamel.
As the term implies, PG is formed around the cingulum of the tooth and continues apically down from the cementoenamel junction, terminating at various depths and length along the root [ 18 ]. In contrast to maxillary bicuspids, incisors generally display a U-shaped groove.
This anatomic anomaly is frequently associated with a breakdown of the periodontal attachment involving the groove; a self-sustaining localized periodontal pocket can develop [ 4 ], where the PG itself provides a site for bacterial accumulation. The subsequent progressive inflammation along the PG and its apical portion may lead to periodontal and endodontic pathologic conditions [ 19 ]. Furthermore, there may be communication between the pulp canal system and the periodontium through the pulp cavity and/or accessory canals, which may also lead to combined endodontic-periodontal lesions [ 20 ]. According to the 2017 classification of periodontal and peri-implant diseases and conditions [ 21 ], PG can be classified as a localized tooth-related factor that modifies or predisposes to plaque-induced gingival diseases/periodontitis [ 22 ], and can be associated with periodontal abscess in non-periodontitis patients.
The prognosis for teeth with PG extending apically is often poor [ 12 ], highlighting the critical need for prompt and accurate diagnosis to avert further periodontal and endodontic complications, ultimately preventing tooth extraction. This study is fundamentally motivated by the scarcity of consolidated guidelines for managing such complex dental conditions. Hence, the objective of this study was to conduct a systematic review of the existing literature, focusing on the diagnosis and management of periodontal lesions linked to PG. Based on this review, the goal was to develop a comprehensive decisional tree, thereby proposing a standardized treatment protocol to aid in the clinical decision-making. This study also includes a clinical case report to demonstrate the practical application of the developed decisional tree, reinforcing its clinical relevance and utility.
Development of the systematic review protocol.
A protocol covering all aspects of the systematic review methodology was developed before starting the review. The protocol included the definition of: a focused question; the literature search strategy; the study selection criteria; the outcome measures; the screening methods; the data extraction; and the data synthesis. The protocol was registered in PROSPERO (CRD42022363194).
The research question was formulated according to the PICOS (Population, Intervention, Comparison, Outcome, Study) strategy, which identify the search and selection criteria as follows:
P: Patients with periodontal lesion(s) associated with a PG
I: PG identification (diagnosis) and management. All treatment approaches (non-surgical, surgical, with or without the adjunctive use of potentially regenerative materials, i.e. barrier membranes, grafting materials, growth factors/proteins and combinations thereof) were considered.
C: alternative treatment approach or no comparison.
O: periodontal parameters, including clinical attachment level (CAL, measure in mm), probing pocket depth (PPD, measured in mm), recession (REC, measured in mm), plaque index (PI, any validated clinical score), bleeding on probing (BOP) or other inflammatory indexes, radiographic bone loss.
S: Any type of human studies including case reports, with a minimum of 6 weeks follow-up after treatment. Only studies published in English were considered. Studies written in languages other than English, review articles, cell and/or animal studies, letters, editorials, conference summaries, commentaries, and studies considering PG with only an endodontic involvement or that used self-report assessment of treatment outcomes were not considered.
So, the focused question was formulated as follows: what is the efficacy of treatments for periodontal lesions associated with PG?
The literature was searched for articles published up to June 2022 on MEDLINE and Cochrane databases. Multiple combinations of pertinent search terms were employed (Supplemental Table 1). The reference lists of the included studies were also evaluated in order to identify additional articles. To ensure its reproducibility, the PRISMA guidelines were followed [ 23 ], and the PRISMA flowchart was filled [ 24 ] (Fig. 1 ).
PRISMA flow diagram on the selection process of the studies included in the systematic review
The titles and abstracts of the initially identified studies were screened by two independent reviewers (Y.G. and V.G.). Then, the pre-selected studies underwent a full text evaluation to assess the final inclusion or not. All records for which inclusion was obtained “uncertain” for on reviewer, disagreement was solved by discussion between authors. Whenever needed, the authors of the selected studies were contacted to provide missing data.
Study screening and selection was carried out by using the Rayyan online software [ 25 ], which assisted the reviewers in the different step of the literature review process. Duplicate references were removed automatically using Mendeley software. Data extraction was carried out on a dedicated excel spreadsheet. The risk of bias assessment was carried out by using the Joanna Briggs Institute (JBI) scale [ 26 , 27 ].
The literature search resulted in 451 potentially relevant publications (Fig. 1 ). After the first selection step, based upon the title and abstract, 88 articles were pre-selected. After full-text evaluation, 34 articles were included and analyzed. All of them were case series and case reports. A total of 40 patients were described, of which 23 women (57.5%). The characteristics of the selected studies are presented in Table 1 . Their quality assessment is reported in Table 2 .
