Frecuencia de Pseudomonas aeruginosa en bolsas periodontales de pacientes con Periodontitis Crónica / Frequency of Pseudomonas aeruginosa in periodontal pockets of patients with Chronic Periodontitis

La periodontitis crónica es una patología caracterizada por la destrucción de los tejidos de soporte del diente. Existe evidencia científica de la presencia en bolsas periodontales de Pseudomonas aeruginosa, bacteria que altera la microbiota subgingival. Ha sido asociada al fracaso en el tratamiento de la periodontitis y podría constituir un riesgo para la salud general de los pacientes. El objetivo de esta investigación fue determinar la frecuencia de P. aeruginosa en bolsas periodontales de pacientes con periodontitis crónica que acudieron a la cátedra de Periodoncia de la Universidad Autónoma de Asunción. El estudio fue observacional descriptivo de corte transversal, para el mismo fueron seleccionados pacientes con periodontitis crónica que cumplían con los criterios de inclusión. Las piezas dentariasseleccionadas para la toma de muestras fueron aisladas con rollos de algodón estéril, y una vez removida la placa bacteriana supragingival, se retiró la placa subgingival de las bolsas periodontales por medio de curetas de Gracey y se introdujeron en tubos de ensayo que contenían medio de Stuart, para luego llevar las muestras hasta el laboratorio de microbiología para su análisis. Del total de 14 muestras, solo una dio positivo a P. aeruginosa representando el 7,14%. El microrganismo aislado resultó resistente a los antibióticos utilizados como coadyuvantes en el tratamiento de la periodontitis crónica,al igual que en otros trabajos encontrados en la literatura internacional. La presencia de estas bacterias dificulta el control de la enfermedad periodontal y podría significar un riesgo para desarrollar infecciones oportunistas, especialmente en los pacientes inmunodeprimidos

Chronic periodontitis is a pathology characterized by the destruction of tooth supporting tissues. There is scientific evidence of the presence in periodontal pockets of Pseudomonas aeruginosa, a bacterium that alters the subgingival microbiota and that has been associated with failure to treat periodontitis and could constitute a risk to patient general health. The objective of this research was to determine the frequency of P. aeruginosa in periodontal pockets of patients with chronic periodontitis who attend the Chair of Periodontology at the Autonomous University of Asunción. Descriptive, cross-sectional observational study, in which patients with chronic periodontitis who met the inclusion criteria were selected. The pieces selected for sampling were isolated with sterile cotton rolls, and once the supragingival bacterial plaque had been removed, the subgingival plaque was removed from the periodontal pockets by means of Gracey curettes and placed in test tubes containing Stuart medium, then the samples were taken to the microbiology lab for analysis. Of the total of 14 samples, only one was positive for P. aeruginosa, representing 7.14%. The isolated microorganism was resistant to the antibiotics used as adjuvants in the treatment of chronic periodontitis, as in other studies found in the international literature. The presence of these bacteria makes it difficult to control periodontal disease and could pose a risk for developing opportunistic infections, especially in immunosuppressed patients

Microbiological and host-derived biomarker evaluation following non-surgical periodontal therapy with short-term administration of systemic antimicrobials: secondary outcomes of an RCT.

Nonsurgical periodontal therapy with adjunctive use of systemic antimicrobials (for 7-14 days) showed improved clinical, microbiological and immunological results over the mechanical protocol alone. Considering the increasing risk for antimicrobial resistance with longer antibiotic regimes, it is important to establish the optimal antibiotic protocol with a maximum antimicrobial benefit and minimum risk for adverse effects. The aim of the study was to evaluate the microbiological and inflammatory outcomes 12-months after a 3-/7-day systemic antibiotic protocol [amoxicillin (AMX) + metronidazole (MET)] adjunctive to subgingival debridement in severe periodontitis compared to mechanical treatment alone. From the initially treated 102 patients, 75 subjects (Placebo group: n = 26; 3-day AMX + MET group: n = 24; 7-day AMX + MET group: n = 25) completed the 12-month examination. Clinical parameters, eight periodontal pathogens and inflammatory markers were determined at baseline and 3-, 6-, 12-months after therapy using real-time PCR and ELISA respectively. After 6 months, several periodontopathogens were significantly more reduced in the two antibiotic groups compared to placebo (p < 0.05). After 1 year, both antibiotic protocols showed significant reductions and detection of the keystone pathogen P. gingivalis compared to placebo. Antibiotic protocols, smoking, disease severity, baseline-BOP, -CAL and -IL-1ß, as well as detection of T. denticola at 12-months significantly influenced the residual number of deep sites. The present data indicate that the systemic use of both short and longer antibiotic protocols (AMX + MET) adjunctive to nonsurgical periodontal therapy lead to higher microbiological improvements compared to subgingival debridement alone. The two investigated antibiotic protocols led to comparable microbiological and inflammatory results.

