Healing of Periodontal Suprabony Defects following Treatment with Open Flap Debridement with or without Hyaluronic Acid (HA) Application.

Background and Objectives: This randomized, double-arm, multicentric clinical trial aims to compare the clinical outcomes following the treatment of suprabony periodontal defects using open flap debridement (OFD) with or without the application of hyaluronic acid (HA). Materials and Methods: Sixty systemically healthy patients with at least two teeth presenting suprabony periodontal defects were randomly assigned with a 1:1 allocation ratio using computer-generated tables into a test (OFD + HA) or control group (OFD). The main outcome variable was clinical attachment level (CAL). The secondary outcome variables were changes in mean probing pocket depth (PPD), gingival recession (GR), full-mouth plaque score (FMPS), and full-mouth bleeding score (FMBS). All clinical measurements were carried out at baseline and 12 months. Results: Sixty patients, thirty in each group, were available for statistical analysis. The mean CAL gain was statistically significantly different (p < 0.001) in the test group compared with the control group (3.06 ± 1.13 mm vs. 1.44 ± 1.07 mm). PPD reduction of test group measurements (3.28 ± 1.14 mm) versus the control group measurements (2.61 ± 1.22 mm) were statistically significant (p = 0.032). GR changes were statistically significant only in the test group 0.74 ± 1.03 mm (p < 0.001). FMBS and FMPS revealed a statistically significant improvement mostly in the test group. Conclusions: Suprabony periodontal defects could benefit from the additional application of HA in conjunction with OFD in terms of improvement of the clinical parameters compared with OFD alone.

Resolution of peri-implant mucositis at tissue- and bone-level implants: A 6-month prospective controlled clinical trial.

OBJECTIVE: The objective of the study was to compare resolution of inflammation of naturally occurring peri-implant mucositis (PM) at tissue-level (TL) and bone-level (BL) implants after non-surgical mechanical debridement. MATERIALS AND METHODS: Fifty-four patients with 74 Implants with PM were allocated in two groups (39 TL and 35 BL implants) and treated by means of subgingival debridement using a sonic scaler with a plastic tip without adjunctive measures. At baseline and at 1, 3, 6 months, the full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), probing depth (PD), bleeding on probing (BOP), and modified plaque index (mPlI) were recorded. The primary outcome was BOP change. RESULTS: After 6 months, the FMPS, FMBS, PD, and number of implants with plaque decreased statistically significantly in each group (p < .05); however, no statistically significant differences were found between TL and BL implants (p > .05). After 6 months, 17 (43.6%) TL and 14 (40%) BL implants showed a BOP change in (17.9%) and (11.4%), respectively. No statistical difference was recorded between groups. CONCLUSIONS: Within the limitations of present study, the findings showed no statistically significant differences in terms of changes in clinical parameters following non-surgical mechanical treatment of PM at TL and BL implants. A complete resolution of PM (i.e., no BOP at all implant sites) was not achieved in both groups.

Post-Operative Complications and Risk Predictors Related to the Avulsion of Lower Impacted Third Molars.

Background and Objectives: This prospective cohort study aimed to evaluate the onset and severity of pain and other complications following lower impacted third molar extraction and to identify potential risk predictors. Materials and Methods: Twenty-five patients were treated with at least one lower impacted third molar extraction. The primary outcome was the onset of post-operative pain, evaluated at 6 h, 12 h, 24 h, 48 h, 72 h, and 7 days. The secondary outcomes (trismus, edema, alveolitis, dehiscence, neuralgic injury, and suppuration) were recorded at 3, 7 and 21 days after oral surgery. A correlation analysis was performed to identify potential associations between patient- and tooth-related factors and VAS (Visual Analogue Scale) scale. When a statistically significant correlation was identified, a regression analysis was performed. Results: Most of the patients were female (84%) with a mean age of 25 ± 3 years; the reason for oral surgery was dysodontiasis in 60% of cases, while the most frequent Pell and Gregory class was BII (36%). The VAS scale showed the onset of mild pain at 6 h (44%), 12 h (48%), 24 h (68%) and 48 (68%) after surgery. Trismus, edema, and alveolitis were observed at 3-day (20%, 64% and 12%, respectively) and at 7-day (16%, 12% and 4%, respectively) follow-up. Neuralgic injury was reported in one case (4%). The linear regression analysis showed a statistically significant association (p < 0.05) between the duration of oral surgery and VAS scores at 6 and 12 h. Finally, the binary logistic regression identified systemic disease, Pell and Gregory classification, duration of oral surgery, VAS at 6 and 12 h, trismus, and edema at 3 and 7 days as predictive factors of post-operative complications. Conclusions: Within their limits, the results of this study suggest that the onset of post-operative complications increases in proportion to the duration of the surgical procedure.

