Change in clinical parameters after subgingival instrumentation for the treatment of periodontitis and timing of periodontal re-evaluation: A systematic review and meta-analysis.

AIM: To evaluate the changes in periodontal parameters (reduction in probing pocket depth [PPD], gain in clinical attachment level [CAL] and reduction in full-mouth bleeding on probing [BoP]) after subgingival instrumentation of periodontal pockets at different time points in systemically healthy patients suffering from periodontitis. MATERIALS AND METHODS: Four databases were searched for RCTs that carried out subgingival instrumentation in periodontal pockets and evaluated PPD at a minimum of two consecutive time points other than baseline. The analysis was conducted for both all pocket depths and stratified for initially shallow (4-5 mm) and deep (≥6 mm) pockets and data were extracted for various time points, 1-2, 3-4 and 5-6 months. Weighted mean effects (WMEs) were calculated with 95% confidence interval (CI) and predictive intervals were calculated. RESULTS: Twenty-nine RCTs were identified, and all of them were included in the meta-analysis. The results showed that for both shallow and deep pockets there was a small though clinically meaningful change between 1- to 2-month and 3- to 4-month time points and between these and 5-6 months. CONCLUSIONS: In systemically healthy patients, the greater part of reduction in PPD and gain in CAL occurs within the first 1-2 months after subgingival instrumentation. However, additional benefits in terms of pocket depth reduction occur beyond these early time points.

Healthy lifestyles are associated with a better response to periodontal therapy: A prospective cohort study.

AIM: To evaluate the association between lifestyle behaviours and clinical periodontal outcomes following Steps 1/2 of periodontal therapy. METHODS: A total of 120 subjects with untreated Stage II/III periodontitis participated in this study. At baseline, questionnaires were administered to assess the following lifestyle behaviours: adherence to Mediterranean diet (MD), physical activity (PA) and stress levels, sleep quality, smoking and alcohol use. Participants received Steps 1/2 of periodontal therapy and were re-evaluated after 3 months. A composite outcome of the endpoint of therapy (i.e., no sites with probing pocket depth [PPD] ≥4 mm with bleeding on probing, and no sites with PPD ≥ 6 mm) was regarded as the primary outcome. Simple and multiple regression analyses were used to evaluate the association between lifestyle behaviours and clinical periodontal outcomes. Disease severity at baseline, body mass index, diabetes, household disposable income and plaque control were considered as confounders. RESULTS: Multiple regression analyses showed significantly lower odds of achieving the endpoint of therapy in subjects with poor sleep quality (odds ratio [OR] = 0.13; 95% confidence interval [CI]: 0.03-0.47; p < .01), smoking (OR = 0.18; 95% CI: 0.06-0.52; p < .05) and alcohol use above the suggested intake (OR = 0.21; 95% CI: 0.07-0.63; p < .01). Subjects with a combination of 'unhealthy lifestyles' (low adherence to MD and low PA levels and high levels of stress and poor sleep quality) showed higher proportions of residual PPD≥6 mm (MD = 1.51; 95% CI: 0.23-2.80; p < .05) and lower odds of achieving the endpoint of therapy (OR = 0.85; 95% CI: 0.33-0.99; p < .05) at re-evaluation. CONCLUSIONS: Subjects with unhealthy lifestyle behaviours showed worse clinical outcomes 3 months after Steps 1/2 of periodontal therapy.

Evaluation of the adjunctive use of Er:YAG laser or erythritol powder air-polishing in the treatment of peri-implant mucositis: A randomized clinical trial.

