Structure, governance and delivery of specialist training programs in periodontology and implant dentistry.

AIM: To update the competences and learning outcomes and their evaluation, educational methods and education quality assurance for the training of contemporary specialists in periodontology, including the impact of the 2018 Classification of Periodontal and Peri-implant Diseases and Conditions (2018 Classification hereafter) and the European Federation of Periodontology (EFP) Clinical Practice Guidelines (CPGs). METHODS: Evidence was gathered through scientific databases and by searching for European policies on higher education. In addition, two surveys were designed and sent to program directors and graduates. RESULTS: Program directors reported that curricula were periodically adapted to incorporate advances in diagnosis, classification, treatment guidelines and clinical techniques, including the 2018 Classification and the EFP CPGs. Graduates evaluated their overall training positively, although satisfaction was limited for training in mucogingival and surgical procedures related to dental implants. Traditional educational methods, such as didactic lectures, are still commonly employed, but they are now often associated with more interactive methods such as case-based seminars and problem-based and simulation-based learning. The evaluation of competences/learning outcomes should employ multiple methods of assessment. CONCLUSION: An update of competences and learning outcomes of specialist training in periodontology is proposed, including knowledge and practical application of the 2018 Classification and CPGs. Harmonizing specialist training in periodontology is a critical issue at the European level.

Bifidobacterium animalis subsp. lactis as adjunct to non-surgical periodontal treatment in periodontitis: a randomized controlled clinical trial.

OBJECTIVES: The purpose of this study is to investigate the clinical and microbiological effects of Bifidobacterium animalis subsp. lactis DN-173010 containing yogurt as an adjunct to non-surgical periodontal treatment in periodontitis patients. MATERIALS AND METHODS: This is a prospective randomized controlled clinical study registered with NCT05408364 under clinical trial registration. Thirty periodontitis patients were divided into 2 groups at random. As adjunctive to supra and subgingival instrumentation, the test group consumed Bifidobacterium animalis subsp. lactis DN-173010 containing yogurt while the control group consumed natural yogurt, once daily for 28 days. The plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL) were recorded at baseline, 28th day, and 3rd month. Microbiological analysis was performed using culture method by obtaining subgingival plaque samples from 2 periodontal sites with 4≤PD≤6 mm at the same time points. RESULTS: The inter-group comparisons of PI, GI, and BOP as well as the changes between the measurement time points were statistically significant in favor of the test group. There were no significant differences in terms of PD and CAL changes between the study groups at all times (∆baseline-28 days, ∆baseline-3 months) (p>0.05). The number of patients presenting subgingival Bifidobacterium species was significantly greater in the test group than the control group at the 28th day (p<0.05). CONCLUSIONS: The administration of probiotics has shown beneficial effects, albeit limited, on clinical and microbiological outcomes in the management of periodontitis patients. CLINICAL RELEVANCE: Daily consumption of probiotic yogurt may be supportive for supra and subgingival instrumentation.

Different scaling and root planing strategies in Turkish patients with aggressive periodontitis: A randomized controlled clinical trial.

OBJECTIVES: The aim of this study was to compare clinical, cytokine and microbiological responses after quadrant-based scaling and root planing (Q-SRP), full-mouth SRP (FM-SRP) and full-mouth disinfection (FMD) in patients with generalized aggressive periodontitis (GAgP), which is currently termed as generalized stage-III and grade-C periodontitis. METHODS: Forty-two patients with GAgP were randomly assigned into groups as Q-SRP, FM-SRP or FMD with chlorhexidine. Clinical parameters were recorded, and gingival crevicular fluid (GCF) and subgingival plaque samples were collected at baseline, 3 and 6 months after treatment. GCF levels of interleukin (IL)-1ß and IL-17 were analysed using ELISA. Quantities of six bacterial species were determined using qPCR. RESULTS: Clinical parameters improved significantly in all groups at 3 and 6 months (p < 0.05). Percentage of sites with probing depth >6 mm was lower in the FMD than Q-SRP group at 3 and 6 months (p < 0.05). FMD showed significantly higher percentage of pocket closure compared with Q-SRP and FM-SRP at both 3 and 6 months after treatment (p < 0.05). The IL-1ß levels decreased only in the FMD group (p < 0.05), whereas no changes were found in IL-17 levels in any group. The levels of five out of six bacterial species decreased at 3 and/or 6 months only in the FMD group (p < 0.05). CONCLUSIONS: The FMD treatment appears to offer superior outcome than Q-SRP and could be the first choice for patients with GAgP.