The role of surgical flap design (minimally invasive flap vs. extended flap with papilla preservation) on the healing of intrabony defects treated with an enamel matrix derivative: a 12-month two-center randomized controlled clinical trial.

OBJECTIVES: Minimally invasive flap designs have been introduced to enhance blood clot stability and support wound healing. Limited data appear to suggest, that in intrabony defects, better clinical outcomes can be achieved by means of minimally invasive flap compared to more extended flaps. The aim of this study was to evaluate the healing of intrabony defects treated with either minimally invasive surgical flaps or with modified or simplified papilla preservation techniques in conjunction with the application of an enamel matrix derivative (EMD). MATERIALS AND METHODS: Forty-seven subjects were randomly assigned to either test (N = 23) or control (N = 24) procedures. In the test group, the intrabony defects were accessed by means of either minimally invasive surgical technique (MIST) or modified minimally invasive surgical technique (M-MIST) according to the defect localization while the defects in the control group were treated with either the modified or simplified papilla preservation (MPP) or the simplified papilla preservation technique (SPP). EMD was used as regenerative material in all defects. The following clinical parameters were recorded at baseline and after 12 months: full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), probing depths (PD), clinical attachment level (CAL), and gingival recession (GR). Early healing index (EHI) score was assessed in both groups 1 week following the surgery. CAL gain was set as primary outcome. RESULTS: After 12 months follow-up, the CAL gain was 4.09 ± 1.68 mm in test group and 3.79 ± 1.67 mm in control group, while the PD reduction was 4.52 ± 1.34 mm and 4.04 ± 1.62 mm for test and control sites. In both groups, a minimal GR increase (0.35 ± 1.11 mm and 0.25 ± 1.03 mm) was noted. No residual PDs ≥ 6 mm were recorded in both groups. CAL gains of 4-5 mm were achieved in 30.4% and in 29.2% of test and control group, respectively. Moreover, CAL gains ≥ 6 mm were recorded in 21.7% of experimental sites and in 20.8% of control sites. No statistically significant differences in any of the evaluated parameters were found between the test and control procedures (P > 0.05). After 1 week post-surgery, a statistically significant difference (P < 0.05) between the groups was found in terms of EHI score. CONCLUSIONS: Within the limits of this pilot RCT, the results have failed to show any differences in the measured parameters following treatment of intrabony defects with EMD, irrespective of the employed surgical technique. CLINICAL RELEVANCE: In intrabony defects, the application of EMD in conjunction with either MIST/M-MIST or M-PPT/SPPT resulted in substantial clinical improvements.

Effectiveness of a nutraceutical agent in the non-surgical periodontal therapy: a randomized, controlled clinical trial.

OBJECTIVE: Nutraceutical agents have been demonstrated as adjuncts for the treatment of several inflammatory diseases. The present study analyzed and compared new nutraceutical agent as an adjunct to Scaling and root planing (SRP) versus SRP alone for the treatment of periodontitis. MATERIALS AND METHODS: Sixty-six patients with moderate periodontitis were enrolled. Through a randomized design, the patients were randomly assigned to SRP + nutraceutical agent (test group) or SRP alone (control group). Patients were regularly examined the clinical, inflammatory mediators and visual analogue scale (VAS) changes over a 6-month period. Clinical attachment level (CAL) was the primary outcome variable chosen. Gingival crevicular fluid (GCF) inflammatory mediator change and the impact of treatment on VAS were evaluated through a linear regression model. RESULTS: Both treatments demonstrated an improvement in periodontal parameters compared with baseline. After 6 months of treatment, compared with the control group, the test group determined a significant probing depth (PD) (p = 0.003) and bleeding on probing (BOP) reduction (p < 0.001), while CAL gain was significantly obtained at 30 and 60 days after treatment (p < 0.05). In the test group, the level of inflammatory mediators was significantly reduced compared with the control group (p < 0.05). The linear regression analysis demonstrated that the nutraceutical agent exerted, in the test group, a significant influence on VAS at 6, 12, 24, and 48 h after treatment (p < 0.05). CONCLUSIONS: Nutraceutical agent resulted in a more significant reduction in clinical, inflammatory mediators and short-term pain compared with SRP alone. CLINICAL RELEVANCE: Nutraceutical agent, when combined with SRP, was demonstrated to be effective in reducing periodontal parameters and controlling the levels of inflammatory mediators and pain in patients with periodontitis.