Patient self-care of periodontal pocket infections.

Treatment of periodontitis aims to control the infection caused by the periodontal pathogenic flora and includes mechanical debridement of root surfaces to disrupt the supragingival and subgingival biofilm. As periodontal pockets of ≤ 5 mm can be perform in a stable condition and may not need additional therapy, the ability and the willingness of the patient to perform good oral hygiene on a long-term basis are of utmost importance for ensuring long-term success of periodontal treatment. In this context, the aim of all home-care measures must be the optimal control of plaque biofilm in order to prevent or treat gingival inflammation as a primary stage of periodontitis. Despite the fact that toothbrushing and other mechanical cleaning practices are the most important elements for preventing periodontal diseases or their progression, other factors, including education, motivation, manual dexterity and compliance with professional recommendation, provision of time and socio-economic status, as well as risk factors, play a role. The present article provides an overview on the various possibilities for self-care of residual pockets in patients with periodontitis.

Significant association of rheumatoid arthritis-related inflammatory markers with non-surgical periodontal therapy.

BACKGROUND/PURPOSE: Chronic periodontitis (CP) and rheumatoid arthritis (RA) are the most common chronic inflammatory diseases and their immunopathogenesis is similar. The aim of this study was to evaluate the effect of non-surgical periodontal treatment on the serum levels of RA-related inflammatory markers in patients with chronic periodontitis. METHODS: Thirty-one Taiwanese adults with CP were included. Demographics and periodontal parameters, including probing depth, clinical attachment level, and number of remaining teeth in the oral cavity, were recorded. All subjects received non-surgical periodontal treatment such as scaling and subgingival root planing. Serum samples were collected before and after the treatment. Serum levels of anti-citrullinated protein antibodies (ACPA), rheumatoid factor, tumor necrosis factor-α (TNF-α), C-reactive protein, interleukin-1ß (IL-1ß), and Interleukin-6 (IL-6) were measured using an enzyme-linked immunosorbent assay. RESULTS: Non-surgical periodontal treatment significantly reduced the serum ACPA (p = 0.015) and TNF-α levels (p = 0.026) in CP patients, particularly in patients with generalized CP. Furthermore, there was a significant and positive correlation between the number of extracted teeth and the reduction in the serum ACPA (p = 0.05) and IL-1ß levels (p = 0.029) after non-surgical periodontal treatment. CONCLUSION: Non-surgical periodontal therapy may aid in the control of RA-related inflammatory markers in patients with CP. A large-scale study with well-defined populations is needed to clarify the benefit of non-surgical periodontal therapy.

Técnicas de afastamento gengival em prótese dental: revisão da literatura / Gingival retraction methods in dental prosthesis: literature review

A proposta desta revisão da literatura foi avaliar as técnicas empregadas no afastamento gengival para prótese dental incluindo métodos mecânicos, químicos-mecânicos e cirúrgicos. A técnica de afastamento gengival deve ser previamente avaliada pelo profissional e a sua indicação, dependerá de cada situação clínica. Nesta revisão foram apresentadas as vantagens e desvantagens das técnicas de afastamento gengival incluindo fio afastador embebido ou não em soluções químicas, técnicas cirúrgicas, procedimentos a base de laser, curetagem gengival e eletro cirurgia. Após a realização desta revisão verificamos que o método químico-mecânico é o mais utilizado pelos profissionais. Atualmente podemos considerar que mesmo com a utilização de tecnologias mais elaboradas, como por exemplo scanners intraorais, quando o término do preparo dental estiver ao nível gengival ou subgengival se faz necessário o afastamento gengival. Para atingir o sucesso de uma prótese dental e importante coexistir uma harmonia entre a prótese e os tecidos periodontais circunvizinhos. (AU)

The aim of this review was to assess the use of gingival retraction methods in the fixed tooth supported prosthesis including mechanical, chemicals-mechanical and surgical methods. The choice of the best gingival retraction technique should be considered previously by the professional and it depends of each individual clinical conditions. In this review were discussed the advantages and the disadvantages of each gingival retraction technique including mechanical, chemical and surgical methods. In this review, we could understand that chemicals-mechanical technical is the most indicate by dentists. Nowadays, we can consider that even with the hightech use in dental area, such as intraoral scanners, when the margin of the restoration is placed sub-gingivally the gingival retraction should be considered. For the successful in dental prosthesis, a healthy coexistence between the restoration and their surrounding periodontal structure should be the goal of a prosthodontist. (AU)

Role of mechanical curettage with and without adjunct antimicrobial photodynamic therapy in the treatment of peri-implant mucositis in cigarette smokers: A randomized controlled clinical trial.