Efficacy of adjunctive photodynamic therapy in the treatment of generalized aggressive periodontitis: A randomized controlled clinical trial.

OBJECTIVES: Generalized aggressive periodontitis (GAgP) is a distinct type of periodontal disease characterized by rapid loss of attachment and alveolar bone occurring in young individuals. Photodynamic therapy (PDT) was introduced in periodontology as an adjunctive approach to non-surgical periodontal treatment (NPT) in periodontitis patients. In this trial, the aim was to evaluate the clinical and microbiological effects of adjunctive PDT to NPT in patients with GAgP. METHODS: In this prospective controlled clinical study, 24 systemically healthy, non-smoking subjects with GAgP were enrolled. Subjects were randomly assigned into a control group (n = 12) treated with NPT only or to a test group (n = 12) treated with NPT and PDT. Plaque index, sulcus bleeding index (SBI), probing depth (PD), relative attachment level, gingival recession, and tooth mobility were recorded at baseline and on day 63. Microbiological samples were obtained from the sites with PD ≥ 5 mm at both time periods and evaluated for Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, and Treponema denticola via micro-IDent® test. RESULTS: Clinical and microbial parameters declined significantly in both groups after the treatments (P < 0.01). The comparisons between the groups showed that only the full mouth SBI score of the test group was significantly lower than the control group on day 63 (P < 0.05). Although the reduction in periodontopathogens of the test group was greater than the control group, there was no significant difference between the groups (P > 0.05). CONCLUSIONS: Within the limits of this study, it can be concluded that in the treatment of GAgP, usage of PDT as an adjunct to NPT does not lead to any beneficial effects on the investigated clinical and microbiological parameters except for SBI. Nevertheless, the statistically significant difference for the SBI score demonstrates that PDT may have additional effect on the reduction in gingival bleeding. Lasers Surg. Med. 51:167-175, 2019. © 2018 Wiley Periodicals, Inc.

Primary prevention of periodontitis: managing gingivitis.

UNLABELLED: Periodontitis is a ubiquitous and irreversible inflammatory condition and represents a significant public health burden. Severe periodontitis affects over 11% of adults, is a major cause of tooth loss impacting negatively upon speech, nutrition, quality of life and self-esteem, and has systemic inflammatory consequences. Periodontitis is preventable and treatment leads to reduced rates of tooth loss and improved quality of life. However, successful treatment necessitates behaviour change in patients to address lifestyle risk factors (e.g. smoking) and, most importantly, to attain and sustain high standards of daily plaque removal, lifelong. While mechanical plaque removal remains the bedrock of successful periodontal disease management, in high-risk patients it appears that the critical threshold for plaque accumulation to trigger periodontitis is low, and such patients may benefit from adjunctive agents for primary prevention of periodontitis. AIM: The aims of this working group were to systematically review the evidence for primary prevention of periodontitis by preventing gingivitis via four approaches: 1) the efficacy of mechanical self-administered plaque control regimes; 2) the efficacy of self-administered inter-dental mechanical plaque control; 3) the efficacy of adjunctive chemical plaque control; and 4) anti-inflammatory (sole or adjunctive) approaches. METHODS: Two meta-reviews (mechanical plaque removal) and two traditional systematic reviews (chemical plaque control/anti-inflammatory agents) formed the basis of this consensus. RESULTS: Data support the belief that professionally administered plaque control significantly improves gingival inflammation and lowers plaque scores, with some evidence that reinforcement of oral hygiene provides further benefit. Re-chargeable power toothbrushes provide small but statistically significant additional reductions in gingival inflammation and plaque levels. Flossing cannot be recommended other than for sites of gingival and periodontal health, where inter-dental brushes (IDBs) will not pass through the interproximal area without trauma. Otherwise, IDBs are the device of choice for interproximal plaque removal. Use of local or systemic anti-inflammatory agents in the management of gingivitis has no robust evidence base. We support the almost universal recommendations that all people should brush their teeth twice a day for at least 2 min. with fluoridated dentifrice. Expert opinion is that for periodontitis patients 2 min. is likely to be insufficient, especially when considering the need for additional use of inter-dental cleaning devices. In patients with gingivitis once daily inter-dental cleaning is recommended and the adjunctive use of chemical plaque control agents offers advantages in this group.

