Omega-3 PUFA and aspirin as adjuncts to periodontal debridement in patients with periodontitis and type 2 diabetes mellitus: Randomized clinical trial.

BACKGROUND: Supplementation with omega-3 polyunsaturated fatty acids (ω-3 PUFA) and low-dose aspirin (ASA) have been proposed as a host modulation regimen to control chronic inflammatory diseases. The aim of this study was to investigate the clinical and immunological impact of orally administered ω-3 PUFA and ASA as adjuncts to periodontal debridement for the treatment of periodontitis in patients type 2 diabetes. METHODS: Seventy-five patients (n = 25/group) were randomly assigned to receive placebo and periodontal debridement (CG), ω-3 PUFA + ASA (3 g of fish oil/d + 100 mg ASA/d for 2 months) after periodontal debridement (test group [TG]1), or ω-3 PUFA + ASA (3 g of fish oil/d + 100 mg ASA/d for 2 months) before periodontal debridement (TG2). Periodontal parameters and GCF were collected at baseline (t0), 3 months after periodontal debridement and ω-3 PUFA + ASA or placebo for TG1 and CG (t1), after ω-3 PUFA + ASA (before periodontal debridement) for TG2 (t1), and 6 months after periodontal debridement (all groups) (t2). GCF was analyzed for cytokine levels by multiplex ELISA. RESULTS: Ten patients (40%) in TG1 and nine patients (36%) in TG2 achieved the clinical endpoint for treatment (less than or equal to four sites with probing depth ≥ 5 mm), as opposed to four (16%) in CG. There was clinical attachment gain in moderate and deep pockets for TG1. IFN-γ and interleukin (IL)-8 levels decreased over time for both test groups. IL-6 levels were lower for TG1. HbA1c levels reduced for TG1. CONCLUSION: Adjunctive ω-3 and ASA after periodontal debridement provides clinical and immunological benefits to the treatment of periodontitis in patients with type 2 diabetes.

Evaluating the effect of photobiomodulation with a 940-nm diode laser on post-operative pain in periodontal flap surgery.

The aim of this study was to evaluate the efficacy of low-power of 940-nm diode laser on post-operative pain after undisplaced flap surgery. This randomized clinical trial study was conducted using a split-mouth design. The study participants comprised 30 patients who needed periodontal flap surgery for periodontal pockets on the same tooth on both sides of the mandible. One side of the mandible was subjected to undisplaced flap surgery plus treatment with a 940-nm diode laser, and on the contralateral side, the surgery was conducted without applying the laser. Patients received anti-inflammatory medication and analgesics after surgery. The patients were asked to report the number of analgesics they took and the pain they experienced each night for 1 week using a visual analogue scale. An independent-sample t test was used to compare the results between the two groups. Patients reported less pain on days 2, 3, 4, 5, 6, and 7 after surgery in the laser-treated group (p < 0.05). Furthermore, fewer analgesics were used in this group on days 3, 4, 5, 6, and 7 following the surgery (p < 0.05). The 940-nm diode laser with the settings used in this study could significantly reduce pain and the number of analgesics taken by patients after undisplaced flap surgery.

Effects of two different post-surgical protocols including either 0.05 % chlorhexidine herbal extract or 0.1 % chlorhexidine on post-surgical plaque control, early wound healing and patient acceptance following standard periodontal surgery and implant placement.

OBJECTIVES: The aim of this study was to compare early wound healing, tooth staining and patient acceptance with two different post-surgical maintenance protocols. MATERIALS AND METHODS: Forty patients scheduled for flap surgery to treat periodontal pockets or accommodate dental implants were randomly assigned to receive the following two different post-surgical maintenance protocols: (a) 2 weeks rinsing with a 0.05 % chlorhexidine digluconate (CHX)/herbal extract combination (test) or (b) a 0.1 % CHX solution (control). Early wound healing was evaluated clinically and immunologically. Tooth staining and patient acceptance were assessed by means of visual analogue scale (VAS). RESULTS: Both groups presented with comparable wound healing profiles. No statistically significant differences were observed between the two protocols regarding early wound healing and plaque index (p > 0.05). However, in the control group, statistically significantly more patients felt discomfort due to tooth staining (p = 0.0467). Compared with patients from the test group, patients in the control group reported statistically significant more irritation of taste at week 1 (p = 0.0359) and at week 2 (p = 0.0042). CONCLUSIONS: The present findings indicate that the two CHX protocols resulted in comparable healing and inhibition of plaque formation. Tooth staining and subjective discomfort related to irritation of taste were more frequent in the control group. CLINICAL RELEVANCE: A post-operative protocol including 0.05 % CHX/herbal extract may have the potential to improve patient compliance during post-operative maintenance.