OBJECTIVE: The aim of the present 12-weeks follow-up randomized clinical trial was to investigate the outcome of mechanical curettage (MC) with or without adjunct antimicrobial photodynamic therapy (aPDT) in the treatment of peri-implant mucositis in cigarette smokers. METHODS: Therapeutically, subjects with peri-implant mucositis were divided into 2 groups: (a) Group-A: MC+aPDT; and (b) Group-B: MC alone (control group). In both groups, peri-implant plaque index (PI), bleeding on probing (BOP) and probing pocket depth (PPD) were gauged at baseline and after 12-weeks follow-up. Group comparisons were performed using the Kruskall-Wallis test. P-values less than 0.05 were considered statistically significant. RESULTS: Fifty-four male patients (28 in Group-A and 26 in Group-B) were included. The mean age of individuals in groups A and B were 50.6±0.8 and 52.2±0.5years, respectively. In groups A and B the participants were smoking 16.5±2.7 and 14.2±1.7 cigarettes daily since 25.2±6.5 and 24.6±4.3years, respectively. Periimplant PI, BOP and PPD were comparable among individuals in both groups at baseline. At 12-weeks follow-up, there was a significant reduction in PI (P<0.001) and PPD (P<0.001) among patients in groups A and B compared with their respective baseline values. At 12-weeks follow-up, PI (P<0.001) and PPD (P<0.001) were significantly higher among patients in Group-B compared with Group-A (P<0.001). BOP was comparable in both groups at baseline and at 12-weeks follow-up. CONCLUSION: In cigarette smokers, MC with adjunct aPDT is more effective in the treatment of peri-implant mucositis compared with MC alone.

Efficacy of periimplant mechanical curettage with and without adjunct antimicrobial photodynamic therapy in smokeless-tobacco product users.

OBJECTIVE: The aim was to investigate the effectiveness of antimicrobial photodynamic therapy (aPDT) as an adjuvant to mechanical curettage (MC) in the treatment of periimplant mucositis in smokeless tobacco (ST) product users. METHODS: Forty-eight ST product users with periimplant mucositis were randomly divided into 2 groups. In the test-group, participants underwent periimplant MC with adjunct aPDT; and in the control-group, the patients underwent MC alone. Periimplant plaque index (PI), bleeding on probing (BOP), and probing depth (PD) were measured at baseline and after 3-months of follow-up. Statistical analysis was performed using the Kruskal-Wallis test. Level of significance was set at P<0.05. RESULTS: At baseline, periimplant PI, BOP and PD were comparable among individuals in the test- and control groups. At 3-months follow-up, scores of periimplant PI (P<0.05), BOP (P<0.05) and PD (P<0.05) were statistically significantly higher among patients in the control-group compared with the test-group. At 3-months follow-up, the percentages of sites of PI, BOP and PD were statistically significantly higher in the control-sites as compared to the test-sites. CONCLUSION: Among patients with periimplant mucositis, MC with adjunct aPDT is more effective in reducing periimplant inflammation in ST product users as compared to MC alone; however, the present result should be interpreted with caution as they were based on a short-term follow-up. Further long-term studies are needed in this regard.

The histopathological comparison on the destruction of the periodontal tissue between normal junctional epithelium and long junctional epithelium.

