Minimally invasive non-surgical therapy (MINST) in stage III periodontitis patients: 6-month results of a split-mouth, randomised controlled clinical trial.

OBJECTIVES: To determine if minimally invasive non-surgical therapy (MINST) outperforms classical non-surgical periodontal therapy for stage III periodontitis with primarily suprabony (horizontal) type defects. MATERIALS AND METHODS: In a split-mouth randomised controlled trial, 20 patients' dental quadrants were randomly assigned to MINST or classical non-surgical treatment. The primary outcome variable was the number of sites with probing pocket depth ≥ 5 mm and BOP. Treatment method, tooth type, smoking status, and gender were evaluated using a multivariate multilevel logistic regression model. RESULTS: After 6 months, the percentage of sites with PD ≥ 5 mm and BOP that healed (MINST = 75.5%; control group = 74.1%; p = 0.98), and the median number of persisting sites (MINST: 6.5, control group: 7.0; p = 0.925) were similar in both groups. In the test and control groups, respectively, median probing pocket depths (2.0 mm vs. 2.1 mm) and clinical attachment level (1.7 mm vs. 2.0 mm) changed significantly (p < 0.05) but similarly. Significantly less gingival recession occurred in the MINST group's deep molar pockets compared to the control group (p = 0.037). Men (OR = 0.52, p = 0.014) and non-molars (OR = 3.84, p 0.001) had altered odds for healing of sites with PD ≥ 5 mm and BOP. CONCLUSIONS: MINST reduces gingival recession associated with molar teeth, although it performs similarly to traditional non-surgical therapy in treating stage III periodontitis with predominately horizontal-type defects. CLINICAL RELEVANCE: MINST performs similarly to non-surgical periodontal therapy in stage III periodontitis with predominantly suprabony defects. TRIAL REGISTRATION: Clinicaltrials.gov (NCT04036513) on June 29, 2019.

Gingival shape analysis using surface curvature estimation of the intraoral scans.

BACKGROUND: Despite many advances in dentistry, no objective and quantitative method is available to evaluate gingival shape. The surface curvature of the optical scans represents an unexploited possibility. The present study aimed to test surface curvature estimation of intraoral scans for objective evaluation of gingival shape. METHODS: The method consists of four main steps, i.e., optical scanning, surface curvature estimation, region of interest (ROI) definition, and gingival shape analysis. Six different curvature measures and three different diameters were tested for surface curvature estimation on central (n = 78) and interdental ROI (n = 88) of patients with advanced periodontitis to quantify gingiva with a novel gingival shape parameter (GS). The reproducibility was evaluated by repeating the method on two consecutive intraoral scans obtained with a scan-rescan process of the same patient at the same time point (n = 8). RESULTS: Minimum and mean curvature measures computed at 2 mm diameter seem optimal GS to quantify shape at central and interdental ROI, respectively. The mean (and standard deviation) of the GS was 0.33 ± 0.07 and 0.19 ± 0.09 for central ROI using minimum, and interdental ROI using mean curvature measure, respectively, computed at a diameter of 2 mm. The method's reproducibility evaluated on scan-rescan models for the above-mentioned ROI and curvature measures was 0.02 and 0.01, respectively. CONCLUSIONS: Surface curvature estimation of the intraoral optical scans presents a precise and highly reproducible method for the objective gingival shape quantification enabling the detection of subtle changes. A careful selection of parameters for surface curvature estimation and curvature measures is required.

Periodontal and systemic health of morbidly obese patients eligible for bariatric surgery: a cross-sectional study.