Changes in clinical parameters following adjunctive local sodium hypochlorite gel in minimally invasive nonsurgical therapy (MINST) of periodontal pockets: a 6-month randomized controlled clinical trial.

BACKGROUND: The mechanical disruption and removal of the subgingival biofilm represent the most important step in the treatment of periodontitis. However, in deep periodontal pockets, mechanical removal of the subgingival biofilm is difficult and frequently incomplete. Preliminary findings indicate that the use of amino acid buffered sodium hypochlorite (NaOCl) gel may chemically destroy the bacterial biofilm and facilitate its mechanical removal. OBJECTIVES: To clinically evaluate the efficacy of minimally invasive nonsurgical therapy (MINST) of periodontal pockets with or without local application of an amino acid buffered sodium hypochlorite (NaOCl) gel. MATERIALS AND METHODS: Forty untreated patients diagnosed with severe/advanced periodontitis (i.e. stage III/IV) with a slow/moderate rate of progression (i.e. grade A/B) were randomly allocated in two treatment groups. In the test group, the periodontal pockets were treated by means of MINST and NaOCl gel application, while in the control group, treatment consisted of MINST alone. Full-mouth plaque scores (FMPS), full-mouth bleeding scores (FMBS), probing depths (PD), clinical attachment levels (CAL) and gingival recessions (GR) were assessed at baseline and at 6 months following therapy. The primary outcome variable was PD reduction at sites with PD ≥ 5 mm at baseline. RESULTS: At 6 months, statistically significant differences between the two groups were found (p = 0.001) in terms of PD and CAL change. No statistically significant differences were found in terms of GR (p = 0.81). The number of sites with PD ≥ 5 mm and BOP (+) decreased statistically significantly (p = 0.001), i.e. from 85.3 to 2.2% in the test group and from 81.6 to 7.3% in the control group, respectively. Statistically significant differences between test and control groups were recorded at 6 months (p = 0.001). MINST + NaOCl compared to MINST alone decreased statistically significantly (p = 0.001) the probability of residual PDs ≥ 5 mm with BOP- (14.5% vs 18.3%) and BOP+ (2.2% vs. 7.2%). CONCLUSIONS: Within their limits, the present results indicate that (a) the use of MINST may represent a clinically valuable approach for nonsurgical therapy and (b) the application of NaOCl gel in conjunction with MINST may additionally improve the clinical outcomes compared to the use of MINST alone. CLINICAL RELEVANCE: In patients with untreated periodontitis, treatment of deep pockets by means of MINST in conjunction with a NaOCl gel may represent a valuable approach to additionally improve the clinical outcomes obtained with MINST alone.

Healing of periodontal suprabony defects following treatment with open flap debridement with or without an enamel matrix derivative: A randomized controlled clinical study.

OBJECTIVES: To compare the healing of suprabony defects following treatment with either open flap debridement (OFD) and application of an enamel matrix derivative (EMD) with OFD alone. METHODS: Eighty patients with suprabony periodontal defects were randomly assigned to treatment with OFD + EMD (test) or OFD alone (control). The primary outcome variable was the difference in clinical attachment level (CAL) gain. At baseline and after 12 months, full-mouth plaque scores (FMPS), full-mouth bleeding scores (FMBS), probing depths (PD), gingival recessions (GR), and CAL were recorded. RESULTS: Sixty-five patients were available for the 12-month follow-up examination. At 12 months, the mean FMPS was 21.9 ± 3.0% in the OFD + EMD and 21.1 ± 2.4% in the OFD group, respectively (p = 0.30), while mean FMBS measured 20.4 ± 3.4% in the OFD + EMD group and 19.9 ± 2.9% in the OFD group (p = 0.48). Mean CAL gain at sites treated with OFD + EMD was statistically significantly different (p = 0.0001) compared with sites treated with OFD alone (3.4 ± 0.6 mm vs 1.8 ± 0.6 mm). A statistically significant difference (p = 0.0001) was found between mean PD change in the OFD + EMD (3.9 ± 0.6 mm) and OFD alone (3.2 ± 0.6 mm) treated groups and also in terms of mean GR change between treatment with OFD + EMD (0.5 ± 0.7 mm) and OFD alone (1.4 ± 1.0 mm) (p = 0.001). CONCLUSION: Within their limits, the present results indicate that in suprabony periodontal defects, the application of EMD in conjunction with OFD may additionally improve the clinical outcomes compared with OFD alone. CLINICAL RELEVANCE: In periodontal suprabony defects, the application of EMD in conjunction with OFD may additionally enhance the clinical outcomes in terms of CAL gain and PD reduction.