Among those 40 clinical cases, 12 cases report failed to provide a clinical description of the PG. Four studies described the PG depth alone, 17 studies described the PG length alone, and 7 studies provided a combined description of depth and length of the PG. From a periodontal point of view, the periodontal lesion morphology was correctly described (depth and width) in only 4 cases, 2 of which also reported the number of bony walls. Among the 22 cases reporting a diagnosis, 17 (77.3%) described combined endo-periodontal lesions, whereas 5 were purely periodontal lesions.
Endodontic involvement was present in 29 cases: 22 cases presented with a pulp necrosis, and 7 cases with an endodontic treatment. Pulp vitality was present in 10 cases and 1 case failed to report the endodontic status.
The endodontic treatment consisted in either a temporary filling (calcium hydroxide) later replaced by a definitive filling (gutta percha), or directly with a definitive filling (gutta percha) when indicated. Among those 29 endodontically treated teeth, 9 underwent an apicoectomy (using mineral trioxyde aggregate) at the surgical phase.
PG sealing was performed in 16 cases using mainly glass-ionomer cement but also mineral trioxide aggregate (MTA), tricalcium silicate cement, composite flow and amalgam. In 5 cases, an extra-oral filling of the groove was performed before the tooth reimplantation. In all cases, radiculoplasty was performed either for groove removal when it was shallow or by saucerization to allow a proper filling when grooves were deep.
To treat the PG associated periodontal defect, several different intervention types were described, using: allogenic bone, xenogeneic bone, alloplastic materials, barriers, growth factors and biological factors (and combinations thereof). These surgical regenerative procedures were reported in 25 cases. Only 2 cases [ 3 , 40 ], justified the use of biomaterials and flap designs in relation to the analysis of the associated periodontal lesion after PG management.
All cases reported clinical healing except for 2 cases of failures following tooth reimplantation due to external root resorption leading to tooth removal after 36 months [ 33 ] and 2 failures after 6 months following a surgery without regeneration or root filling [ 29 ]. The case with the longest follow-up (324 months) indicated that following an endodontic treatment with a periodontal regeneration and an orthodontic treatment, a recurrent periodontal breakdown occurred 11 years, leading to tooth extraction and implant placement [ 35 ].
We describe the case of an 18-year-old male patient referred to the periodontics department of the Rothschild Hospital (AP-HP) in Paris. Written informed consent was obtained for the publication of clinical data and images included in this article. The patient was experiencing pain due to the inflammation on the palatal side of tooth #22 with intermittent suppuration. The clinical examination revealed a central, shallow, and of moderate length (up to 70% of the root length) PG on the tooth #22, with a probing pocket depth of 12 mm on the palatal side associated with a tooth mobility 3 (Mühlemann 1951). The tooth responded positively to electrical test. At the radiographic evaluation, bone loss could be noted mesially and distally of #22 (Fig. 2 ).
Case report. Clinical and radiographical initial situation of the tooth #22 presenting with a palatal groove. The periodontal charting showed deep periodontal pockets on the palatal probing sites associated with bleeding and plaque accumulation
A slight bony bridge could be distinguished between #21 and #22 in the coronal portion. Thus, a localized periodontal defect due to the presence of subgingival PG was diagnosed.
The periodontal treatment first consisted in a non-surgical debridement performed in one session. Tooth splinting was performed from #21 to #23 to minimize mobility (Fig. 3 ).
Root planning and flattening of PG on tooth #22: initial occlusal view of #22 ( a ); Manual scaling 22 ( b ); flattening of PG 22 in the coronal part ( c )
At the re-evaluation 8 weeks later, the tooth presented no superficial inflammation, but a persistent periodontal pocket of 12 mm deep on the palatal side. Surgery was indicated due to the presence of a large, deep, 3-wall intra-bony defect around tooth #22 (Fig. 4 ).
Regenerative therapy: view at the periodontal re-evaluation, 2-months after the initial treatment ( a ); large and deep 3-walls intra-bony defect ( b ); application of EMD ( c ); application of DBBM (soft tissue support, osteoconductive) ( d ); sutures ( e ); radiographic image at the 2-month follow-up ( f )
A SFA (Single Flap Approach) was designed with a surgical access limited on the palatal side for esthetic reason and optimal visualization. A full periosteal flap was raised, and the granulation tissue was removed. The aberrant local anatomy was corrected up to the most apical part and a regenerative procedure combining enamel matrix derivates with a bone substitute was applied to avoid soft tissue shrinkage and collapse. Sutures with a non-resorbable monofilament 6/0 were made using U-crossed and single points. A postoperative radiograph was taken (Fig. 4 f). An antibiotic therapy with amoxicillin (1 g twice a day for 7 days) was administered. Paracetamol was prescribed as a painkiller and a mouthwash containing 0.12% chlorhexidine gluconate were prescribed for 2 weeks postoperatively. Healing was uneventful and sutures were removed 10 days postoperatively.