BACKGROUND: In obese patients, periodontitis might be associated with deprived systemic health. Edmonton obesity staging system (EOSS) is a new tool for classification of obesity that considers the metabolic, physical, and psychological health. The cross-sectional study aimed to evaluate the periodontal status of morbidly obese patients eligible for bariatric surgery and the association between periodontitis, obesity-related comorbidities, and EOSS. METHODS: Morbidly obese patients eligible for bariatric surgery underwent detailed periodontal examination and were divided into the periodontitis group (PG) and the non-periodontitis group (NPG). The medical and demographic data were obtained from medical files, while behavioural data were obtained by the interview. Descriptive statistics and simple statistical tests were used to summarise the characteristics of the sample and the differences between PG and NPG. The logistic regression models were used to calculate the association (odds ratio (OR)) between periodontitis and obesity-related diseases and EOSS. RESULTS: The study included 79 patients, with an average BMI of 44.6 kg/m2 (SD = 7.2). The prevalence of periodontitis was 65% (CI 95% 53%-75%). PG patients (n = 51) were older, more often smokers and were more often hypertensive than NPG patients (n = 28) (p < 0.05). Hypertension was positively associated with periodontitis with adjusted OR 3.98 (95% CI 1.23-12.8; p = 0.021)) and age with adjusted OR 1.06, (95% CI 1.01-1.13; p = 0.038)), while other tested conditions (diabetes, dyslipidaemia, and smoking habits) did not show significant association with periodontitis. Periodontitis did not correlate with EOSS or other obesity-related comorbidities (p > 0.05). CONCLUSION: The morbidly obese patients eligible for bariatric surgery show a high prevalence of periodontitis and, therefore, are advised to be examined by a dentist before undergoing surgery. They have higher odds of hypertension but not of other obesity-related diseases or higher stages of EOSS. The medical personnel should raise awareness among obese patients on the potential association of poor periodontal health with hypertension. TRIAL REGISTRATION: NCT04653714.

Systemic azithromycin as an adjunct to scaling and root planing in patients with stage III/IV periodontitis: 12-month results of a randomized controlled clinical trial.

OBJECTIVES: To determine whether azithromycin (AZI) as an adjunct to scaling and root planing (SRP), when compared to placebo, decreases the number of sites demonstrating pocket depth (PD) ≥ 5 mm and bleeding on probing (BOP) 12 months post-treatment in stage III/IV periodontitis patients. MATERIALS AND METHODS: In a double-blind randomized parallel-arm placebo-controlled trial, 40 stage III/IV periodontitis patients received steps 1 and 2 of periodontal treatment in two sessions within 7 days. Patients then received systemic antibiotic therapy (n = 20; AZI 500 mg/day, 3 days) or placebo (n = 20). Additional instrumentation of residual diseased sites (DS) - sites with PD ≥ 5 mm and BOP - was performed at the 3-, 6- and 9-month follow-ups. The primary outcome variable was the number of DS at the 12-month re-evaluation. Using a multivariate multilevel logistic regression model, the effects of gender, age, antibiotic therapy, presence of Porphyromonas gingivalis or Aggregatibacter actinomycetemcomitans, smoking, tooth being a molar and interdental location were evaluated. RESULTS: The number of DS after 12 months was similar in the test (median (Me) = 4, interquartile range (IQR) = 0-6) and control (Me = 3, IQR = 1-6.5) groups. Both groups showed substantial but equivalent improvements in periodontal parameters, with no intergroup differences at initially shallow or deep sites. The logistic regression showed a lower odds ratio (OR) for the healing of DS on molars (OR = 0.29; p < 0.001) and in smokers (OR = 0.36; p = 0.048). CONCLUSION: Stage III/IV periodontitis patients showed significant but comparable improvements in periodontal parameters and the number of residual DS at the 12-month revaluation regardless of treatment type. This may have been the result of the additional instrumentation received by patients at residual DS in both treatment groups. CLINICAL RELEVANCE: Treatment with AZI + SRP provided no additional benefits after 12 months in terms of periodontal parameters or the number of persisting sites with PD ≥ 5 mm + BOP as compared to SRP plus placebo. TRIAL REGISTRATION: EUDRA-CT: 2015-004306-42; https://www.clinicaltrialsregister.eu/ctr-search/trial/2015-004306-42/SI , registered 17. 12. 2015.

The precision of gingival recession measurements is increased by an automated curvature analysis method.

