Gingival recession after scaling and root planing with or without systemic metronidazole and amoxicillin: a re-review.

BACKGROUND: Gingival recessions inevitably occur during healing after scaling and root planing, but synoptic data on this topic is still lacking. This review compared the recession formation with and without the administration of systemic antibiotics. OBJECTIVES: To evaluate the formation of recession with and without the administration of antibiotics during the healing after scaling and root planing. MATERIALS AND METHODS: This study re-analyzed publications that reported clinical attachment levels (CAL) and probing pocket depths (PD) up to January 2019, including the pivotal review by Zandbergen and co-workers (2013). Whereas these studies traditionally focused on PD and CAL, the present analysis compared recession formation (ΔREC) after adjunctive systemic administration of amoxicillin (amx) and metronidazole (met) during scaling and root planing (SRP) and SRP alone. The mean increase in ΔREC, if not reported, was calculated from CAL and PD values and statistically analyzed. Recession formation was compared after 3 and 6 months after therapy. Results were separately reported for chronic periodontitis (CP) as well as aggressive periodontitis (AP) cases. RESULTS: Recessions increased consistently between baseline and follow-up. In the AP group, median ΔREC was 0.20 mm after 3 months, irrespective of whether antibiotics were administered or not. After 6 months, median ΔREC increased to 0.35 mm after AB and remained stable at 0.20 mm with SRP alone. In the CP group, after 3 months with and without antibiotics, median ΔREC accounted for 0.30 mm and 0.14 mm, respectively. After 6 months, median ΔREC accounted for 0.28 mm (with AB) and 0.20 mm (without AB). The quantitative assessment by meta-analyses also yielded small values (≤ 0.25 mm) for the estimated differences in recession formation between AB and noAB; however, none of them reached statistical significance. CONCLUSIONS: Although a slight tendency towards higher recession formation after SRP in combination with AB could be observed in many studies, quantitative meta-analyses showed no clinically relevant difference in recession formation due to the administration of AB. In general, the description and discussion of recessions in the literature seems not to be a major focus so far. CLINICAL RELEVANCE: Since the preservation of gingival tissues is important by preventive and therapeutic means, e.g., when avoiding postoperative root sensitivity or performing regenerative surgery, these aspects should not be neglected. We thus suggest to report REC measurements along with PD and CAL values for more direct recession formation (ΔREC) assessments in the future.

[Periodontal rehabilitation in a deaf patient with symptomatic epilepsy in Sturge-Weber syndrome - a case report]. / Parodontale Rehabilitation bei einer gehörlosen Patientin mit symptomatischer Epilepsie bei Sturge-Weber-Krabbe-Syndrom. Ein Fallbericht.

When a syndrome forms the background of a systemic involvement of periodontal disease, it is necessary to fully exploit the resources outside, which soon reaches its limits in private practice. In the patient's environment, it must be checked whether support for the patient can be guaranteed. Without support, as in this presented case, the patient's oral hygiene could hardly be maintained. This article reports on a female patient who was referred to the Center for Dental Medicine at the University of Zurich. In addition to various secondary carious lesions, an apical whitening, two carious wisdom teeth and two extremely mobile molars in the third quadrant, the patient had chronic, localized advanced (stage III, grade B) periodontitis associated with systemic disease (deafness and Sturge-Weber syndrome). For two years, the patient was treated at the Department of Periodontology. Due to the strong bleeding tendency on the left side, facial localization of the naevus flammeus, the patient was partially referred to the Polyclinic of Oral Surgery and treated there. Numerous oral hygiene sessions, scaling and root planing, restoration with composite fillings, a root filling, removal of wisdom teeth and finally removal of hypermobile molars 36 and 37 during corona lockdown were performed. In the meantime, the patient has been orally rehabilitated. Home oral hygiene was reorganized with the patient's family and the patient was discharged to a close supportive periodontal recall for the time being.