AIM: To assess the efficacy of Er:YAG laser (ERL) and erythritol powder air-polishing (AP) in addition to the submarginal instrumentation in the non-surgical treatment of peri-implant mucositis (PM). MATERIALS AND METHODS: Patients with at least one implant diagnosed with PM were included in the present 6-month randomized clinical trial (RCT). Implants were randomly assigned to one of the three treatment groups after submarginal instrumentation: AP (test 1 group), ERL (test 2 group) or no adjunctive methods (control group). The primary and secondary outcomes were, respectively, bleeding on probing (BoP) reduction and, complete disease resolution (total absence of BoP) and probing pocket depth (PPD) changes. The patient and the implant were considered the statistical unit. A multivariate logistic regression analysis was performed. RESULTS: A total of 75 patients were enrolled in the study. At each time point, significant BoP and PPD reductions were observed within each group. Intergroup analysis did not show statistically significant differences. Complete disease resolution ranged between 29% and 31%. The logistic regression showed that supramucosal restoration margin, PPD < 4 mm and vestibular keratinized mucosa (KM) significantly influenced the probability to obtain treatment success. CONCLUSION: The adjunctive use of AP and ERL in PM non-surgical therapy does not seem to provide any significant or clinically relevant benefit in terms of BoP and PPD reductions and complete disease resolution, over the use of submarginal instrumentation alone. Baseline PPD < 4 mm, presence of buccal KM and supramucosal restoration margin may play a role in the complete resolution of PM.

The impact of COVID-19 on Italian dentists: A cross-sectional survey on 2443 participants.

OBJECTIVE: To evaluate the impact of COVID-19 pandemic among a sample of Italian dentists in terms of infection, strategies for infection control, organization of the dental clinic, attitude, and behavior. MATERIAL AND METHODS: This was a cross-sectional survey. The sample consisted of 8000 Italian dentists selected among 63,375 using a computerized random sampling method. An electronic informed consent had to be signed. The questionnaire categories were on demographic, infection risk management, organization, and dentists' attitude and behavior. Geographic macro-areas were used for subgroup analysis. RESULTS: Among 8000 invited dentists, 2443 agreed to participate to the survey (30.6%). Mean age was 51.2 years, women were 34.5%. A total of 6.1% self-reported COVID-19 experience and higher rate of infection was reported in north Italy compared to the south (p < 0.05). FFP2/FFP3 respirators (97.1%) and visors (97.4%) were used by almost all dentists. While, natural ventilation and mouthwashes were the most frequent approaches used to reduce the infection risk. Most of the dentists reported positive attitude, nevertheless 83.6% felt an increased responsibility. CONCLUSION: The self-reported COVID-19 prevalence was 6.1% with some differences among geographic areas. COVID 19 had a deep impact on preventive strategies, dental office organization, and behavior within this sample.

The impact of COVID-19 pandemic in patients with a diagnosis of Oral Lichen Planus: Pain perception and psychological profile analysis.

OBJECTIVES: To assess the impact of COVID-19 in patients affected by OLP, in terms of level of pain, stress, depression and anxiety and their impact on the clinical manifestation of the disease. MATERIAL AND METHODS: A longitudinal design was employed. Psychometric evaluations of anxiety, stress, and depression were conducted using the DASS21 scale, while pain levels were measured using the VAS scale. Clinical diagnosis and phenotype evaluation were performed. RESULTS: The study included 24 patients with an average age of 62.9 years, with 70.8% presenting erosive OLP. Results revealed a significant worsening of anxiety, stress, and depression scores during the pandemic. Pain level (1.5 ± 1.2 pre-pandemic VS 3.8 ± 1.1 during the pandemic, p < 0.0001) was also negatively affected. CONCLUSIONS: These findings highlight the potential interplay between psychological stress and oral health conditions, emphasizing the need for a comprehensive understanding of OLP's complex etiology and its response to external stressors. CLINICAL RELEVANCE: Multidisciplinary care strategies to address both physical and psychological aspects of OLP patients is recommended following the present findings. Further research is warranted to confirm these observations in larger multicenter studies and to guide tailored guidance approaches for OLP patients during challenging times.

Oroantral Communications: Clinical Efficacy of a Double-layered Technique With/Without the Palatal Connective Tissue Flap: A Superiority, Single-center, University-based Randomized Clinical Trial.