Dimensional changes following alveolar ridge preservation in the posterior area using bovine-derived xenografts and collagen membrane compared to spontaneous healing: a 6-month randomized controlled clinical trial.

OBJECTIVES: To assess dimensional changes following alveolar ridge preservation using bovine-derived xenograft with 10% collagen and collagen membrane compared to ridge preservation by means of bovine-derived xenograft particles and collagen membrane or spontaneous healing in posterior sites. MATERIALS AND METHODS: Forty subjects with 40 posterior teeth or roots candidate to extraction and presenting integrity of alveolar bone walls were randomly allocated into three groups. Patients of test group were treated by ridge preservation technique using bovine-derived xenograft with 10% collagen and collagen membrane; patients of control group 1 were treated by means of bovine-derived xenograft particles and collagen membrane while in patients of control group 2, no grafting was performed. Changes in vertical and horizontal bone dimensions were compared at baseline and after 6-month observation time. RESULTS: Statistically significant differences between baseline and 6 month were observed in all groups in terms of vertical and horizontal bone resorption (p < 0.001), except for vertical resorption in control group 2. After 6-month intergroup comparisons showed not statistically significant changes between test and control groups in terms of alveolar bone changes (p > 0.05). CONCLUSIONS: Within the limits of this study, the sites grafted using bovine-derived xenograft with 10% collagen in combination with a collagen membrane showed no statistical differences in terms of vertical and horizontal bone resorption compared to control groups. CLINICAL RELEVANCE: Ridge preservation in posterior area failed to show clinically relevant benefits in sites presenting integrity of alveolar bone walls and adequate buccal bone wall thickness.

Association between periodontitis and glycosylated haemoglobin before diabetes onset: a cross-sectional study.

OBJECTIVES: The aim of the present cross-sectional study was to investigate the association between serum glycosylated haemoglobin (HbA1c) levels and periodontal status in patients with periodontitis (CP) and periodontally healthy controls. Furthermore, the objectives were to determine if the periodontitis influenced the serum HbA1c levels. MATERIALS AND METHODS: A total of 93 patients with CP and 95 periodontally healthy subjects were enrolled in the present study using a cross-sectional design. At baseline, patients were examined and characterized on a regular basis for blood serum parameters and non-fasting blood samples levels. In all patients, a full periodontal examination was performed and clinical attachment loss (CAL) was the primary outcome variable chosen. The spearman correlation, a stepwise multivariable linear regression, and Jonckheere-Terpstra tests were applied in order to assess the relationship between HbA1c levels and periodontitis. RESULTS: Patients in the CP group presented a significantly higher median serum level of HbA1c [40.9 (31.2; 45.6) mmol/mol)] compared to patients in the healthy control group [35.3 (29.6; 38.6) mmol/mol)] (p < 0.001). HbA1c levels were negatively correlated with the number of teeth and positively correlated with C-reactive protein levels and all periodontal parameters (p < 0.001). Moreover, there was a significant decrease in the number of teeth when HbA1c levels increased (P-trend < 0.001), while there was a significant increase in periodontal parameters (CAL, p = 0.002); PD, p = 0.008; BOP, p < 0.001) when levels of HbA1c increased. CONCLUSIONS: Patients with CP and undiagnosed diabetes presented significantly higher serum levels of HbA1c compared to periodontally healthy controls. Moreover, the presence of periodontitis was positively correlated with serum HbA1c levels before diabetes onset. CLINICAL RELEVANCE: HbA1c levels were positively correlated with the severity of periodontitis before diabetes onset.

Anti-infective therapy of peri-implant mucositis with adjunctive delivery of a sodium hypochlorite gel: a 6-month randomized triple-blind controlled clinical trial.