At the 6 months reevaluation, the periodontal pocket was no deeper than 4 mm on the palatal side with no bleeding on probing. A recession of 1 mm was observed. Radiographically, a mineralized tissue could be observed up to both bony peaks mesially and distally to #22 (Fig. 5 ).
Re-evaluation at 6 months ( a ); 18 months ( b ) and 30 months ( c )
At the 1-year follow-up, periodontal health was maintained and an orthodontic treatment was undertaken. After 2 years of treatment, tooth #22 is still healthy with a CAL gain of 7 mm, a functional and esthetic position resulting in the patient’s satisfaction. These results support that periodontal regeneration can be effectively carried out also for deep intra-bony defect associated with PG, once the local risk factor has been adequately managed.
The results of the present systematic review indicate that PG are relatively uncommon root anomaly, but they are frequently associated with periodontal lesion that require treatment. The selected studies showed that PG can be managed concomitantly with periodontal regeneration, with or without associated endodontic treatment. It must be noted that the presence of a PG may play a significant role in exacerbating periodontal lesions. This could be explained, at least partly, by the mediation role of inflammatory factors like the TGF-B1, which is involved in the regulation of the inflammatory response and in the remodeling of periodontal tissues, as highlighted by recent studies [ 58 , 59 ]. These findings necessitate a nuanced and well-defined diagnostic and therapeutic approach, which should consider not only on the anatomical challenges linked to the presence of a PG but also on the underlying inflammatory mechanisms, in order to ensure an effective treatment and prevent potential endodontic complications.
A variety of treatments approaches has been described in case reports and case series and summarized in the present review. The appreciation of the morphology and origin of PG on maxillary incisors may be challenging and thus delay the diagnosis and treatment planning. Therefore, developing a standardized approach based on the available literature is advisable.
A PG can be classified according to its location, length along the root, and depth of the groove towards the pulp cavity [ 60 ]. The analysis of the associated periodontal lesion is also a key parameter to consider. Based on the work of Kim et al. [ 60 ], a simplified version including the groove description and the periodontal parameters has been suggested. Such a classification (Table 3 ) would provide the clinician with precise criteria to justify the therapeutic approach.
Groove location was disregarded in most cases, only one case [ 40 ] reported a distal location of the PG. It can be explained by the fact that this parameter will not affect the prognosis or the treatment sequence. In the latest study done on extracted teeth, PG appeared to originate in the distal area of the cingulum margin in most cases (65%), followed by the central fossa (25%), and the mesial area of the cingulum margin (10%) [ 61 ].
In terms of depth, only 7 cases reported a shallow PG (50%) and 7 cases reported a deep PG (50%) and no closed tube has been described. This finding is in accordance with Kogon’s study [ 8 ] where 44% percent of the PG were described as shallow depressions, 42% as deep depressions, and 4% as closed tubes.
Considering the groove length, 4 cases reported an extension in the cervical third of the groove (17%), 6 in the middle third (25%) and 14 cases in the apical third (58%). According to Pinheiro’s study [ 61 ], those grooves extended rarely only to the cervical third (5%), followed by the middle thirds (45%) and the apical thirds of the root in most cases (50%). It is of paramount importance for clinicians to understand the combination of both variations of groove depth along with their length to adapt an adequate treatment considering the fact that PG with deeper grooves and greater degree of extension are the determinants and predictors of poor prognosis periodontally and endodontically wise [ 5 , 31 , 42 ].
Considering the groove description in the selected studies, most of them failed to adequately report it. Only 7 of the 40 cases described the depth and length of the PG. This lack of analysis might result in an inadequate treatment highlighting the need for a classification.
Considering the periodontal approach of the associated intra-bony defect, the selection of the regenerative biologic principle (or material) to use with the soft tissue surgical approach dependeds on the morphology of the intra- bony defect (width, depth, and number of residual bony walls) and on the amount (and quality) of the soft tissues available to cover it [ 62 ]. As a general rule, deep and wide defects with only one residual bony wall require a mechanical stabilizer of the blood coagulum (membrane and/or bone filler), whereas in defects with lower defect angles and a greater number of bony walls, biologic mediators of the healing process (e.g. enamel matrix derivates) are indicated [ 62 ]. In the present study, only 2 cases [ 3 , 40 ] succeeded in justifying the use of their regenerative procedure based on the description and analysis of the associated intra-bony lesion. As for PG anatomy, this lack of description of the associated periodontal lesion morphology could mislead the diagnosis and result in a non-optimal treatment. The PG issue had mostly been a concern for endodontist based on those case reports coming from endodontic journals, which might explain the few periodontal parameters reported and the lack of a clear description of the intra-bony defect associated to justify the different management of the periodontal defect. Moreover, the selected case reports do not cover all potentially applicable regenerative techniques, which continue to evolve [ 63 , 64 , 65 ] and should be further investigated in the particular context, from the microbiological and inflammatory perspectives, of PG-associate lesions.