The aim of this study was to compare the clinical results of combining a pedicle connective palatal flap coupled with the trapezoid buccal flap against the buccal flap alone in the closure of the oroantral fistula. Individuals with oroantral communication were consecutively included and eventually randomly allocated into 2 groups. In the group test, oroantral fistula was treated with the association of a buccal flap with a pedicle palatal connective tissue flap; in group control, a classic buccal sliding flap was performed. Patients' outcomes were recorded at 48 hours, 1 week, 2 weeks, and 1 month after surgery for assessment of primary (success rate) and secondary endpoints, such as experienced pain, discomfort, and complications. The success rate was 96.6% for the test group and 86.6% for the control group. No significant difference between the 2 groups could be observed regarding discomfort and pain. More pronounced pain was detected in the test group during the early healing period. This surgical procedure was demonstrated to be successful, with a high success rate and low patient discomfort.

Accuracy and Security Analysis of a Cranio-Maxillofacial Plastic Surgery Robot Equipped With Piezosurgery in Genioplasty.

ABSTRACT: This study aims to verify that the craniofacial plastic surgery robot with piezosurgery is more accurate and safer than traditional operations in genioplasty. This study chose data from the Digital Plastic Surgery of Plastic Surgery Hospital in the Chinese Academy of Medical Sciences and Peking Union Medical College. The CT data of the patient's skull were reconstructed in the software, and the authors designed the measurement index. The surgical plan was designed as an ideal scheme (control group). Patients underwent traditional surgery according to the preoperative surgery plan (clinical group). Guided by surgical navigation, the osteotomy was operated on patients' same size plaster model using the surgery robot equipped with a piezosurgery (robot group). At last, the accuracy was calculated by CT data. There was no significant difference between the robotic group and control groups in the postoperative measurement index (P < 0.05). There was no significant difference between the robotic group and the control group ( P > 0.05) in the line of osteotomy, but there was a significant difference between the clinical group and the control group in the line of the osteotomy.

Dental Caries Occurrence in Inflammatory Bowel Disease Patients: A Systematic Review and Meta-Analysis.

OBJECTIVE: The present review aimed to systematically evaluate the occurrence of caries in patients with inflammatory bowel disease (IBD), either Crohn's disease (CD) or ulcerative colitis (UC), compared to healthy controls. MATERIALS AND METHODS: MEDLINE (PubMed), Embase, Google Scholar, LILACS, and Cochrane Library electronic databases were screened. Caries experience was measured through the Decayed, Missing, Filled Teeth (DMFT) index. The weighted mean difference (WMD) with 95% confidence interval was calculated between IBD patients and healthy controls. RESULTS: Six studies were selected for the inclusion in the systematic review, 5 of which were also included in the quantitative synthesis of data. The WMD in the DMFT index between IBD and healthy subjects was 3.04 (1.52, 4.56) (p = 0.10). Subgroup analysis showed no difference (p = 0.31) between CD (2.52 [0.54, 4.49]) and UC (4.01 [1.52, 4.56]) subjects. CONCLUSIONS: There is a remarkably higher past and present occurrence of dental caries in subjects with IBD than healthy controls. This result should encourage clinicians to include oral health preventive programs in the overall treatment plan of IBD patients.

Efficacy of Behaviour Change Techniques to improve oral hygiene control of individuals undergoing orthodontic therapy. A systematic review.

AIM: This study aims to review the available evidence on the efficacy of behaviour change techniques to improve compliance in young orthodontic patients and to compare these with conventional oral hygiene instructions. METHODS: The review was conducted according to the PRISMA statement. PICO method was used to define eligibility criteria. Two independent reviewers performed the research, examined electronic databases (MEDLINE, Scopus and CENTRAL) and manually checked relevant journals. Only RCTs with more than 10 participants and 3 months follow-up were included. Data extraction and their qualitative analysis were performed for included studies. RESULTS: Search strategy identified 320 articles. After screening for titles, abstracts and full texts, 10 articles were then selected for qualitative analysis. High methodological heterogeneity was present among studies and therefore no meta-analysis was performed. Low risk of bias was detected for one study only. The most common intervention was "mobile phone communication," which was investigated in five studies. Motivational interviewing, repeated reinforcements and visual-aided approach were also examined. CONCLUSION: The interest in remote control of patients compliance appears to be fruitful, nonetheless there is no consensus as to a unique treatment protocol. Every other treatment looks beneficial but higher methodological homogeneity should be sought for in future investigations.