Clinical evaluation of coronally advanced flap with or without acellular dermal matrix graft on complete defect coverage for the treatment of multiple gingival recessions with thin tissue biotype.

AIM: The objective of this study was to compare acellular dermal matrix graft (ADM) combination with coronally advanced flap (CAF) on complete defect coverage, aesthetics and patient satisfaction with CAF alone for multiple recessions with gingival thickness (GT) <0.8 mm. MATERIALS AND METHODS: Forty-eight Miller Class I multiple recessions ≥3 mm were divided into test (CAF + ADM) and control (CAF) groups. At baseline and 12 months, recession height (RH), keratinized tissue height (KT), GT, mean and complete defect coverage were evaluated. Patient satisfaction, root coverage aesthetic score (RES) and the correlation between GT and defect coverage were also assessed. RESULTS: Baseline RH in CAF + ADM and CAF groups was 3.25 ± 0.34 mm and 3.21 ± 0.26 mm, respectively. Mean and complete defect coverage were 94.84% and 83.33% in test group, 74.99% and 50.00% in control group, respectively. Inter-group differences were found to be statistically significant for RH reduction, attachment gain, KT and GT increase, mean defect coverage and RES in favour of test group (p < 0.05). There was a significant positive correlation between GT and mean defect coverage (p < 0.05). CONCLUSION: Coronally advanced flap in association with ADM can be proposed as a valid approach for the treatment of multiple recessions with thin tissue biotype.

Determination of storage time of saliva samples obtained from patients with and without chronic periodontitis for the comparison of some biochemical and cytological parameters.

BACKGROUND: Salivary glutathione (GSH), malondialdehyde (MDA), protein, sialic acid (SA) levels, cytological parameters, and tissue factor activities (TFa) were investigated when fresh and after 3, 7, 11, 15, 21, and 30 days (d) of storage at -20°C both in the control and the periodontitis group. Moreover, the control and the periodontits groups were compared and continuity of the significances detected between the two groups were evaluated. METHODS: GSH, MDA, SA, protein, and TFa were determined using the methods of Beutler, Yagi, Warren, Lowry, and Quick, respectively. Saliva imprint samples were stained with Giemsa and microscopically examined. RESULTS: When the continuity of the significances of differences between the two groups was investigated, differences continued to be significant for GSH and TFa on days 3, 7, 11, 15, 21, and 30. Cytologically, only the significance detected between leucocyte numbers continued to be significant for 30 d. However significance of differences in total protein, MDA, and SA levels on day 0, were interrupted on days 3, 7, and 11, respectively. CONCLUSION: Saliva samples may be stored for 30 d for GSH and TFa analyses in patients with and without periodontitis. However, to compare salivary MDA, SA, and total protein levels in these groups we suggest fresh samples to be studied.

In Vitro Evaluation of the Different Supragingival Prophylaxis Tips on Enamel Surfaces.

