Efeito da terapia fotodinâmica antimicrobiana como adjuvante no tratamento não cirúrgico da periodontite estádio III ou IV grau C / Effect of antimicrobial photodynamic therapy as an adjuvant in the non-surgical treatment of stage III or IV grade C periodontitis

A Periodontite estádio III e IV grau C em pacientes jovens tem um caráter mais destrutivo dos tecidos periodontais de suporte e tem impacto em perdas dentárias, função mastigatória e pior resposta ao tratamento. E a Terapia Fotodinâmica Antimicrobiana (TFD) tem surgido como uma alternativa promissora adjuvante à Terapia Periodontal não Cirúrgica (TPNC) desta doença. OBJETIVO: avaliar os efeitos da TFD como adjuvante no TPNC da Periodontite estádio III ou IV grau C, através dos parâmetros clínicos periodontais (Índice de Placa Visível (IPV), Índice de Sangramento Gengival (ISG), Sangramento à Sondagem (SS), Profundidade de Sondagem (PS), Recessão Gengival (RG), Nível de Inserção Clínica (NIC) e Mobilidade Dentária (MOB)) bem como avaliar seu impacto na qualidade de vida dos pacientes por meio do Oral healthrelated quality of life (OHRQoL). METODOLOGIA: Vinte e um indivíduos participaram desse ensaio clínico controlado randomizado, duplo cego, em um desenho de boca dividida por quadrantes. Todos os pacientes foram tratados com orientação de higiene bucal, raspagem e alisamento radicular por meio do Full Mouth Disinfection (FMD) e antibioticoterapia sistêmica. Os quatro quadrantes foram randomizados de acordo com os seguintes grupos: grupo 1 (FMD + AB), grupo 2 (FMD + AB + TFD em sessão única), grupo 3 (FMD + AB + TFD em quatro sessões) e grupo 4 (FMD + AB + laserterapia com luz infravermelha em quatro sessões). As avaliações foram feitas no baseline e com média de 6 meses após o tratamento. RESULTADOS: Obteve-se uma melhora dos parâmetros clínicos com redução significativa da PS, NIC e SS para todos grupos e da MOB para os grupos FMD + AB, FMD + AB + TFD sessão única e FMD + AB + TFD em 4 sessões após o tratamento, apresentou redução expressivamente maior do NIC no grupo FMD + AB + TFD 4 sessões (ΔMédia = 3,04 mm) em relação ao grupo FMD + AB (Δmédia =2,18 mm), ou seja, com diferença de 0,86 mm. A estratificação das PS no baseline em PS = 5mm e PS ≥ 6mm mostrou que para PS ≥ 6mm, o grupo FMD + AB + TFD em 4 sessões apresentou maior redução da PS (p = 0,005) e NIC (p = 0,001) em relação ao grupo FMD + AB. Em relação à QV, houve aumento significativo dos valores OHRQoL (p = 0,001) e dos domínios físico (p < 0,001), social (p = 0,027) e psicológico (p = 0,005) após o tratamento. CONCLUSÃO: A terapia periodontal do FMD associada a antibioticoterapia, com acréscimo ou não da TFD apresenta resultados significativos na melhora dos parâmetros clínicos periodontais e, em bolsas mais profundas, a TFD em 4 sessões apresentou resultados superiores. Ademais, a Periodontite estádio III ou IV grau C reflete negativamente na percepção da QV, porém, a TPNC apresentou impacto positivo sobre a mesma (AU).