Biologically guided flap stability: the role of flap thickness including periosteum retention on the performance of the coronally advanced flap-A double-blind randomized clinical trial.

AIM: To evaluate the possible benefit on wound healing and flap stability of periosteum inclusion, comparing a "split-full-split" thickness flap elevation versus a "split" thickness approach performed during CAF for the treatment of isolated-type gingival recessions in the upper jaw. MATERIAL AND METHODS: Forty patients were randomized, 20 were treated with "split-full-split" (test group) and 20 with a "split" approach (control group). Analysed parameters at 1 year were CRC, percentage of recession coverage (RC), keratinized tissue (KT) gain and patient-related outcome measurements. RESULTS: After 12 months, CRC was 80% in the test group and 35% in the control group. Percentages of RC and KT gain were higher in the test group, and a significant association between CRC and the thickness of the flap after elevation was found. Patient-related outcomes measurements were better for the test group. CONCLUSIONS: Flap thickness preservation and the presence of the periosteum in part of the flap may play a fundamental role in obtaining CRC.

Sealing effectiveness against Staphylococcus aureus of five different implant-abutment connections.

PURPOSE: To compare the sealing effectiveness of four different implant-abutment connections against Staphylococcus aureus (S. aureus). The null hypotheses stated that there was no difference on sealing ability among the implant-abutment connections tested. METHODS: Five diverse commercially available dental implants were used to investigate the degree of microleakage at the implant-abutment junction (IAJ): Group 1: Torque Type conical implant with double conic connection - TTc (Winsix); Group 2: Torque Type conical implant with Cone Morse connection - TTcm (Winsix); Group 3: Free Lock connection - K type implant (Winsix); Group 4: Internal double hexagon - OsseoSpeed; Group 5: Internal hexagon - Aadva Implant. Nine implants were tested in each group and one group was used as the negative control (Group 4). The abutments were connected to implants according to manufacturers' recommendations. All procedures involving connection and disconnection of implants were performed in sterile conditions in a laminar flow biological safety cabinet. S. aureus ATCC 6538, a methicillin susceptible reference strain, was chosen for the experiments to test the degree of microleakage. Statistical analysis was performed in order to find significant differences among the five groups regarding sealing capability of the implant-abutment connections tested. The recorded data were statistically analyzed. RESULTS: One implant from Group 4 was excluded from the study because of the growth of a contaminant after 48 hours of incubation in all three wells (i.e. Paenibacillus pabuli, environmental Gram-positive bacteria). Wells A and B (i.e. wells where the samples were passed before being located in the final well C) of all other samples (n = 46) remained sterile over the 72 hours of incubation, indicating the lack of external contamination during implant-abutment connection. Similarly, no bacterial growth was observed in the five negative controls (i.e. one implant for each type), which had been inoculated with sterile saline and processed as the others. Bacterial microleakage was demonstrated with three samples, including one sample of Group 1, one of Group 3 and one of Group 5, in which growth of S. aureus in wells C after 48 hours of incubation was demonstrated (Table 1). No statistically significant difference between groups was noticed (P> 0.05). CLINICAL SIGNIFICANCE: Within the limitations of the present in vitro model, the results obtained suggest a tendency toward a better sealing capability for conical connections and internal hexagon.

Fresh extraction socket: spontaneous healing vs. immediate implant placement.

AIM: To evaluate the impact that immediate implant placement may have on bone remodelling in comparison with adjacent sockets left to heal spontaneously. MATERIALS AND METHODS: In a beagle dog model (N = 16 dogs), mandibular premolars were extracted, and implants were placed in each distal socket (test) with the corresponding mesial site left to heal undisturbed (control). Healing was assessed measuring both the vertical distance between buccal and lingual crest (B'L') and the width of buccal and lingual walls at different levels. Five healing periods were evaluated. Differences between means for each variable and for each healing period between test and control were compared (Kruskal-Wallis test; Friedman test). RESULTS: At 2 and 8 weeks of healing, the B'L' distance revealed significant higher values at test compared to control sites, being this difference three times higher at the end of the study (P < 0.05). In the test group, the width of the crest was reduced between baseline (0.37 [0.04]) and 8 weeks healing (0.13 [0.64]), demonstrating a 62% reduction of the initial width. These differences were not observed in the control group. CONCLUSIONS: Immediate implant placement into fresh extraction sockets may jeopardize the vertical bone remodelling of the socket. Furthermore, a tendency towards greater buccal horizontal resorption was observed in the most coronal aspect of the buccal bone crest.