BACKGROUND: The extent of gingival recession represents one of the most important measures determining outcome of periodontal plastic surgery. The accurate measurements are, thus, critical for optimal treatment planning and outcome evaluation. Present study aimed to introduce automated curvature-based digital gingival recession measurements, evaluate the agreement and reliability of manual measurements, and identify sources of manual variability. METHODS: Measurement of gingival recessions was performed manually by three examiners and automatically using curvature analysis on representative cross-sections (n = 60). Cemento-enamel junction (CEJ) and gingival margin (GM) measurement points selection was the only variable. Agreement and reliability of measurements were analysed using intra- and inter-examiner correlations and Bland-Altman plots. Measurement point selection variability was evaluated with manual point distance deviation from an automatic point. The effect of curvature on manual point selection was evaluated with scatter plots. RESULTS: Bland-Altman plots revealed a high variability of examiner's recession measurements indicated by high 95% limits of agreement range of approximately 1 mm and several outliers beyond the limits of agreement. CEJ point selection was the main source of examiner's variability due to smaller curvature values than GM, i.e., median values of - 0.98 mm- 1 and - 4.39 mm- 1, respectively, indicating straighter profile for CEJ point. Scatter plots revealed inverse relationship between curvature and examiner deviation for CEJ point, indicating a threshold curvature value around 1 mm- 1. CONCLUSIONS: Automated curvature-based approach increases the precision of recession measurements by reproducible measurement point selection. Proposed approach allows evaluation of teeth with indistinguishable CEJ that could be not be included in the previous studies.

3D computer-aided treatment planning in periodontology: A novel approach for evaluation and visualization of soft tissue thickness.

OBJECTIVE: Current approaches for soft tissue thickness evaluation and visualization still represent a challenge for full extent evaluation and visualization. The aim of this clinical technique article is to introduce a novel approach for comprehensive visualization and precise evaluation of oral soft tissue thickness utilizing a fusion of optical 3D and cone-beam computed tomography (CBCT) images. CLINICAL CONSIDERATIONS: 3D models of the maxilla were obtained by CBCT imaging and intraoral scanning. The CBCT images were reconstructed to standard tessellation language (STL) file format models by segmentation of teeth and bone using implants planning software. 3D soft tissues and teeth models were obtained by intraoral scanning and were exported in STL file format as well. 3D multimodal models were then superimposed using best-fit matching on teeth. Soft tissue thickness was then visualized and evaluated with a 3D color-coded thickness map of gingival and palatal areas created by surface comparison of both 3D models. Additionally, threshold color-coding was used to increase comprehensibility. Palatal areas were further visualized and evaluated for the optimal donor site. CONCLUSIONS: A novel approach for 3D evaluation and visualization of masticatory mucosa thickness presents all available 3D data in a comprehensible, "clinician-friendly" manner, using threshold regions and clinically relevant views. CLINICAL SIGNIFICANCE: Proposed approach could provide comprehensive presurgical treatment planning in periodontal plastic surgery and implantology without additional invasive procedures for the patient, resulting in more predictable treatment, improved outcomes, and reduced risk for complications.

Influence of adjunctive azithromycin on microbiological and clinical outcomes in periodontitis patients: 6-month results of randomized controlled clinical trial.