Differential benefits of amoxicillin-metronidazole in different phases of periodontal therapy in a randomized controlled crossover clinical trial.

BACKGROUND: The specific advantage of administering systemic antibiotics during initial, non-surgical therapy or in the context of periodontal surgery is unclear. This study assesses the differential outcomes of periodontal therapy supplemented with amoxicillin-metronidazole during either the non-surgical or the surgical treatment phase. METHODS: This is a single-center, randomized placebo-controlled crossover clinical trial with a 1-year follow-up. Eighty participants with Aggregatibacter actinomycetemcomitans-associated moderate to advanced periodontitis were randomized into two treatment groups: group A, antibiotics (500 mg metronidazole plus 375 mg amoxicillin three times per day for 7 days) during the first, non-surgical phase of periodontal therapy (T1) and placebo during the second, surgical phase (T2); and group B, placebo during T1 and antibiotics during T2. The number of sites with probing depth (PD) >4 mm and bleeding on probing (BOP) per patient was the primary outcome. RESULTS: A total of 11,212 sites were clinically monitored on 1,870 teeth. T1 with antibiotics decreased the number of sites with PD >4 mm and BOP per patient significantly more than without (group A: from 34.5 to 5.7, 84%; group B: from 28.7 to 8.7, 70%; P <0.01). Twenty patients treated with antibiotics, but only eight treated with placebo, achieved a 10-fold reduction of diseased sites (P = 0.007). Consequently, fewer patients of group A needed additional therapy, the mean number of surgical interventions was lower, and treatment time in T2 was shorter. Six months after T2, the mean number of residual pockets (group A: 2.8 ± 5.2; group B: 2.2 ± 5.0) was not significantly different and was sustained over 12 months in both groups. CONCLUSION: Giving the antibiotics during T1 or T2 yielded similar long-term outcomes, but antibiotics in T1 resolved the disease quicker and thus reduced the need for additional surgical intervention.

Significance of scaling and root planing with and without adjunctive use of a water-cooled pulsed Nd:YAG laser for the treatment of periodontal inflammation.

The aim was to assess the significance of scaling and root planing (SRP) with adjunctive use of a water-cooled pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) laser for the treatment of periodontal inflammation. Thirty-nine patients were equally divided into three groups. In group 1, the upper jaw was treated with Nd:YAG laser application; whereas in groups 2 and 3, the upper jaw was treated with SRP alone and Nd:YAG laser application immediately after SRP, respectively. In each group, probing pocket depth (PPD), plaque index (PI), and gingival index (GI) were measured and gingival crevicular fluid (GCF) volume was determined after using at 1 week and after 3 months. Three-month follow-up results showed that PPD, PI, GI, and GCF volume were significantly reduced in group 3 compared to groups 1 and 2. In short term, SRP with a single application of a water-cooled pulsed Nd:YAG laser reduced PI, GI, PPD, and GCF volume more significantly compared to when Nd:YAG laser and SRP are used alone to treat periodontal inflammation.

Long-term effect on tooth vitality of regenerative therapy in deep periodontal bony defects: a retrospective study.

Over the last few decades, many authors have investigated the effect of periodontal disease and treatment on pulpal status with controversial results. This study was conducted to verify whether periodontal disease in a deep intrabony defect and complex therapy, including aggressive root planing such as in periodontal regeneration, have an influence on tooth vitality. One hundred thirty-seven patients who fulfilled the requirements were included. The collected data did not support the need for "preventive" root canal treatment in severely compromised teeth that are planned to undergo periodontal regenerative surgery.

Clinical outcome of a nonsurgical and surgical treatment protocol in different types of peri-implantitis: a case series.