Objective: Periodontal instrumentation during supragingival prophylaxis may increase enamel surface roughness, which may lead to increased dental biofilm accumulation and demineralization of the enamel. The aim of this study was to evaluate the changes of the enamel surface profilometrically after the application of different scaler tips used for the professional supragingival prophylaxis. Materials and methods: Forty-eight enamel block samples obtained from extracted human maxillary premolar teeth were prepared and randomly assigned to four different treatment groups. Each treatment group was instrumented by the same clinician with different tools as Group 1: Er:YAG laser chisel tip, Group 2: scaler, Group 3: new generation universal curette; and Group 4: ultrasonic device. Sample surfaces were evaluated with a profilometer before and after instrumentations and after the polishing process. Results: Baseline roughness of the prepared enamel samples was similar between the groups. After instrumentation and polishing, the Er:YAG laser chisel tip revealed the most irregular surface morphology, whereas the new generation curette induced the smoothest surface. Conclusions: New generation universal curette is a promising tool, which can be used safely for supragingival calculus removal without the need for polishing on enamel surfaces.

Microstructural Changes of Human Dentin Tubules after Citric Acid Immersion of Specimens Treated with Different Desensitising Approaches: An SEM Analysis.

PURPOSE: This in-vitro study aimed to evaluate the effectiveness and acid resistance on dentin surfaces following the application of a linear-oscillating device (LOD) with a hydroxyapatite-based polishing fluid, Er:YAG laser or sodium fluoride (NaF) used alone or in combinations for desensitising purposes. MATERIALS AND METHODS: Freshly extracted impacted third molars were used to obtain 120 specimens, all completely immersed in 1% citric acid for 5 min and divided randomly into 6 groups. Group I, with no treatment, served as the control; group II: Er:YAG laser (30 Hz, 60 mJ/pulse, 10 s); group III: NaF gel; group IV: LOD; groups V and VI: the combinations of NaF+Er:YAG and LOD+Er:YAG, respectively, were applied. Following these treatments, the effectiveness of each was evaluated in half of the specimens in each group (n = 10). The other half of the specimens (n = 10) served for acid-resistance testing. All evaluations were made on SEM photomicrographs. RESULTS: The post-treatment tubule diameters and numbers were the lowest with LOD+Er:YAG, followed by NaF+Er:YAG, LOD, Er:YAG and NaF. Paired comparisons revealed LOD+Er:YAG to be the best treatment method (p < 0.05). After 3 h of acid immersion, all treatments revealed significant increases (p < 0.05) in both tubule number and diameter study between post-treatment and post-acid immersion values. The exception was LOD+Er:YAG. LOD+Er:YAG showed the highest resistance to acid challenge, presenting the lowest increase in tubular diameters and numbers followed by NaF+Er:YAG, LOD, Er:YAG and NaF. CONCLUSION: Combined LOD+Er:YAG treatment revealed the highest effectiveness and acid resistance. Further clinical studies are warranted to confirm these in-vitro results.

Treatment of residual pockets using an oscillating chitosan device versus regular curettes alone-A randomized, feasibility parallel-arm clinical trial.

BACKGROUND: A brush made of chitosan has shown to be an effective and harmless device for non-surgical treatment of mild to moderate peri-implantitis. To date, no study has evaluated the use of a chitosan brush in the non-surgical treatment of residual pockets in periodontal treatment. METHODS: Seventy-eight patients with periodontitis were included in this multicenter, randomized, examiner-blind clinical trial of 6 months duration. Patients with residual probing pocket depth (PPD) of ≥5 mm and ≤7 mm following previous active periodontal treatment were included. Patients were assigned either subgingival treatment with curettes (control) or an oscillating chitosan brush (test). Changes in bleeding on probing (BoP) and PPD between baseline and terminal evaluation at 6 months were evaluated. RESULTS: A significant reduction in both PPD and BoP was seen within both groups. There was no significant difference in BoP between test and control groups after 6 months, but the reduction in PPD was significantly improved in the test group (P ≤ 0.01). The combined outcome of no BOP and PPD ≤4 mm was significantly better in the test group (P ≤ 0.01). No adverse reactions were seen. CONCLUSION: Treatment of residual periodontal pockets (PPD = 5 to 7 mm) with a chitosan brush disclosed equal or better clinical results as compared to regular curettes. This study supports that a chitosan brush can be used for subgingival biofilm removal and soft tissue curretage in the treatment of periodontitis.