Efficacy of periodontal plastic procedures in the treatment of multiple gingival recessions.

OBJECTIVE: To systematically review the efficacy of periodontal plastic procedures (PPP) in the treatment of multiple gingival recessions (MGR). METHODS: Randomized clinical trials (RCT) on MGR treatment with at least 6 months duration were identified through electronic databases and hand-searched journals. Primary outcomes were complete root coverage (CRC) and percentage of root coverage (PRC). Weighted means and forest plots were calculated for all PPP. Subgroup analysis was performed according to the type of flap. A Bayesian network meta-analysis (NM) on secondary outcomes was also performed. RESULTS: Nine trials including 208 subjects and 858 recessions were identified. CRC after PPP was 24-89%. Mean weighted PRC was 86.27% (95% CI 80.71-91.83; p < 0.01). Heterogeneity of the literature prevented inter-techniques comparison. Coronally advanced flap (CAF) shows the higher variability in terms of CRC. Modified CAF and tunnel approaches show higher level of CRC. The NM suggests that CAF plus graft showed the higher probability of being the best treatment. CONCLUSIONS: Limited evidence is available for MGR coverage. PPP are associated with high level of efficacy, in terms of PRC, and high variability of CRC. Indirect evidence indicates that CAF may benefit from newer variations of the technique and by the additional use of grafting.

Does enamel matrix derivative application provide additional clinical benefits in residual periodontal pockets associated with suprabony defects? A systematic review and meta-analysis of randomized clinical trials.

OBJECTIVE: To review the effectiveness of enamel matrix derivative (EMD) in the treatment of periodontal pockets of suprabony defects. METHODS: Randomized Clinical Trials comparing open flap debridement (OFD) versus EMD in periodontal suprabony defects were identified through electronic and manual search. Screening, data extraction and quality assessment were conducted. The primary outcome measures were tooth survival (TS) and clinical attachment level (CAL) gain. Pocket probing depth (PPD) reduction and recession (REC) increase were secondary outcome measures. Information concerning clinical and radiological bone gain was also collected. RESULTS: The search identified 1170 studies, three articles reporting on (99 subjects/358 teeth) met the inclusion criteria and were included. No tooth was lost during follow-up (8-12 months). The adjunctive mean benefit of EMD was: 1.2 mm for CAL gain [confidence interval (CI): (0.9, 1.4), p < 0.00001, I(2) = 66%], 1.2 mm for the PPD reduction (CI: [0.8, 1.5], p < 0.0001, I(2) = 0%), -0.5 mm for the REC increase (CI: [-0.8, -0.2], p = 0.003, I(2) = 0%). Potential risk of bias was identified. CONCLUSIONS: No differences were noted in TS but EMD application resulted in clinical and radiographic additional benefits compared to OFD alone. Nevertheless, the paucity of data, the risk of methodological and potential publication bias suggests caution in interpreting these results while supporting multicenter studies for this specific application.

Multiplicative effect of stress and poor sleep quality on periodontitis: A university-based cross-sectional study.

BACKGROUND: The aim of this study was to evaluate the association of perceived stress and poor sleep quality with periodontitis in a university-based cohort of individuals. METHODS: A total of 235 individuals were included in this cross-sectional study. Perceived stress and sleep quality were evaluated through validated questionnaires, while periodontitis was identified with a full-mouth periodontal examination protocol using both European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) and Centers for Disease Control and Prevention (CDC)/AAP case definitions. Simple and multiple linear and ordinal logistic regression analyses were performed to evaluate the association between perceived stress and sleep quality with periodontitis prevalence and severity. RESULTS: Stage III/IV periodontitis resulted associated with both moderate/high perceived stress (odds ratio [OR] = 5.4; 95% confidence interval [CI]: 2.2-13.5; p < 0.001) and poor sleep quality (OR = 3.0; 95% CI: 1.2-7.4; p < 0.05). The interaction between moderate/high perceived stress and poor sleep quality presented a multiplicative association with stage III/IV periodontitis (EFP/AAP; OR = 5.8; 95% CI: 1.6-21.3; p < 0.001). Multiple linear regression analyses indicated a similar trend of association also with linear periodontal parameters, that is, mean clinical attachment level (CAL) and mean probing pocket depth (PPD). CONCLUSIONS: The findings from the present study suggest that stress and poor sleep quality may exert a multiplicative effect on periodontitis prevalence and severity.