BACKGROUND AND OBJECTIVE: The barrier function of long junctional epithelium is thought to be important after periodontal initial therapy and periodontal surgery. Although the difference between long junctional epithelium and normal junctional epithelium regarding their resistance to destruction of periodontal tissue has been investigated, the mechanism still remains unclear. Using our rat experimental periodontitis model in which loss of attachment and resorption of alveolar bone is induced by the formation of immune complexes, we investigated the resistance of periodontal tissue containing long junctional epithelium and normal junctional epithelium to destruction. MATERIAL AND METHODS: Rats were divided into four groups. In the immunized long junctional epithelium (I-LJE) group, rats were immunized with lipopolysaccharide (LPS), and curettage and root planing procedures were performed on the palatal gingiva of the maxillary first molars to obtain reattachment by long junctional epithelium. In the immunized normal junctional epithelium (I-JE) group, rats were immunized without curettage and root planing procedures. In the nonimmunized long junctional epithelium (nI-LJE) group, rats were not immunized but curettage and root-planing procedures were performed. In the control group, neither immunization nor curettage and root-planing was performed. In all rats, periodontal inflammation was induced by topical application of LPS into the palatal gingival sulcus of maxillary first molars. The rats were killed at baseline and after the third and fifth applications of LPS. Attachment loss and the number of inflammatory cells and osteoclasts in the four groups were compared histopathologically and histometrically. RESULTS: After the third application of LPS in the I-LJE group, attachment loss showed a greater increase than in control and nI-LJE groups, and inflammatory cell infiltration and osteoclasts were increased more than in the other groups. After the fifth application of LPS, attachment loss was greater and there was a higher degree of inflammatory cell infiltration in nI-LJE and I-LJE groups than in control and I-JE groups. CONCLUSION: Our findings suggest that the destruction of periodontal tissue is increased in tissue containing long junctional epithelium compared with normal junctional epithelium and that the immunized condition accelerates the destruction by forming immune complexes.

Is mechanical curettage with adjunct photodynamic therapy more effective in the treatment of peri-implantitis than mechanical curettage alone?

BACKGROUND: The aim of the present study was to review the pertinent literature on the effects of mechanical curettage (MC) with and without adjunct photodynamic therapy (PDT) for the management of peri-implantitis. METHODS: The addressed focused question was "Is PDT effective in the treatment of peri-implantitis?" A search without language or time restrictions up to March 2016 was conducted using various key words. The exclusion criteria included; review papers, in vitro Studies, case reports, commentaries, interviews, and letters to the editors. RESULTS: In total 9 studies were included. Among them 5 studies were clinical and 4 were experimental. All the studies used PDT as an adjunctive to MC in their test groups. The laser wavelengths used ranged from 660nm to 830nm. One study showed significant reduction of the bleeding scores, inflammatory exudates and Aggregatibacter actinomycetemcomitans count in group with PDT as an adjunctive when compared to MC and 0.2% chlorhexidine. However, in four clinical studies comparable periodontal parameters were reported when PDT is used as an adjunct to MC was compared to MC in treatment of peri-implantitis. In three experimental studies, outcomes were significantly better in group with PDT as an adjunct to MC when compared to MC alone at follow-up. CONCLUSION: The role of PDT as an adjunct to MC in the treatment of peri-implantitis is debatable. Further longterm randomised control trails are needed to justify the role PDT as an adjunct to MC in treatment of peri-implantitis.

Scaling and root planing vs. conservative surgery in the treatment of chronic periodontitis.

A renewed interest in conservative surgical techniques has been fueled by new technology, changes in referral patterns to periodontists and a desire to achieve periodontal health in the least invasive, most cost-efficient manner possible. Trends suggest that an increasing amount of periodontal care is being provided in the offices of general dentists. If true, it is likely that patients receiving care in these offices will be offered simpler surgical treatment modalities that do not require an extensive armamentarium. The purpose of this article was to review the effectiveness of six relatively simple surgical techniques - gingivectomy, flap debridement, modified Widman flap, excisional new attachment procedure, modified excisional new attachment procedure and laser-assisted new attachment procedure - and to compare the results obtained using these procedures with the well-known clinical benefits of scaling and root planing. The intent was to determine whether the benefits of surgical procedures in the hands of most general dentists extend beyond those of conventional nonsurgical therapy.

The comprehensive periodontal, resorative end prosthodontic therapy of chronic periodontitis Case presentation.

