Liposomal anesthetic gel for pain control during periodontal therapy in adults: a placebo-controlled RCT.

INTRODUCTION: Periodontal therapy usually requires local anesthesia. If effective, a non-invasive, liposomal anesthetic gel could increase the levels of acceptance of patients in relation to periodontal therapy. OBJECTIVE: This study investigated the efficacy of liposomal anesthetic gel for pain control during periodontal therapy. METHODOLOGY: Forty volunteers with moderate to severe chronic periodontitis were recruited, of which at least three sextants required periodontal therapy. At least one of the selected teeth had one site with a probing depth of ≥4 mm. The volunteers received the following three gels: a placebo, lidocaine/prilocaine (Oraqix®), or a liposomal lidocaine/prilocaine, which were applied to different sextants. Pain frequency was registered during treatment and the volunteers received a digital counter to register any painful or uncomfortable experiences. At the end of each session, the volunteers indicated their pain intensity using rating scales (NRS-101 and VRS-4). The volunteers had their hemodynamic parameters measured by a non-invasive digital monitor. RESULTS: Pain frequency/intensity did not show statistical difference between intervention groups. The tested gels did not interfere with the hemodynamic indices. Dental anxiety, suppuration and probing depth could influence pain during periodontal therapy. CONCLUSION: Our results suggest limited indications for the use of non-invasive anesthesia when used for scaling and root planing. Intra-pocket anesthetic gel could be a good option for anxious patients, or those who have a fear of needles.

Liposomal anesthetic gel for pain control during periodontal therapy in adults: a placebo-controlled RCT

Abstract Periodontal therapy usually requires local anesthesia. If effective, a non-invasive, liposomal anesthetic gel could increase the levels of acceptance of patients in relation to periodontal therapy. Objective: This study investigated the efficacy of liposomal anesthetic gel for pain control during periodontal therapy. Methodology: Forty volunteers with moderate to severe chronic periodontitis were recruited, of which at least three sextants required periodontal therapy. At least one of the selected teeth had one site with a probing depth of ≥4 mm. The volunteers received the following three gels: a placebo, lidocaine/prilocaine (Oraqix®), or a liposomal lidocaine/prilocaine, which were applied to different sextants. Pain frequency was registered during treatment and the volunteers received a digital counter to register any painful or uncomfortable experiences. At the end of each session, the volunteers indicated their pain intensity using rating scales (NRS-101 and VRS-4). The volunteers had their hemodynamic parameters measured by a non-invasive digital monitor. Results: Pain frequency/intensity did not show statistical difference between intervention groups. The tested gels did not interfere with the hemodynamic indices. Dental anxiety, suppuration and probing depth could influence pain during periodontal therapy. Conclusion: Our results suggest limited indications for the use of non-invasive anesthesia when used for scaling and root planing. Intra-pocket anesthetic gel could be a good option for anxious patients, or those who have a fear of needles.

Minimally invasive non-surgical vs. surgical approach for periodontal intrabony defects: a randomised controlled trial.

BACKGROUND: Periodontal intrabony defects are usually treated surgically with the aim of increasing attachment and bone levels and reducing risk of progression. However, recent studies have suggested that a minimally invasive non-surgical therapy (MINST) leads to considerable clinical and radiographic defect depth reductions in intrabony defects. The aim of this study is to compare the efficacy of a modified MINST approach with a surgical approach (modified minimally invasive surgical therapy, M-MIST) for the treatment of intrabony defects. METHODS: This is a parallel-group, single-centre, examiner-blind non-inferiority randomised controlled trial with a sample size of 66 patients. Inclusion criteria are age 25-70, diagnosis of periodontitis stage III or IV (grades A to C), presence of ≥ 1 'intrabony defect' with probing pocket depth (PPD) > 5 mm and intrabony defect depth ≥ 3 mm. Smokers and patients who received previous periodontal treatment to the study site within the last 12 months will be excluded. Patients will be randomly assigned to either the modified MINST or the M-MIST protocol and will be assessed up to 15 months following initial therapy. The primary outcome of the study is radiographic intrabony defect depth change at 15 months follow-up. Secondary outcomes are PPD and clinical attachment level change, inflammatory markers and growth factors in gingival crevicular fluid, bacterial detection, gingival inflammation and healing (as measured by geometric thermal camera imaging in a subset of 10 test and 10 control patients) and patient-reported outcomes. DISCUSSION: This study will produce evidence about the clinical efficacy and potential applicability of a modified MINST protocol for the treatment of periodontal intrabony defects, as a less invasive alternative to the use of surgical procedures. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03797807. Registered on 9 January 2019.