Stage III ­ IV grade C periodontitis in young patients has a more destructive character of periodontal support tissues and has impact on loss of teeth, masticatory function and worse response to treatment. The Antimicrobial Photodynamic Therapy (PDT) has become as a promising alternative, adjuvant to Non-Surgical Periodontal Therapy (NSPT) of this disease. OBJECTIVE: To evaluate the effect of adjunctive PDT on the non-surgical treatment of stage III ­ IV, grade C Periodontitis, through the analysis of periodontal clinical parameters (Visible Plaque Index (VPI), Gingival Bleeding Index (GBI), Bleeding on Probing (BP), Pocket Probing Depth (PPD), Gingival Recession (GR), Clinical Attachment Level (CAL) and Tooth Mobility (Mob)) as well as to assess their impact on quality of life (QoL) of the patients through Oral health-related quality of life (OHRQoL) questionnaire. METHODOLOGY: Twenty-one subjects particpated in this controlled randomized, double-blind trial, in a split-mouth design divided into quadrants. All the patients were treated with oral hygiene guidance, scaling and root planing through Full Mouth Disinfection (FMD) and systemic anbiotics. The four quadrants were randomly assigned to the following treatment groups: group (FMD + AB), group 2 (FMD + AB + PDT in a single session), group 3 (FMD + AB + PDT in four sessions), and group 4 (FMD + AB + laser therapy with infrared light in four sessions). Assessments were made at baseline and an average of 6 months after treatment. RESULTS: There was an improvement in clinical parameters with significant reduction of PPD, CAL and BoP for all therapies as well as Mob for FMD + AB, FMD + AB + PDT in a sihgle session and FMD + AB + PDT in 4 sessions groups, however there was a significantly greater reduction in CIN in the FMD + AB + PDT group 4 sessions (ΔAverage = 3.04 mm) in relation to the FMD + AB group (ΔAverage = 2.18 mm), that is, with a difference of 0.86 mm. Stratification of the baseline pockets in PPD = 5mm and PPD ≥ 6mm showed that, for PPD ≥ 6mm, FMD + PDT in 4 sessions had a greater reduction of PPD (p = 0.005) and CAL (p = 0.001) in relation to FMD group). Regarding QoL analysis, there was a significant increase in the OHRQoL (p = 0.001) and in the physical (p < 0,001), social (p = 0.027) and psychological (p = 0.005) domains after treatment. CONCLUSION: FMD therapy associated with systemic antibiotic therapy, with or without addition of PDT, showed significant improvement of the clinical periodontal parameters and, in deeper pockets, PDT in 4 sessions showed better results. Furthermore, stage III - IV grade C Periodontitis reflected negatively on the QoL perception, however, NSPT had a positive impact on it (AU).

Long-term treatment costs for aggressive periodontitis in a German population.

AIM: This study assessed the long-term annual costs for treating aggressive periodontitis (AgP) patients. METHODS: A cohort of compliant AgP patients was retrospectively evaluated. Costs for active periodontal therapy (APT, including scaling and root planing, open flap debridement, root resections, but not pocket elimination or regenerative surgery) and supportive periodontal therapy (SPT, including also costs for restorative, endodontic, prosthetic and surgical treatments) were estimated from a mixed payer perspective in Germany. The impact of tooth- and patient-level factors on annual costs was assessed using mixed modelling. RESULTS: A total of 52 patients (mean [SD] age: 35.2/6.8 years), with 26.5 (4.0) teeth (38% with bone loss >50%) were treated. Mean follow-up (retention) time was 16.9 (5.4) years. Total treatment costs per patient and per tooth were 6,998 (3,807) and 267 (148) Euro, respectively. Approximately 87% of the costs were generated during SPT, 13% during APT. Annual patient- and tooth-level costs were 536 (209) and 20.1 (65.0) Euro, respectively. Annual tooth-level costs were significantly increased in patients aged 34 years or older, male patients, former or current smokers, teeth with furcation involvement degree II/III, and bone loss 50%-70%. CONCLUSIONS: Annual treatment costs for treating AgP patients were similar to those found for chronic periodontitis patients. Certain parameters might predict costs.

Local wound healing biomarkers for real-time assessment of periodontal regeneration: pilot study.

BACKGROUND AND OBJECTIVES: Within the same surgical procedure, a great variability on achievement of clinical outcomes exists and may be associated to different molecular factors related to tissue healing. The aim of the present study was to assess the distribution of clinical success separately in regenerative therapy (REG) and open flap debridement (OFD) to evaluate if factors related with healing of epithelium, connective tissue and bone may be associated to the clinical outcome within each surgical procedure. MATERIAL AND METHODS: Sixteen patients underwent periodontal REG and nine patients underwent OFD. Periodontal wound fluid was collected at baseline, 3-5, 7, 14 and 21 d after surgery, and expression of wound healing proteins was assessed. Pocket depth and clinical attachment level were taken at baseline and at 6 mo of follow-up. Percentage pocket depth reduction and percentage clinical attachment level gain were computed. Patients were regarded as better or worse responders depending on their percentage pocket depth reduction or percentage clinical attachment level gain. RESULTS: Higher percentage of better responders was observed in the REG group (68.7%) compared to the OFD group (22.2%). At 21 d, no difference in the profile of most of the proteins emerged, with two exceptions, both regarding REG treatment. Bone morphogenetic protein-7 tended to increase in better responders and to decrease in worse responders. Matrix metalloproteinase-1 increased in worse responders and remained substantially unchanged in better responders. CONCLUSION: Local expression of matrix metalloproteinase-1 and bone morphogenetic protein-7 during wound healing is associated with the clinical performance of periodontal regenerative surgery. The use of local biomarkers offers the potential for real-time assessment of the periodontal healing process.

