Ibero-Panamerican Federation of Periodontology Delphi study on the trends of periodontology and periodontics by the year 2030. A Latin American consensus.

BACKGROUND AND OBJECTIVE: As elsewhere in the world, the prevalence of periodontitis in stages I-II is high in the Latin American population, this scenario emphasizes the need for identification of urgent needs for allocating adequate resources to provide diagnosis, prevention, and treatment of these diseases. The aim of this Delphi study was to predict the trends in periodontology/periodontics in the Latin American region by the year 2030. METHODS: A steering committee and an advisory group of experts in periodontology/periodontics were selected from 16 countries. An open questionnaire of 60 questions was validated and used following the Delphi methodology. RESULTS: Two hundred and twenty-five experts from Latin America answered the two rounds of the questionnaire. Moderate to strong consensus was reached on 45 questions (75%). The prediction was that the prevalence of gingivitis and periodontitis in stages I and II will be maintained, the importance of the link with systemic diseases will increase, and the impact of prevention and periodontal treatment will also increase, mainly in the private sector. There was a strong consensus that plastic and regenerative surgical procedures will increase, as well as the demand for training in the specialty of periodontology. CONCLUSIONS: The present study has provided relevant and useful information on predictions in periodontology/periodontics in Latin America, with important level of consensus among experts. It has been predicted that periodontitis will still be a highly prevalent disease, and its links with other medical conditions should demand more attention by health authorities to develop adequate prevention and management policies and strategies.

Clinical outcomes following atrophic alveolar ridge reconstruction using collagenated xenogeneic bone block or autogenous bone block: One-year follow-up of a randomized controlled clinical.

AIM: This investigation aimed to evaluate the 1-year survival of implants placed after staged lateral alveolar ridge augmentation using equine-derived collagenated xenogeneic bone blocks (CXBBs) or autogenous bone block (ABB). MATERIALS AND METHODS: Fifty patients who underwent lateral augmentation in a previous trial were included. The primary outcome measure was implant survival at the 1-year follow-up, and secondary outcomes included implant success, peri-implant clinical and volumetric parameters, pink aesthetic scores (PES) and patient-reported outcome measures. Data analysis involved Fisher's exact test, the Mann-Whitney U-test and the Wilcoxon signed-rank test. RESULTS: In this study, no late implant failures were observed. The cumulative survival rates were 78.6% for the CXBB group and 90.9% for the ABB group, with no difference between the groups. Similarly, the success rates were 53.6% and 63.6%, respectively, showing no significant difference. Peri-implant clinical and volumetric parameters indicated the presence of healthy peri-implant tissues surrounding implants placed in both CXBB- and ABB-augmented sites. PES were 8.5 and 11.0 for implants placed in CXBB- and ABB-augmented sites, respectively. Furthermore, patient satisfaction rates were high and similar between the groups. CONCLUSIONS: Dental implants placed in both CXBB- and ABB-augmented ridges demonstrated no statistically significant differences in clinical, volumetric and aesthetic outcomes, along with high patient satisfaction rates.

Radiographic outcomes of ridge reconstruction with autogenous bone block versus collagenated xenogeneic bone block: A randomized clinical trial.

AIM: To compare, at different levels from the alveolar crest, the radiographic outcomes of equine-derived collagenated xenogeneic bone blocks (CXBB) and autogenous bone blocks (ABB) used for lateral alveolar ridge augmentation. MATERIALS AND METHODS: Sixty-four patients with tooth gaps in atrophic alveolar ridges with ≤4 mm were randomly assigned to lateral augmentation using CXBB or ABB. The lateral bone thickness (LBT) was measured 2, 4, 6, 8, and 10 mm below the alveolar crest using CBCT scans obtained before augmentation surgery and at 30 weeks, prior to implant placement. Statistical analysis was performed using Shapiro-Wilk, Fisher's exact, Mann-Whitney, and Wilcoxon signed-rank tests. RESULTS: Both CXBB and ABB resulted in significant total and buccal LBT gains at 2, 4, 6, 8, and 10 mm. LBT gains were similar between CXBB- and ABB-augmented sites, except for greater buccal LBT gains at 8 mm at CXBB-augmented sites. While ABB-augmented sites gained vertical bone height, CXBB-treated sites suffered vertical bone loss (CXBB: -0.16 mm; ABB: 0.38 mm, p < .0009). CONCLUSIONS: CXBB and ABB were both associated with significant and similar LBT gains at 30 weeks.