The use of immersive virtual reality for pain control during periodontal scaling and root planing procedures in dental hygiene clinic.

OBJECTIVE: To identify the effect of immersive virtual reality (VR) on pain perception during scaling and root planing procedures (SRP) in dental hygiene clinic. METHODS: Participants were recruited based on inclusion and exclusion criteria. Within-subject/split-mouth design was used in this study. The participants received a full mouth SRP. The participants were divided into two treatment conditions: (a) without VR condition or (b) with VR condition. Blood pressure (BP) and pulse rate (PR) were measured. Level of pain was measured by the Visual Analog Scale (VAS). Participants gave ratings using 0-10 scales with cut points on the scale indicating that (0) none, (1-3) mild, (4-6) moderate or (7-10) severe. Participants were also asked three questions to assess presence, realism and nausea. The immersive virtual environment used for this study was nonviolent and inoffensive. RESULTS: Data were analysed using SPSS® software. Fifty subjects with a mean age of 36 years completed the study. The Wilcoxon signed-rank test revealed that VAS scores were significantly (P = < 0.05) lower during VR compared without VR condition. Paired t test revealed that on average, participants experienced significantly lower systolic Bp after using VR (M = 113.72, SE = 2.16) than systolic Bp after treatment without VR However, Bp (diastolic) and PR showed no difference. 84% of the participants felt like they went inside the virtual world, 82% felt that the virtual objects seem real to them, and 94% did not feel nausea. 98% of the participants preferred using VR during SRP. CONCLUSIONS: The results of this study indicate that the immersive VR has the potential in becoming a future method for pain control during scaling and root planing procedures.

Restoration of Lost Interdental Papilla: A Surgical Technique.

Loss of interdental papilla due to trauma or inflammatory periodontal diseases presents significant esthetic-zone challenges to clinicians. Miniscule working spaces and limited blood supply to these areas render conventional surgical techniques somewhat unpredictable. The implementation of vertical releasing incisions can further jeopardize blood supply and leave unattractive scarring upon healing. This article discusses a surgical technique utilizing microscopes and microsurgical instruments to more effectively achieve esthetic results. Additionally, the article provides a brief overview on the development of periodontal plastic and reconstruction surgery and updated information to support previously published reports by this author.

aPDT for periodontitis treatment in ovariectomized rats under systemic nicotine.

BACKGROUND: This study evaluated the antimicrobial photodynamic therapy (aPDT) as an adjunctive therapy to scaling and root planning (SRP) for the treatment of experimental periodontitis (EP) in ovariectomized rats under systemic nicotine. METHODS: Female ovariectomized rats (n = 180) were divided into two groups: vehicle administration (Veh) and nicotine administration (Nic). Mini-pumps containing either vehicle or nicotine were inserted in the rats 30 days before the induction of EP, which was induced by placing a ligature around the left mandibular first molar. The rats were randomly divided into three treatment subgroups: SRP, SRP plus low-level laser therapy (LLLT), and SRP plus aPDT. aPDT consisted of the application of a phenothiazine photosensitizer followed by LLLT. Ten animals from each group were euthanized at days 7, 15, and 30 after periodontal treatment. The furcation region was evaluated using histological, histometric analyses and immunolabelling for PCNA, TRAP, RANKL, and OPG. RESULTS: Nicotine administration resulted in greater bone loss (BL). aPDT resulted in lower BL compared to SRP. aPDT showed higher quantities of PCNA-positive cells compared to SRP, regardless of the nicotine status. aPDT resulted in less recruitment of osteoclasts and lower RANKL immunolabelling compared to LLLT and SRP. CONCLUSION: aPDT was effective in animals treated with nicotine.

Comparative evaluation of effectiveness of intra-pocket anesthetic gel and injected local anesthesia during scaling and root planing - A split-mouth clinical trial.