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.

Cost-effectiveness of non-surgical peri-implantitis treatments.

AIM: The purpose of the present study was to assess the cost-effectiveness of various alternatives of non-surgical peri-implantitis treatment. MATERIALS AND METHODS: A decision analytical model was constructed and populated with parameter estimates from recent literature for reduction in pocket probing depth (PPD) in response to eight different treatment alternatives. A micro-costing approach combined with an online expert survey was applied to simulate a decision-making scenario taking place in Germany. The treatment alternatives providing the most advantageous cost/outcome combinations were identified according to the net benefit criterion. Uncertainties regarding model input parameters were incorporated via simple and probabilistic sensitivity analysis based on Monte Carlo simulation. RESULTS: In the base case scenario, debridement alone, Air-Flow, debridement combined with PerioChip, and debridement combined with local antibiotics were identified as treatment strategies with comparably better value for money than Er:YAG laser monotherapy, Vector System, debridement combined with CHX, and photodynamic therapy. Sensitivity analysis revealed considerable decision uncertainty corresponding to limited evidence about different treatment alternatives for peri-implantitis treatment. CONCLUSIONS: Derivation of robust treatment recommendations for peri-implantitis requires more comprehensive and patient-centred evidence on peri-implantitis treatments.

Preventing and Treating Peri-Implantitis: A Cost-Effectiveness Analysis.

BACKGROUND: A large number of treatments for peri-implantitis are available, but their cost-effectiveness remains uncertain. This study evaluates the cost-effectiveness of preventing and treating peri-implantitis. METHODS: A Markov model was constructed that followed each implant over 20 years. Supportive implant therapy (SIT) for managing peri-implant mucositis and preventing development of peri-implantitis was either provided or not. Risk of peri-implantitis was assumed to be affected by SIT and the patient's risk profile. If peri-implantitis occurred, 11 treatment strategies (non-surgical or surgical debridement alone or combined with adjunct therapies) were compared. Treatments and risk profiles determined disease progression. Modeling was performed based on systematically collected data. Primary outcomes were costs and proportion of lost implants, as assessed via Monte Carlo microsimulations. RESULTS: Not providing SIT and performing only non-surgical debridement was both least costly and least effective. The next best (more costly and effective) option was to provide SIT and perform surgical debridement (additional 0.89 euros per 1% fewer implants lost). The most effective option included bone grafts, membranes, and laser treatment (56 euros per 1%). For patients at high risk, the cost-effectiveness of SIT increased, whereas in low-risk groups, a cost-optimized strategy was cost-effective. CONCLUSIONS: Although clinical decision-making will be guided mainly by clinical condition, cost-effectiveness analyses might add another perspective. Based on these findings, an unambiguous comparative effectiveness ranking was not established. However, cost-effectiveness was predominantly determined by provision of SIT and initial treatment costs. Transferability of these findings to other healthcare systems needs further confirmation.

The utility of 40 MHz periodontal ultrasonography in the assessment of gingival inflammation evolution following professional teeth cleaning.

UNLABELLED: The AIM of this study was to evaluate the usefulness of 40 MHz periodontal ultrasonography in the assessment of gingival inflammation, following professional teeth cleaning. MATERIAL AND METHODS: The study was performed on 18 teeth without restorations having subgingival calculus (upper and lower premolars and frontal teeth). After the clinical exam the Gingival Index and the Sulcus Bleeding Index were calculated. Then a 40MHz transducer (ULTRASONIX SonoTouch device) was used to obtain longitudinal sections in the frontal plane. Three measurements were performed: alveolar crest - cementum-enamel junction distance (ACJ), gingival height (GH), and gingival width (GW). Professional cleaning was performed by ultrasound scaling (SatelecP5 booster, France) and airflow (NSK, Japan). Two and seven days after the first evaluation, ultrasonographic and clinical examinations were repeated. RESULTS: Two days after the treatment the median value of the ACJ, was 2.70 (2.38; 2.95) mm, whereas 7 days after treatment it was 2.55 (2.45; 3.01) mm. The intraclass correlation coefficient for ACJ measurement was 98.8 (p<0.001).The values obtained measuring GH [3.84(3.44; 4.27) mm vs. 3.52 (3.00; 3.76) mm] and GW [(1.81 (1.65; 1.95) mm vs.1.62 (1.40; 1.95) mm) had statistically significant differences between the 2nd and 7th day. CONCLUSIONS: Periodontal ultrasonography is a highly precise and reproducible imagistic method, with which bone resorption, gingival inflammation as well as the presence or absence of subgingival calculus can be assessed.