BACKGROUND: Our aim was to determine if azithromycin therapy, as an adjunct to scaling and root planing (SRP), decreases the number of pathobiontic subgingival plaque species and sites demonstrating pocket depth (PD) ≥ 5 mm and bleeding on probing (BOP) 6 months post-treatment. METHODS: In a double-blind randomized parallel-arm placebo-controlled trial, 40 patients received nonsurgical periodontal treatment in two sessions within 7 days. Patients then received systemic antibiotic therapy (n = 20, azithromycin 500 mg/day for 3 days) or placebo (n = 20). Pooled microbiologic samples were taken before and 6 months after therapy and analysed by established culture methods. The primary outcome variable was the number of sites with PD ≥ 5 mm and BOP at the 6-month re-evaluation. Using multivariate multilevel logistic regression, the effects of gender, age, antibiotic therapy, presence of P. gingivalis or A. actinomycetemcomitans, smoking, tooth being a molar and interdental location were evaluated. RESULTS: The number of sites with PD ≥ 5 mm and BOP after 6 months was similar in the test (Me = 4, IQR = 0-11) and control (Me = 5, IQR = 1-22) group. Adjunctive azithromycin treatment, compared to SRP alone, resulted in more frequent eradication of A. actinomycetemcomitans (p = 0.013) and C. rectus (p = 0.029), decreased proportion (p = 0.006) and total counts (p = 0.003) of P. gingivalis, and decreased proportion of C. rectus (p = 0.012). Both groups showed substantial but equivalent improvements in periodontal parameters, with no intergroups differences at initially shallow or deep sites. The logistic regression showed a lower odds ratio for healing of diseased sites on molars (OR = 0.51; p <  0,001). CONCLUSION: Despite significant changes in numbers of A. actinomycetemcomitans, P. gingivalis and C. rectus, patients with periodontitis do not benefit from adjunctive systemic azithromycin in terms of number of persisting sites with PD ≥ 5 mm and BOP. TRIAL REGISTRATION: EUDRA-CT: 2015-004306-42; https://www.clinicaltrialsregister.eu/ctr-search/trial/2015-004306-42/SI , registered 17. 12. 2015.

Occurrence of Dental Injuries and Periodontal Complications in Tongue-piercing Jewellery Users.

PURPOSE: Tongue piercing (TP) has been gaining in popularity, mainly among adolescents and young adults, and there has been a corresponding increase in reports of dental injury and adverse effects on periodontal tissue due to TP jewellery. The purpose of this study was to assess the type and prevalence of dental injury and periodontal complications in a group of Slovenian adolescents and young adults with TP in comparison with a control group. MATERIALS AND METHODS: This case-control study included 17 subjects with TP (study group) and 28 subjects without TP (control group). Subjects were clinically examined for dental injuries, as classified according to Andreasen. Periodontal complications were evaluated using an estimation of clinical attachment loss (CAL) and gingival recession (GR). Differences in categorical variables were analyzed using the chi-squared or Fisher's exact test as appropriate. Differences between the groups in numerical variables were analyzed with the Mann-Whitney U-test. A multiple logistic regression model was built to test the association between dental injuries and TP when controlling for cofounders, namely age and gender of study participants. The significance level was set at α = 0.05 (two-tailed). RESULTS: Subjects with TP had 12.2 higher odds of dental injury (CI = 2.2-67.7, p = 0.004) compared with subjects without TP. Enamel fractures were more prevalent in the study group (p = 0.002). Frequencies of other dental injuries in the two groups were similar. GR was significantly associated with TP (p = 0.008), while differences in CAL between the groups were not statistically significant. CONCLUSION: Subjects with tongue piercing had more dental injuries and gingival recession.

EFP Delphi study on the trends in Periodontology and Periodontics in Europe for the year 2025.

AIM: The aim was to assess the potential trends in Periodontology and Periodontics in Europe that might be anticipated by the year 2025, using the Delphi method. MATERIAL AND METHODS: The expert opinion of 120 experts was sought through the use of an open-ended questionnaire, developed by an advisory group, containing 40 questions concerning the various trends in periodontology. RESULTS: The experts (113 responders) expect a stabilization of the prevalence of periodontitis, both for the chronic as well as the aggressive cases, but an increase in implant-related diseases up to the year 2025. Concurrently, the importance of implants is seen to be increasing. They foresee an increased demand for postgraduate periodontology and implantology training. This is mirrored in an increase in publications for implant dentistry and increase in demand and need for training. Concerning the patients, better-informed individuals seeking more routine check-ups are expected. CONCLUSION: A continued need for specialized periodontists, but also well trained dental practitioners is foreseen for next decade in Europe. Apart from periodontology they will be increasingly exposed to and trained in implant dentistry.

Prehydrated collagenated cortico-cancellous heterologous bone gel and papillae tunneling for isolated intrabony defects: 12-month noninferiority trial.