Based on the presented literature review and in order to guide clinicians towards a comprehensive and complete evaluation of PG associated lesion, we suggested a decisional tree (Fig. 6 ) that introduces the periodontal parameter in the PG assessment, after evaluating the endodontic status. Indeed, the successful management of a tooth with a PG is firstly dependent on endodontic status, which should be systematically assessed. In cases of negative pulp response and periapical lesions, an endodontic treatment has to be undertaken in the first place [ 66 ]. But, the periodontal evaluation is also cardinal to obtain a successful and long-lasting management of PG.
Decisional tree. This graph proposes a decision-making process for the management of PG-associated lesions that takes into account the endodontic status, the characteristics of the palatal groove, and the presence of intra-bony defect
The recognition and management of PG for tooth survival has been reported in details in a study done by Kim et al. [ 60 ] in 2017. In the rest of the considered literature, half of the treatments described were made without a clear initial diagnosis or proper description of the associated lesions to justify the type of regenerative strategy and flap design approached. Another interesting observation made in this review is that in the case of intentional replantation, among the 5 reported cases, 2 resulted in a failure necessitating the tooth removal [ 33 ]. This suggests that replantation strategy should be used as a the latest resort for complex cases involving a PG to the apex with a deep groove.
It must be acknowledged that the available literature and thus the present systematic review present several limitations. Firstly, as mentioned above, there is a lack of standardization in the diagnostic and treatment processes, with a high heterogeneity among the selected articles, most of the times case reports or case series. Secondly, the follow-up time was mostly set between 6 and 24 months, which may be too short to assess treatment outcomes or observed complications and relapse. Indeed, after a 36 months follow-up, failures have been reported [ 33 ] and after 10 years, a periodontal breakdown occurred on a treated tooth [ 35 ] and both resulted in the tooth removal. No re-entry surgery and/or histologic evaluations were described and no prospective longitudinal studies evaluating the stability of the clinical and radiographic parameters and the absence of the recurrence of disease were found. Thus, any conclusion about the success achieved with the treatments described in the present review should be drawn with caution as the long-term prognosis of the treatment of PG-associated lesions of teeth remains to be determined. Updates of case series and case reports that could describe results after 5, 10 and 15 years from the initial PG diagnosis are advocated. Finally, the level of the body of evidence on PG is considered as low. Although the nature of PG as rare condition may explain why mainly case reports or case series are published, future clinical and comparative studies should be designed to investigate PG management and treatment success at long term. Nonetheless, based on the currently available literature, a decisional tree (Fig. 6 ) has been proposed to guide clinicians and create a reference for PG management to respond to a patient’s health condition. This should be periodontally updated as new evidence emerges but in the meantime, it can be useful to provide a clinical guidance as well as a model for the standardization of the diagnostic and treatment processes in clinical cases dealing with PG management.
Teeth with PG represent a challenge for clinicians. Despite their rarity (2% of maxillary lateral incisors), the complexities associated with PG, such as diverse anatomical features and clinical scenarios, underscore the necessity for accurate diagnosis and tailored treatment approaches. This study provides a systematic review of pertinent literature, consisting mainly in case reports, and culminates in the proposal of a decision tree, which aims to assist clinicians in the decision-making process through a structured evaluation of the PG characteristics guiding the treatment approach. The ultimate goal is to mitigate potential periodontal and endodontic complications of PG while providing a successful management. In parallel, the present study highlights the need of future research on this topic, particularly with clinical studies with a sufficiently long follow-up to monitor the treatment outcomes and their stability over time. Indeed, further evidence is needed to develop standardized diagnostic and treatment protocols for PG.
The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.