Provision of specific dental procedures by general dentists in the National Dental Practice-Based Research Network: questionnaire findings.

BACKGROUND: Objectives were to: (1) determine whether and how often general dentists (GDs) provide specific dental procedures; and (2) test the hypothesis that provision is associated with key dentist, practice, and patient characteristics. METHODS: GDs (n = 2,367) in the United States National Dental Practice-Based Research Network completed an Enrollment Questionnaire that included: (1) dentist; (2) practice; and (3) patient characteristics, and how commonly they provide each of 10 dental procedures. We determined how commonly procedures were provided and tested the hypothesis that provision was substantively related to the three sets of characteristics. RESULTS: Two procedure categories were classified as "uncommon" (orthodontics, periodontal surgery), three were "common" (molar endodontics; implants; non-surgical periodontics), and five were "very common" (restorative; esthetic procedures; extractions; removable prosthetics; non-molar endodontics). Dentist, practice, and patient characteristics were substantively related to procedure provision; several characteristics seemed to have pervasive effects, such as dentist gender, training after dental school, full-time/part-time status, private practice vs. institutional practice, presence of a specialist in the same practice, and insurance status of patients. CONCLUSIONS: As a group, GDs provide a comprehensive range of procedures. However, provision by individual dentists is substantively related to certain dentist, practice, and patient characteristics. A large number and broad range of factors seem to influence which procedures GDs provide. This may have implications for how GDs respond to the ever-changing landscape of dental care utilization, patient population demography, scope of practice, delivery models and GDs' evolving role in primary care.

Retaining or replacing molars with furcation involvement: a cost-effectiveness comparison of different strategies.

AIM: The comparative cost-effectiveness of retaining or replacing molars with furcation involvement (FI) remains unclear. We assessed the cost-effectiveness of retaining FI molars via periodontal treatments versus replacing them via implant-supported crowns (ISCs). METHODS: Using tooth-level Markov models, we followed a molar with FI degree I or II/III in a 50-year-old patient over his lifetime. Tooth-retaining periodontal treatments (scaling and root planing, flap debridement, root resection, guided-tissue regeneration, tunnelling) were compared with tooth replacement using ISCs. We analysed costs, time until first re-treatment and total time of tooth or implant retention. The model adopted a private payer perspective within German health care. Transition probabilities were calculated based on current evidence. Monte-Carlo microsimulations were performed, and robustness of the model and effects of heterogeneity assessed using sensitivity analyses. RESULTS: Despite requiring re-treatment later than other strategies, ISCs were the most costly therapy. Compared with most periodontal treatments, ISCs were retained for shorter time than natural teeth regardless of the degree of FI, the patients' age or risk profile (smoker/non-smoker). CONCLUSIONS: Based on available data and within its limitations, our study indicates that retaining FI molars via periodontal treatments might be more cost-effective than replacing them via ISCs. Changes in the underlying evidence or the setting might alter these results.

Economics of periodontal care: market trends, competitive forces and incentives.