OBJECTIVE: To evaluate the effects of adjunctive delivery of a sodium hypochlorite gel in the treatment of peri-implant mucositis (PM). MATERIALS AND METHODS: Forty-six subjects with 68 implants diagnosed with PM were randomly assigned to two treatment groups. Prior to mechanical debridement, a sodium hypochlorite gel was delivered to the implants of the test group while implants of the control group received a placebo gel. Application of both test and placebo gels was repeated 5 times at baseline. The primary outcome variable was the change in pocket probing depth (PPD) between baseline and 6 months. RESULTS: After 6 months, the mean PPD decreased statistically significantly from 3.93 ± 1.09 mm to 3.04 ± 0.46 mm in the test (p = 0.0001) and from 3.68 ± 0.85 mm to 3.07 ± 0.58 mm in the control (p = 0.0001) group, respectively. No statistically significant difference (p = 0.53) was observed with respect to PPD changes from baseline to 6 months between test (0.88 ± 1.04 mm) and control group (0.61 ± 0.75 mm), respectively. The number of implants with bleeding on probing (BoP) decreased statistically significantly from 33 to 18 in the test group (p = 0.0001) and from 34 to 23 in the control group (p = 0.0001) after 6 months. CONCLUSIONS: In conclusion and within the limits of the present study, changes in PPD from baseline to 6 months were not statistically significantly different between groups. Complete resolution of mucosal inflammation was not achieved with either of the therapies. CLINICAL RELEVANCE: The present outcomes have showed that a complete resolution of peri-implant mucositis is not possible to obtain by means mechanical debridement with or without a sodium hypochlorite gel application.

Efficacy of a drug composed of herbal extracts on postoperative discomfort after surgical removal of impacted mandibular third molar: a randomized, triple-blind, controlled clinical trial.

OBJECTIVES: This study investigated and compared the effectiveness of a phytotherapeutic drug composed of herbal extracts on postsurgical discomfort after mandibular third molar surgery. MATERIALS AND METHODS: Eighty-two patients requiring the surgical removal of a mandibular third molar were randomly assigned to receive placebo (group 1), ibuprofen (group 2), and a phytotherapeutic drug (composed of baicalin, 190 mg; bromelain, 50 mg; escin, 30 mg) (group 3). Drugs were administered after tooth extraction twice a day for 5 days. The primary outcome, pain, was evaluated using a visual analogue scale at 2 h, 6 h, 12 h, 24 h, 48 h, and 7 and 10 days after surgery. The secondary outcomes were the changes in maximum mouth opening and facial contours (mm) between baseline and at 24 h, 72 h, and 7 and 10 days after surgery. RESULTS: Compared to the baseline, all treatments demonstrated an improvement in the primary and secondary outcomes. Moreover, compared to groups 1 and 2, patients in group 3 yielded a significant reduction of the postoperative pain score at 12 h (p < 0.001), 24 h (p = 0.010), and 48 h (p = 0.048) after surgery. The mean reduction of the swelling and trismus was similar between groups. CONCLUSIONS: The results of this study suggest that a postoperative administration of a phytotherapeutic drug was found to be effective in postoperative pain management after the surgical removal of impacted mandibular third molars. CLINICAL RELEVANCE: The phytotherapeutic drug composed of herbal extract determined a decrease in the severity of postoperative pain compared to ibuprofen and placebo.

Implant surface roughness alterations induced by different prophylactic procedures: an in vitro study.

AIM: To evaluate surface roughness alterations at the smooth neck of dental implants after the use of eight different prophylactic procedures. MATERIALS AND METHODS: 50 tissue level implants (Institut Straumann AG, Basel, Switzerland) were used for the present investigation. The smooth collar of each implant was divided into two segments, each treated with one of eight cleaning procedures: use of a rubber cup (RCZ) or a brush (BZ) combined with an abrasive paste containing zirconium or a paste derived from perlite (RCP, BP); use of 2 composite resin burs reinforced by zirconium glass fibers (F1, F2); and use of an air-polishing system with glycine powder and two power settings (AP1, AP2). The qualitative alterations were recorded by means of a laser profilometer and the mean roughness (Ra ) and mean roughness profile depth (Rz ) were reported. Twenty untreated surfaces were used as controls. RESULTS: The implant collars treated with RCZ (Ra  = 0.33 µm, Rz  = 2.43 µm) or BZ (Ra  = 0.30 µm, Rz  = 3.70 µm) yielded the highest roughness values, followed by the surfaces treated with RCP (Ra  = 0.28 µm, Rz  = 2.02 µm), with BP (Ra  = 0.25 µm, Rz  = 2.16 µm) and by the use of F1 (Ra  = 0.27 µm, Rz  = 2.22 µm) and F2 (Ra  = 0.27 µm, Rz  = 2.04 µm). The lowest roughness values were observed in the AP1 (Ra  = 0.23 µm, Rz  = 1.60 µm) and AP2 (Ra  = 0.16 µm, Rz  = 1.06 µm) group, respectively. Implant collars treated with AP2 yielded statistically significantly lower (P = 0.01) Rz values compared with untreated surfaces. CONCLUSION: All tested procedures did not increase implant surface roughness significantly. Treatment with an air-powder abrasive system at high-pressure setting resulted in a smoothening of the implant collar surface.