BACKGROUND AND AIM: Pain control is an important outcome measure for successful periodontal therapy. Injected local anesthesia has been used to secure anesthesia for scaling and root planing (SRP) and continues to be the anesthetic of choice for pain control. Alternatively, intra-pocket anesthetic gel has been used as an anesthetic during SRP. Hence, this clinical trial was done to compare the effectiveness of intra-pocket anesthetic gel and injected local anesthesia during SRP and also to assess the influence of intra-pocket anesthetic gel on treatment outcomes in chronic periodontitis patients. MATERIALS AND METHODS: Fifteen systemically healthy chronic periodontitis patients were recruited. The dental quadrants on right side received either intra-pocket 20% benzocaine gel (Gel group) or infiltration/block by 2% lidocaine with 1:80,000 adrenaline (injection group). Quadrants on the left side received the alternative. Pain perception and patients preference for the type of anesthesia was recorded. Clinical parameters: plaque index, modified gingival index, modified sulcular bleeding index, probing pocket depth, and clinical attachment level were recorded at baseline and 1 month after treatment. RESULTS: No difference was observed in visual analog scale (P > 0.05) and verbal rating scale (P > 0.05) pain perception between gel group and injection group. A slightly increased preference to gel as anesthesia (53% vs. 47%) was observed. The treatment outcome after SRP did not show a significant difference between gel and injection group (P > 0.05). CONCLUSION: Intra-pocket administration of 20% benzocaine gel may be effective for pain control during SRP and may offer an alternative to conventional injection anesthesia.

[Bleeding control of periodontal mechanical therapy for patients taking aspirin].

OBJECTIVE: To investigate the feasibility of periodontal mechanical therapy for chronic periodontitis and coronary heart disease patients with low dose of aspirin. METHODS: Sixty nine chronic periodontitis patients with coronary heart disease were randomly selected as the experimental group (medication group, group A), the control group (withdrawal group, group B) including 20 chronic periodontitis patients with coronary artery disease, stopping the drug for one week and another control group with 50 chronic periodontitis patients (group C). The three groups were examined with pocket probing, and received supragingival scaling, subgingival scaling, and root planning. Local bleeding after operation was observed. In 30 minutes after periodontal mechanical treatment, there was still a need to take some hemostatic measures (containing the oxidized cellulose putting in the periodontal pocket, gauze oppressing, and suturing). Nd:YAG laser was used to stop bleeding 60 minutes after operation. RESULTS: At baseline, there was no significant difference in the three groups, as to the plaque index(PLI), the probing depth (PD), and the attachment loss (AL). The bleeding index (BI)in group A was significantly higher than that in group C (P=0.024), higher than that in group B (P=0.088). The platelet maximum aggregation rate (Agg(max)) was detected in some subjects. The average Agg(max) value group A was 15.2%, which was much greater than that in group B (60.7%) and group C (62.5%). The three groups were all safe in the treatment of periodontal therapy. There were five cases of active bleeding in group A, one case in group B and one case in group C in 30 minutes after operation. In 60 minutes after operation, there was one case of bleeding actively in group A. Nd:YAG laser was used to stop bleeding successfully. CONCLUSION: The chronic periodontitis and coronary heart disease patients with long-term oral administration of low dose of aspirin can be safely treated with periodontal mechanical treatment, and the effect of local hemostasis is positive without stopping the drug.

Acute-phase response following full-mouth versus quadrant non-surgical periodontal treatment: A randomized clinical trial.

AIM: A moderate acute-phase response occurs 24-h following full-mouth non-surgical treatment (FM-SRP). The aim of this study was to compare acute-phase (24-h) and medium-term (3 months) inflammation after quadrant scaling (Q-SRP) versus FM-SRP. MATERIAL & METHODS: Thirty-eight periodontitis-affected subjects were randomly allocated to FM-SRP or Q-SRP after a baseline visit. Periodontal and anthropometric parameters were collected at baseline and 3 months. Serum samples were drawn at baseline, 1, 7, and 90 days after treatment. High-sensitivity assays of inflammation and endothelial assays were performed. RESULTS: FM-SRP produced a greater acute-phase response after 24 h [threefold increase in C-reactive protein (CRP), twofold increase in interleukin (IL-6), and a slight increase in tumour necrosis factor]. No differences in systemic biomarkers were noted between groups at any later follow-ups. Both periodontal treatments produced a comparable improvement in clinical periodontal parameters with no between-group differences. Treatment time was positively associated with the relative 24-h increase in CRP (R = 0.5, p < 0.001) and IL-6 (R = 0.5, p = 0.002), while the number of deeper (>6 mm) pockets predicted only the relative increase in IL-6 (R = 0.4, p < 0.05). CONCLUSIONS: FM-SRP triggers a moderate acute-phase response of 24 h duration compared to Q-SRP. Further research is needed to assess the eventual impact of such findings on the risk of vascular events is advocated. (ClinicalTrials.gov NCT01857804).

Intrapulpal temperature changes during root surface irradiation with dual-wavelength laser (2780 and 940 nm): in vitro study.