OBJECTIVE: The replacement of missing teeth with dental implants has been standard practice in dentistry for many years. The success of dental implants depends on many factors, among which the diagnosis, clinical severity, and treatment of peri-implant diseases play a key role. In this prospective case series, the influence of cumulative treatment modalities on peri-implantitis with and without pus formation on clinical outcome was assessed. METHOD AND MATERIALS: During 2010, 28 patients were referred for peri-implantitis treatment. They presented two different types of peri-implant diseases: peri-implantitis with (17 implants) or without pus formation (33 implants). After microbiologic diagnosis, all patients were treated at baseline with full-mouth scaling and root planing. Two months later, further full-mouth scaling and root planing and additional antimicrobial photodynamic therapy (aPDT) was applied. Four months after baseline, patients with pus formation additionally underwent access flap surgery. Active human matrix metalloproteinase-8 (aMMP-8) levels were measured in eluates before and after all treatment modalities and 7 months after baseline. RESULTS: Clinical parameters (probing depth, bleeding on probing) and aMMP-8-levels improved in both groups after treatment and the final examination. In periimplantitis patients without pus formation, all parameters decreased after full-mouth scaling and root planing and the additional aPDT and no surgery was necessary to improve the parameters. In patients with pus formation, the parameters decreased only after access flap surgery. CONCLUSION: The presence of pus influences the clinical outcome of the treatment of peri-implant diseases. Whereas peri-implantitis cases without pus formation can be successfully managed nonsurgically, peri-implantitis with pus formation can be effectively treated after an additional observation time of 3 months postoperatively only with additional flap surgery.

Five-year results evaluating the effects of platelet-rich plasma on the healing of intrabony defects treated with enamel matrix derivative and natural bone mineral.

BACKGROUND: Regenerative periodontal surgery using the combination of enamel matrix derivative (EMD) and natural bone mineral (NBM) with and without addition of platelet-rich plasma (PRP) has been shown to result in substantial clinical improvements, but the long-term effects of this combination are unknown. METHODS: The goal of this study was to evaluate the long-term (5-year) outcomes after regenerative surgery of deep intrabony defects with either EMD + NBM + PRP or EMD + NBM. Twenty-four patients were included. In each patient, one intrabony defect was randomly treated with either EMD + NBM + PRP or EMD + NBM. Clinical parameters were evaluated at baseline and 1 and 5 years after treatment. The primary outcome variable was clinical attachment level (CAL). RESULTS: The sites treated with EMD + NBM + PRP demonstrated a mean CAL change from 10.5 ± 1.6 to 6.0 ± 1.7 mm (P <0.001) at 1 year and 6.2 ± 1.5 mm (P <0.001) at 5 years. EMD + NBM-treated defects showed a mean CAL change from 10.6 ± 1.7 to 6.1 ± 1.5 mm (P <0.001) at 1 year and 6.3 ± 1.4 mm (P <0.001) at 5 years. At 1 year, a CAL gain of ≥4 mm was measured in 83% (10 of 12) of the defects treated with EMD + NBM + PRP and in 100% (all 12) of the defects treated with EMD + NBM. Compared to baseline, in both groups at 5 years, a CAL gain of ≥4 mm was measured in 75% (nine of 12 in each group) of the defects. Four sites in the EMD + PRP + NBM group lost 1 mm of the CAL gained at 1 year. In the EMD + NBM group, one defect lost 2 mm and four other defects lost 1 mm of the CAL gained at 1 year. No statistically significant differences in any of the investigated parameters were observed between the two groups. CONCLUSIONS: Within their limits, the present results indicate that: 1) the clinical outcomes obtained with both treatments can be maintained up to a period of 5 years; and 2) the use of PRP does not appear to improve the results obtained with EMD + NBM.

Comparative evaluation of autologous platelet-rich fibrin and platelet-rich plasma in the treatment of mandibular degree II furcation defects: a randomized controlled clinical trial.

BACKGROUND: The treatment of molar furcation defects remains a considerable challenge in clinical practice. The identification of clinical measurements influential to treatment outcomes is critical to optimize the results of surgical periodontal therapy. The present study aimed to explore the clinical and radiographical effectiveness of autologous platelet-rich fibrin (PRF) and autologous platelet-rich plasma (PRP) in the treatment of mandibular degree II furcation defects in subjects with chronic periodontitis. MATERIAL AND METHODS: Seventy-two mandibular degree II furcation defects were treated with either autologous PRF with open flap debridement (OFD; 24 defects) or autologous PRP with OFD (25), or OFD alone (23). Clinical and radiological parameters such as probing depth, relative vertical clinical attachment level and horizontal clinical attachment level along with gingival marginal level were recorded at baseline and 9 mo postoperatively. RESULTS: All clinical and radiographic parameters showed statistically significant improvement at both the test sites (PRF with OFD and PRP with OFD) compared to those with OFD alone. Relative vertical clinical attachment level gain was also greater in PRF (2.87 ± 0.85 mm) and PRP (2.71 ± 1.04 mm) sites as compared to control site (1.37 ± 0.58 mm), and relative horizontal clinical attachment level gain was statistically significantly greater in both PRF and PRP than in the control group. CONCLUSIONS: The use of autologous PRF or PRP were both effective in the treatment of furcation defects with uneventful healing of sites.