Chronic periodontitis predictable responds to mechanical cleaning and cause related periodontal surgery. Nowadays the therapeutic protocol of the chronic periodontitis is widely known and scientifically proven. The therapy can be split into two major phases, the inicial or cause related therapy and the surgical therapy, however in the most of the cases the patients need complex periodontal, restorative and prosthodontic therapy. The presented case demonstrates the process and results of the complex treatment of a 55 years old patient suffering from chronic periodontitis. The patient didn't have hopeless teeth. In the first phase of the cause related periodontal therapy professional oral hygiene treatment, scaling rootplaning and subgingival curettage were performed by quadrants. At the re-evaluation after the conservative periodontal therapy there was a significant pocket reduction in the mandibular quadrants, however there was a need for surgical pocket therapy in the molar regions of the maxillary quadrants. Modified Widman-flap surgery and osteoplasty were performed in both of the maxillary quadrants. After the surgical periodontal therapy the revision of the old root canal fillings was accomplished in the teeth 24, 36 and 47. Due to an inflammatory root resorption, root resection was performed following the root canal filling on the tooth 24. Three months after the root resection surgery, the tooth was reinforced by a glass fiber post. Nine months postoperatively the periapical area of the tooth 24 showed growing radioopacity After the second reevaluation of patient's compliance and the healing tendencies full mouth prosthodontic reheabilitation was provided. Metalloceramic crowns with a supragingival margin were made on the teeth 12, 24 and 36, metalloceramic bridge was made on the teeth 44 and 47. After the periodontal, restorative and prosthodontic therapy were finished the patient was remanded every 3 months for periodontal supportive therapy and could maintain excellent oral hygiene with a plaque score under 20% and a bleeding score of 6%.

Efectos del raspaje y alisado radicular a boca completa con azitromicina sobre los niveles de proteina C reactiva ultra sensible, parametros clínicos y microbiológicos periodontales. Ensayo clinico aleatorizado / High sensitive- C reactive protein, periodontal parameters and periodontal microbiota after scaling-root planning plus Azithromycin as treatment of Chronic Periodontitis: A Randomized Clinical Trial

Objetivo: El propósito de este ensayo clínico controlado aleatorizado simple ciego fue determinar el efecto del raspaje y alisado radicular en una sesión adjunto a azitromicina oral, sobre los niveles de proteína C reactiva ultra sensible y otros biomarcadores sanguíneos, parámetros clínicos y microbiológicos periodontales en pacientes con periodontitis crónica tres meses después del tratamiento. Materiales y Métodos: 49 sujetos con periodontitis crónica participaron en el estudio y fueron asignados aleatoriamente en dos grupos de 27 pacientes, el grupo intervención recibió raspaje y alisado ra- dicular adjunto a azitromicina (RAR+Azi) 500 mg/día por cinco días, y el grupo con- trol recibió raspaje y alisado radicular más placebo (RAR+Pb), ambos tratamiento en sesión única. Los grupos de periodontitis recibieron un examen periodontal a boca completa, análisis de sangre y cultivos microbiológicos al inicio del estudio y tres meses después del tratamiento. Se incluyó un grupo referencia de 25 pacientes perio- dontalmente sanos tomando muestras sólo al inicio. La variable principal de desenlace fue la variación de la proteína C reactiva ultra sensible. Las variables de resultado secundarias fueron la variación de triglice - ridos, colesterol de alta densidad (HDL), colesterol de baja densidad (LDL), glucosa en ayunas, profundidad al sondaje (PS) y composición microbiana. Resultados: La terapia RAR+Azi no redujo significativamente los niveles plas - máticos de hsPCR, sin embargo, se observó una tendencia positiva (4,33 a 2,99 mg/L). Este grupo obtuvo también una mayor re- ducción en PS, índice arterial y frecuencia de detección de Porphyromonas gingivalis y Prevotela intermedia en comparación con el grupo RAR+Pb (p<0.05). Los otros pa- rámetros sanguíneos no cambiaron signifi - cativamente. En contraste, el grupo control aumentó los niveles de hsPCR después de la terapia y en algunos casos se detectó un aumento de PS. Conclusiones: La terapia de RAR+Azi ofrece a corto plazo beneficios clínicos y microbiológicos comparado a RAR solo. No se encontraron diferencias significati - vas en los niveles de hsPCR. Es necesario realizar estudios con mayor tiempo de seguimiento para confirmar o rechazar la hipótesis que el tratamiento periodontal solo o con antibióticos generan efectos en los niveles de hsPCR y otros marcadores de riesgo cardiovascular...(AU)