This work reports that the ablation volume and rate of porcine skin changed significantly with the change of skin water content. Under the same laser irradiation conditions (532 nm Nd:YAG laser, pulse width = 11.5 ns, pulse energy = 1.54 J, beam radius = 0.54 mm), the ablation volume dropped by a factor of 4 as the skin water content decreased from 40 wt. % (native) to 19 wt. % with a change in the ablation rate below and above around 25 wt. %. Based on the ablation characteristics observed by in situ shadowgraph images and the calculated tissue temperatures, it is considered that an explosive rupture by rapid volumetric vaporization of water is responsible for the ablation of the high water content of skin, whereas thermal disintegration of directly irradiated surface layer is responsible for the low water content of skin.

The prevalence of tooth hypersensitivity following periodontal therapy with special reference to root scaling. A systematic review of the literature.

PURPOSE: To provide a current status of the art, answering the question whether a certain procedure of periodontal treatment is more reliable than another and where innovative developments could improve on the incidence of hypersensitivity by a systematic literature review. METHODS: Pubmed, Embase and Cochrane library were considered for the study. 2,656 articles of the PubMed search were found, from the beginning of 1945 until April 2011. 99 articles from PubMed were evaluated for this review. From Embase, 60 articles were selected and one was included in this review. From the Cochrane library, 182 were found, of which two contributed to the review. Included were all studies dealing with periodontal treatment followed by hypersensitivity and all studies dealing with the loss of attachment, followed by hypersensitivity. Excluded were any treatments of tooth hypersensitivity with pathogenesis not related to dentin exposure, genetically caused disorders, and fractures. Ultimately, 102 papers were evaluated, included and referred to in the review. RESULTS: The term "tooth hypersensitivity" is most often used. Common causes of loss of hard substance are listed and updated. Mechanical loss of hard tissue formed one group of etiological factors; gingival recession and loss of attachment another. Surgical interventions, scaling and root planing were considered and in most cases performed as combined procedures. The different methods were evaluated and critically discussed. There were no properly randomized studies in the literature. The weak point of all epidemiological studies is the lack of any objective measurement. With respect to periodontal therapy, further research and developmental work on medical devices is needed, as well as ongoing applied research with laser technologies, continuing education and training programs for professionals.

Effect of eutectic mixture of local anesthetics on pain perception during scaling by ultrasonic or hand instruments: a masked randomized controlled trial.

BACKGROUND: The aims of this study are to evaluate the efficacy of a eutectic mixture of local anesthetic (EMLA) cream on pain perception during scaling and to compare the intensities of pain provoked by hand and ultrasonic instruments. METHODS: Forty subjects with chronic gingivitis or periodontitis were enrolled in the study. In this randomized, split-mouth, controlled, masked clinical trial, each of the four quadrants in subjects was randomly assigned to receive one of the following protocols: scaling with an ultrasonic scaler with or without the application of the EMLA cream or scaling with a Gracey curet with or without the application of the EMLA cream. Pain levels after each quadrant of scaling were assessed with a visual analog scale (VAS; 0 to 100 mm) and verbal rating score (VRS; 0 to 4). All subjects were recalled to detect any complications after 24 hours. RESULTS: The mean VAS and VRS when EMLA cream was applied (18.39 ± 14.47 mm and 0.95 ± 0.69) were significantly lower (P <0.001 for VAS and VRS) compared to when EMLA cream was not used (26.54 ± 16.46 mm and 1.30 ± 0.75). The mean VAS and VRS of the ultrasonic scaler group (20.43 ± 16.40 mm and 0.98 ± 0.76) were significantly lower (P = 0.024 for VAS; P = 0.003 for VRS) than those of the Gracey curet group (24.50 ± 15.17 mm and 1.28 ± 0.69). None of the subjects showed adverse effects after EMLA-cream application. CONCLUSION: Although most patients experienced limited pain during scaling, a significant reduction of pain is achieved by using EMLA cream and ultrasonic scaler.

Effects of irrigation with an antiseptic and oral administration of azithromycin on bacteremia caused by scaling and root planing.