A Comparative Evaluation of Root Surface Biomodification with Erbium-Doped Yttrium Aluminum Garnet Laser, Ethylenediaminetetraacetic Acid Gel, and Titanium Nitride Curette: In Vitro Scanning Electron Microscope and Profilometry Analyses.

Objective: This study aims to evaluate the in vitro effects of different biomodification treatment methods on extracted tooth/root surfaces in terms of biologically acceptable changes favoring better periodontal healing. Background data: The use of various agents for root surface biomodification (RSB), during periodontal procedures is of critical importance to increase the success of the treatments through healing. Ethylenediaminetetraacetic acid (EDTA) is the most frequently used chemical RSB agent in periodontal clinical practice. Erbium-doped yttrium aluminum garnet (Er:YAG) lasers have well-known advantages on blood cell adhesion and fibrin network formation on root surfaces. Recently, novel titanium nitride (TIN) curettes are of great interest due to smoother surface changes obtained after their application. Materials and methods: Forty-four dentine specimens from extracted single-rooted teeth were randomly divided into four groups: Group 1: No treatment; Group 2: Er:YAG laser irradiation; Group 3: EDTA gel application; Group 4: TIN curette instrumentation. All specimen surfaces were wet polished before treatments. Before and after root surface roughness parameters of all specimens were assessed with a profilometer. Further, all scanning electron microscopy micrographs were analyzed and scored for root surface and smear layer morphology characteristics by two different blinded researchers. Results: There were no statistical differences between the initial roughness of all groups (p = 0.687). After treatments, EDTA gel group revealed an intact intertubular area, some smear debris on dentine surfaces, and partially occluded dentine tubules. Er:YAG laser created the highest roughness (p < 0.05) among all treatment groups with no smear layer and exhibited fully exposed dentine tubules and collagen fibrils. Surfaces instrumented with TIN curette were the smoothest (p < 0.05) and covered with a compact and thick smear layer. Conclusions: Within the limits of this study, Er:YAG laser-irradiated surfaces exhibited exposed collagen fibrils, and Er:YAG laser irradiation was found as the only method yielding the desired surface characteristics for better periodontal healing, where the fibrils are exposed in the absence of smear layer.

Regenerative treatment with platelet-rich plasma combined with a bovine-derived xenograft in smokers and non-smokers: 12-month clinical and radiographic results.

AIM: The purpose of this study was to assess the healing response of intrabony defects following regenerative treatment with platelet-rich plasma (PRP) combined with a bovine-derived xenograft (BDX) in smokers and non-smokers. MATERIALS AND METHODS: A total of 24 advanced chronic periodontitis patients, 12 smokers and 12 non-smokers, with 113 intrabony defects with an intrabony component of or /=3 mm were included in this study. Defects were surgically treated with PRP/BDX. At baseline and 12 months after surgery, the following parameters were recorded: plaque and sulcus bleeding indices, probing depth (PD), relative attachment level, marginal recession, probing and radiographic bone levels. RESULTS: Considering the soft tissue measurements, smokers and non-smokers presented a mean PD reduction of 3.97 +/- 0.76 and 4.63 +/- 0.52 mm, recession of 0.76 +/- 0.44 and 0.50 +/- 0.12 mm and attachment gain of 3.26 +/- 0.42 and 4.06 +/- 0.40 mm, respectively. Evaluation of the hard tissue findings revealed that the mean clinical and radiographic bone gains in smokers and non-smokers were 2.83 +/- 0.47 and 3.63 +/- 0.38 mm, 2.98 +/- 0.38 and 3.67 +/- 0.48 mm, respectively. Inter-group differences for PD reduction (p<0.05), attachment (p<0.001), clinical (p<0.001) and radiographic bone gains (p<0.001) were found to be significant between smokers and non-smokers. CONCLUSIONS: Within the limits of this study, the results indicate that treatment outcome following PRP/BDX application in intrabony defects is impaired with smoking.

Peri-implantitis and Severity Level.