The influence of smoking on the incidence of peri-implantitis: A systematic review and meta-analysis.

OBJECTIVE: The aim of this study was to systematically analyze the influence of smoking on the incidence of peri-implantitis. MATERIALS AND METHODS: The search was performed in the National Library of Medicine (MEDLINE-PubMed), SCOPUS, EMBASE, and ISI Web of Science databases (finished on November 30, 2022). Systematic review and meta-analysis were conducted according to PRISMA statement. Prospective cohort studies that evaluate the incidence of peri-implantitis in smokers and non-smokers were included. Two authors independently searched for eligible studies, screened titles, and abstracts, did the full-text analysis, extracted data, and performed the risk-of-bias assessment. The results were summarized through random-effects meta-analyses. The GRADE method was used to determine the certainty of evidence. RESULTS: A total of 7 studies with 702 patients and 1959 implants were included for analysis. The meta-analysis revealed a significant difference between smokers and non-smokers for the risk of peri-implantitis in the implant-based (p < .0001) and patient-based analysis (p = .003). A strong association between smoking and the risk for peri-implantitis was verified at the implant level (RR: 2.04, 95% CI: 1.46-1.85) and the patient level (RR: 2.79, 95% CI: 1.42-5.50). CONCLUSIONS: Moderate certainty evidence suggests that smoking is associated with peri-implantitis compared to non-smoking at the patient and implant levels.

Autogenous bone block versus collagenated xenogeneic bone block in the reconstruction of the atrophic alveolar ridge: A non-inferiority randomized clinical trial.

AIM: To compare the efficacy of equine-derived collagenated xenogeneic bone blocks (CXBB) and autogenous bone block (ABB) for lateral alveolar ridge augmentation and two-stage implant placement. MATERIALS AND METHODS: Sixty-four patients with tooth gaps up to four teeth and atrophic alveolar ridges with ≤4 mm were randomly assigned to lateral augmentation using CXBB or ABB. Lateral bone thickness (LBT) was measured 2 mm below the alveolar crest at augmentation surgery and 30 weeks later at implant placement. Implant-related outcomes, adverse events, surgery duration, pain sensation, analgesic consumption, and oral health-related quality of life were also assessed. Data were analysed using Fisher's exact, Mann-Whitney, and Wilcoxon signed-rank tests. RESULTS: At 30 weeks, the median change in LBT amounted to 2.90 (CXBB) and 3.00 (ABB), respectively. Secondary endpoints demonstrated similar results for CXBB and ABB in terms of possibility to place an implant, need to perform a secondary bone augmentation at implant placement and rate of complications. Early implant failure was 20% for CXBB and 10% for ABB, with no difference between the groups. Pain scores and post-operative consumption of analgesics were significantly lower in the CXBB group than in the ABB group, especially during the first days post-surgery. CONCLUSIONS: CXBB is non-inferior to ABB for horizontal alveolar ridge augmentation and two-stage implant placement.

Peri-implant tissue changes at sites treated with alveolar ridge preservation in the aesthetic zone: Twenty-two months follow-up of a randomized clinical trial.

AIM: To compare tissue changes at implant sites previously treated with two biomaterials for alveolar ridge preservation (ARP) in the aesthetic zone, 1 year after restoration. MATERIALS AND METHODS: Sixty-six participants were treated with ARP using demineralized bovine bone mineral (DBBM) or DBBM +10% of collagen (DBBM-C), both covered with a collagen matrix (CM). Dental implants were placed, and definitive crowns were installed. Silicon impressions were taken before tooth extraction (T0), 2 weeks after crown insertion (T1) and 1 year after restoration (T2). Mid-facial mucosal level change (MLC), soft tissue thickness changes (TT), and marginal bone loss (MBL) were analysed using inter-group comparisons. RESULTS: Fifty-four participants were included in the analysis. The mid-facial level change between T0-T1 and T1-T2 showed no statistical difference between DBBM and DBBM-C. Between T0 and T1 for soft tissue thickness, DBBM performed significantly better at 3 and 5 mm below the mucosal margin. From T1 to T2, no significant differences between groups were found at any level for soft tissue thickness and MBL. CONCLUSION: At the aesthetic zone, advanced recession from tooth extraction to crown placement can be expected at sites treated with ARP regardless of biomaterial used. However, after crown insertion, tissue stability can be predicted.

