Ibero-Panamerican Federation of Periodontology Delphi study on the trends of periodontology and periodontics by the year 2030. A Latin American consensus.

BACKGROUND AND OBJECTIVE: As elsewhere in the world, the prevalence of periodontitis in stages I-II is high in the Latin American population, this scenario emphasizes the need for identification of urgent needs for allocating adequate resources to provide diagnosis, prevention, and treatment of these diseases. The aim of this Delphi study was to predict the trends in periodontology/periodontics in the Latin American region by the year 2030. METHODS: A steering committee and an advisory group of experts in periodontology/periodontics were selected from 16 countries. An open questionnaire of 60 questions was validated and used following the Delphi methodology. RESULTS: Two hundred and twenty-five experts from Latin America answered the two rounds of the questionnaire. Moderate to strong consensus was reached on 45 questions (75%). The prediction was that the prevalence of gingivitis and periodontitis in stages I and II will be maintained, the importance of the link with systemic diseases will increase, and the impact of prevention and periodontal treatment will also increase, mainly in the private sector. There was a strong consensus that plastic and regenerative surgical procedures will increase, as well as the demand for training in the specialty of periodontology. CONCLUSIONS: The present study has provided relevant and useful information on predictions in periodontology/periodontics in Latin America, with important level of consensus among experts. It has been predicted that periodontitis will still be a highly prevalent disease, and its links with other medical conditions should demand more attention by health authorities to develop adequate prevention and management policies and strategies.

Factors associated with the performance and achieving goals of specialized periodontal procedures in Brazilian dental specialties centers.

BACKGROUND: The Brazilian Dental Specialty Centers (CEO, in Portuguese) represent the strategy of the National Oral Health Policy to provide secondary-level dental care. They offer more complex procedures, such as the treatment of periodontitis. This study aims to investigate the factors associated with the performance and the achievement goals of specialized procedures and the achievement gols of periodontics in CEO. METHODOLOGY: Analytical and cross-sectional study using secondary data. The database of the second cycle of the External Evaluation of the National Program for Improving Access and Quality in CEO (PMAQ-CEO, in Portuguese), was utilized, which assessed 1,042 CEO on-site in 2018. The data were analyzed using multiple Poisson regression, estimating the prevalence ratio (PR) (p < 0.05). RESULTS: A third of the CEO (n = 305) performed all specialized procedures, with a higher prevalence observed in those with more than one bicarbonate jet prophylaxis unit (RP = 2.12; 95% CI: 1.160-3.881; p = 0.015) and when they had a higher percentage of specialist professionals (RP = 1.004; 95% CI: 1.002-1.006; p < 0.001). The periodontics goal was achieved by 617 (59.2%) CEO, with a higher prevalence among those who had a manager with supplementary training (PR = 1.21; 95% CI: 1.100-1.335; p < 0.001) and with a higher workload for the periodontist dentist (PR = 1.15; 95% CI: 1.103-1.201; p < 0,001). CONCLUSION: Although most CEOs do not perform allspecialized periodontics procedures, more than half achieved the established goals. The provision of specialized periodontics services in CEO and the achievement of goals are influenced by the quantity and professional qualifications, as well as the availability of equipment.

Importance of periodontal phenotype in periodontics and restorative dentistry: a systematic review.

BACKGROUND: Periodontal phenotype is regarded to be one of the key factors influencing the efficacy of restorative therapies in dental practice. The objective of the systematic review was to explore the importance of thin and thick periodontal phenotypes and how they affect the outcome of periodontal and restorative therapies by looking at a number of academic publications from various online databases. METHODS: Following the PRISMA guidelines (Preferred Reporting Items for Systematic Review standards), relevant data will be searched and retrieved from three significant scientific databases, including PubMed, EBSCO, and Scopus. The articles with full texts that matched the keywords and published in English between 2018 and 2023 were taken into consideration. RESULTS: The majorities of these articles were based on the type of periodontal phenotype and their impact on periodontal and restorative treatment outcomes were selected. The initial search yielded a total of 530 articles. Only 273 were relevant to the review's objectives, and these were considered for determining eligibility. Only 20 publications were eligible for analysis. CONCLUSION: Understanding these anatomical aspects of periodontal phenotype is crucial to both periodontology and restorative dentistry. The clinical outcome of restorative, prosthetic, orthodontic, surgical, and periodontal therapies is determined in large part by the periodontal phenotype, which also plays a significant role in clinical failure or success in dental treatments. TRIAL REGISTRATION: This study protocol registered with the International Prospective Register of Systematic Reviews (PROSPERO) dated 16th June 2023 with the registration ID CRD42023432568.