The adoption of new technologies for the treatment of periodontitis and the replacement of teeth has changed the delivery of periodontal care. The objective of this review was to conduct an economic analysis of a mature periodontal service market with a well-developed workforce, including general dentists, dental hygienists and periodontists. Publicly available information about the delivery of periodontal care in the USA was used. A strong trend toward increased utilization of nonsurgical therapy and decreased utilization of surgical periodontal therapy was observed. Although periodontal surgery remained the domain of periodontists, general dentists had taken over most of the nonsurgical periodontal care. The decline in surgical periodontal therapy was associated with an increased utilization of implant-supported prosthesis. Approximately equal numbers of implants were surgically placed by periodontists, oral and maxillofacial surgeons, and general dentists. Porter's framework of the forces driving industry competition was used to analyze the role of patients, dental insurances, general dentists, competitors, entrants, substitutes and suppliers in the periodontal service market. Estimates of out-of-pocket payments of self-pay and insured patients, reimbursement by dental insurances and providers' earnings for various periodontal procedures and alternative treatments were calculated. Economic incentives for providers may explain some of the observed shifts in the periodontal service market. Given the inherent uncertainty about treatment outcomes in dentistry, which makes clinical judgment critical, providers may yield to economic incentives without jeopardizing their ethical standards and professional norms. Although the economic analysis pertains to the USA, some considerations may also apply to other periodontal service markets.

Local and systemic antimicrobial therapy in periodontics.

CONTEXT: This review aimed to update the current evidence on the efficacy of the adjunctive use of local and systemic antimicrobials in the treatment of periodontitis and to assess whether it might improve the clinical limitations and shortcomings of standard nonsurgical treatment in the management of periodontitis. EVIDENCE ACQUISITION: Relevant randomized clinical trials (RCT) with more than 3 months of follow-up, published from 2010 to 2012 for systemic antimicrobials and from 2008 to 2012 for local antimicrobials, were searched in Medline and critically analyzed. Scientific evidence evaluated in different systematic reviews and reviews presented at European and World Workshops were also included. Only adjunctive therapies were considered in the present review: articles comparing debridement alone or plus placebo, versus debridement plus systemic or local antimicrobials were included. EVIDENCE SYNTHESIS: Adjunctive systemic antimicrobials have been evaluated both in aggressive and chronic periodontitis: in aggressive periodontitis, amoxicillin and metronidazole have been extensively studied, reporting clinical and microbiological benefits; in chronic periodontitis, different products are under scrutiny, such as azithromycin. The clinical efficacy of local antimicrobials, although extensively demonstrated, is still surrounded by a constant debate on the cost-effectiveness evaluation and on its adequate indications. CONCLUSIONS: Despite the clinical efficacy of the adjunctive use of local and systemic antimicrobials, demonstrated in RCTs and in systematic reviews, there is a lack of evidence to support well-defined clinical protocols, including products and dosages.

Low-cost periodontal therapy.

Periodontitis is a complex infectious disease that affects low-income individuals disproportionately. Periodontitis is associated with specific bacterial species and herpesviruses, and successful prevention and treatment of the disease is contingent upon effective control of these pathogens. This article presents an efficacious, highly safe, minimally invasive, practical and low-cost periodontal therapy that involves professional and patient-administered mechanical therapy and antimicrobial agents. The major components are scaling for calculus removal, periodontal pocket irrigation with potent antiseptics, and treatment with systemic antibiotics for advanced disease. Povidone-iodine and sodium hypochlorite have all the characteristics for becoming the first-choice antiseptics in the management of periodontal diseases. Both agents show excellent antibacterial and antiviral properties, are readily available throughout the world, have been safely used in periodontal therapy for decades, offer significant benefits for individuals with very limited financial resources, and are well accepted by most dental professionals and patients. Four per cent chlorhexidine applied with a toothbrush to the most posterior part to the tongue dorsum can markedly reduce or eliminate halitosis in most individuals. Systemic antibiotics are used to treat periodontopathic bacteria that are not readily reached by topical therapy, such as pathogens within gingival tissue, within furcation defects, at the base of periodontal pockets, and on the tongue, tonsils and buccal mucosae. Valuable antibiotic therapies are amoxicillin-metronidazole (250 mg of amoxicillin and 250 mg of metronidazole, three times daily for 8 days) for young and middle-aged patients, and ciprofloxacin-metronidazole (500 mg of each, twice daily for 8 days) for elderly patients and for patients in developing countries who frequently harbor enteric rods subgingivally. Scaling to remove dental calculus and the prudent use of inexpensive antimicrobial agents can significantly retard or arrest progressive periodontitis in the great majority of patients.

Evaluating components of dental care utilization among adults with diabetes and matched controls via hurdle models.