OBJECTIVES: This study assessed the effectiveness of prehydrated collagenated xenogenic bone gel and a collagenated cortico-cancellous heterologous bone mixture in conjunction with papillae tunneling techniques (PTT) for treating isolated periodontal intraosseous defects. MATERIALS AND METHODS: Twenty patients with periodontitis stage III/IV and at least one deep isolated interdental 2/3-wall intraosseous defect were included in the study. Surgical incisions were made vertically at the adjacent tooth or horizontally at the mucogingival junction. A full-thickness flap was then carefully lifted under the papillae using special tunneling instruments. The root surfaces were completely cleaned, and the defects were randomly filled with either prehydrated collagenated bone gel (test group; n = 10) or collagenated cortico-cancellous heterologous bone mixture (control group; n = 10). Wounds were closed with microsurgical sutures. We predicted that the lower 95% confidence interval for the difference between the two procedures would exceed a prespecified noninferiority threshold. RESULTS: All wounds closed sufficiently to prevent biomaterial exposure. The test and control groups showed similar mean pocket depth reduction (3.5 ± 1.0 vs. 3.9 ± 1.7 mm; p = 0.52), similar gingival recession (-0.10 ± 0.99 vs. 0.2 ± 0.8 mm; p = 0.46), and similar clinical attachment gain (3.6 ± 1.51 vs. 3.7 ± 1.8 mm; p = 0.89) at the 12-month follow-up. All results were below the noninferiority margin of the sample. CONCLUSIONS: At 12 months, prehydrated collagenous bone gel performed similarly to collagenous heterologous bone granules in the treatment of intraosseous lesions with PTT. In addition, both biomaterials preserved soft tissue with minimal further recession at 1 year. CLINICAL RELEVANCE: When combined with PTT, collagenous xenogeneic bone granules and prehydrated collagenous bone gel achieve comparable clinical outcomes in intrabony defects. The study was registered under the NCT04782921 on ClinicalTrails.

Periodontal health status in systemic sclerosis patients: Systematic review and meta-analysis.

OBJECTIVE: The present systematic review and meta-analysis aimed to evaluate the periodontal health of systemic sclerosis patients compared with non-systemic sclerosis controls. MATERIALS AND METHODS: Online databases were searched for eligible studies on February 24, 2023. The primary outcomes of interest in systemic sclerosis patients and controls included the clinical attachment level, periodontal probing depth, recession depth, plaque index, bleeding on probing score, gingival index, number of teeth with periodontitis, prevalence of periodontitis and gingivitis, and extent and severity of periodontitis. RESULTS: Fourteen studies met inclusion criteria and were incorporated in the qualitative and quantitative analysis. In comparison with the controls, systemic sclerosis patients had a higher prevalence of periodontitis (OR = 7.63 (1.74-33.50), p = 0.04, I2 = 69%), including more severe forms of periodontitis (OR = 6.68 (3.39-13.15), p = 0.85, I2 = 0%), as well as higher periodontal probing depth ((0.88 (0.45-1.31), p = 0.02, I2 = 99%)), clinical attachment level (1.22 (0.8-1.64), p = 0.003, I2 = 98%), and plaque presence (0.83 (0.13-1.53), p = 0.03, I2 = 96%). There was no statistically significant difference in gingival inflammation (1.14 (0.07-2.21), p = 0.04, I2 = 98%). CONCLUSIONS: The systematic review and the meta-analysis showed that systemic sclerosis patients suffer from worse periodontal health than non-systemic sclerosis individuals.

Implant rehabilitation of a posterior maxilla with 4-mm long implants splinted to a 10-mm long implant in a patient with osteopenia taking antiresorptive drugs: A 5-year follow-up case report.

The report describes the rehabilitation of a maxillary arch with limited bone volume in a 67-year-old female taking antiresorptives due to osteopenia. One 10-mm and two extra-short 4-mm implants were inserted, and implant-supported splinted crowns were fabricated. The 5-year follow-up showed stable bone levels, despite poor initial stability (ISQ: 14-51).

Retentive design of a small surgical guide for implant surgery: An in-vitro study.