BACKGROUND: Transient bacteremia frequently occur secondary to several periodontal procedures. The purpose of the present study is to investigate the effects of irrigation with an essential oil-containing antiseptic (EO) and oral administration of azithromycin (AZM) on bacteremia caused by scaling and root planing (SRP). METHODS: Thirty patients with chronic periodontitis were randomly assigned to three groups (control, EO, and AZM). The EO group received quadrant subgingival irrigation with EO, and mouthrinsing was continued at home for 1 week. Oral administration of AZM was started 3 days before SRP in the AZM group. No adjunctive treatment was performed before SRP in the control group. Peripheral blood and subgingival plaque were collected at baseline and after 1 week. The second blood sample was taken 6 minutes after the initiation of quadrant SRP. The blood samples were cultured and analyzed for bacteremia. Quantitative analysis of periodontopathic bacteria in the sulcus was performed using the polymerase chain reaction Invader method. RESULTS: Bacteremia incidence rates were 90%, 70%, and 20% for the control, EO, and AZM groups, respectively. Significant reduction of the incidence of bacteremia was shown in the AZM group only (P <0.01). Subgingival bacterial counts significantly decreased in both the EO and AZM groups (P <0.01). CONCLUSIONS: Quadrant SRP frequently induced bacteremia. Although AZM was effective in reducing bacteremia incidence, EO showed less effectiveness.

Dentinal hypersensitivity following scaling and root planing: comparison of low-level laser and topical fluoride treatment.

The aim of this study is to compare the effectiveness of low-level laser irradiation to traditional topical fluoride treatment for treatment choices of dentinal hypersensitivity following scaling and root planing. The experimental group (15 patients) was treated with low-energy-level diode laser at each site of dentinal hypersensitivity following scaling and root planning. The control group (15 patients) received topical fluoride treatment (protective varnish for desensitization). All the patients were treated at baseline visit, and then at day 2 and 4 after the initial treatment; the pain was subjectively assessed by the patients as strong, medium, medium low, low, or no pain. Total absence of the dental hypersensitivity was reported in 26.66% of the examined group even after the second visit, compared to the control group where complete resolution of the hypersensitivity was not present after the second visit in any of the treated cases. Complete absence of pain was achieved in 86.6% of patients treated with laser and only in 26.6% in the fluoride treated group, after the third visit. Based on our findings, we conclude that low-energy biostimulative laser treatment can be successfully used for treatment of dental hypersensitivity following scaling and root planing.

Full-mouth versus quadrant-wise scaling--clinical outcome, efficiency and treatment discomfort.

The aim of this randomized clinical study was to compare full-mouth scaling and root planing (FM-SRP) in two sessions within 24 hours with quadrant-wise scaling and root planing (Q-SRP) in four sessions within 4-6 weeks and evaluate (I) clinical outcome, (II) treatment efficiency, and (III) treatment discomfort of patients and therapists. Twenty individuals, aged 28-65 years, with severe chronic periodontitis were randomly assigned to treatment with FM-SRP or Q-SRP. At baseline and after 6 months, there were no between-group differences in clinical findings, treatment discomfort, or post-treatment body temperature. The therapists, however, felt that FM-SRP was more physically and psychologically demanding than Q-SRP. Mean effective scaling and root planing (SRP) time was 165.5 min during the two FM-SRP sessions and 202.1 min during the four Q-SRP sessions. FM-SRP's initial time savings of 36.6 min compared with Q-SRP diminished to 30.8 min at the 6-month follow-up due to rescaling needs. Total mean treatment time (comprising SRP and patient reinformation and reinstruction in oral hygiene) during the first 6 months post-treatment was 321.2 min for FM-SRP and 353.0 min for Q-SRP. Thus, mean savings in total treatment time with FM-SRP was 31.8 min compared with Q-SRP. In conclusion, this study found that both treatment modalities may be recommended for chronic periodontitis patients. Although time saving is possible with FM-SRP,the modality may compromise the therapist's well-being if practiced frequently due to the risk of musculoskeletal problems.

The frequency of bleeding complications after invasive dental treatment in patients receiving single and dual antiplatelet therapy.