Objective: This single blind randomized clinical trial (RCT) determined the effect of scaling and root planning plus azithromycin (SRP+Azi) in serum C reactive protein levels and other blood biomarkers, clinical periodontal parameters and subgingival microbial composition three months after periodontal therapy. Materials and Methods: Forty-nine chronic periodontitis patients participated in the study and were randomly assigned Recibido para publicación: Octubre 09 de 2016 Aceptado para publicación: Diciembre 07 de 2016 Correspondencia: JE, Soto, Universidad del Valle jesotofranco@gmail.com R E V I S T A ESTOMATOLOGIA Artículo original La Revista Estomatología usa la licencia Creative Commons de Atribución ­ No comercial ­ Sin Derivar 4.0 Internacional; de tal forma que los textos de la revista pueden ser descargados en ver - sión PDF siempre que sea reconocida la autoría y el texto no tenga modificaciones de ningún tipo. Volumen 24 Nº 2 2016 15 to a test group of 27 patients received one session of scaling and root planning plus oral azithromycin 500 mg daily for five days (SRP+Azi) while, 27 patients in the control group received the same single session of scaling and root planning plus placebo (SRP+Pb). A group of 25 subjects presenting periodontal health-gingivitis were included as a comparison group and in them was determined clinical periodontal parameters, blood parameters and micro - biota at baseline. Periodontitis groups recei - ved a full mouth periodontal examination, blood test and microbiological cultures at baseline, and three months after therapy. Primary outcome variable was the variation in serum high sensitive C- reactive protein (hs-CRP). Secondary outcome variables were variation of triglycerides, High density Cholesterol (HDL), low density Cholesterol (LDL), fasting glucose, pocket depth and microbial composition. Results: Therapy with SRP+Azi do not significantly reduce the plasmatic levels of hs-CRP however, a positive trend was noti - ce (4,33 to 2,99 mg/l). This group obtained also greater reduction of pocket depth (PD), artery index and P. gingivalis and P inter - media detection frequency when compared to the SRP-placebo group (p<0.05). Other blood biochemistry parameters did not changed significantly in the test group. In contrast, the control group increased the hs- CRP levels after therapy and in some cases a increase of pocket depth was detected. Conclusions: Combined SRP+Azi therapy in chronic periodontitis did not reduced hs- CRP serum level significantly after three months. However, this group reduced signi - ficantly their probing pocket depth, reduced P. gingivalis and P intermedia frequency and increased clinical attachment gain.

Effects of non-equilibrium plasma in the treatment of ligature-induced peri-implantitis.

AIM: To evaluate the effects of non-equilibrium plasma in the treatment of ligature-induced peri-implantitis in beagle dogs. MATERIALS AND METHODS: Six beagles received 12 implants installed in the position of the fourth mandibular premolars. Ligature-induced peri-implantitis was initiated at 3 months post-implantation. When approximately 40% of the supporting bone was lost, the ligatures were removed. The implants were subjected to the muco-periosteal scaling and chlorhexidine irrigation with or without plasma irrigation. Three months later, clinical, radiographic and microbiological analyses were performed. Block biopsies were prepared for micro-CT and histomorphometric analysis. The primary outcome was the difference in bone healing of peri-implant sites, and the secondary outcomes included changes in clinical parameters (SBI, PD) and bacterial detection. RESULTS: At baseline, no significant differences were observed between the two groups. At 3 months post-treatment, the plasma group showed a significantly higher bone level than the control group (p < 0.05), a significantly decreased detection of bacteria (Porphyromonas gingivalis and Tannerella forsythia) (p < 0.05), and a significant improvement in clinical examination (p < 0.05). CONCLUSIONS: Within the limits of this study, non-equilibrium plasma treatment as an adjunct to the conventional therapy is a feasible approach for the treatment of peri-implantitis.

Periodontal Examination Profiles and Treatment Approaches of a Group of Turkish General Dentists.

PURPOSE: To investigate the periodontal examination profiles and treatment approaches of a group of Turkish general dentists. MATERIALS AND METHODS: 457 general dentists were called and 173 dentists agreed to participate in the study. The questionnaire comprised 10 questions including gender, years of experience, periodontal probing during examination, oral hygiene motivation methods (do you perform, yes/no; the oral hygiene motivation method; verbal expression or using visual materials), periodontal treatments (supragingival scaling, subgingival scaling and planing or surgery) and knowledge about diagnosis and treatment for aggressive and chronic periodontitis. The participants were grouped according to their years of clinical experience: group 1: 0 to 10 years of clinical practice (n = 58); group 2: 10 to 20 years (n = 68); group 3: >20 years (n = 47). RESULTS: The 'periodontal probing' performance percentages were 70.69%, 26.47% and 40.43% in groups 1, 2 and 3, respectively. The oral hygiene motivation rate was high in the first 10 years of clinical practice (60.3%). In addition, 72.4% of the dentists in group 1 used visual materials in addition to verbal expression during oral hygiene motivation. 72.25% of the general dentists performed supragingival scaling. The knowledge of diagnosis and treatment of chronic periodontitis was present in >90% of the dentists surveyed. In contrast, >50% of the general dentists were not knowledgeable in the diagnosis and treatment of aggressive periodontitis. CONCLUSION: Periodontal probing is a gold standard for periodontal diagnosis, but as the dentists' clinical experience increases, the frequency of its performance decreases. The percentage of the knowledge and treatment of chronic periodontitis is higher than that of aggressive periodontitis. Postgraduate education in periodontology is important to keep general dentists up to date on current periodontal practice and improve awareness of periodontal diseases.