Adverse events of metronidazole and amoxicillin: Retrospective analysis of a large data set of five randomized clinical trials.

AIM: To evaluate the frequency of side effects associated with intake of metronidazole (MTZ) + amoxicillin (AMX) in periodontal treatment, and to explore associations between these events and patients' features. MATERIALS AND METHODS: Data of five randomized clinical trials testing MTZ + AMX adjunctive to mechanical therapy were evaluated. Volunteers answered an adverse event questionnaire. RESULTS: Information from 656 subjects was assessed. The frequency of side effects in the antibiotic- and placebo-treated groups ranged from 1.0% to 17.7% and 0.9% to 13.7%, respectively. The events more frequently observed in the antibiotic than in the placebo group were diarrhoea and metallic taste (p < .05). Diabetes significantly raised the odds of a patient reporting discomfort (odds ratio [OR] = 2.6), diarrhoea (OR = 4.0), weakness (OR = 6.0) and excessive sleepiness (OR = 2.9). In systemically healthy volunteers, using antibiotics 3 months post-mechanical treatment (healing phase) (OR = 3.0), being a woman (OR = 3.9) and aged ≤49 (OR = 4.5) significantly increased the chances of reporting adverse events. CONCLUSIONS: The occurrence of side effects during MTZ + AMX treatment ranged from uncommon (1%) to very common (17.7%). The main factors raising the chances of a patient reporting adverse events were diabetes and taking antibiotics in the healing phase, instead of in the active phase of treatment. Patients ≤ 49 years old and females also tend to report more side effects.

Short-term effect of non-surgical periodontal treatment on local and systemic cytokine levels: Role of hyperglycemia.

BACKGROUND: The effect of non-surgical periodontal treatment on oral and systemic inflammatory mediators in subjects with periodontitis and hyperglycemia remains largely unknown. Therefore, the aim of this clinical study was to compare the short-term effect of non-surgical periodontal treatment on serum, saliva and GCF inflammatory markers levels in GP subjects with or without hyperglycemia. METHODS: Sixty subjects divided into four groups of equal size were selected to participate: type 2 diabetics with generalized periodontitis (T2DM + GP), pre-diabetics with GP (PD + GP), normoglycemic subjects with GP (NG + GP), and healthy controls. GCF, serum, and saliva samples were obtained at baseline and 30 days after scaling and root planning (SRP) and the levels of interleukin-1ß (IL-1 ß), IL-8, IL-6, IL-2, IL-5, IL-4, IL-10, Interferon gamma (IFN-γ), Granulocyte macrophage colony-stimulating factor (GM-CSF) and Tumor necrosis factor-alpha (TNF-α) were determined by ultrasensitive multiplex assay. Clinical periodontal measurements were recorded. RESULTS: SRP yielded significant improvement of all periodontal parameters for all GP groups (p < 0.01). A significant reduction in GCF levels of several cytokines were observed; however, only IL-1B and IFN-γ were consistently reduced post-treatment across all GP groups. Salivary levels of IL-1ß were significantly reduced in all GP groups following treatment. No significant differences were observed for serum levels after SRP. CONCLUSIONS: Periodontal treatment reduced local inflammatory markers, specifically IL-1B and IFN-γ, irrespective of the diabetes status. Periodontal treatment had no significant effect on serum levels of the inflammatory markers evaluated in this study.

The 2018 EFP/AAP periodontitis case classification demonstrates high agreement with the 2012 CDC/AAP criteria.

