Long-term stability (21-30 years) of root coverage outcomes using sub-epithelial connective tissue grafts at single or multiple gingival recessions: A longitudinal case series.

AIM: To evaluate outcomes and predictive factors for the long-term stability of root coverage using a sub-epithelial connective tissue graft. MATERIALS AND METHODS: One-hundred and two healthy subjects (221 gingival recessions, GRs) were treated from 1987 to 1996. Keratinized tissue width (KTW), GR depth (RD), GR width (RW) and GR area (RA) were evaluated at baseline (M0) and at 1 month (M1), 1 year (M2), 11 years (M3), 21 years (M4) and 27 years (M5) after surgery. Primary outcomes consisted of complete root coverage (cRC) and relative dimensional changes in recession depth (measured in mm [c%-RD]), recession width (measured in mm [c%-RW]) and recession area (measured in mm2 [c%-RA]). RESULTS: cRC was 88.7% at 1 year (M2), 59.8% at M3, 44.4% at M4 and 51.9% at M5. Average c%-RD was 95.2% at 1 year, 81.9% at M3, 71.5% at M4 and 81.7% at M5. KTW increased after surgery and over time and was positively correlated with favourable outcomes. Increased baseline RA was associated with less favourable clinical outcomes. CONCLUSIONS: The sub-epithelial connective tissue graft is effective in the treatment of GRs and facilitates long-term stability of clinical outcomes. Wider baseline RA was a strong predictor of unfavourable short- and long-term RC outcomes.

Are periodontal outcomes affected by personality patterns? A 18-month follow-up study.

OBJECTIVES: This research aims to study the relationship between personality traits and periodontal clinical outcomes by taking into account the level of anxiety and depression, periodontal health and oral hygiene behaviour of patients affected with gingivitis or moderate periodontitis requiring periodontal therapy. MATERIAL AND METHODS: The periodontal data of 40 systemically healthy patients affected by gingivitis or moderate periodontitis were collected at baseline and 18 months later. The psychological variables, dental awareness and adherence intent of the patients were assessed through questionnaires, and only those patients that exhibited a higher degree of compliance were included in the study. The personality traits (cluster A: paranoid, schizoid, schizotypal; cluster B: borderline, antisocial, narcissistic, and histrionic; cluster C: avoidant, dependent, and obsessive-compulsive) and the level of anxiety and depression of the patients were assessed. Patients were instructed with oral hygiene measures and were treated with periodontal therapy. RESULTS: Clusters A and B showed a consistent tendency for reduced levels of oral hygiene (increased full-mouth plaque score - FMPS). The results from cluster B were found to be significantly related to deep periodontal pockets at baseline. On the contrary, cluster C seemed to be linked to clinically better indices, particularly in terms of full-mouth-bleeding-score and pocket depth, both at baseline and 18 months later. The results collected from clusters B and C were directly correlated with anxiety, depression and FMPS. Moreover, anxiety was directly correlated with the patient's need for professional oral-care. CONCLUSIONS: Personality traits appear to play a significant role in determining the therapeutic outcomes of periodontal therapy in themselves. Thus, it is ideal for several important psychological, affective or behavioural factors to be associated with various personality traits so as to orient the outcome of periodontal therapy.

Herpes Simplex I virus impairs regenerative outcomes of periodontal regenerative therapy in intrabony defects: a pilot study.

AIM: To evaluate the impact of herpesvirus type-1 and -2 on the clinical outcomes of periodontal regenerative procedures in isolated deep intrabony pockets, in an experimental population with no detectable periodontal pathogens. MATERIALS AND METHODS: Seventeen periodontal intraosseous defects in 17 moderate-to-advanced periodontitis patients were treated with regenerative therapy and amelogenins. Microbiological evaluation was performed at baseline (after the completion of initial therapy) and at 1 year to exclude the presence of periodontal pathogens. Herpesviruses-1 and -2 DNA were quantified in the pocket tissues associated to the intrabony defect using molecular assays. Clinical attachment level (CAL), probing pocket depth (PPD) and gingival recession (REC) were recorded at baseline and at 1 year. RESULTS: After 1 year, the 17 defects resulted in significant CAL gain, PPD reduction and REC increase. HSV-1 was detected in five patients. Herpesvirus-2 was never found. The two subpopulations positive or negative to herpesvirus-1 were homogeneous at baseline. At 1 year, the five herpesvirus-1 positive patients resulted in lower amounts of CAL-gain and PPD reduction and greater amount of REC with respect to the 12 herpesvirus-1 negative patients. CONCLUSIONS: The presence of herpesvirus-1 at baseline is associated with poor clinical outcomes following regenerative therapy.