Biofilm removal from implants supported restoration using different instruments: a 6-month comparative multicenter clinical study.

OBJECTIVES: The aim of this study was to compare the efficacy of different instruments on biofilm removal from implant supported restorations. MATERIALS AND METHODS: The study was designed as comparative multicenter clinical study including patients proceeding from the Milan, Naples, and Buenos Aires, with a peri-implant mucositis. Implants enrolled for the study were allocated in 4 groups and treated with ultrasonic scalers with plastic tips, with titanium curettes, with airflow with glycine powder, and with rubber cup and polishing paste, respectively. mPI was assessed at baseline, immediately after therapy, at 1, 3, and 6 months. mBI, PD, and REC were assessed at baseline, 1, 3, and 6 months. All parameters were recorded on six sites per implant. Kruskal-Wallis and Mann-Whitney tests were used to compare groups and centers. A generalized linear model for repeated measures was chosen for inter-group comparison. An intra-group comparison was performed with repeated measure ANOVA test to assess differences between baseline and recalls. RESULTS: A total of 89 patients (39 males, 50 females) were enrolled in the study, and 141 implants were available for the analysis. 55 implants were enrolled in University of Buenos Aires, 32 in University of Milan, and 54 in University of Naples. There were no significant differences between the four groups in inflammatory status reduction of peri-implant mucosa. CONCLUSIONS: Non-surgical therapy is effective in reducing peri-implant mucositis. Sonic scaler with plastic tip and rubber cup with polishing paste showed higher efficacy when compared with titanium curettes or airflow with glycine powder.

Clinical and radiographic outcomes of a combined resective and regenerative approach in the treatment of peri-implantitis: a prospective case series.

AIM: To assess the clinical and radiographic outcomes applying a combined resective and regenerative approach in the treatment of peri-implantitis. MATERIALS AND METHODS: Subjects with implants diagnosed with peri-implantitis (i.e., pocket probing depth (PPD) ≥5 mm with concomitant bleeding on probing (BoP) and ≥2 mm of marginal bone loss or exposure of ≥1 implant thread) were treated by means of a combined approach including the application of a deproteinized bovine bone mineral and a collagen membrane in the intrabony and implantoplasty in the suprabony component of the peri-implant lesion, respectively. The soft tissues were apically repositioned allowing for a non-submerged healing. Clinical and radiographic parameters were evaluated at baseline and 12 months after treatment. RESULTS: Eleven subjects with 11 implants were treated and completed the 12-month follow-up. No implant was lost yielding a 100% survival rate. At baseline, the mean PPD and mean clinical attachment level (CAL) were 8.1 ± 1.8 mm and 9.7 ± 2.5 mm, respectively. After 1 year, a mean PPD of 4.0 ± 1.3 mm and a mean CAL of 6.7 ± 2.5 mm were assessed. The differences between the baseline and the follow-up examinations were statistically significant (P = 0.001). The mucosal recession increased from 1.7 ± 1.5 at baseline to 3.0 ± 1.8 mm at the 12-month follow-up (P = 0.003). The mean% of sites with BoP+ around the selected implants decreased from 19.7 ± 40.1 at baseline to 6.1 ± 24.0 after 12 months (P = 0.032). The radiographic marginal bone level decreased from 8.0 ± 3.7 mm at baseline to 5.2 ± 2.2 mm at the 12-month follow-up (P = 0.000001). The radiographic fill of the intrabony component of the defect amounted to 93.3 ± 13.0%. CONCLUSION: Within the limits of this study, a combined regenerative and resective approach for the treatment of peri-implant defects yielded positive outcomes in terms of PPD reduction and radiographic defect fill after 12 months.

Clinical, radiographic, and esthetic evaluation of immediately loaded laser microtextured implants placed into fresh extraction sockets in the anterior maxilla: a 2-year retrospective multicentric study.