The effect of virtual simulation technology applied to undergraduate teaching of periodontal probing.

INTRODUCTION: The rise of virtual simulation technology and dental simulators has created a new pedagogical approach for undergraduate medical education. The purpose of this study is to evaluate the effect of virtual simulation (VS) technology on improving the students' comprehensive abilities in periodontal probing teaching in pre-practicum periodontology, such as increasing the accuracy of probing, tactile perception and performance on force control. MATERIALS AND METHODS: Twenty students were randomly selected among the fourth-year students and equally divided into VS technology teaching group (VS group) and traditional teaching group (TT group) by drawing half lots. One day later, students were required to probe the periodontal pathology model. The consistency rate between PD measurements and PD reference values, time consumption and final exam scores were recorded and statistically analysed using an unpaired Student's t test and p < .05 was considered statistical significance. Finally, questionnaires relating to teaching methods evaluation and the fidelity of the digital VS training system were distributed to students and teachers. RESULTS: VS group had a significantly higher consistency rate (72.976 ± 6.811%) than TT group (64.107 ± 4.988%, p = .004). To specify, the difference of consistency rates between the two groups in posterior teeth was larger than anterior teeth. Similarly, a larger difference was also found in proximal surfaces compared with buccal-lingual surfaces. As the pocket depth increased, the difference between the two groups increased too. These results indicated that VS is more efficient in complicated parts of periodontal probing teaching. In addition, students in VS group spent less time and gained a higher score than TT group (p < .05). The overall satisfaction rating in VS group was significantly higher than TT group. Lastly, teachers gave significant lower scores than students concerning the fidelity of VS system. CONCLUSION: Although there are much to improve, VS technology has obvious advantages in periodontal probing teaching in pre-practicum periodontology.

An Endodontology Icon Who Fostered an Appreciation for Pulpal Biology and Its Relevance to Restorative Dentistry and Periodontics: Dr. Kaare Langeland.

The impact of ground-breaking research on the dental pulp and its response to dental procedures, materials and associated diseases significantly influenced the evolution and scope of Endodontics, creating a science of Endodontology. While there were scattered studies in the early 20th century in this regard, the clarification and codification of these concepts took a major leap forward in the late 1950s due to the academic prowess and in-depth research endeavors of Dr. Kaare Langeland. The story begins during World War I in Norway.

Introducing Nanozymes: New Horizons in Periodontal and Dental Implant Care.

The prevalence of periodontal and peri-implant diseases has been increasing worldwide and has gained a lot of attention. As multifunctional nanomaterials with enzyme-like activity, nanozymes have earned a place in the biomedical field. In periodontics and implantology, nanozymes have contributed greatly to research on maintaining periodontal health and improving implant success rates. To highlight this progress, we review nanozymes for antimicrobial therapy, anti-inflammatory therapy, tissue regeneration promotion, and synergistic effects in periodontal and peri-implant diseases. The future prospects of nanozymes in periodontology and implantology are also discussed along with challenges.

Errors and complications in clinical periodontal practice due to methodologic bias and bad interpretation of the evidence.

Different types of errors and complications may arise during and after the execution of periodontal or implant-related procedures. Some of the most relevant, although also controversial, and less commented, causative agents of errors and complications are methodological biases and bad interpretation of the evidence. Proper assessment of the literature requires of solid clinical knowledge combined with a systematic approach built on the recognition of common methodological biases and the avoidance of interpretive errors to critically retrieve, dissect, and judiciously apply available information for the promotion of periodontal and peri-implant health. This review addresses common types of methodological bias and interpretive errors that can alter the reader's perceptions on the real effect and potential ramifications of the reported outcomes of a given therapeutic approach due to bad interpretation of the available evidence: (1) types of methodological biases; (2) spin and interpretive bias; (3) interpretation pitfalls when assessing the evidence (4) choice of relevant endpoints to answer the question(s) of interest; and (5) balance between statistical significance and clinical relevance.

Why is there a lack of evidence regarding errors and complications in periodontal and implant therapy?