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Service of Odontology, Rothschild Hospital (AP-HP), 5 Rue Santerre, Paris, 75012, France
Yvan Gaudex, Vianney Gandillot, Philippe Bouchard, Stephane Kerner & Maria Clotilde Carra
Department of Periodontology, UFR of Odontology, Université Paris Cité, 5 Rue Garanciere, Paris, 75006, France
Service of Odontology, CH Eure Seine Hospital, Evreux, France
Isabelle Fontanille
Cordeliers Research Centre, Laboratory of Molecular Oral Physiopathology, Paris, France
Stephane Kerner
Department of Periodontology, Loma Linda University School of Dentistry, Loma Linda, CA, USA
INSERM- Sorbonne Paris Cité Epidemiology and Statistics Research Centre, Paris, France
Maria Clotilde Carra
Institution Nationale Des Invalides, Paris, France
Vianney Gandillot
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Y.G. and V.G. drafted the manuscript text, and were involved in the literature review, data acquisition, analysis, and interpretation. Y.G. and V.G. prepared Tables 1 and 2 . Y.G., P.B. and I.F. Contributed the case report and Figs. 2 , 3 , 4 and 5 M.C.C and S.K. prepared Table 3 and Fig. 6 . M.C.C., P.B. and S.K revised the draft of the manuscript and contributed to the general criticism. All authors reviewed and approved the manuscript.
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Gaudex, Y., Gandillot, V., Fontanille, I. et al. Palatal groove associated with periodontal lesions: a systematic review illustrated by a decisional tree for management. BMC Oral Health 24 , 1037 (2024). https://doi.org/10.1186/s12903-024-04771-z
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Cyclodextrin complexes for the treatment of chagas disease: a literature review.
2. flowchart of this study.
Year | Reference | Title | Goals | Conclusions |
---|---|---|---|---|
2023 | [ ] | New drug encapsulated incyclodextrin with promising anti-Trypanosoma cruzi activity. | Production and Characterization of a host–guest complex (Anti-Chagas Drug-Modified Chalcone (CHC) in 2-Hydroxypropyl-Beta-Cyclodextrin). | HPβCD/CHC showed promising activity against Trypanosoma cruzi. This complex offers improved water solubility and requires a lower amount of CHC to be effective. |
2023 | [ ] | Elucidating the complexation of nifurtimox (NIF) with cyclodextrins. | Evaluate whether the formation of complexes with β-cyclodextrin and sulfobutyl ether-β-cyclodextrin would improve the solubility and dissolution rate of the drug. | β-CD/NIF and SBE-β-CD/NIF improved drug solubility and dissolution rate, showing significant stability in dissolution and crystallinity over 6 months at 25 °C and 40 °C. |
2023 | [ ] | O-allyl-lawsone inclusion complex with 2-hydroxypropyl-β-cyclodextrin: Preparation, physical characterization, antiparasitic and antifunga activity. | Evaluate the antiparasitic and antifungal activity of O-allyl-lawsone (OAL) free and encapsulated in 2-hydroxypropyl-β-cyclodextrin (OAL MKN) against Trypanosoma cruzi. | HPβCD/OAL increased antiparasitic activity compared with the free form (OAL) while reducing cytotoxicity and enhancing selectivity for the trypomastigote form of T. cruzi. |
2021 | [ ] | Characterization and trypanocidal activity of a drug carrier containing β-lapachone. | Investigate the in vitro action of anti-T. cruzi, effects of β-Lap encapsulated in 2-hydroxypropyl-β-cyclodextrin (2HP-β-CD), and its potential toxicity to mammalian cells. | The trypanocidal activity was increased by encapsulation of HP-β-CD/β-Lap compared with free naphthoquinone (β-Lap). |
2020 | [ ] | Synthesis and biological evaluation of β-lapachone and nor-β-lapachone complexes with 2-hydroxypropyl-β-cyclodextrin as trypanocidal agents. | Study βLAP and its derivative complexes nor-β-Lapachone (NβL) with 2-hydroxypropyl-β-cyclodextrin to increase solubility and bioavailability. | HP-β-CD/βLAP and HP-β-CD/NβL increased the drug solubility and, additionally, vectorization was observed, resulting in higher biological activity against the epimastigote and trypomastigote forms of T. cruzi. |