Early healing of the alveolar process after tooth extraction: an experimental study in the beagle dog.

AIM: To describe the early healing events in the alveolar socket during the first 8 weeks of spontaneous healing after tooth extraction. MATERIALS AND METHODS: 16 adult beagle dogs were selected and five healing periods were analysed (4 h, 1 week, 2 weeks, 4 weeks, 8 weeks). Mandibular premolars were extracted and each socket corresponding to the mesial root was left to heal undisturbed. In each healing period, three animals were euthanatized, each providing four study sites. Healing was assessed by descriptive histology and by histometric analysis using as landmarks: the vertical distance between buccal and lingual crest (B'L') and the width of buccal and lingual walls at three different levels. Differences between means for each variable for each healing period were compared (ANOVA; p < 0.05). RESULTS: B'L' at baseline was 0.45 (0.18) mm and decreased during the healing period to a final value of 0.18 (0.08) mm. The lingual width (Lw) remains almost unchanged while the buccal width (Bw) at 1 (Bw1) and 2 (Bw2) mm was reduced in about 40% of its initial value. CONCLUSIONS: Minor vertical bone reduction in both the buccal and lingual socket walls were observed. A marked horizontal reduction of the buccal bone wall was observed mostly in its coronal aspect.

Effectiveness of periodontal treatment to improve glycemic control: an umbrella review.

AIM: The aim of the present umbrella review was to systematically assess existing evidence on the effect of non-surgical periodontal therapy, both per se' and with adjuvants, on glycemic control in patients with type 2 diabetes and periodontitis and to combine quantitative data with a meta-analysis. MATERIALS AND METHODS: A detailed study protocol was registered on PROSPERO (CRD42021222279). Four electronic databases (Medline via Pubmed, EMBASE, Cochrane Database of Systematic Reviews and Scielo) were searched independently and in duplicate to identify potentially eligible systematic reviews up to March 2022. Two pre-calibrated independent reviewers performed study selection, data extraction and quality assessment with two checklists (AMSTAR 2 and PRISMA). Moreover, general characteristics of primary studies included in each systematic review were abstracted, and JADAD scale was used to assess the risk of bias for included randomized controlled trials. Data from the individual studies included in each meta-analysis were analyzed, using both fixed and random effect model. The statistical heterogeneity was calculated using the Q test and the I2 index. The publication bias was evaluated using a funnel plot and Egger's linear regression method. RESULTS: Sixteen systematic reviews, published between 2010 and 2021, were included for qualitative synthesis. From these systematic reviews, a total of 27 studies were included in the meta-analysis: all of them were randomized clinical trials, except 1 controlled clinical study. A statistically significant mean difference of - 0.49% and of - 0.38% HbA1c reductions was seen respectively at 3- and 6-month post-treatment, favoring the treatment group (non-surgical periodontal therapy alone) compared to the control group (no treatment). The effect of periodontal treatment with the adjunctive use of antibiotics or laser on the glycemic control was not statistically significant compared to non-surgical periodontal therapy alone. CONCLUSIONS: The findings of the present study, within its limitations, indicated that non-surgical treatment of periodontitis is an efficacious therapy for improving the glycemic control in type 2 diabetes mellitus patients, both at 3- and 6-month follow-up.

Bone modelling at fresh extraction sockets: immediate implant placement versus spontaneous healing: an experimental study in the beagle dog.