The occurrence of errors, complications, and adverse effects may occur as a consequence of single or multiple events related to the clinician and/or patient. Apparently, the amount of dental literature on these undesirable outcomes has not been as prolific as that obtained for conventional primary periodontal outcome measures. This review explores the potential reasons for the lack of studies reporting on errors and complications in periodontal and implant therapy, as well as other noteworthy methodological aspects, to enlighten their impact on the selection of the best (or most appropriate) "gold standard" periodontal/implant-related treatment options, and on the overall decision-making process. The following points were addressed: (a) the importance of reporting errors and complications in clinical research; (b) the adequate reporting of errors and complications in periodontology and dental implantology; and (c) efficacy trials vs effectiveness studies and their impact on the assessment and report of periodontal and implant treatment-related risks and complications.

Complications and treatment errors involving periodontal tissues related to orthodontic therapy.

In this review, typical clinical complications involving periodontal tissues are illustrated that can be encountered in conjunction with orthodontic therapy (OT). Special considerations are given for various clinical scenarios, such as the patient presenting in periodontal health, with periodontitis, or with mucogingival conditions. While some of the complications are seen as common side effects of OT, other, more severe, problems that could have been avoided may be viewed as treatment errors. Recommendations are made on how to prevent these complications, based on the currently available evidence, on clinical practice guidelines, and on expert opinion. In conclusion, while there are several areas in which OT can have unwanted adverse effects on periodontal/mucogingival conditions, there is also great potential for synergies, offering opportunities for close cooperation between the two specialties (periodontics and orthodontics) for the benefit of patients affected by tooth malpositioning and/or periodontal or mucogingival problems.

Assessment of gingival thickness in multi-ethnic subjects with different gingival pigmentation levels.

AIM: Assessment of the thickness of gingival tissues using the probe visibility test is regarded as the method of choice during routine examinations. However, the probe visibility test has not been validated for patients with gingival pigmentation and its accuracy in populations with physiological gingival pigmentation is yet unknown. This study aims to evaluate different methods for the clinical assessment of gingival thickness in participants with varying levels of gingival pigmentation. MATERIALS AND METHODS: Buccal mucosa of the maxillary right central incisor teeth of 171 participants was evaluated using four methods, which were direct measurements using calliper, transgingival probing method using an endodontic probe, and probe visibility method using Colorvue biotype probe (CBP) and UNC-15 probe. The pigmentation of the gingiva was assessed using the Dummett-Gupta oral pigmentation lesion index. RESULTS: The average gingival thickness of the selected population was 1.22 ± 0.38 mm with a distribution of 70% thick and 30% thin gingiva. Transgingival and calliper methods showed good agreement and significant correlation (r = 0.229; p = .003). Visual assessment using CBP and UNC-15 probe showed poor agreement with the direct measurement methods. Gingival pigmentation significantly affected the probe visibility assessment, reducing the visibility of both the CBP (odds ratio [OR] = 4.00; 95% confidence interval [CI], 1.83-8.74) and UNC-15 probe (OR = 1.84; 95% CI, 1.05-3.23) while controlling for thickness of the gingiva. CONCLUSION: The probe visibility method using either CBP or the UNC-15 probe is affected by the degree of gingival pigmentation. Direct measurements using either a calliper or transgingival probing are recommended as methods to measure the gingival thickness in populations with gingival pigmentation.

Anne Haffajee: An inspirational role model.

This article honors Dr. Anne Haffajee's career, her highest research standards, scholarly integrity, and inspirational mentorship. Anne-as she liked to be called-was one of the most productive clinical scientists of her time. Gifted with the unique combination of knowledge in the fields of clinical research, oral ecology, data analysis, and computer programing, her work triggered unprecedented advances in the diagnosis, progression, and treatment of periodontitis. Anne's pivotal clinical trials elucidated the effects of non-surgical and surgical periodontal therapies. In addition to her scholarly achievements, Anne played an important role in mentoring young scientists, many of whom have developed independent leadership careers in periodontal research. She always found time to help her mentees, and ultimately became a warm-hearted friend to many of them, including myself. Anne was consistently devoted to contributing to the future of clinical investigation, and more specifically concerned about the lack of interest by (1) funding agencies in supporting such studies and by (2) the new generation of investigators in pursuing a career in the area. She passed away prematurely, in 2013, at the age of 65. Undoubtedly, her work and legacy assured the continuity of high-standard clinical studies in periodontics and the survival of a whole generation of clinical researchers.

Influence of decision-making algorithms on the diagnostic accuracy using the current classification of periodontal diseases-a randomized controlled trial.