OBJECTIVES: Different diagnostic criteria were used for diagnosis of peri-implant diseases. The aim of this cross-sectional study was to explore prevalence of peri-implant diseases and subclassify peri-implantitis based on different levels of radiographic and clinical findings. MATERIALS AND METHODS: Two hundred patients having 655 dental implants were included in this study. In addition to clinical measurements, standard long-cone parallel technique was used to evaluate marginal bone level around implants. Following diagnosis of peri-implant diseases, peri-implantitis was further subclassified using a severity leveling in terms of marginal bone level and probing depth. RESULTS: Mean age of 200 subjects was 52.8 ± 12.2 years and 63% were females. In total, bleeding on probing was present in 93% and suppuration in 27% of implants. On subject basis, 2.5% were diagnosed as healthy, 28% with peri-implant mucositis (PM), and 69.5% with peri-implantitis, whereas on implant basis, 3.6% were healthy, 36% presented PM, and 60.4% peri-implantitis. Furthermore, when severity leveling was applied, peri-implantitis prevalence changed markedly and ranged from 14.5 to 31.0% at the subject level and from 10.0 to 22.0% at the implant level. Subgingival restoration margins were observed in 70.6% of patients for implants with PM and in 44% patients for implants with peri-implantitis. Most of the implants with peri-implantitis were with platform match (71.5%). CONCLUSIONS: Applying different thresholds to the peri-implantitis definition yielded different prevalence rates ranging from 10 to 31%. As no established diagnostic criteria are being used today, results from clinical studies may not reflect the true disease prevalence.

Plaque Inhibitory Effect of Hyaluronan-Containing Mouthwash in a 4-Day Non-Brushing Model.

PURPOSE: Despite being the gold standard antiplaque agent, chlorhexidine (CHX) has many adverse effects that make scientists search for new agents to combat biofilms as effective as CHX. Hyaluronan, also known as hyaluronic acid (HA), is a natural polysaccharide with anti-inflammatory, antioxidant and bacteriostatic properties. The objectives were to evaluate the plaque inhibitory, and anti-inflammatory effects of HA mouthwash compared to CHX and distilled water (DW) in a 4-day non-brushing model together with the participants' preference to the used products. MATERIALS AND METHODS: Thirty-three systemically and periodontally healthy subjects were included in this randomised, double-blinded, crossover clinical study. Subjects were randomly assigned into three treatment-sequence groups to use three mouthwashes one after another, in three different time periods. After professional prophylaxis at day 1, subjects refrained from all oral hygiene measures and used mouthwashes that were individually allocated to them. On day 5, scoring of plaque index (PI) according to Turetsky modification of Quigley Hein Index system, modified gingival index (MGI) and measurement of gingival crevice fluid (GCF) volume were performed. Treatment satisfaction questionnaire form was given at the end of each experimental period. RESULTS: CHX showed statistically significant reduction in PI followed by HA (p = 0.048). No statistically significant differences were detected between HA and CHX in terms of MGI and GCF volume. For HA, subjects reported significantly better taste, less sensitivity, burning sensation, mouth dryness and numbness perception compared to CHX and DW. CONCLUSIONS: CHX revealed the best plaque inhibition closely followed by HA. Early gingival inflammatory changes were found similar for CHX and HA. Furthermore, HA was well accepted with better perceptions than CHX and DW.

Profilometric Analysis of Periodontally Diseased Root Surfaces After Application of Different Instrumentation Tools: An In Vitro Study.

Objective: The topography of the root surface plays an important role in plaque accumulation, cell adhesion, and periodontal healing. The aim of this study is to profilometrically evaluate the root surface changes following the instrumentation using different tools. Methods: Forty dentin blocks of buccal and lingual root surfaces were obtained from 20 single-rooted periodontally diseased hopeless teeth and randomly divided into 4 groups. Each group was subjected to different root instrumentation tools such as stainless steel (SS) Gracey curette (Group 1); titanium nitride (TIN) Gracey curette (Group 2); ultrasonic piezoelectric device with a special tip designed for root surfaces (H3) (Group 3); and Er:YAG laser (Er:YAG tip) chisel (Group 4). A calibrated clinician instrumented all surfaces in each group. The root surfaces were profilometrically evaluated before and after instrumentations. Results: There were no statistical differences between the initial roughness levels of the groups. TIN curettes revealed the most prominent effect on smoothing the surface, whereas the Er:YAG tip showed the highest roughness in comparison with the other root surface instrumentation tools. Conclusions: Considering the importance of root surface roughness after treatment for the success of periodontal therapy, the TIN curette was the most periodontally appealing tool followed by H3, SS curette, and Er:YAG tip.