BACKGROUND: The dental literature suggests that a patient's antiplatelet medication schedule should not be altered before invasive dental procedures. The authors conducted a study to examine the frequency of bleeding complications after invasive dental procedures in patients taking antiplatelet medications. METHODS: In a retrospective study of 43 dental patients who were receiving single or dual antiplatelet therapy, the authors conducted a chart review of patient records and examining documentation of the medical history. They collected demographic data; medical history; medication history; social history; presence of preoperative infection at any dental visit as evidenced by swelling, purulence or periapical radiolucency; number and type of invasive dental visits; emergency department visits; types of dental procedures performed; use of adjunctive perioperative local hemostatic measures (for example, topical thrombin, absorbable gelatin compressed sponge, sutures); blood products used preoperatively and postoperatively; and postoperative complications. RESULTS: Twenty-nine patients (67 percent) were receiving dual antiplatelet therapy. There were 88 invasive-procedure visits consisting of extractions, periodontal surgery, and subgingival scaling and root planing. The authors found no differences between patients receiving single or dual antiplatelet therapy for all variables, most notably the number of invasive-procedure visits, total extractions and adjunctive hemostatic measures. There were no documented episodes of prolonged postoperative bleeding. CONCLUSIONS: The frequency of oral bleeding complications after invasive dental procedures was low to negligible for patients who were receiving single or dual antiplatelet therapy. CLINICAL IMPLICATIONS: The risks of altering or discontinuing use of antiplatelet medications far outweigh the low risk of postoperative oral bleeding complications resulting from dental procedures.

[Bacteremia after periodontal procedures]. / Bacteriemia secundaria a procedimientos odontológicos periodontales.

INTRODUCTION: Bacteremia frequently occurs after oral surgery and odontology procedures. Periodontitis may affect the incidence and bacterial spectrum of bacteremia. Periodontal disease may be a significant risk factor for the development of certain systemic diseases. This study has aimed to evaluate the frequency of aerobic and anaerobic bacteria in the bloodstream following scaling and root planing. MATERIAL AND METHODS: Thirteen patients with generalized chronic periodontitis were included in the study. Two samples of peripheral blood were drawn for culture at different times: pre-treatment and immediately after odontology treatment (full-mouth scaling). RESULTS: None of the 13 patients had bacteremia before the procedures. Bacteremia after scaling occurred in 10/13 (76.9 %) of periodontitis patients. The anaerobic bacteria (Prevotella spp., Micromonas micros and Fusobacterium nucleatum) were the most predominant microorganism. CONCLUSIONS: Our findings suggest that periodontal procedures induce bacteremia and may represent risk of developing systemic complications. The use of antibiotic prophylaxis is crucial for its prevention.

Evaluation of the effect of the GaAlAs laser on subgingival scaling and root planing.

OBJECTIVE: To evaluate the auxiliary effect of the low-intensity laser in subgingival scaling and root planing by analysis of its clinical aspects, as well as its analgesic potential during the procedure. BACKGROUND DATA: Despite the large number of studies conducted on low-intensity laser energy, few clinical studies are available on periodontics. MATERIALS AND METHODS: Ten patients were selected and submitted to measurement of six sites per tooth, four teeth per hemiarch (960 sites in all). All patients then received subgingival scaling and root planing. Besides periodontal treatment, the test side was also submitted to laser application. The analysis comprised measurement of probing depth, clinical attachment level, and gingival index. Laser energy was applied at a wavelength of 780 nm (35 J/cm(2), 70 mW, 20 sec per site) for preoperative analgesia, and scaling and root planing were performed with application of laser energy at a wavelength of 780 nm (35 J/cm(2), 70 mW, 20 sec) for analgesia, and at a wavelength of 630 nm (8.8 J/cm(2), 35 mW, 10 sec) for healing. The patients filled out a visual analogue scale to assess the pain they felt during the procedure. After 24 and 48 h, the laser was again applied at the wavelength of 630 nm, and the patients were re-evaluated after 3 d. RESULTS: There was a reduction in gingival inflammation, yet without a statistically significant difference between the study and control sides, both in clinical aspects and evaluation of pain during the procedure. CONCLUSION: Utilization of the diode laser as an auxiliary in subgingival scaling and root planing did not provide any apparent clinical benefit for teeth with shallow to moderate pockets.

A critically severe gingival bleeding following non-surgical periodontal treatment in patients medicated with anti-platelet.

BACKGROUND: Only a few dental procedures have been reported to cause life-threatening bleeding. All of these cases followed surgical intervention. MATERIAL AND METHODS: In this paper, we report a case of severe bleeding following non-surgical periodontal procedures in a patient treated with a dual anti-platelet regimen post-coronary stent insertion. RESULTS: Her medical history included ischaemic heart disease, hypertension and diabetes mellitus. Haemostasis was achieved at the conclusion of the non-surgical periodontal treatment. However, several hours later, the patient arrived at the emergency room and was diagnosed with hypovolemic shock. CONCLUSION: This case should raise the clinician's awareness of bleeding complications in non-surgical procedures as well as the risk for bleeding when a dual anti-platelet regimen is administered. The importance of patient monitoring and the use of local haemostatic agents is demonstrated in these cases.