2022 | [ ] | Synthesis and study of the trypanocidal activity of catechol-containing 3-arylcoumarins, inclusion in β-cyclodextrin complexes and combination with benznidazole. | Evaluate trypanocidal activity and cytotoxicity of a series of catechol-containing 3-arylcoumarins, their combination with BZN, and inclusion in β-cyclodextrins (β-CDs). | Catechol-containing 3-arylcoumarins showed moderate trypanocidal activity against Trypanosoma cruzi, and their inclusion in β-cyclodextrins improved solubility. Combining these coumarins with benznidazole (BZN) further enhanced their effectiveness. |
2018 | [ ] | Technological innovation strategies for the specific treatment of Chagas disease based on Benznidazole. | Conduct a literature review to identify current pharmaceutical technologies used in conjunction with BNZ to improve therapy for Chagas disease. | A lower concentration of BNZ was required to eliminate 50% of T. cruzi trypomastigote forms. This was achieved through the formation of BNZ/CD complexes and the modulation and targeting of anti-Chagas treatment using metal-organic frameworks. |
2017 | [ ] | Benznidazole nanoformulates: A chance to improve therapeutics for Chagas disease. | Describe the characterization of several encapsulated formulations of benznidazole, currently a first-line medication for the treatment of Chagas disease. | The in vitro cytotoxicity of BZN/CDs was significantly lower than that of free benznidazole, while their trypanocidal activity was not impaired. |
2011 | [ ] | Activity of a metronidazole analogue and its β-cyclodextrin complex against Trypanosoma cruzi. | Prepare an inclusion complex between a metronidazole iodide analog (MTZ-I) and cyclodextrin (CD) to develop a safer and more effective method of treating Trypanosoma cruzi infections. | MTZ-I and MTZ-I/β-CD were 10 times more active than MTZ, indicating that the presence of an iodine atom in the side chain increased trypanocidal activity while maintaining its cytotoxicity. |
2011 | [ ] | Modulated dissolution rate of the antichagasic benznidazole inclusion complex and cyclodextrin using hydrophilic polymer. | Investigate the utility of hydroxypropylmethylcellulose (HPMC) polymer in controlling the release of BNZ from solid inclusion complexes with cyclodextrin to overcome the problem of its bioavailability. | The addition of HPMC to BZN/CD inclusion complexes significantly improved the dissolution rate and controlled drug release, showing promising potential for Chagas disease therapy. |
2012 | [ ] | Benznidazole drug delivery by binary and multicomponent inclusion complexes using cyclodextrins and polymers. | Develop and characterize inclusion complexes in binary systems with BNZ and randomly methylated β-cyclodextrin (RMβCD), and in ternary systems with BNZ, RMβCD, and hydrophilic polymers. | Cyclodextrin-based inclusion complexes with benznidazole (BNZ) and hydrophilic polymers demonstrated effective, standardized, and safe drug delivery. |
2008 | [ ] | Study of the interaction between hydroxymethyl nitrofurazone and 2-hydroxypropyl-β-cyclodextrin. | Characterize an NFOH inclusion complex in 2-hydroxypropyl-β-cyclodextrin (HP-β-CD). | HP-β-CD/NFOH significantly reduced the toxic effects of NFOH, according to preliminary toxicity studies and cell viability tests. |
2007 | [ ] | Hydroxymethylnitrofurazone inclusion complex: dimethyl-β-cyclodextrin: a physicochemical characterization. | Characterize inclusion complexes formed between NFOH and dimethyl-β-cyclodextrin (DM-β-CD) through complexation/release kinetics and solubility isotherm experiments using ultraviolet (UV)–visible spectrophotometry and dynamics measurement. | NFOH/DM-β-CD showed improved solubility and favorable complexation, as demonstrated by solubility isotherm studies. |
3.1. cyclodextrin, 3.2. industrial applications, 3.3. complexation mechanism, 3.4. chagas disease, 3.5. biological cycle, 3.6. nifurtimox and benznidazole, 3.7. studies conducted on the treatment of t. cruzi, 4. impact of cyclodextrins on the optimization of drug solubility and efficacy, 5. impact of cyclodextrins with benznidazole in the treatment of chagas disease, 6. impact of cyclodextrins with natural products in the treatment of chagas disease, 7. discussion, 8. final considerations, 9. conclusions, author contributions, conflicts of interest.