The effect of an 810-nm diode laser on postoperative pain and tissue response after modified Widman flap surgery: a pilot study in humans.

BACKGROUND: The purpose of this single-masked pilot clinical study is to compare the tissue response and postoperative pain after the use of a diode laser (810 nm) (DL) as an adjunct to modified Widman flap (MWF) surgery to that of MWF alone. METHODS: Thirteen patients with generalized severe chronic periodontitis completed the study. Control sites were randomly selected to receive an MWF and the contralateral test sites an MWF in conjunction with a DL. The study tooth/site was treated plus any additional teeth in the quadrant in which the site was located, if needed. Randomization was done using a coin flip. The DL was used to de-epithelialize the inner part of the periodontal flap and photo-biostimulate the surgical area. Pain scale assessment (PS), pain medication consumption (PM), tissue edema (TE), and tissue color (TC) were evaluated 1 week after surgery. RESULTS: Statistically significant differences were seen for TE (P = 0.041), PM (P <0.001), and PS (P <0.001) favoring test sites. TC did not show a statistically significant difference (P = 0.9766). Patients rated the first surgical treatment (test or control; random assignment to first treatment) performed as more painful than the second (P <0.002). CONCLUSION: The use of an 810-nm diode laser provided additional benefits to MWF surgery in terms of less edema and postoperative pain.

Doxycycline-loaded ß-tricalcium phosphate release following EDTA root surface etching improved the clinical outcomes in chronic periodontitis: an in vivo study.

BACKGROUND: The main objective of the present study is to quantify doxycycline (DOX) release from ß-tricalcium phosphate (ß-TCP) after EDTA root surface treatment. METHODS: Thirty systemically healthy patients with ≥1 paired contralateral interproximal intrabony defect ≥4 mm deep along with an interproximal probing depth ≥6 mm and clinical attachment level ≥4 mm were randomized into two groups. Group 1 (G1) consisted of sites treated with open flap debridement followed by placement of DOX blended with ß-TCP (DOX-ß-TCP), whereas group 2 (G2) sites were treated with flap surgery followed by the placement of DOX blended with ß-TCP after EDTA etching of the exposed root surfaces (DOX-ß-TCP + EDTA). Samples of gingival crevicular fluid (GCF) were obtained 1, 3, 7, 14, and 21 days after surgery. Quantitative measurements of DOX were taken with high-performance liquid chromatography. Clinical evaluation and follow-up for 6 months were performed. RESULTS: At 21 days, the DOX-ß-TCP + EDTA-treated group showed a 194.7 µg/mL value. The DOX-ß-TCP + EDTA-treated group retained more DOX during the periods of 3, 7, 10, 14, and 21 days than the DOX-ß-TCP-treated group. Six months after therapy, DOX-ß-TCP + EDTA-treated sites showed more significant clinical improvements compared to DOX-ß-TCP-treated sites (P ≤ 0.05). CONCLUSIONS: EDTA root surface etching enhances DOX availability in the GCF following its release from ß-TCP as a drug carrier.

Ten-year results following treatment of intrabony defects with an enamel matrix protein derivative combined with either a natural bone mineral or a ß-tricalcium phosphate.