OBJECTIVES: To examine the influence of the decision-making algorithms published by Tonetti and Sanz in 2019 on the diagnostic accuracy in two differently experienced groups of dental students using the current classification of periodontal diseases. MATERIALS AND METHODS: Eighty-three students of two different clinical experience levels were randomly allocated to control and study group, receiving the staging and grading matrix, resulting in four subgroups. All diagnosed two patient cases with corresponding periodontal charts, panoramic radiographs, and intraoral photographs. Both presented severe periodontal disease (stage III, grade C) but considerably differed in complexity and phenotype according to the current classification of periodontal diseases. Controls received the staging and grading matrix published within the classification, while study groups were additionally provided with decision-trees published by Tonetti and Sanz. Obtained data was analyzed using chi-square test, Spearman's rank correlation, and logistic regression. RESULTS: Using the algorithms significantly enhanced the diagnostic accuracy in staging (p = 0.001*, OR = 4.425) and grading (p < 0.001**, OR = 30.303) regardless of the clinical experience. In addition, even compared to the more experienced control, less experienced students using algorithms showed significantly higher accuracy in grading (p = 0.020*). No influence on the criteria extent could be observed comparing study groups to controls. CONCLUSION: The decision-making algorithms may enhance diagnostic accuracy in dental students using the current classification of periodontal diseases. CLINICAL RELEVANCE: The investigated decision-making algorithms significantly increased the diagnostic accuracy of differently experienced under graduated dental students and might be beneficial in periodontal education.

Discriminant validity of the current gingivitis classification in adolescents: a cohort study.

OBJECTIVES: To compare the prevalence of gingivitis estimated by the 2018 European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) classification with the other case definitions and assess the ability of this classification system in discriminating sociodemographic and clinical factors associated with the presence of gingivitis in a cohort study. MATERIALS AND METHODS: A multistage random sample of 1134 12-year-old adolescents was submitted to a full-mouth examination according to the Community Periodontal Index. Socioeconomic and clinical variables were collected at baseline. Gingivitis was considered according to the following criteria: (a) ≥ 10% of bleeding sites (the 2018 EFP/AAP criteria); (b) ≥ 15% of bleeding sites; and (c) the mean full-mouth bleeding sites. Adjusted multilevel Poisson regression assessed the association between independent variables at baseline and each definition of gingivitis at 2-year follow-up. RESULTS: Seven hundred forty-two 14-year-old adolescents were re-revaluated at follow-up. The prevalence of gingivitis was 28.7% according to 10% of bleeding threshold. The 2018 EFP/AAP criteria and other definitions showed higher prevalence and mean of gingivitis for low-household income adolescents and for those with higher levels of dental plaque and untreated dental caries. Nonetheless, the highest strengths of association were observed for the threshold of ≥ 15% of bleeding sites. CONCLUSION: The 2018 EFP/AAP case definition of gingivitis showed a similar discriminant validity compared to the 15% threshold and the mean full-mouth bleeding sites. CLINICAL RELEVANCE: The 2018 EFP/AAP classification allows the discrimination of important risk factors and should be used for the establishment of priorities for large-scale therapeutic programs.

Assessment of suturing and scaling skills of periodontology and oral medicine residents by OSATS method: a pilot study.

INTRODUCTION: Updating the method for evaluating suturing and scaling skills in dental education has attracted relatively little attention and there is no consensus to what should be assessed and how. The purpose of this study was to investigate the applicability of the Objective Structured Assessment of Technical Skill (OSATS) method for these two basic skills, the possible association between the scores and demographic factors, and the level of satisfaction of residents with this method. METHODS: All six periodontics and three oral medicine residents were recruited by census method and video-recorded while performing a simple interrupted suture, a figure eight suture and scaling on a model. Then, the videos were evaluated independently via a checklist and a global rating scale (GRS) by two expert raters. Agreement between raters and residents' satisfaction were evaluated. Correlation between demographic factors of participants and scores was also assessed. T-test and linear regression analysis were used. RESULTS: There was no significant difference between the scores based on the views of the two raters for each of the checklist (ICC = 0.99, CI = 0.96-0.99, P < 0.001) and GRS (ICC = 0.97, CI = 0.86-0.99, P < 0.001). Linear regression showed no correlation between gender and scores but periodontics major and higher year of education showed correlation with higher scores. CONCLUSION: Considering the excellent agreement between raters in using both the checklist and GRS components of OSATS, and satisfaction of 88% the residents with this method, it seems to be able to provide a reliable assessment.

The Involvement of Photobiology in Contemporary Dentistry-A Narrative Review.