Oral Diagnostic Methods for the Detection of Periodontal Disease.

Periodontitis is a common immune-inflammatory oral disease. Early detection plays an important role in its prevention and progression. Saliva is a reliable medium that mirrors periodontal health and is easily obtainable for identifying periodontal biomarkers in point-of-care diagnostics. The aim of this study is to evaluate the effectiveness of diagnostic salivary tests to determine periodontal status. Whole saliva (stimulated/unstimulated) from twenty healthy and twenty stage III grade B generalized periodontitis patients was tested for lactoferrin, alkaline phosphatase, calcium, density, osmolarity, pH, phosphate, buffer capacity, salivary flow rate and dynamic viscosity. A semi-quantitative urinary strip test was used to evaluate markers of inflammation in saliva (erythrocytes, leukocytes, urobilinogen, nitrite, glucose, bilirubin, and ketones), clinical periodontal parameters and pathogenic bacteria. Concentrations of lactoferrin, hemoglobin, and leukocytes were found to be significantly higher in the stimulated and unstimulated saliva in periodontitis patients compared to healthy patients, whereas alkaline phosphatase levels were higher in unstimulated saliva of periodontitis patients (p < 0.05). Periodontal biomarker analysis using test strips may be considered rapid and easy tool for distinguishing between periodontitis and healthy patients. The increase in lactoferrin, hemoglobin, and leucocytes-determined by strip tests-may provide a non-invasive method of periodontal diagnosis.

The Strange Case of a Broken Periodontal Instrument Tip.

This case report describes a rare case of a broken periodontal probe tip and its removal. A male patient presented himself in June 2019 due to a painful tooth in the upper left quadrant. The patient elected treatment in the dental school's student course. In October 2019, in preparation for full-mouth rehabilitation, a complete diagnostic status was performed, including radiographs. In this context, a metal-dense fragment was identified in the apical region of the (missing) tooth 45. It was diagnosed as the broken tip of a periodontal probe (type AE P OWB). Since a PCP-12 probe is generally used in-house, iatrogenic damage during the initial examination or student course could be excluded a priori. The patient was not able to remember any treatment that could be associated with the instrument's breaking. Since the probe fragment was palpable and a translocation could not be precluded, the patient agreed to its removal under local anesthesia, after a cone-beam CT. This article describes and discusses this particular case, with special emphasis on iatrogenic instrument fractures and their removal.

Systemically administered amoxicillin/ metronidazole versus azithromycin as adjuncts to subgingival instrumentation during non-surgical periodontal therapy. A systematic review.

The aim of this systematic review was to compare the combination of amoxicillin and metronidazole or azithromycin when used as adjunct systemic antibiotics during the non-surgical periodontal therapy of chronic periodontitis. The databases Medline, Embase, Cochrane and Biosis were electronically searched. Additionally, a hand search was conducted up to24 October 2019. From 76 papers, only two papers could be included in the analysis. The calculated mean probability of having probing depth (PD) ≤ 3 mm after non-surgical periodontal therapy in moderate (4-6 mm) and deep (> 6 mm) pockets accounted for 7% and 6% for the combination of amoxicillin and metronidazole. For azithromycin it was 3% and 1%, respectively. The mean probability of persisting pockets ≥ 5 mm was 0 for moderate pockets with both antibiotic therapies whereas for deep pockets therapy with amoxicillin and metronidazole seems slightly lower. On the basis of two studies included in this systematic review, azithromycin as an adjunct to scaling and root planing in the non-surgical adjunctive treatment of chronic periodontitis seems to provide clinical results similar to the combination of amoxicillin and metronidazole. On behalf of patients' compliance and well-being, the use of azithromycin as an adjunct to non-surgical periodontal therapy of chronic periodontitis may be a substitute to amoxicillin and metronidazole. However, interpretation should be taken with caution, since the results are based on two studies only; thus, further clinical trials are necessary to underline or refute this trend.