Click here to enlarge figure
Cyclodextrin | Glucose Unit Number | Molecular Weight | Cavity Diameter (Å) | Cavity Volume (Å ) | Aqueous Solubility at 25° C (% m/v) |
---|---|---|---|---|---|
α-CD | 6 | 972 | 4.5–5.3 | 174 | 14.5 |
β-CD | 7 | 1135 | 6.0–6.5 | 262 | 1.85 |
γ-CD | 8 | 1297 | 7.5–8.3 | 427 | 23.2 |
Symptom/Sign | Benznidazol | Nifurtimox |
---|---|---|
Anorexia | ++ | +++ |
Headache | + | ++ |
Dermatopathy | +++ | + |
Psychic excitement | - | +++ |
Gastralgia | + | +++ |
Insomnia | + | ++ |
Nausea | ++ | +++ |
Weight loss | + | +++ |
Polyneuropathy | + | +++ |
Vomiting | ++ | +++ |
Type of Cyclodextrin | Reference | Cyclodextrin Structure |
---|---|---|
β-cyclodextrin (β-CD) | [ ] | |
2-Hydroxypropyl-β-cyclodextrin (HP-β-CD) | [ ] | |
Dimethyl-β-cyclodextrin (DM-β-CD) | [ ] | |
Ether sulfobutílico-β-cyclodextrin (SBE-β-CD) | [ ] |
Molecule Name | Reference | Molecular Structure |
---|---|---|
HidroximetilNitrofurazone (NFOH) | [ ] | |
Chalcones (CHC) | [ ] | |
O-allyl-lawsone (OAL) | [ ] | |
Nifurtimox (NF) | [ ] | |
Benznidazole (BNZ) | [ ] | |
Metronidazole (MTZ) | [ ] | |
β-lapachone (β-Lap) | [ ] | |
Nor-β-lapachone (NβL) | [ ] |
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Taio, F.; Converti, A.; Lima, Á.A.N.d. Cyclodextrin Complexes for the Treatment of Chagas Disease: A Literature Review. Int. J. Mol. Sci. 2024 , 25 , 9511. https://doi.org/10.3390/ijms25179511
Taio F, Converti A, Lima ÁANd. Cyclodextrin Complexes for the Treatment of Chagas Disease: A Literature Review. International Journal of Molecular Sciences . 2024; 25(17):9511. https://doi.org/10.3390/ijms25179511
Taio, Fabrice, Attilio Converti, and Ádley Antonini Neves de Lima. 2024. "Cyclodextrin Complexes for the Treatment of Chagas Disease: A Literature Review" International Journal of Molecular Sciences 25, no. 17: 9511. https://doi.org/10.3390/ijms25179511
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With a view to compare the quantity and quality characteristics of greywater from different sources, raw greywater was collected from a household, a girls’ hostel and a boys’ hostel daily for four months. Mixed greywater from the hand basin, bathroom and laundry was collected in each case. The results showed that the mean greywater generation from the household, the girls’ hostel and the boys’ hostel was 60, 85 and 80 L/person/day, respectively. No significant difference in greywater generation was observed for days of the week and the months of the year for a particular source. Greywater from the household was more polluted compared to the greywater from the girls’ hostel and boys’ hostel for different physicochemical and microbiological parameters, and no significant difference was observed in the quality of greywater from the boys’ hostel and the girls’ hostel except for NH 4 -N. Turbidity, COD and NH 4 -N in greywater from the household were 258 NTU, 522 mg/L and 11.63 mg/L, while PO 4 -P and faecal coliforms were 5.94 mg/L and 7.8 × 10 4 CFU/100 ml, respectively. Copper, zinc and chromium concentrations in the greywater from the household were 65.05, 240.43 and 26 µg/L, respectively. The turbidity, organic content, PO 4 -P and faecal coliform concentration in household greywater were at least three times higher than those in hostel greywater, while the concentrations of Cu and Zn were at least two times higher. Results indicated that the quality of greywater was related to the quantity of greywater generation and the source of greywater needs to be considered in the selection of the greywater treatment technology.
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Shaikh, I.N., Mansoor Ahammed, M. (2024). A Comparative Analysis of Greywater Quantity and Quality Characteristics in Household and Hostels. In: Sivakumar Babu, G.L., Mulangi, R.H., Kolathayar, S. (eds) Technologies for Sustainable Transportation Infrastructures. SIIOC 2023. Lecture Notes in Civil Engineering, vol 529. Springer, Singapore. https://doi.org/10.1007/978-981-97-4852-5_61
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This paper presents a literature review of the quality of greywater generated in different, especially developing, countries, constituents found in greywater, some treatment systems, natural materials for treatment, some reuse strategies and public perception regarding greywater reuse. ... Otterpohl R. Grey water treatment in UASB reactor at ...
Concerns about decreasing urban water supplies and environmental degradation caused by existing water infrastructure have prompted research on more resilient and long-term water delivery systems. Greywater reuse has been proposed to expand local water supply portfolios while minimizing stress on existing ecosystems and infrastructure. Researchers have developed several technologies for ...
This paper presents a literature review of the quality of greywater generated in different, especially developing, countries, constituents found in greywater, some treatment systems, natural materials for treatment, some reuse strategies and public perception regarding greywater reuse. The review shows that generation rates are mostly influenced by lifestyle, types of fixtures used and ...
With the rapid socio-economic and industrial development, the problem of water shortage is becoming increasingly serious. Seeking alternative water sources to reduce the need for freshwater resources is an increasing concern. Household greywater production is high and accounts for about 50-80% of domestic wastewater. In recent years, the in situ treatment and reuse of greywater have received ...