Light is an emerging treatment approach that is being used to treat many diseases and conditions such as pain, inflammation, and wound healing. The light used in dental therapy generally lies in visible and invisible spectral regions. Despite many positive results in the treatment of different conditions, this therapy still faces some skepticism, which has prevented its widespread adoption in clinics. The main reason for this skepticism is the lack of comprehensive information about the molecular, cellular, and tissular mechanisms of action, which underpin the positive effects of phototherapy. However, there is currently promising evidence in support of the use of light therapy across a spectrum of oral hard and soft tissues, as well as in a variety of important dental subspecialties, such as endodontics, periodontics, orthodontics, and maxillofacial surgery. The merging of diagnostic and therapeutic light procedures is also seen as a promising area for future expansion. In the next decade, several light technologies are foreseen as becoming integral parts of modern dentistry practice.

Periodontists' perceptions and attitudes toward the use of social media for professional purposes in Saudi Arabia.

BACKGROUND: There is a notable increase in the usage of social media platforms, especially for health communication, as more clinicians and patients count on this kind of technology. Therefore, this research aimed to investigate the perception and attitude toward social media (SM) use for professionalism and dental practice promotion among periodontal specialists working in Saudi Arabia (KSA). METHODS: Electronic surveys were distributed in person or online using WhatsApp, Snapchat or Email from October 2022 until March 2023. The questionnaire was targeting periodontists in KSA, and it consists of three parts: the first part includes sociodemographic and professional data; the second part asks about the daily usage of SM in dental practice; and the third part asks about the periodontist's opinion about SM usage. Descriptive data were presented as numbers and percentages. The association between the demographic variables and the means of periodontists' opinions was tested using Pearson's chi-square test. Any value equal to or less than 0.05 was considered statistically significant. RESULTS: A total of 121 responses were received from the periodontists. Most of the participants were in the 36-45 age group, with a percentage of 40.5%. In terms of gender, males made up 52.9% of the population, while females made up 47.1%, and the majority of the participants were consultants. The most common SM platform used by periodontists for daily using and dental practice promotion was Snapchat (56.2%), followed by Instagram and Twitter (54.5% and 49.6%, respectively). There was a significant difference in proportions among Twitter, Snapchat and TikTok between older and younger periodontists, with a p value < 0.05. There was no significant difference between the gender of the participants and their opinions regarding the usage of SM. CONCLUSIONS: This study highlighted the effectiveness of SM in the promotion of dental practices and the discipline of periodontics, as more clinicians and patients rely on this kind of technology. These online platforms can improve periodontal practice in terms of dental health education, counseling, advertising, and oral health services.

The yawning gap: Waiting for cariology to germinate whilst periodontology is fruiting.

INTRODUCTION: The aim of this study is to investigate whether periodontology and cariology receive equal emphasis in dental education at two moments in time, thirteen years apart. MATERIALS AND METHODS: An online search was conducted in Nov 2021 of all the dental schools in ten English-language speaking countries (U.S., Canada, U.K., Ireland, South Africa, Australia, New Zealand, Singapore, Hong Kong, and Malaysia) to identify departments/divisions in the disciplines of periodontology, cariology, and conservative/restorative/operative dentistry. The results were then compared against the findings of a similar investigation that was conducted from July to October 2008. RESULTS: Of the 126 dental schools identified in 2021, information was available for 93 dental schools. Of these 93 schools, only 10 listed departments/divisions/disciplines of cariology, whereas 83 and 86 schools had listed periodontology and conservative/restorative/operative dentistry, respectively. Despite a doubling of the number of dental schools with a department/division/discipline of cariology from 2008 to 2021, the absolute gap in the number of departments/divisions/disciplines in the other two disciplines compared to cariology had widened during the thirteen years. In 2008, there were 70 more departments/divisions/disciplines in periodontology compared to cariology departments/divisions/disciplines. In 2021, there were 73 more departments/divisions/disciplines in periodontology. Additional information on research output was available for 90 dental schools in 2021, where 30 schools self-identified as undertaking cariology research, whereas 68 and 47 schools undertook research in periodontology and conservative/restorative/operative dentistry, respectively. CONCLUSIONS: Dental education does not give equal emphasis to periodontology and cariology, and the discipline of cariology is grossly neglected.

Antibiotics in the non-surgical treatment of peri-implantitis.