OBJECTIVES: To assess the clinical, radiographic, and esthetic outcomes of implants with a laser microtextured collar placed in the anterior region of the maxilla at the time of tooth extraction and immediately temporized. METHODS: Forty-six Tapered Internal Laser-Lok BioHorizons implants were immediately placed and immediately restored with nonfunctional loading in 46 patients (24 men and 22 women) with a thick gingival biotype, ideal gingival level/contour, and postextraction intact walls. Survival rate, cortical bone loss, and periimplant mucosal responses were evaluated at 6, 12, and 24 months. RESULTS: Survival rate was 95.6%. Mean mesial and distal marginal bone loss, 24 months after installation, were 0.58 mm (SD = 0.53; range, 0.17-1.15) and 0.57 mm (SD = 0.70; range, 0.42-1.10), respectively. A mesial and distal papilla regrowth mean of 1.8 and 1.5 mm, respectively, were found. The midfacial soft tissue levels showed 0.12 mm of mean recession after 24 months. CONCLUSION: Immediate implants with a laser microtextured surface restored at the day of surgery, may be considered as a predictable procedure in terms of implant survival and hard and soft tissue remodeling.

Clinical and radiographic outcomes of implants placed in extraction sites treated with alveolar ridge preservation: a 10-year retrospective analysis of a case series.

OBJECTIVES: The aim of the present study was to evaluate clinical and radiographic outcomes of implants placed in alveolar sockets treated by means of alveolar ridge preservation after 10 years of follow-up. METHOD AND MATERIALS: Eleven patients treated with 11 implants placed after alveolar ridge preservation using bovine-derived xenograft particles and collagen membrane were selected. Full-mouth plaque score, full-mouth bleeding score, probing depth at four sites per implant, and radiographic marginal bone level at mesial and distal aspects for each implant were recorded at baseline and after 10 years of follow-up. The primary outcome was the radiographic marginal bone loss. The marginal bone loss was considered as the difference between marginal bone level at baseline and after 10 years of observation time. RESULTS: After 10 years of follow-up, full-mouth plaque score increased significantly (P < .05), while no statistically significant differences were found in the change in full-mouth bleeding score (P ≥ .05). At the 10-year observation period, a significant increase in probing depth was observed at all sites (P < .05), except at the mesial aspects (P ≥ .05). Radiographic marginal bone loss was 1.1 ± 0.1 mm and 1.0 ± 0.1 mm at mesial and distal sites, respectively. CONCLUSION: Whitin the limitations of the present study, implants placed in post-extraction sockets treated with alveolar ridge preservation yielded stable clinical and radiographic results after 10 years of follow-up.

Clinical and Radiographic Evaluation of Intrabony Periodontal Defects Treated with Hyaluronic Acid or Enamel Matrix Proteins: A 6-Month Prospective Study.

PURPOSE: To compare the regenerative clinical and radiographic effects of cross-linked hyaluronic acid (xHyA) with enamel matrix proteins (EMD) at six months after regenerative treatment of periodontal intrabony defects. MATERIALS AND METHODS: Sixty patients presenting one intrabony defect each were randomly assigned into control (EMD) and test (xHyA) groups. Clinical attachment level (CAL) gain was the primary outcome, while pocket probing depth (PPD), gingival recession (REC), bleeding on probing (BOP), full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), and radiographic parameters such as defect depth (BC-BD), and defect width (DW) were considered secondary outcome variables. Parameters were recorded at baseline and after 6 months. RESULTS: At the 6-month follow-up, 54 patients were available for statistical analysis. In the control and test groups, the mean CAL gain was statistically significant in the intragroup comparison (p < 0.001). 48.1% of test sites showed a CAL gain ≤ 2 mm compared with 33.3% of control sites. The mean PPD reduction was statistically significant in the intragroup comparison in both groups (p < 0.001). The mean REC increase was similar in the two groups: 1.04 ± 1.29 mm vs 1.11 ± 1.22 mm (test vs control). The mean BC-BD, DW, FMPS, FMBS, and BOP changed statistically significantly only in the intragroup comparison, not in the intergroup comparison. CONCLUSION: Both treatments, EMD and xHyA, produced similar statistically significant clinical and radiographical improvements after six months when compared with baseline.

Comparative Study of Systemic vs. Local Antibiotics with Subgingival Instrumentation in Stage III-IV Periodontitis: A Retrospective Analysis.