Trauma from instrumentation after non-surgical periodontal treatment with ultrasonic scalers and Nd:YAG laser.

OBJECTIVE: Periodontal therapies aimed at altering the progression of periodontal diseases must include meticulous mechanical debridement during both the non-surgical and the surgical phases of periodontal treatment. The aim of this study was to evaluate and compare the immediate effect of trauma from instrumentation on clinical attachment level after non-surgical periodontal treatment with ultrasonic scalers and a Nd:YAG laser. MATERIALS AND METHODS: Twenty-four patients with untreated chronic periodontitis, presenting probing depths of 4-6 mm on anterior teeth, upper and lower, were entered into the study. The selected teeth were probed with a pressure-controlled probe, guided by stents. Each quadrant was randomly allocated in a split-mouth design either to treatment with Nd:YAG laser using an energy of 1W, 100mj, 1064nm (test group) or to periodontal treatment using ultrasonic scalers (control group). Clinical parameters, including plaque index (PI), bleeding on probing (BOP), probing pocket depth (PPD) and probing attachment level (PAL) were acquired prior to and immediately after treatment. RESULTS: Statistical analysis demonstrated no differences between groups at baseline for all parameters (p > 0.05). Immediately after treatment, the control group showed a greater PAL loss than the test group (p < 0.05). For the control group, there were statistically significant differences between PAL immediately before and after treatment (p < 0.05), but not test group (p > 0.05). CONCLUSIONS: Within the limits of the present study, it may be concluded that non-surgical periodontal treatment with ultrasonic scalers causes a mean immediate attachment loss of 0.68 mm and that a Nd:YAG laser seems to reduce significantly the trauma the instrumentation produced.

Clinical efficacy of subgingival debridement with adjunctive erbium:yttrium-aluminum-garnet laser treatment in patients with chronic periodontitis: a randomized clinical trial.

BACKGROUND: The efficacy of erbium:yttrium-aluminum-garnet (Er:YAG) laser application as an adjunct to subgingival debridement in the treatment of chronic periodontitis (CP) is controversial. This study assesses the efficacy of combining full-mouth subgingival debridement with Er:YAG laser application in the treatment of patients with CP. METHODS: In this 12-month, single-masked, parallel-group clinical trial, 40 patients with moderate CP were selected and randomly assigned to a test group (one session of full-mouth ultrasonic subgingival debridement followed 1 week later by Er:YAG application in sites with initial probing depths [PDs] of ≥4.5 mm) and a control group (two sessions of ultrasonic debridement within 1 week). The main outcome variable was change in PD; the secondary outcomes were change in clinical attachment level and proportion of sites with bleeding on probing. Outcomes were assessed at baseline and after 3, 6, and 12 months. Data were analyzed as intention to treat using analysis of variance to assess intergroup differences. RESULTS: Both treatments resulted in significant clinical improvements. The test group achieved, in comparison with the control, a significantly lower percentage of sites with PD ≥4.5 mm (17.44% versus 22.83%, respectively; P = 0.004) and a tendency for a lower percentage of sites with PD ≥4.5 mm and bleeding on probing (9.78% versus 12.69%; P = 0.052). CONCLUSION: This limited added clinical effect may justify the use of a protocol combining full-mouth ultrasonic debridement with laser therapy in the treatment of initial moderate CP.

Histological and profilometric evaluation of the root surface after instrumentation with a new piezoelectric device - ex vivo study.