Platelet-rich plasma in combination with bovine derived xenograft in the treatment of deep intrabony periodontal defects: a report of 20 consecutively treated patients.

There is currently great interest concerning the use of platelet-rich plasma (PRP) in combination with bone grafts for predictably obtaining periodontal regeneration. The aim of the present study was to investigate the effectiveness of PRP and bovine derived xenograft (BDX) combination in the treatment of deep intrabony defects with an emphasis on the evaluation of early wound healing. A total of 85 intrabony defects with an intrabony component of > or =3 mm were selected in 20 advanced chronic periodontitis patients. Defects were surgically treated with PRP/BDX. At baseline and 12 months after surgery, the following parameters were recorded: plaque and sulcus bleeding indices, probing depth (PD), relative attachment level, marginal recession (REC), probing bone and radiographic bone levels. Postoperative healing was evaluated by an early healing index at 1 and 2 weeks after surgery. At 12 months, all clinical and radiographic parameters were improved (p < 0.0001). The mean changes at 12 months were: PD reduction of 4.78 +/- 1.20 mm, attachment gain of 4.24 +/- 1.03 mm, REC of 0.54 +/- 0.34 mm, clinical bone gain of 3.75 +/- 0.97 mm, and radiographic bone gain of 3.79 +/- 1.02 mm, respectively. Two weeks after surgery, primary closure was maintained in 95% of the defect sites. Treatment with a combination of PRP and BDX leads to a significantly favorable clinical and radiographic improvement in deep intrabony periodontal defects.

Evaluation of the Effects of Er:YAG Laser for the De-Epithelialization of the Palatal Graft in the Treatment of Multiple Gingival Recessions: A Randomized Clinical Trial.

Objective: The purposes of this split-mouth pilot study were to investigate the efficacy of the Er:YAG laser use for the de-epithelialization of the palatal graft in the treatment of the multiple gingival recessions using the bilaminar procedure and also to evaluate the patient-reported esthetic outcomes after 6 months. Materials and methods: Five systemically healthy participants with total 28 bilateral-multiple adjacent maxillary Miller I recessions were included. The treatment was performed with the bilaminar technique [coronally advanced flap (CAF)+de-epithelialized free gingival graft]. De-epithelialization procedure was done with scalpel (control site) or Er:YAG laser (Versawave, Hoya ConBio, San Francisco, CA; 40 hz, 50 mJ/pulse), under water irrigation, noncontact mode (∼1 mm away from the target tissue) in sweeping motion with chisel-type laser (test site). Root coverage and patient-reported outcomes were evaluated at 6 months after the operations. Results: Clinical outcomes of the both treatment sites did not show any statistically significant differences except for the gingival thickness parameter. However, patient-reported outcomes regarding the esthetic appearance of the gingiva was detected in favor of the Er:YAG laser applied sites. Conclusions: Within the limits of the study, it can be concluded that both de-epithelialization techniques were highly effective at 6 months. However, Er:YAG laser-applied grafted sites revealed more uniform and esthetic gingival appearance compared with scalpel-used grafted sites.

Effect of topically applied hyaluronic acid on pain and palatal epithelial wound healing: An examiner-masked, randomized, controlled clinical trial.