To improve the clinical and microbiological outcomes of non-surgical mechanical periodontal therapy, the adjunctive use of antimicrobials has been utilized in treating moderate-to-severe periodontitis. In our study, the retrospective design included previously collected health-related patient data, obtained from the printed and digital charts of patients who received systemic or local antibiotic adjuncts to SI (subgingival instrumentation). A total of 34 patients (diagnosed with generalized Stage III/IV periodontitis) met the inclusion and exclusion criteria and were evaluated. The samples were tested for the following bacterial strains: Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans), Porphyromonas gingivalis (P. gingivalis), Prevotella intermedia (P. intermedia), Tanererella forsythia (T. forsythia), and Treponema denticola (T. denticola). The inter-group comparisons of the bacterial species did not show statistically significant differences between groups. The present study aimed to evaluate the clinical effects after SI and the adjunctive use of systemically administered (SA) AMX (amoxicillin) + MET (metronidazole) (administered for 7 days), with locally delivered (LDD) piperacillin + tazobactam in step 2 of periodontal therapy. Results: Overall, all parameters were improved in the groups, with a significant difference in inter-group comparison regarding the full-mouth bleeding score (FMBS) (p < 0.05) in favor of the SA group, and the p-value < 0.05 was considered to be statistically significant. Statistically significant PPD (probing pocket depth) reductions and CAL (clinical attachment level) gains were observed in both groups at the 3-month follow-up. In conclusion, within the limitations, the outcomes of this study suggest that SI, with adjunctive local or systemic antibiotic therapy, provided comparable clinical improvements. Systemic AMX + MET protocols were more efficacious with regard to the reduction in FMBS. Follow-up studies with larger patient numbers are needed to further investigate this effect.

A Single Dose of Piperacillin Plus Tazobactam Gel as an Adjunct to Professional Mechanical Plaque Removal (PMPR) in Patients with Peri-Implant Mucositis: A 6-Month Double-Blind Randomized Clinical Trial.

OBJECTIVES: This randomized, placebo-controlled, double-masked clinical trial aimed to evaluate the clinical and microbiological efficacy of professional mechanical plaque removal (PMPR) with or without adjunctive application of piperacillin plus tazobactam gel in the treatment of peri-implant mucositis (PiM) for up to 6 months. MATERIALS AND METHODS: The study included 31 patients with peri-implant mucositis (bleeding on probing (BoP) > 1 at at least one site at baseline, absence of peri-implant bone loss compared with a previous radiograph). After randomized assignment to test and control groups, patients received full-mouth supragingival scaling with or without piperacillin plus tazobactam gel. Clinical examination was performed at baseline and after 3 and 6 months, and a microbiological examination was performed at baseline and after 3 months. RESULTS: After six months, both treatment modalities resulted in significant reductions and improvements in clinical parameters at the implant sites. Neither study group achieved a complete resolution of PiM (i.e., BoP ≤ 1 per implant). The number of implants with BoP decreased statistically significantly between subsequent time points (p < 0.001) in both the test and the control group. Significant BoP differences (p = 0.039) were observed between groups at 6 months (difference to baseline) following therapy. CONCLUSIONS: Within the limitations of the present study, the single use of a slow-release, locally applied antibiotic combination of piperacillin and tazobactam gel, adjunctive to PMPR, showed an improvement in clinical variable of implants diagnosed with PiM. The adjunctive treatment resulted in higher BoP reduction when compared to the control, but no significant differences were observed regarding the changes in other clinical and microbiological parameters.

Periodontal care as a fundamental step for an active and healthy ageing.

In the industrialized part of the world, an increasing number of people live the old age without too many restrictions due to illness or physiological impairment. This group is known as the young elderly. On the contrary, a consistent part of seniors develops a greater number of medical conditions and become more and more dependent, these are the old elderly. The first cause of tooth lost in industrialized word is periodontitis that generally strikes people older than 40 years and determines serious detriment of the stomatognatic organ. Smoking and stress are risk factors for periodontitis that are common and shared between young, adult, and older age. Diabetes mellitus, obesity, and osteoporosis are very frequent pathological situations in older age. They have been identified as cofactors in the progression of periodontitis. Many dental associations recognize the importance of continued research on oral fluids diagnostics and welcome the development of rapid point-of-care tests providing accurate measurements of clinically validated biomarkers. At present, well-studied molecules associated with host response factors and with derived tissue destruction mediators have been proposed as diagnostic biomarkers for periodontitis detected in the oral fluids.