OBJECTIVES: The purpose of this investigation is to describe histologically the undisturbed healing of fresh extraction sockets when compared to immediate implant placement. METHODS: In eight beagle dogs, after extraction of the 3P3 and 4P4, implants were inserted into the distal sockets of the premolars, while the mesial sockets were left to heal spontaneously. Each animal provided four socket sites (control) and four implant sites (test). After 6 weeks, animals were sacrificed and tissue blocks were dissected, prepared for ground sectioning. RESULTS: The relative vertical buccal bone resorption in relation to the lingual bone was similar in both test and control groups. At immediate implant sites, however, the absolute buccal bone loss observed was 2.32 (SD 0.36) mm, what may indicate that while an apical shift of both the buccal and lingual bone crest occurred at the implant sites, this may not happen in naturally healing sockets. CONCLUSIONS: The results from this investigation showed that after tooth extraction the buccal socket wall underwent bone resorption at both test and control sites. This resorption appeared to be more pronounced at the implant sites, although the limitations of the histological evaluation method utilized preclude a definite conclusion.

Artificial biofilm removal in a peri-implant mucositis model: Efficacy of air polishing technology as adjunct to ultrasonic debridement alone and impact of the site and the depth of mucosal tunnel-An in vitro study.

AIM: The current in vitro model aims to evaluate the adjunctive effect on artificial biofilm removal determined by the use of a glycine-powder air-polishing procedure (GPAP) over the ultrasonic debridement (USD) alone when the removal of artificial biofilm on abutment surface is performed. The procedures were carried out also evaluating the impact of the site (mesial, distal, vestibular, and oral) and three different mucosal tunnel depths (2 mm, 4 mm, and 6 mm). MATERIALS AND METHODS: Single tooth implant replacement was simulated. Three different abutment heights together with a prosthetic contour were investigated (2 mm, 4 mm, and 6 mm); custom-made gingival masks were created to mimic peri-implant soft tissue. Biofilm was simulated with an indelible ink. The protocol consisted in two intervention stages for each abutment: (a) USD with PEEK tip plus (b) GPAP. At the end of each intervention, abutments were unscrewed, and standardized photographs were taken. Statistical analysis was carried out to compare residual stain percentage between the two intervention stages and among different sites and mucosal tunnels. RESULTS: A total of 30 abutments were instrumented. A significant reduction of the percentage of residual staining (PRS) after the combination of GPAP + USD over USD alone was demonstrated (16% vs. 32%; p < 0.05). Moreover, the better performance of the GPAP + USD protocol was observed regardless of the different mucosal tunnel heights and the sites analyzed. Intragroup analysis unveils that the smaller PRS was observed for shallow mucosal tunnels (2 mm) and vestibular sites for both protocols. CONCLUSION: GPAP + USD provided adjunctive effect on artificial biofilm removal in comparison to the USD alone. Furthermore, proximal surfaces and deeper mucosal tunnels (4 and 6 mm) showed a reduced instrumentation efficacy for both protocols.

Adherence to Mediterranean diet, physical activity level, and severity of periodontitis: Results from a university-based cross-sectional study.

BACKGROUND: The aim of this study was to evaluate the association between adherence to Mediterranean diet (MD) and physical activity (PA) level with the periodontal status of a University-based cohort of individuals. METHODS: A total of 235 individuals were included in the study. MD adherence and PA level were registered through validated questionnaires, together with a full periodontal examination. Crude and adjusted odds ratios (ORs) [95% confidence interval] were calculated to evaluate the association between MD adherence, PA level, and periodontitis severity. A final logistic multivariate regression model was built to evaluate the impact of the combination between low MD adherence and low PA level on the prevalence of Stage III/IV periodontitis. RESULTS: The adjusted ORs for Stage III/IV periodontitis were 1.65 [0.84 to 3.28; P = 0.42] for low PA and 5.63 [3.21 to 9.84; P = 0.00] for low MD adherence. The final logistic multivariate regression model resulted in OR = 10.23 [4.01, 26.09; P = 0.00] of having Stage III/IV periodontitis in individuals with low MD adherence and low PA. CONCLUSIONS: Individuals conducting a lifestyle characterized by the combination of low MD adherence and lack of regular exercise had 10 times the odds to have severe forms of periodontitis.