AIM: To investigate the agreement between the 2018 EFP/AAP periodontitis case classification and the 2012 CDC/AAP criteria. MATERIALS AND METHODS: This cross-sectional study assessed a population-based sample from a rural area in southern Brazil. A complete periodontal examination was performed at six sites/tooth. The periodontitis case definition was estimated and compared according to the 2018 EFP/AAP classification and the 2012 CDC/AAP criteria (reference). Diagnostic tests included sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and area under ROC curve (AUC). RESULTS: Five hundred and eighty-eight subjects with ≥6 teeth each were included. Based on the 2018 EFP/AAP classification, 71.1% of the subjects were classified as stage III/IV showing 100% agreement with 2012 CDC/AAP criteria for the severe category. For the moderate and severe classification, the 2018 EFP/AAP SN was 99.8% and 100%, SP 13.6% and 43.6%, PPV 83.4% and 47.4%, and NPV 93.7% and 100%, respectively. The AUC was 0.9059 (95% CI = 0.879-0.933) and the optimal cut-off based on the curve was stage III. CONCLUSIONS: The 2018 EFP/AAP periodontitis case classification showed high agreement with the 2012 CDC/AAP criteria in a rural sample with high periodontitis occurrence.

Comparison between two bone substitutes for alveolar ridge preservation after tooth extraction: Cone-beam computed tomography results of a non-inferiority randomized controlled trial.

AIM: To test the non-inferiority of demineralized bovine bone mineral (DBBM) compared to DBBM with 10% collagen (DBBM-C) for maintenance of bone volume after tooth extraction in the anterior maxilla. MATERIALS AND METHODS: Sixty-six patients were randomly treated with DBBM or DBBM-C, both of which were covered with a collagen matrix for ridge preservation in the anterior maxilla. Cone-beam computed tomographic analysis was performed immediately and 4 months after treatment. The primary outcome, for which non-inferiority of DBBM was tested, was change in the horizontal ridge width 1 mm below the buccal alveolar crest (HW-1) 4 months after extraction. RESULTS: Four months after extraction, HW-1 measured -1.60 mm ± 0.82 mm for DBBM-C, while the DBBM group showed a mean loss of -1.37 mm ± 0.84 mm (p = 0.28, 0.23 [95% CI: -0.19; 0.64]). The horizontal ridge width at 3 mm (HW-3) showed -0.98 mm (±0.67 mm) for DBBM-C and -0.84 mm (±0.62 mm) for DBBM (p = 0.40, 0.12 [95% CI: -0.19; 0.45]), and the horizontal ridge width at 5 mm (HW-5) showed -0.67 mm (±0.47 mm) for DBBM-C and -0.56 mm (±0.48 mm) for DBBM (p = 0.36, 0.11 [95% CI: -0.13; 0.34]). CONCLUSIONS: The present clinical trial demonstrated non-inferiority of DBBM compared to DBBM-C for maintenance of alveolar bone volume 4 months after tooth extraction in the anterior maxilla.

Influence of T2DM and prediabetes on blood DC subsets and function in subjects with periodontitis.

OBJECTIVE: To compare the myeloid and plasmacytoid DC counts and maturation status among subjects with/without generalized periodontitis (GP) and type 2 diabetes mellitus (T2DM). METHODS: The frequency and maturation status of myeloid and plasmacytoid blood DCs were analyzed by flow cytometry in four groups of 15 subjects: healthy controls, T2DM with generalized CP (T2DM + GP), prediabetes with GP (PD + GP), and normoglycemics with GP (NG + GP). RT-PCR was used to determine levels of Porphyromonas gingivalis in the oral biofilms and within panDCs. The role of exogenous glucose effects on differentiation and apoptosis of healthy human MoDCs was explored in vitro. RESULTS: Relative to controls and to NG + GP, T2DM + GP showed significantly lower CD1c + and CD303 + DC counts, while CD141 + DCs were lower in T2DM + GP relative to controls. Blood DC maturation required for mobilization and immune responsiveness was not observed. A statistically significant trend was observed for P. gingivalis levels in the biofilms of groups as follows: controls 

Systemic administration of curcumin or piperine enhances the periodontal repair: a preliminary study in rats.