BACKGROUND: The purpose of the present study is to evaluate the 10-year results following treatment of intrabony defects treated with an enamel matrix protein derivative (EMD) combined with either a natural bone mineral (NBM) or ß-tricalcium phosphate (ß-TCP). METHODS: Twenty-two patients with advanced chronic periodontitis and displaying one deep intrabony defect were randomly treated with a combination of either EMD + NBM or EMD + ß-TCP. Clinical evaluations were performed at baseline and at 1 and 10 years. The following parameters were evaluated: plaque index, bleeding on probing, probing depth, gingival recession, and clinical attachment level (CAL). The primary outcome variable was CAL. RESULTS: The defects treated with EMD + NBM demonstrated a mean CAL change from 8.9 ± 1.5 mm to 5.3 ± 0.9 mm (P <0.001) and to 5.8 ± 1.1 mm (P <0.001) at 1 and 10 years, respectively. The sites treated with EMD + ß-TCP showed a mean CAL change from 9.1 ± 1.6 mm to 5.4 ± 1.1 mm (P <0.001) at 1 year and 6.1 ± 1.4 mm (P <0.001) at 10 years. At 10 years two defects in the EMD + NBM group had lost 2 mm, whereas two other defects had lost 1 mm of the CAL gained at 1 year. In the EMD + ß-TCP group three defects had lost 2 mm, whereas two other defects had lost 1 mm of the CAL gained at 1 year. Compared with baseline, at 10 years, a CAL gain of ≥3 mm was measured in 64% (i.e., seven of 11) of the defects in the EMD + NBM group and in 82% (i.e., nine of 11) of the defects in the EMD + ß-TCP group. No statistically significant differences were found between the 1- and 10-year values in either of the two groups. Between the treatment groups, no statistically significant differences in any of the investigated parameters were observed at 1 and 10 years. CONCLUSION: Within their limitations, the present findings indicate that the clinical improvements obtained with regenerative surgery using EMD + NBM or EMD + ß-TCP can be maintained over a period of 10 years.

Five-year retrospective study of laser-assisted periodontal therapy.

This article outlines a five-year retrospective study involving a diode dental laser used on periodontally infected teeth. The present study utilized a specific protocol: scaling and root planing, light ultrasonic scaling, and the use of a diode laser. In 80% of cases, pocket depth of 3 mm or less was maintained.

Adjunctive clinical effect of a water-cooled Nd:YAG laser in a periodontal maintenance care programme: a randomized controlled trial.

BACKGROUND: Various laser systems are currently available for intra-oral use. Neodymium:Yttrium-Aluminium Garnet lasers(Nd:YAG) have been approved by the US Food and Drug Administration for soft tissue treatment in the oral cavity. OBJECTIVES: The aim of this study was to test whether the use of a water-cooled Nd:YAG laser during a maintenance care programme as an adjunct to supragingival and subgingival debridement (scaling and root planing, SRP) with hand and ultrasonic instruments results in clinical improvement compared with SRP alone. MATERIAL AND METHODS: This study was an examiner-blind, randomized and controlled clinical trial using a split-mouth design. Thirty subjects were selected, originally diagnosed with moderate to severe generalized periodontitis, following a periodontal maintenance care programme (PMC). Immediately after SRP in two randomly assigned contra-lateral quadrants, all pockets ≥5 mm were additionally treated with a Nd:YAG laser (1064 nm, 4W, 250-µsec pulse). Clinical assessments [probing pocket depth PPD, bleeding on pocket probing (BOPP)] were performed pre-treatment and at 6 months. Based on these assessments, the periodontal inflamed surface area (PISA) was calculated. RESULTS: At 6 months, the clinical parameters had significantly improved for both regimens. No statistically significant differences between treatment modalities were observed for PPD and BOPP scores at any time. PISA scores supported these findings. CONCLUSIONS: In residual pockets ≥5 mm, treated in a PMC, the adjunctive use of an Nd:YAG laser does not provide a clinically significant additional advantage.

Influence of autogenous platelet concentrate on combined GTR/graft therapy in intrabony defects: a 7-year follow-up of a randomized prospective clinical split-mouth study.

OBJECTIVES: To investigate the influence of autogenous platelet concentrate (APC) on the long-term regeneration outcome 7 years after guided tissue regeneration (GTR) in deep intrabony periodontal defects. MATERIAL AND METHODS: In 25 patients, two deep contra-lateral intrabony defects were treated according to GTR (randomized split-mouth-design). In the test defects, APC was additionally applied. After 7 years, healing results were assessed clinically by a blinded examiner and compared to baseline and 12-months results. Furthermore, a tooth survival analysis was performed. RESULTS: After 7 years, 23 patients were available for survival analysis and 16 patients for split-mouth analysis; 84% of the test and control teeth were still in situ. In both groups, the median attachment level of 10.5 mm [(25/75%): test 9.0/13.0, control 10.0/12.0] at baseline was significantly (p ≤ 0.05) reduced to 6.0 mm [test 4.0/6.8, control 5.0/7.0] after 1 year. Six years later, it had increased again to 7.0 mm in test sites [5.3/10.0] (p ≤ 0.05) and had remained stable in control sites [5.0/7.8] (p > 0.05). Bleeding on Probing (BOP) had increased in both groups. During the last 6 years, only 26% of the patients received a structured supportive periodontal therapy in the clinic. CONCLUSION: Within its limitations, the present study indicates that the clinical outcome of GTR therapy can be maintained over 7 years. However, the additional use of APC may even have a possibly negative influence on the long-term stability.