OBJECTIVES: Instability of the surgical guide is an overlooked factor that can result in a difference between the planned and the actual positions of an implant. Our aim was to compare the stability of the retentive surgical guide (RSG) with a conventional surgical guide (CSG) in an in-vitro experiment. METHODS: A platform to evaluate the stability of the surgical guide was designed using 3D-modelling software (Meshmixer 3.5, Autodesk). Imaging data from 15 patients with a single missing tooth were used to plan the virtual implant. Two surgical guides were designed (Blue Sky Plan 4.8, Blue Sky Bio) and 3D printed (Form2, Dental SG resin, Formlabs) for each case: the CSG with the default, predetermined software settings, and the RSG, designed on a dental model with a 0.1-mm undercut and altered production parameters (reduced guide-to-teeth offset of 0.07 mm, reduced guide thickness of 2.3 mm and a retentive clasp in a marginal area). The dental models were reproducibly secured on the testing platform using a digital force gauge, and the surgical guides were positioned. An increasing force of 0.1 N, 1 N, 2.5 N, and 5 N was sequentially applied from the buccal and the oral directions to the surgical guide via a drill handle. For each force, either the magnitude of the guide's displacement was captured with an intra-oral scanner (CEREC Omnicam AC, Dentsply Sirona; software version: SW 4.5.2) or the dislodgement of the guide was recorded. Scans were imported for analysis (GOM Inspect 2018, GOM GmbH), and library files of the surgical guides and implants were superimposed as a joined complex. The deviation of the implant's position was calculated from the displacement of the guide's position RESULTS: Three-way repeated measures using ANOVA revealed a more significant guide displacement and virtually projected implant deviation in the CSG group than the RSG group and with increasing force in all the deviation parameters. Both groups showed greater resistance to the displacement with the force applied from the oral direction than the buccal direction. The application of the force in the buccal direction resulted in guide dislodgements of 13% and 0% for the CSG and RSG, respectively. In the oral direction, the dislodgement rates were 33% and 7% for the CSG and RSG, respectively. CONCLUSIONS: Within the limitations of this study, the retentive design increased the stability of the surgical guide and, consequently, the accuracy of the virtually projected implants in comparison to the conventional surgical guide designed using the default settings. Clinical trials are needed to confirm its advantages in clinical use. CLINICAL SIGNIFICANCE: With a simple modification to the design, the surgical guide retention provided greater stability, with smaller deviations under loading; this resulted in improved implant precision parameters without requiring additional materials or software. Further studies are needed to assess the clinical feasibility of this surgical guide with improved retention and function.

Extra-Short 4-mm Implants Splinted to 10-mm Implants in the Posterior Maxilla: 3-year Results.

PURPOSE: To evaluate the 3-year success and survival rates of fixed prostheses supported by 4-mm extra-short implants splinted to 10-mm implants in patients with shortened maxillary arches and low maxillary sinus floors. METHODS: A total of 11 patients with reduced alveolar bone heights due to low maxillary sinus floors received two or three titanium-zirconium tissue-level implants: one or two extra-short (4 mm) implants, and one implant 10 mm in length. After 6 months, prosthetic rehabilitation with splinted crowns connecting the 4- and 10-mm implants was performed. Follow-up visits and maintenance protocols were implemented every 4 to 6 months. RESULTS: The 11 patients were treated with 11 10-mm implants and 17 4-mm implants. One extra-short implant failed and was removed before loading, and its planned design was modified from three splinted crowns to a bridge between the 10- and 4-mm implants. After 36 months, all (11/11) prosthetic rehabilitations connecting the 10-mm (11/11) and 4-mm (16/16) implants were functional. At the 10-mm implant sites, the median (interquartile range [IQR]) probing depth and marginal bone loss measured 2.9 mm (2.3 to 3.2) and 1.3 mm (1.0 to 1.5), respectively. At the 4-mm implant sites, the median (IQR) probing depth and marginal bone loss measured 2.9 mm (2.4 to 3.1) and 0.3 mm (0.1 to 0.5), respectively. CONCLUSION: Prosthetic rehabilitation with splinted crowns connecting 4-mm and 10-mm implants showed promising outcomes in shortened maxillary dental arches after 3 years. Additional studies are needed to further validate these findings.