BACKGROUND: This study aims to evaluate the effects of two different concentrations of topical hyaluronic acid (HA) on postoperative patient discomfort and wound healing of palatal donor sites after free gingival graft (FGG) surgery. METHODS: Thirty-six patients requiring FGG were randomly assigned into three groups in an examiner-masked, randomized, controlled clinical trial. After harvesting palatal grafts, 0.2% and 0.8% HA gels were used in test groups 1 and 2, respectively. Gels were applied on donor sites and protected with periodontal dressing in the test groups, whereas the wound was covered only with periodontal dressing in the control group. On days 3, 7, 14, and 21, pain and burning sensation were recorded using a visual analog scale (VAS) as well as other parameters such as complete epithelization (CE) and color match on days 3, 7, 14, 21, and 42. RESULTS: Test groups experienced less pain than the control group on days 3 and 7 (P <0.001 and P <0.001, respectively). Mean VAS score for burning sensation was higher in the control group on day 3 compared with test groups 1 and 2 (P = 0.03 and P = 0.02, respectively). CE in all patients was achieved on day 21 in both test groups, whereas it was achieved on day 42 in the control group. The test groups showed higher color match scores than the control group on days 21 (P <0.001 and P <0.001, respectively) and 42 (P = 0.004 and P = 0.002, respectively). CONCLUSION: Topical application of HA exhibits positive impact on postoperative pain and burning sensation, and accelerates palatal wound healing in terms of epithelization and color match.

Effect of the diode laser on bacteremia associated with dental ultrasonic scaling: a clinical and microbiological study.

OBJECTIVE: The purpose of this study is to evaluate the potential use of diode lasers (DLs) to reduce bacteremia associated with ultrasonic scaling (US). Furthermore, the clinical efficacy of DLs as an adjunct to US in the treatment of gingivitis was investigated. BACKGROUND DATA: Recently, lasers have found new applications in dental practice. The benefits of the use of DLs as an adjunct to US have not yet been determined. METHODS: Twenty-two gingivitis patients were treated using a split-mouth study design in which each side was randomly treated by US alone or DL followed by US (DL + US). Blood samples were drawn just before and during US in each treatment step to detect induced bacteremia. Clinical parameters including plaque index, sulcus bleeding index, probing depth, and relative attachment level were recorded at baseline and 4 weeks postoperatively. RESULTS: Bacteremia was detected in 15 patients (68%) after US alone, and in 8 patients following DL + US (36%). The reduction of the incidence of odontogenic bacteremia during US after the application of DL was statistically significant (p < 0.05). Clinical signs improved eventually, with no significant differences between the two treatment regimens (p > 0.05). CONCLUSIONS: Application of DL energy can reduce bacteria in gingival crevices which may reduce bacteremia following US. The use of DL did not show additional clinical influence on gingival healing after treatment of gingivitis with US.

Relationships between initial probing depth and changes in the clinical parameters following non-surgical periodontal treatment in chronic periodontitis.

PURPOSE: The aim of this study was to evaluate the relationship between initial probing depth (IPD) and changes in clinical parameters following non-surgical periodontal treatment (NPT) in chronic periodontitis patients. SUBJECTS AND METHODS: A total of 1672 periodontal pockets having 3mm≤IPD≤9mm of depth in 15 chronic periodontitis patients were included. NPT consisting of oral hygiene instructions, scaling and root planing was applied in two sessions. Probing depth (PD), clinical attachment level, gingival recessions (GR) were measured before and eight weeks after treatment. Pocket sites were grouped according to their IPD and root number as single- or multi-rooted teeth. RESULTS: Other than the sites having 3 mm IPD, PD reduction and GR increase were significant in all groups (p<0.001). Attachment gains (AG) were significant in all single-rooted teeth (p<0.001) again except those having IPD=3mm. However, AG was significant in multi-rooted teeth having only 7mm≤IPD≤9mm (p<0.05). Positive correlations were observed between IPD and PD reduction, GR increase and AG in single-rooted teeth (p<0.001). Furthermore, positive correlations were found between IPD and PD reduction and GR increase in multi-rooted teeth (p<0.001), but there was no correlation between IPD and AG. CONCLUSION: NPT may lead to positive association between IPD and PD reduction as well as GR increase, which is independent from tooth root anatomy.