Influence of Tooth-Brushing on Early Healing after Access Flap Surgery: A Randomized Controlled Preliminary Study.

In the present study, the clinical outcomes obtained using three different protocols of post-operative plaque control for the 4 weeks after surgery were compared. Thirty healthy subjects, presenting at least one periodontal pocket requiring resective surgery, were selected and randomly distributed to three different groups corresponding to respective post-surgical protocols: (A) toothbrushes + chlorhexidine + anti-discoloration system (ADS + CHX); (B) toothbrushes + chlorhexidine (CHX); (C) only toothbrushes. The full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), probing pocket depth (PPD), recession depth (REC), clinical attachment level (CAL), and bleeding on probing (BoP) were measured in six aspects per tooth (mesio-buccal (MB), buccal (B), disto-buccal (DB), disto-lingual (DL), lingual (L), and mesio-lingual (ML)) at baseline, 3 months, and 6 months after surgery. FMPS and FMBS did not significantly change (p > 0.05), whereas PPD and CAL significantly decreased, and REC significantly increased in all groups during the study (p < 0.05). Clinical results were satisfactory in all cases, with no significant differences between groups 3 months after surgery. Six months after surgery, only PPD-MB was significantly different in the three groups (p < 0.05). Nevertheless, this value was not clinically relevant because the value of PPD-B (about 2 mm) in group C was physiologic. The mechanical plaque control was proven to be fundamental and sufficient in all the six aspects per tooth to guarantee an excellent clinical outcome without the need of chemical plaque control.

How Intraday Index Changes Influence Periodontal Assessment: A Preliminary Study.

It is reputed that periodontal indices remain unchanged over a 24-hour period, with great clinical significance. This preliminary study analyzes daily index changes. In 56 selected patients, full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), periodontal screening and recording (PSR) indices, and periodontal risk assessment (PRA) were recorded at baseline and three times per day (check-I: 08.30, check-II: 11.30, and check-III: 14.30), after appropriate cause-related therapy. Correlation between variables was statistically analyzed by Stata. All periodontal indices improved at the examination phase. Statistical differences were detected for FMPS comparing all thrice daily checks. Statistical differences were detected for FMBS and PRA comparing check-III with check-I and check-II. PSR showed no significant changes. The worst baseline indices produced the widest daily fluctuation at the examination phase. Significant variation of indices is directly related to clinical severity of periodontal conditions at baseline. Patients affected by severe periodontal disease may show significantly greater index changes. As indices are routinely recorded only once per day, the index daily variation has clinical significance. This greatly affects therapeutic strategy as correct periodontal assessment requires multiple evaluations at standardized times, particularly when baseline conditions are severe.

Risk factors and socioeconomic condition effects on periodontal and dental health: A pilot study among adults over fifty years of age.

OBJECTIVE: Observational studies on the association among systemic/general and oral cavity indices, tooth loss, periodontal conditions, and socioeconomic inequalities are to be still performed in the population of Southern Europe. This study aims to determine the extent of this relationship among Italian healthy adults 50 years of age and above. MATERIALS AND METHODS: Socioeconomic and lifestyle characteristics, cardiovascular indicators, and systemic indices were examined by contrasting the dental indices among adult people of Northern Italy. Data were processed through correlation analysis, and multivariate analysis was carried out using seemingly unrelated regressions. RESULTS: A total of 118 adults 50 years of age and above, after anamnesis, underwent systemic and dental examination. Their socioeconomic status was found to be inversely associated only with smoking and dental parameters. Unexpected outcomes between lifestyle and risk factors were detected. The statistical analysis showed an uneven correlation among dental indices and between those indices and the socioeconomic status, such as, a periodontal condition, apparently free from influences, unusually became worse as the socioeconomic status enhanced. CONCLUSIONS: The study outcomes indicate a relationship between tooth loss and conservative endodontic therapy, but they result in alternative choices. Nevertheless, the socioeconomic status has an inverse relationship with tooth loss and conservative endodontic therapy, but a direct relation with worsening of the periodontal condition. This pilot study highlights a need for the public health administration to adopt a socioeconomic assessment not only based on the household income, but also to accordingly improve its therapeutic course.