Porous titanium granules in the surgical treatment of peri-implant osseous defects: a randomized clinical trial.

PURPOSE: Porous titanium granules (PTG) may have potential as an osteoconductive bone graft substitute to treat peri-implant osseous defects. The aim of this study was to analyze clinical and radiographic outcomes of peri-implant osseous defects after treatment with PTG. MATERIALS AND METHODS: This prospective, randomized, case-control, clinical 12-month study compared open-flap debridement and surface decontamination with titanium curettes and 24% ethylenediaminetetraacetic acid gel (n = 16) to the same protocol but with the addition of PTG (n = 16). One-, two-, and three-wall infrabony defects were included. Patients were given amoxicillin and metronidazole 3 days before surgery and for 7 days afterwards. Implants were submerged and allowed to heal for 6 months. Probing pocket depths, bleeding on probing, implant stability using resonance frequency analysis, and radiographic evaluation were performed at baseline and at 12 months. The threshold for significance was set at .05. RESULTS: Change in radiographic defect height and percent fill of the peri-implant osseous defect significantly favored patients treated with PTG. Both treatment modalities demonstrated significant improvements in probing pocket depth, but significant differences between groups were not observed. The PTG-treated implants showed an increase in implant stability quotient (ISQ) of 1.6 units, compared with a decrease of 0.7 ISQ for the control group. No adverse effects were associated with PTG treatment. CONCLUSIONS: Reconstruction with PTG resulted in significantly better radiographic peri-implant defect fill compared with controls; however, the results do not necessarily imply reosseointegration or osseointegration of PTG particles. Improvements in clinical parameters were seen in both groups, but no differences between groups were demonstrated.

Four-year results following treatment of intrabony periodontal defects with an enamel matrix derivative alone or combined with a biphasic calcium phosphate.

The aim of this study was to evaluate the 4-year clinical outcomes following regenerative surgery in intrabony defects with either EMD + BCP or EMD. Twenty-four patients with advanced chronic periodontitis, displaying one-, two-, or three-walled intrabony defect with a probing depth of at least 6 mm, were randomly treated with either EMD + BCP (test) or EMD alone (control). The following clinical parameters were evaluated at baseline, at 1 year and at 4 years after regenerative surgery: plaque index, gingival index, bleeding on probing, probing depth, gingival recession, and clinical attachment level (CAL). The primary outcome variable was CAL. No differences in any of the investigated parameters were observed at baseline between the two groups. The test group demonstrated a mean CAL change from from 10.8 ± 1.6 mm to 7.4 ± 1.6 mm (p < 0.001) and to 7.6 ± 1.7 mm (p < 0.001) at 1 and 4 years, respectively. In the control group, mean CAL changed from 10.4 ± 1.3 at baseline to 6.9 ± 1.0 mm (p < 0.001) at 1 year and 7.2 ± 1.2 mm (p < 0.001) at 4 years. At 4 years, two defects in the test group and three defects in the control group have lost 1 mm of the CAL gained at 1 year. Compared to baseline, at 4 years, a CAL gain of ≥3 mm was measured in 67% of the defects (i.e., in 8 out of 12) in the test group and in 75% of the defects (i.e., in 9 out of 12) in the control group. There were no statistically significant differences in any of the investigated parameters at 1 and at 4 years between the two groups. Within their limits, the present results indicate that: (a) the clinical improvements obtained with both treatments can be maintained over a period of 4 years, and (b) in two- and three-walled intrabony defects, the addition of BCP did not additionally improve the outcomes obtained with EMD alone. In two- and three-walled intrabony defects, the combination of EMD + BCP did not show any advantage over the use of EMD alone.

Surgical therapy of peri-implantitis lesions by means of a bovine-derived xenograft: comparative results of a prospective study on two different implant surfaces.