Engineered combinatorial cell device for wound healing and bone regeneration.

Growth factors are the key regulators that promote tissue regeneration and healing processes. While the effects of individual growth factors are well documented, a combination of multiple secreted growth factors underlies stem cell-mediated regeneration. To avoid the potential dangers and labor-intensive individual approach of stem cell therapy while maintaining their regeneration-promoting effects based on multiple secreted growth factors, we engineered a "mix-and-match" combinatorial platform based on a library of cell lines producing growth factors. Treatment with a combination of growth factors secreted by engineered mammalian cells was more efficient than with individual growth factors or even stem cell-conditioned medium in a gap closure assay. Furthermore, we implemented in a mouse model a device for allogenic cell therapy for an in situ production of growth factors, where it improved cutaneous wound healing. Augmented bone regeneration was achieved on calvarial bone defects in rats treated with a cell device secreting IGF, FGF, PDGF, TGF-ß, and VEGF. In both in vivo models, the systemic concentration of secreted factors was negligible, demonstrating the local effect of the regeneration device. Finally, we introduced a genetic switch that enables temporal control over combinations of trophic factors released at different stages of regeneration mimicking the maturation of natural wound healing to improve therapy and prevent scar formation.

Evaluation of gingival recessions with conventional versus digital methods.

OBJECTIVES: The present study aimed to compare the conventional clinical and a digital method for evaluating differences in gingival recession (ΔREC) in patients with advanced periodontitis treated with the non-surgical treatment protocol. METHODS: Agreement between the methods was evaluated on a sample of ten patients with periodontitis (stage III/IV, grade B/C) with acquired clinical measurements and digital models from baseline (T0) and 12-months after non-surgical treatment of periodontitis (T1). The evaluation was performed on maxillary teeth from right to left second premolar resulting in overall 99 teeth. Clinical evaluation was performed by subtracting the distance measurements between gingival margin and cemento-enamel junction, obtained at T0 and T1 by a calibrated examiner (intra-examiner agreement >90%). The digital evaluation was performed directly by measuring the distance between the gingival margins on superimposed T0 and T1 digital models. Using Bland-Altman and statistical analysis, all six measurements sites around each included tooth (n=594) acquired with both methods were compared. RESULTS: Median ΔREC (5th and 95th percentile) acquired with a conventional clinical and digital method was 0.0mm (-2.0 - 1.0) and -0.4mm (-1.6 - 0.8), respectively (p<0.0001). The complete agreement between rounded digital and clinical ΔREC values was only 38%, revealing high disagreement also confirmed by Bland-Altman analysis with 95% limits of agreement ranging from -2.6 to 1.8mm. Absolute differences between the methods higher than 0.5 and 1 mm, was found in 61% and 38% of measurement sites, respectively. CONCLUSIONS: The conventional clinical method for ΔREC evaluation exhibits lower sensitivity and accuracy than the digital method. CLINICAL SIGNIFICANCE: The quality of both clinical and research data in periodontology and implantology can be considerably improved by the digital method while still preserving the compatibility with the conventional clinical method.

Periodontal Therapy in Bariatric Surgery Patients with Periodontitis: Randomized Control Clinical Trial.