BACKGROUND: About one-third of adults with diabetes have severe oral complications. However, limited previous research has investigated dental care utilization associated with diabetes. This project had two purposes: to develop a methodology to estimate dental care utilization using claims data and to use this methodology to compare utilization of dental care between adults with and without diabetes. METHODS: Data included secondary enrollment and demographic data from Washington Dental Service (WDS) and Group Health Cooperative (GH), clinical data from GH, and dental-utilization data from WDS claims during 2002-2006. Dental and medical records from WDS and GH were linked for enrollees continuously and dually insured during the study. We employed hurdle models in a quasi-experimental setting to assess differences between adults with and without diabetes in 5-year cumulative utilization of dental services. Propensity score matching adjusted for differences in baseline covariates between the two groups. RESULTS: We found that adults with diabetes had lower odds of visiting a dentist (OR = 0.74, p < 0.001). Among those with a dental visit, diabetes patients had lower odds of receiving prophylaxis (OR = 0.77), fillings (OR = 0.80) and crowns (OR = 0.84) (p < 0.005 for all) and higher odds of receiving periodontal maintenance (OR = 1.24), non-surgical periodontal procedures (OR = 1.30), extractions (OR = 1.38) and removable prosthetics (OR = 1.36) (p < 0.001 for all). CONCLUSIONS: Patients with diabetes are less likely to use dental services. Those who do are less likely to use preventive care and more likely to receive periodontal care and tooth-extractions. Future research should address the possible effectiveness of additional prevention in reducing subsequent severe oral disease in patients with diabetes.

Cost-effectiveness of an individually tailored oral health educational programme based on cognitive behavioural strategies in non-surgical periodontal treatment.

AIM: The aim of this cost-effectiveness analysis (CEA), performed from a societal perspective, was to compare costs and consequences of an individually tailored oral health educational programme (ITOHEP) based on cognitive behavioural strategies integrated in non-surgical periodontal treatment compared with a standard treatment programme (ST). MATERIAL AND METHODS: A randomized (n = 113), evaluator-blinded, controlled trial, with two different active treatments, was analysed with respect to their costs and consequences 12 months after non-surgical treatment. Costs referred to both treatment costs and costs contributed by the patient. Consequences (outcome) were expressed as the proportion of individuals classified as having reached the pre-set criteria for treatment success after non-surgical treatment ("successful-NSPT"). RESULTS: More individuals in the ITOHEP group reached the pre-set criteria for treatment success than individuals in the ST group did. The CEA revealed an incremental cost-effectiveness of SEK1724 [€191.09; SEK9.02 = €1 (January 2007)] per "successful-NSPT" case, of which treatment costs represented SEK1189 (€131.82), using the unit cost for a dental hygienist. CONCLUSION: The incremental costs per "successful-NSPT" case can be considered as low and strengthens the suggestion that an ITOHEP integrated into non-surgical periodontal treatment is preferable to a standardized education programme.

[Efficient, minimally invasive periodontal therapy. An evidence based treatment concept]. / Effiziente, minimal-invasive Parodontitistherapie. Ein evidenzbasiertes Behandlungskonzept.

A large number of reports indicate beneficial effects of systemic antibiotics for patients with periodontal diseases. Although these advantages are clear in general, the specific relationship of benefit and risk in various clinical situations remains a subject of debate. Uncertainties persist regarding the individual prescription and combination with other procedures. Since the early 1990s it has been pointed out that systemic antibiotics given in the context of non-surgical subgingival debridement may reduce the need for periodontal surgery. Recent studies confirm these findings especially with regard to the combination of amoxicillin and metronidazole. However, these antibiotics should not be viewed as a substitute for thorough debridement, or as a means to compensate for improper oral hygiene. In addition, current evidence does not provide evidence for the indiscriminate use of just any antibiotic in any periodontal patient. A treatment protocol implementing the recent evidence is shown. It is noteworthy to realize that chronic and aggressive periodontitis today can be treated successfully with simple and cost-effective means in most instances.

Minimally invasive periodontal therapy: will periodontal therapy remain a technologic laggard?

Minimally invasive therapeutic approaches have become the standard of care for many medical procedures. In contrast, the use of minimally invasive techniques in non-surgical and surgical periodontal therapy has not progressed to the same extent. This commentary explores some of the technologic forces that influence the acceptance of minimally invasive therapeutic modalities. There is adequate science to support the development and clinical use of minimally invasive periodontal treatment but the technology to perform minimally invasive procedures is not currently available. Potential explanations for what seems to be a growing technologic lag are explored.