OBJECTIVES: Studies have documented the anti-inflammatory effects of spices, which may be related to treatment of chronic diseases. The purpose of this study was to evaluate the influence of curcumin and piperine and their association on experimental periodontal repair in rats. MATERIALS AND METHODS: Periodontitis was induced via the installation of a ligature around the first molar. After 15 days, the ligatures were removed, and the rats were separated into groups (12 animals per group): (i) curcumin, (ii) piperine, (iii) curcumin+piperine, (iv) corn oil vehicle, and (v) control group (animals had ligature-induced periodontitis but were not treated). The compounds were administered daily, for 15 days by oral gavage. Animals were euthanized at 5 and 15 days, and hemimaxillae and gingival tissues were harvested. Bone repair was assessed by µCT (microcomputer tomography). Histological sections were stained with hematoxylin/eosin (H/E) for the assessment of cellular infiltrate or picrosirius red for quantification of collagen content, and subjected to immunohistochemistry for detecting NF-ĸB. Gingival tissues were used to evaluate levels of TGF-ß and IL-10 (ELISA). RESULTS: Curcumin and piperine increased the TGF-ß level, significantly improved the collagen repair, and decreased the cellularity and activation of NF-ĸB in the periodontal tissues, but only curcumin caused a significant increase in early bone repair. CONCLUSION: Curcumin and piperine promoted a substantive effect on tissue repair; however, there was not synergistic effect of compounds administered in combination. CLINICAL RELEVANCE: Curcumin and piperine stimulates the tissue repair and may be potential candidates for the treatment of periodontal disease.

Oral health of 12-year-old children in Quito, Ecuador: a population-based epidemiological survey.

BACKGROUND: There is a paucity of population-based surveys on oral health conditions in Ecuador. Thus, the aim of this study was to conduct an epidemiological survey with a representative sample of children aged 12 years from public schools of Quito, Ecuador. The aim of this initial report was to describe the methodology used in the survey, as well to present results regarding calibration procedures and prevalence of oral-health related outcomes. METHODS: We invited 33 public schools' coordinators from the urban area of Quito, and 1100 children (12 years old) to take part in this study. Six trained and calibrated examiners conducted clinical examinations using oral mirrors and ball-ended probes to assess: dental caries, traumatic dental injuries, malocclusion, gingival bleeding, presence of calculus and fluorosis. Children also responded a questionnaire on Oral Health-Related Quality of Life (OHRQoL). Individual sociodemographic data was collected through a questionnaire sent to parents. Moreover, some contextual data on school environment (infrastructure conditions, promotion of health practices and negative episodes) were also evaluated. Prevalence values, crude and weighted by sampling weights, and 95% confidence intervals (95%CI) were calculated. RESULTS: Nine hundred and ninety-eight children from 31 schools were examined from March to May 2017. The adjusted prevalence values (95%CI) for the six outcomes evaluated were: dental caries = 60.3% (55.3 to 65.0%); traumatic dental injuries = 20.7% (17.2 to 24.8%); dental fluorosis = 63.7% (58.5 to 68.5%); gingival bleeding = 92.0% (87.1 to 95.2%); presence of calculus = 69.9 (60.5 to 77.9%); and malocclusion = 25.8% (21.8 to 30.3%). Adjusted mean of number of decayed, missed or filled permanent teeth (DMF-T) was 1.61 (1.37 to 1.84). Results on OHRQoL and other contextual variables will be reported in other articles. CONCLUSION: The prevalence of the majority of oral health problems in 12-year-old children from public schools in Quito-Ecuador was compatible with those observed in other similar cities. However, periodontal health and fluorosis seem to be highly prevalent in children from Quito.

Orthodontic treatment in patients with aggressive periodontitis.

INTRODUCTION: Aggressive periodontitis (AP) is a condition that promotes breakdown of the periodontal tissues in a short time. In severe cases, pathologic migration of teeth and tooth loss can occur, producing esthetic and functional problems for the patient. Orthodontic treatment may be recommended to restore esthetics and masticatory function. We assessed the effects of orthodontic movement in the periodontal tissues of treated patients with AP. METHODS: Ten subjects (ages 25.0 ± 5.22 years) with AP received periodontal treatment followed by orthodontic treatment. Maintenance sessions were performed monthly under a strict dental biofilm control. They were compared with 10 periodontally healthy subjects (ages 22.9 ± 5.23 years) who received orthodontic treatment. Probing pocket depth, clinical attachment level, bleeding on probing, and dental plaque index were measured at baseline, after orthodontic treatment, and after 4 months. RESULTS: Statistical analysis showed improvement in all clinical parameters between baseline and 4 months after orthodontic treatment: probing pocket depth (0.29 mm), clinical attachment level (0.38 mm), bleeding on probing (4.0%), and dental plaque index (11%). CONCLUSIONS: The periodontal parameters of the AP patients remained stable during orthodontic treatment under strict biofilm control.