Greywater treatment technologies: a c omprehensive review A. Awasthi 1,3 · K. Gandhi 2,3 · S. Rayalu 1,3 Received: 29 December 2021 / Revised: 26 April 2022 / Accepted: 14 April 2023
The review shows large variations in greywater quality and quantity with respect to time and source, and the selection of a treatment system would largely depend on this variability. The review also shows that at the levels found in greywater, heavy metals and organic micropollutants in recycled greywater generally do not pose a threat to human ...
Finally, future perspectives on greywater management and reuse are presented. Through a comprehensive review, we expect that this review will help the reader to better understand the characteristics of greywater and to more rationally select the appropriate treatment technology based on the removal mechanism of pollutants.
18 Conclusion s. This study review ed greywater ch aracterist ics, treatmen t. systems, reus e strategies an d perception of gr eywater. reuse among us ers. It shows that there is a wi de variatio ...
The main objectives of this critical review are to (i) assess the variations in greywater source characteristics suitable for treatment in GWs; (ii) synthesize the literature on nutrient removal efficiencies from greywater by different types of GWs; (iii) summarize the nutrient removal mechanisms and fate of the nutrients in GWs; (iv) assess ...
This paper presents a comprehensive literature review of different characteristics of greywater (GW) and current treatment methods. GW is domestic wastewater excluding toilet waste and can be ...
Abstract. This paper presents a comprehensive literature review of different characteristics of greywater (GW) and current treatment methods. GW is domestic wastewater excluding toilet waste and can be classified as either low-load GW (excluding kitchen and laundry GW) or high-load GW (including kitchen and/or laundry).
Abstract. This paper presents a literature review of the quality of greywater generated in different, especially developing, countries, constituents found in greywater, some treatment systems, natural materials for treatment, some reuse strategies and public perception regarding greywater reuse. The review shows that generation rates are mostly ...
This review aims to discern a treatment for grey water by examining grey water characteristics, reuse standards, technology performance and costs. The review reveals that the systems for treating grey water, whatever its quality, should consist of processes that are able to trap pollutants with a small particle size and convert organic matter ...
The temporal distribution of studies on NBS designed for greywater treatments is shown in Fig. 1 b. The interest in constructed wetlands for wastewater treatment started in the early 1980s, with a growth around the beginning of the 21st century (Masi et al., 2018).Initial efforts were directed to the treatment of mixed domestic wastewater, while the attention to a proper separation of ...
GW treatment technologies have been extensively reviewed in order to consolidate all available data. The global scenario for grey-water handling and its hazards has also been focused on. A few historical references are also added to explain the interconnection of events from the past to the present. The. Fig. 1.
This paper presents a comprehensive literature review of different characteristics of greywater (GW) and current treatment methods. GW is domestic wastewater excluding toilet waste and can be classified as either low-load GW (excluding kitchen and laundry GW) or high-load GW (including kitchen and/or laundry).
Commercial systems for grey water treatment are costly for small amounts. Therefore, the aim was to gather, treat and reuse wastewater from small to medium-sized mosques using a cost-effective low maintenance treatment system (Ahmed et al. 2008). The long-term performance of three pilot-scale grey water treatment systems was analyzed.
Grey-water is a form of w aste water, consisting of kitchen water, bathrooms, dish and cloth. washers. Reusing of Grey-water has become a better choice, but since the amount of dissolved contents ...
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This study employed the systematic literature review (SLR) approach to assess the existing literature on the topic of greywater treatment technologies and narrow it to the application of BCFS. To answer the research questions, the study adopted a modified version of the fourteen-step approach by Tawfik et al. [28] and the five-step outlined by ...
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Abdel-Shafy et al. (2015) investigated the efficiency of UASB in greywater treatment for unrestricted use in Egypt. The raw greywater characteristics with average concentrations of 95, 392, 298, 10.45, 0.4, 118.5 and. 28 mg/L for TSS, COD, BOD5, TP, nitrates, oil and grease and TKN respectively were treated in a UASB.
This review intends to discuss on greywater treatment technologies, which are the physiochemical, biological and advanced oxidation process (AOP) treatment technologies that are used to remove ...
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Greywater is wastewater collected from household sources without input from toilet or commode streams. Greywater represent ca. 65% of total household wastewaters globally. Different aspects of greywater, including its production sources, its characteristics, the barriers and the global scenarios of its reuse, have been critically reviewed in this paper. Given the current projections on acute ...
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3.1 Single Household. The average daily greywater generation from the household was 60 ± 11 L/person/day, and it was well within the range reported in the literature for a household [].The average greywater generation observed in the present study was less than reported values from other studies in India [20, 21] but higher than those reported from countries with water scarcity such as Jordan ...