OBJECTIVES: The aim of this prospective study was to evaluate a regenerative surgical treatment modality for peri-implantitis lesions on two different implant surfaces. MATERIALS AND METHODS: Twenty-six patients with one crater-like defect, around either TPS (Control) or SLA (Test) dental implants, with a probing depth (PD) ≥6 mm and no implant mobility, were included. The implant surface was mechanically debrided and treated using a 24% EDTA gel and a 1% chlorhexidine gel. The bone defect was filled with a bovine-derived xenograft (BDX) and the flap was sutured around the non-submerged implant. RESULTS: One-year follow-up demonstrated clinical and radiographic improvements. PDs were significantly reduced by 2.1±1.2 mm in the Control implants and by 3.4±1.7 mm in the Test implants. Complete defect fill was never found around Controls, while it occurred in three out of 12 Test implants. Bleeding on probing decreased from 91.1±12.4% (Control) and 75.0±30.2% (Test) to 57.1±38.5% (p=0.004) and 14.6±16.7% (p=0.003), respectively. Several deep pockets (≥6 mm) were still present after surgical therapy around Controls. CONCLUSIONS: Surface characteristics may have an impact on the clinical outcome following surgical debridement, disinfection of the contaminated surfaces and grafting with BDX. Complete fill of the bony defect seems not to be a predictable result.

Adjunctive effect of a water-cooled Nd:YAG laser in the treatment of chronic periodontitis.

OBJECTIVES: To test whether use of a water-cooled Nd:YAG laser adjunctive to supra- and subgingival debridement (SRP) with hand and ultrasonic instruments results in greater clinical improvement than SRP alone. Another objective was to investigate the reduction in the number of microorganisms. METHODS: This study was an examiner-blind, randomized and controlled clinical trial using a split-mouth design. Nineteen subjects with moderate-to-severe generalized periodontitis were selected. Immediately following SRP in two randomly chosen contra-lateral quadrants, all pockets 4 mm were additionally treated with the Nd:YAG laser (1064 nm, 6 W, 400 mJ). Clinical assessments (Plaque index, bleeding on pocket probing, probing pocket depth) were performed pre-treatment and at 3 months post-treatment. In each quadrant, one site was sampled for microbiological evaluation at pre-treatment, immediately post-instrumentation and 3 months post-treatment. RESULTS: At the 3-month visit, the clinical parameters had significantly improved for both regimens. No significant differences between treatment modalities were observed for any of the clinical parameters at any time. Immediately following instrumentation, the total colony forming units for both groups were significantly reduced as compared with pre-instrumentation. No significant differences between treatment modalities were observed. CONCLUSIONS: Three months after SRP, no additional advantage was achieved with the additional use of the Nd:YAG laser. Microbiological findings reflect these clinical results.

The efficacy of host response modulation therapy (omega-3 plus low-dose aspirin) as an adjunctive treatment of chronic periodontitis (clinical and biochemical study).

BACKGROUND AND OBJECTIVE: Regeneration of lost periodontal tissues is considered to be one of the most challenging aspects of periodontal therapy. Our current understanding of the role of the host immuno-inflammatory response in periodontal diseases forms the basis of new therapeutic approaches. The aim of this study was to evaluate the efficacy of systemic administration of omega-3 polyunsaturated fatty acids plus low-dose aspirin as an adjunctive treatment to regenerative therapy of furcation defects. MATERIAL AND METHODS: Forty patients displaying at least a single grade II furcation defect were enrolled in the study. They were randomly allocated into two groups: an experimental group receiving decalcified freeze-dried bone allograft (DFDBA) + omega-3 polyunsaturated fatty acids combined with low-dose aspirin; and a control group receiving DFDBA + placebo. Clinical parameters were monitored at baseline, and at 3 and 6 mo following therapy, and included plaque index, gingival index, gingival bleeding index, probing pocket depth and clinical attachment level. The biochemical markers assessed in gingival crevicular fluid samples were interleukin-1ß and interleukin-10. RESULTS: The experimental intervention resulted in a greater mean probing pocket depth reduction (P < 0.001) and gain in clinical attachment (P < 0.05) compared with the control at 6 mo. Furthermore, the experimental protocol was able to achieve a significant modulatory effect on the levels of interleukin-1ß and interleukin-10 compared with control therapy. CONCLUSION: The findings suggest that the combination therapy demonstrated successful reduction of gingival inflammation, reduction of pocket depth and attachment level gain, accompanied by a trend for modulation of the cytokines profile in gingival crevicular fluid.