Effect of alendronate on the progression of periodontitis induced by Porphyromonas gingivalis and Fusobacterium nucleatum: a study in rats.

OBJECTIVE: The study aimed to investigate the effect of alendronate (ALN) on the inhibition of alveolar bone loss in experimental periodontitis in Wistar rats. MATERIALS AND METHODS: Periodontitis was induced by oral inoculation of Porphyromonas gingivalis with Fusobacterium nucleatum. The rats (n = 80) were randomized as follows: negative control (n = 10); positive control (n = 10); ALN groups: test 8 (n = 10), test 12 (n = 10), and test 16 (n = 10); and placebo groups: control 8 (n = 10), control 12 (n = 10), and control 16 (n = 10). Two milligrams per kilogram of ALN or placebo was administered twice weekly for 8, 12, and 16 weeks. Bone loss was determined by morphological and histological analyses. One independent, blinded examiner (ICC, 0.91) performed the measurements. The distance from the cement enamel junction to the alveolar bone crest of the second lower molar was measured: distal-vestibular (d), furca (f), mesial-vestibular (h), and area. Histometry was performed on the second contralateral molar. Sections (6 µm) were used to determine the furcation bone area (A-FB). The following statistical analyses were conducted: Mann-Whitney and Kruskal-Wallis. RESULTS: PC group developed periodontitis (p < 0.0001). Morphometric analysis determined that ALN was effective in T8 for linear measurements d, f, and h (p < 0.05). No significant differences occurred at test 8, test 12, and test 16. Analysis of A-FB revealed no significant differences between the ALN and placebo groups at 8 and 16 weeks (p > 0.05). ALN was effective against bone loss in relation to A-FB after 12 weeks (p < 0.0001). CONCLUSIONS: According to the methodology used, the results suggest that oral administration of ALN could influence alveolar bone loss in rats submitted to experimental periodontitis. CLINICAL RELEVANCE: ALN could be a potential therapeutic approach when associated with periodontal treatment.

The Anesthetic Effect of Anterior Middle Superior Alveolar Technique (AMSA).

Anesthesia of the soft and hard tissues of the maxilla may require up to 5 injections. Thus, the aim of this study was to evaluate the anesthetic efficacy of the anterior middle superior alveolar (AMSA) and supraperiosteal injection techniques during subgingival scaling and root planing (SRP). Thirty individuals with periodontitis were scheduled for SRP on the buccal aspect of teeth in the anterior maxilla. Before SRP, on a randomly chosen side of the maxilla, the supraperiosteal injection was performed in 1 session, while the AMSA injection was conducted in the contralateral side of the same patient in another session. Immediately after each SRP session, patients rated their pain perception during the procedure with a visual analog scale. No statistically significant differences in mean pain ratings during SRP were found after both anesthetic techniques (P > .05). This preliminary study demonstrated that the AMSA and supraperiosteal injection techniques provided similar anesthetic comfort during SRP. The AMSA injection could be an alternative to anesthetize the buccal aspect of maxilla, without the undesirable effects on facial structures such as the upper lip, nostrils, and lower eyelids. However, further randomized clinical trials with larger samples are necessary to confirm such results.

Effect of smoking cessation on non-surgical periodontal therapy: results after 24 months.