Background: Bariatric surgery (BS) patients may experience the progression of periodontitis during recovery. We aimed to determine whether non-surgical periodontal therapy before BS improves the periodontal and systemic health parameters after the surgery. Methods: BS candidates with periodontitis were randomized into the test (TG) and control group (CG). One month before BS (pre-BS), patients in the TG (n = 15) received non-surgical periodontal therapy, while patients in the CG (n = 15) received only mechanical plaque removal. Patients were re-examined 3 and 6 months after BS. Differences between the TG and CG in clinical periodontal parameters, systemic health-related serum biomarkers, parameters of obesity, and prevalence of obesity-related diseases were evaluated. Results: From the 30 included patients, 26 were re-examined at 3 months and 20 patients at 6 months. Periodontal parameters bleeding on probing (p = 0.015), periodontal pocket dept (PPD, p = 0.0015), % PPD > 4 mm (p < 0.001), and full-mouth plaque levels (p = 0.002) were lower in the TG than in the CG at 6 months after BS. There is a general improvement in systemic health after BS without significant differences (p > 0.05) between the TG and CG at the 6-month follow-up. The TG shows a tendency for improvement in metabolic syndrome components at the 6-month follow-up compared to pre-BS (p < 0.05). Conclusions: Non-surgical periodontal therapy in periodontitis patients before the BS may improve periodontal health 3 and 6 months after the surgery. The possible benefits of periodontal therapy on the overall health of BS patients should be further explored.

Virus transmission by ultrasonic scaler and its prevention by antiviral agent: An in vitro study.

BACKGROUND: It is well recognized that dental procedures represent a potential way of infection transmission. With the COVID-19 pandemic, the focus of dental procedure associated transmission has rapidly changed from bacteria to viruses. The aim was to develop an experimental setup for testing the spread of viruses by ultrasonic scaler (USS) generated dental spray and evaluate its mitigation by antiviral coolants. METHODS: In a virus transmission tunnel, the dental spray was generated by USS with saline coolant and suspension of Equine Arteritis Virus (EAV) delivered to the USS tip. Virus transmission by settled droplets was evaluated with adherent RK13 cell lines culture monolayer. The suspended droplets were collected by a cyclone aero-sampler. Antiviral activity of 0.25% NaOCl and electrolyzed oxidizing water (EOW) was tested using a suspension test. Antiviral agents' transmission prevention ability was evaluated by using them as a coolant. RESULTS: In the suspension test with 0.25% NaOCl or EOW, the TCID50/mL was below the detection limit after 5 seconds. With saline coolant, the EAV-induced cytopathic effect on RK13 cells was found up to the distance of 45 cm, with the number of infected cells decreasing with distance. By aero-sampler, viral particles were detected in concentration ≤4.2 TCID50/mL. With both antiviral agents used as coolants, no EAV-associated RK-13 cell infection was found. CONCLUSION: We managed to predictably demonstrate EAV spread by droplets because of USS action. More importantly, we managed to mitigate the spread by a simple substitution of the USS coolant with NaOCl or EOW.

Methods and parameters for digital evaluation of gingival recession: A critical review.

OBJECTIVES: The aim of the present review was to find, compare, and critically discuss digital methods for quantitative evaluation of gingival recessions dimensions. DATA: Collection of articles and classification related to digital evaluation of gingival recessions. SOURCES: A search of PubMed, Web of Science, Scopus, and reference lists of articles was conducted up to April 2021. STUDY SELECTION: Twenty-two articles used digital evaluation of gingival recessions dimensions. The methods in the included articles were extracted, compared, and categorized. RESULTS: Digital measurements were performed on 2D intraoral photographs, 3D models, or cross-sections obtained from 3D models. Baseline measurement were performed for diagnostic and treatment planning and categorised into distance and area measurements. Follow-up evaluation of treatment was based either on repeating the "baseline" measurements and calculating differences or measuring differences directly on composite images, composed from two superimposed images obtained at two time-points. Direct measurements were categorised into distance, area, and volume measurements. CONCLUSIONS: Digital evaluation predominantly means just digitalization of the established evaluation methods; therefore, increasing measurements accuracy and maintaining comparability with past studies. At present, a large variability of digital evaluation workflow among the included studies renders the comparison among different studies difficult if not impossible. The potential of digital evaluation seems not to have been fully exploited as only a few novel measurements and parameters introduced, i.e., volumetric evaluation of soft tissue dynamics. For reproducible and comparable studies in the future, the research should be aimed at evaluation, optimization and standardization of all phases of the digital evaluation. CLINICAL SIGNIFICANCE: Digital evaluation, based on 3D image superimposition is a promising approach as it increases measurements accuracy, maintains compatibility with past studies and simultaneously introduces novel evaluation possibilities.