Contemporary educational methods in periodontology.

AIM: The 1st European Workshop on Periodontal Education in 2009 made recommendations regarding the scope of periodontal education at undergraduate (UG), postgraduate (PG) and continuing professional development (CPD) levels, defining competencies and learning outcomes that were instrumental at the time in helping to define periodontal teaching curricula. The 19th European Workshop on Periodontology and 2nd European Consensus Workshop on Education in Periodontology (Education in Periodontology in Europe) was held in 2023 to identify changes and future developments in periodontal education (including those informed by the COVID-19 pandemic) and embracing methods and formats of periodontal teaching and training. The aim of this review was to assess current knowledge regarding education methods in periodontology, including traditional face-to-face (F2F) teaching and the move to student-centred methods, virtual learning methods and use of digital technology, as well as blended teaching and learning (including teaching delivery and assessment) at UG, PG and CPD levels. MATERIALS AND METHODS: Systematic searches were conducted to identify relevant studies from the literature. Data were extracted and descriptive summaries collated. RESULTS: The pandemic was a major disruptor of traditional F2F teaching but provided opportunities for rapid implementation of alternative and supplementary teaching methods. Although online learning has become an integral part of periodontal education, teachers and learners alike favour some form of F2F teaching. Blended teaching and learning are feasible in many areas of periodontal education, both for knowledge and skills acquisition as well as in assessment. Student-centred methods and blended approaches such as the flipped classroom seem highly effective, and online/virtual classrooms with both synchronous and asynchronous lectures are highly valued. Learning with haptic methods and virtual reality (VR) enhances the educational experience, especially when VR is integrated with traditional methods. The quality of the teacher continues to be decisive for the best knowledge transfer in all its forms. CONCLUSIONS: Live F2F teaching continues to be highly trusted; however, all types of student-centred and interactive forms of knowledge transfer are embraced as enhancements. While digital methods offer innovation in education, blended approaches integrating both virtual and traditional methods appear optimal to maximize the achievement of learning outcomes. All areas of periodontal education (UG, PG and CPD) can benefit from such approaches; however, more research is needed to evaluate their benefits, both for knowledge transfer and skills development, as well as in assessment.

Microbiological Effects of Sodium Hypochlorite/-Amino Acids and Cross-linked Hyaluronic Acid Adjunctive to Non-surgical Periodontal Treatment.

PURPOSE: To investigate the microbiological outcomes obtained with either subgingival debridement (SD) in conjunction with a gel containing sodium hypochlorite and amino acids followed by subsequent application of a cross-linked hyaluronic acid gel (xHyA) gel, or with SD alone. MATERIALS AND METHODS: Forty-eight patients diagnosed with stages II-III (grades A/B) generalised periodontitis were randomly treated with either SD (control) or SD plus adjunctive sodium hypochlorite/amino acids and xHyA gel (test). Subgingival plaque samples were collected from the deepest site per quadrant in each patient at baseline and after 3 and 6 months. Pooled sample analysis was performed using a multiplex polymerase chain reaction (PCR)-based method for the identification of detection frequencies and changes in numbers of the following bacteria: Aggregatibacter actinomycetemcomitans (A.a), Porphyromonas gingivalis (P.g), Tannerella forsythia (T.f), Treponema denticola (T.d), and Prevotella intermedia (P.i). RESULTS: In terms of detection frequency, in the test group, statistically significant reductions were found for P.g, T.f, T.d and P.i (p < 0.05) after 6 months. In the control group, the detection frequencies of all investigated bacterial species at 6 months were comparable to the baseline values (p > 0.05). The comparison of the test and control groups revealed statistically significant differences in detection frequency for P.g (p = 0.034), T.d (p < 0.01) and P.i (p = 0.02) after 6 months, favouring the test group. Regarding reduction in detection frequency scores, at 6 months, statistically significant differences in favour of the test group were observed for all investigated bacterial species: A.a (p = 0.028), P.g (p = 0.028), T.f (p = 0.004), T.d (p <0.001), and P.i (p = 0.003). CONCLUSIONS: The present microbiological results, which are related to short-term outcomes up to 6 months post-treatment, support the adjunctive subgingival application of sodium hypochlorite/amino acids and xHyA to subgingival debridement in the treatment of periodontitis.

Systemic and topical treatment methods of recurrent aphthous stomatitis: A systematic review.

AIM: To analyze the latest systemic and topical recurrent aphthous stomatitis (RAS) treatment methods that could help patients in their daily lives. MATERIAL AND METHODS: A systematic literature review was performed of randomized control trials in English identified in MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (Cochrane Library), Researchgate, published between 2018 and 2023. Studies had to be performed in vivo. RESULTS: 34 randomized clinical trials matched all criterias and were included in systematic literature review. A wide variety of topical and systemic agents are suggested for the treatment of RAS. CONCLUSION: Topical medications can promote the healing time of ulcers and relieve the pain, but most of the time can not decrease the frequency of RAS relapse. However, for continuous RAS, treatment with systemic medication should be considered.

Use of platelet-rich fibrin versus connective tissue graft in treatment of gingival recessions: Literature review.

AIM: To compare and evaluate the effects of two different approaches on treating gingival recessions: coronally advanced flap (CAF) with platelet rich-fibrin (PRF) membrane and coronally advanced flap (CAF) with connective tissue graft (CTG). MATERIAL AND METHODS: A systematic literature review was performed of randomized control trials in English identified in MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (Cochrane Library), Springer Link, Science Direct and Google Scholar databases, published between 2015 and 2020. Studies had to be performed in vivo with follow-up periods of ≥6 months. RESULTS: 153 publications were found, out of which 8 were identified as relevant to the theme. Six of these studies evaluated periodontal parameters such as probing depth (PD), clinical attachment level (CAL), recession depth (RD), keratinized tissue width (KTW) and gingival thickness (GT). In 3 studies discomfort and aesthetic scores were analyzed as subjective parameters. 1 study histologically evaluated different techniques of gingival recession treatment. CONCLUSION: Both techniques are effective in the treatment of Miller's class I and II gingival recessions. Although the CTG technique may provide better results in KTW and GT, PRF avoids a donor site, which means a major decrease in postoperative discomfort.

Autologous platelet concentrates in treatment of medication related osteonecrosis of the jaw.

BACKGROUND: Medication related osteonecrosis of the jaw (MRONJ) is a severe adverse drug reaction occurring as a progressive bone destruction in the maxillofacial region. MRONJ is usually initiated after oral surgery procedures, however periodontal disease and other chronic inflammations are also risk factors. There is no clear treatment protocol for management of MRONJ, for this reason autologous platelet concentrates (APC) have been introduced to enhance the healing process. AIM: To evaluate the effectiveness of APCs in treatment of MRONJ. METHODS: A systematic literature review was performed according to PRISMA guidelines in MEDLINE (PubMed) and Google Scholar databases. Only no older than 5 years, in vivo studies in English with follow-up until condition totally resolves were included. RESULTS: A total of 2683 publications were identified out of which only 7 met the inclusion criteria, 6 cohort and 1 randomized clinical trial. Most of the studies preferred platelet rich fibrin (PRF) and only one used platelet rich plasma (PRP) in MRONJ treatment. MRONJ stage, patients mean age, drug therapy, follow-up and success rate were analysed in all the studies. Five studies also named how MRONJ initiated and 4 studies mentioned duration of drug intake before developing MRONJ. CONCLUSION: The published data is not sufficient to confirm a specific treatment protocol although the published results are promising. More prospective randomized controlled clinical trials are required in order to evaluate the effectiveness of APCs for treatment of MRONJ.