AIM: The aim of this 24-month prospective study was to assess the effect of smoking cessation on non-surgical periodontal therapy (NSPT) in adult subjects with chronic periodontitis. MATERIALS AND METHODS: Relative to a previous 12-month follow-up study, recruitment and follow-up period were extended, resulting in 116 eligible among the 286 screened subjects. They received NSPT and concurrent smoking cessation interventions. Periodontal maintenance was performed every 3 months. A calibrated examiner, blinded to smoking status, performed full-mouth periodontal examination in six sites per tooth at baseline, 3, 12 and 24 months of follow-up. Expired air carbon monoxide concentration measurements and interviews were performed to gather demographic and behavioural information. RESULTS: From the 116 enrolled subjects, 61 remained up to 24 months of follow-up. Of these, 18 quit smoking (Q), 32 continued smoking (NQ) and 11 oscillated (O) at 24 months of follow-up. Thereby, Q showed significantly higher mean CAL gain in diseased sites and higher reduction in the proportion of sites with CAL ≥ 3 mm, when compared to NQ. In addition, Q presented significantly higher mean probing depth reduction relative to NQ(p ≤ 0.05). CONCLUSION: Smoking cessation promoted additional benefits on NSPT in chronic periodontitis subjects.

Management of an extensive soft tissue deficiency prior to immediate implant in the aesthetic zone: a 4-year follow-up.

Soft tissue deficiency in a tooth extraction site in the aesthetic area is a common and challenging clinical situation. This case report demonstrates the successful treatment of extensive gingival recession and buccal bone dehiscence associated with a hopeless tooth. Initially, a connective tissue graft was used to cover the root and thicken the soft tissue. After 2 months, the tooth was extracted, an implant was immediately placed, and a temporary restoration was installed. After 3 months, the soft tissue exhibited a natural and harmonious architecture. A custom zirconia abutment and crown were then fabricated and placed. At the 4-year follow-up, the peri-implant tissue displayed satisfactory aesthetics, with a well-structured buccal bone plate and healthy peri-implant indicators. This two-stage approach, addressing gingival recession first and proceeding with immediate implant placement after soft tissue healing, proved to be a safe and effective method with stable long-term results.

Digital Planning to Enhance Diagnosis and Precision in Correcting Excessive Gingival Display in the Presence of Asymmetrical Maxillary Position: A Case Report.

This case report addresses the treatment of excessive gingival display (EGD) in the context of maxillary asymmetry, zenith irregularities, and occlusal plane inclination. Digital planning was pivotal in formulating a precise treatment strategy by incorporating facial photographs, digital models, and cone-beam computed tomography data. Parameters, including occlusal plane inclination, teeth position, and lip-to-gingival margin relationships, were considered to ensure treatment alignment with the patient's facial characteristics. Notably, during the planning phase, it was evident that the conventional approach using the cementoenamel junction as the apical limit for incisions would result in asymmetry. Consequently, the gingival margin position was defined in accordance with facial and lip features. The chosen treatment, flapless crown lengthening, was tailored to the patient's thin phenotype and guided by measurements derived from digital planning. Postsurgery, the patient experienced a swift and painless recovery. A harmonious smile with a stable gingival margin position was achieved at the 1-year follow-up, seamlessly complementing the patient's facial attributes. This case underscores the importance of personalized EGD treatment and the value of digital planning in enhancing diagnostic accuracy and precise treatment planning, ultimately facilitating optimal treatment strategies.

Periodontal status among 12-year-old schoolchildren: a population-based cross-sectional study in Quito, Ecuador.

This study aimed to estimate the prevalence and extent of bleeding on probing and calculus in 12-year-old schoolchildren of Quito, Ecuador, and evaluate the associated factors. We conducted an epidemiological survey with a representative sample of 1,100 12-year-old schoolchildren from public schools in the urban area of Quito, Ecuador. We assessed the periodontal health using the Community Periodontal Index (CPI). The prevalence and extent of the periodontal condition was based on the presence of at least one site with bleeding on probing (BOP), and the presence of dental calculus was also evaluated. We used univariate and multiple multilevel Poisson regression analyses to verify the association between the independent variables and the number of sextants with BOP and calculus. The prevalence of BOP and calculus was 92% and 69.9%, respectively. The adjusted mean of the affected sextants was 4.3 and 2.2 for BOP and calculus, respectively. The mother's schooling and malocclusion were associated with the number of sextants with bleeding. The mother's schooling and dental caries experience were associated with calculus. Gingival bleeding and the presence of dental calculus are highly prevalent in 12-year-old schoolchildren from Quito. Gingival bleeding is associated with maternal education and malocclusion, and dental calculus is associated with maternal education and dental caries.