OBJECTIVES: An ex vivo model was designed to profilometrically and histologically assess root changes resulting from scaling with a new ultrasonic device, designed for bone piezoelectric surgery, in comparison with curettes. METHODS: Three groups of 10 periodontal hopeless teeth were each subjected to different root instrumentation: Gracey curettes (CUR); ultrasonic piezoelectric device, Perio 100% setting, level 8 (P100); and ultrasonic piezoelectric device Surg 50% setting, level 1 (S50). After extraction, all teeth were photographed to visually assess the presence of dental calculus. The treated root surfaces were profilometrically evaluated (Ra, Rz, Rmax). Undecalcified histological sections were prepared to assess qualitative changes in cementum thickness. Statistical analysis was carried out using one-way anova test with a significance level of 95%. RESULTS: Both instruments proved to be effective in the complete removal of calculus. The CUR group presented the lowest Ra [2.28 µm (±0.58)] and S50 the highest [3.01 µm (±0.61)]. No statistically significant differences were detected among the three groups, for Ra, Rz and Rmax. Histologically, there was a cementum thickness reduction in all groups, being higher and more irregular in S50 group. CONCLUSIONS: Within the limits of this study, there were no statistically significant differences in roughness parameters analyzed between curettes and the ultrasonic piezoelectric unit. This new instrument removes a smaller amount of cementum, mainly at the Perio 100% power setting, which appears to be the least damaging. The ultrasonic device is effective in calculus removal, proving to be as effective as curettes.

Videoscope-assisted minimally invasive periodontal surgery (V-MIS).

AIM: Small incision surgery has become routine in many areas of medicine but has not been widely accepted in periodontal therapy. A videoscope to assist minimally invasive surgery (MIS) has been developed. The clinical outcomes from MIS performed using this videoscope (V-MIS) are reported. MATERIALS AND METHODS: Patients were evaluated for residual defects following non-surgical therapy consisting of root planing with local anaesthetic. Thirty patients having 110 sites with residual pocket probing depth (PPD) of at least 5 mm, 2 mm loss of clinical attachment level (CAL), and radiographic evidence of bone loss were surgically treated. V-MIS was performed utilizing the videoscope for surgical visualization. RESULTS: At re-evaluation 6 months post surgery, there was a statistically significant improvement (p < .001) in mean PPD and CAL (PPD 3.88 ± 1.02 mm, CAL 4.04 ± 1.38 mm) in 1, 2, and 3 wall defects. All PPD at re-evaluation were 3 mm or less. There was a mean post-surgical increase in soft tissue height (0.13 ± 0.61 mm, p = 0.168) with a decrease in recession. CONCLUSIONS: The improvement in PPD and CAL from V-MIS, in the authors' opinion, appears to be favourable when compared to previously reported results of periodontal regenerative surgery. The lack of post-surgical recession following V-MIS has not been reported with traditional regenerative surgery.

Endodontic therapy of a mandibular canine tooth with irreversible pulpitis secondary to dentigerous cyst.

Dentigerous cysts are uncommon, yet are being reported with increasing frequency in the veterinary literature. Dentigerous cysts are a type of benign odontogenic cyst associated with impacted teeth, most commonly the mandibular first premolar tooth. Significant bone destruction can occur secondary to the expansion of a dentigerous cyst. The expanding cyst can lead to pathology of neighboring teeth, which can include external root resorption or pulpitis. Intraoral dental radiographs are imperative to properly assess the presence and extent of a dentigerous cyst, as well as the status of the neighboring teeth. This case report describes treatment for dentigerous cyst including cyst lining curettage, mandibular bone regeneration, and endodontic therapy for a canine tooth with irreversible pulpitis.

Periodontal pathogens and associated factors in aggressive periodontitis: results 5-17 years after active periodontal therapy.

OBJECTIVES: To assess the association between presence of periodontal pathogens and recurrence of disease in patients with aggressive periodontitis (AgP) after active periodontal therapy (APT) and further influencing factors. MATERIAL & METHODS: Microbiological samples were taken from 73 patients with AgP 5-17 years after APT at 292 sites (deepest site per quadrant). Real-time polymerase chain reactions were used to detect the periodontal pathogens Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola. Uni- and multivariate analyses evaluated the associations between pathogens and recurrence of disease, smoking and adjunctive antibiotic therapy. RESULTS: At re-examination A. actinomycetemcomitans could be detected in six patients (8.2%), P. gingivalis in 24 (32.9%), T. forsythia in 31 (42.5%) and T. denticola in 35 (48.0%). Increased levels of T. forsythia and T. denticola at re-examination were significantly associated with recurrence of disease in multivariate analyses (OR: 12.72, p < 0.001; OR 5.55, p = 0.002 respectively). Furthermore, high counts of T. denticola were found in patients with increased percentage of sites with clinical attachment levels (CAL) ≥ 6 mm compared to those with low counts (13.8% versus 3.2%, p = 0.005). CONCLUSION: In patients with recurrence of disease T. forsythia and T. denticola were detected more frequently and in higher counts. Furthermore, T. denticola was found more frequently in patients with increased CAL.