DATA SOURCES: Four electronic databases (MEDLINE via Pubmed; EMBASE via Ovid; EBSCO Dentistry and Oral Science Source), in addition to six related journals (Clinical Implant Dentistry and Related Research; Clinical Oral Implants Research; International Journal of Oral and Maxillofacial Implants; International Journal of Oral Implantology; Journal of Clinical Periodontology; Journal of Periodontology), were searched for publications until 2022. STUDY SELECTION: Randomised controlled trials (RCTs), evaluating the effectiveness of local or systemic antibiotics as an adjunct in the non-surgical treatment (NST) for peri-implantitis (PI), were assessed. The eligibility criteria included RCTs with a parallel group, split-mouth design and appropriate NST interventions over a three to twelve month period. DATA EXTRACTION AND SYNTHESIS: Data were extracted from RCTs to capture a multitude of primary outcomes, including: implant success rate, radiographic marginal bone loss rate, periodontal health changes and PI resolution. Risk of bias assessments were made using the Cochrane Collaboration's tool, by two authors independently and in duplicate. RCTs with similar observation periods and interventions were included in the meta-analyses. Random-effects meta-analyses of mean differences or relative risks with 95% confidence intervals were calculated, in additional to data heterogeneity calibration through I2 statistics. RESULTS: Following the screening of 270 papers, six RCTs were included, which resulted in the evaluation of 391 patients (375 implants). Adjunctive local antibiotic therapy at disease sites showed statistically significant periodontal outcomes; improvements in success rate (risk ratio = 9.89; 95% CI 2.39-40.84), probing pocket depth (mean difference (MD) = 0.6 mm; 95% CI 0.42-0.78) and bleeding on probing (MD = 0.15%; 95% CI 0.10-0.19). Conversely, adjunctive systemic antibiotics improved probing pocket depths (MD = 1.15 mm; 95% CI 0.31-1.99) and probing attachment levels only (MD = 1.10 mm; 95% CI 0.13-2.08). Across the six included RCTs, the bone loss rate and PI resolution rate determined no significant differences between the groups; mirrored in the single studies and in the meta-analysis. Disease resolution ranged from 2 to 65%. Two of the studies were found to be at low risk of bias and four presented with some concerns. CONCLUSIONS: Adjunctive antibiotics aid NST. However, the heterogeneity of study methods and low quality of current RCTs evidenced, deem their role in NSTs of PI as inconclusive.

Effect modifiers influencing the periodontal healing of the adjacent second molar following mandibular third molar removal.

DATA SOURCES: Studies were selected, using appropriate key words, from the following databases: Cochrane Central Register of Controlled Trials; Medline (via Pubmed); Scopus/Elsevier; and Embase. A manual search was also conducted of five periodontology and oral and maxillofacial surgery journals. It was not clarified what proportion of studies included were derived from which source. STUDY SELECTION: Inclusion criteria included prospective studies and randomised controlled trials published in English, with a minimum 6-month follow-up reporting on parameters of periodontal healing distal to the mandibular second molar following removal of M3M in human subjects. These parameters included pocket probing depth (PPD) reduction and final depth (FD), clinical attachment loss (CAL) reduction and FD, alveolar bone defect (ABD) change and FD. Given prognostic indictors and interventions were investigated, the studies were screened using PICO and PECO (Population, Intervention, Exposure, Comparison, Outcome). Cohen's kappa statistic measured the level of agreement between 2 selecting authors (0.96 stage 1 screening, 1.00 stage 2 screening). Disagreements were resolved with a tie-breaker 3rd author. Ultimately, from 918 studies, 17 met the inclusion criteria and 14 were included in the meta-analysis. Studies were excluded on the basis of same patient pools, non-representative outcomes of interest, insufficient follow-up period, and unclear results. DATA EXTRACTION AND SYNTHESIS: The 17 studies meeting the inclusion criteria underwent validity assessment and data extraction, including risk of bias analysis. Meta-analysis was performed to calculate mean difference and standard error for each outcome measure. If these were unavailable, a correlation coefficient was calculated. Meta-regression was used on different subgroups to determine factors affecting periodontal healing. For all analyses, statistical significance was determined as p < 0.05. Statistical variability in outcomes beyond the expected was estimated using I2 analyses, with a value >50% indicating significant heterogeneity. RESULTS: The periodontal parameters investigated yielded the following results after meta-analysis: overall PPD reduction of 1.06 mm at 6 months and 1.67 mm at 12 months; final PPD of 3.81 mm at 6 months; CAL change of 0.69 mm at 6 months; final CAL of 4.28 mm at 6 months and 4.37 mm at 12 months; ABD reduction of 2.62 mm at 6 months; ABD of 3.2 mm at 6 months. The authors found no statistically significant effect on periodontal healing from the following confounding factors: age; M3M angulation (specifically, mesioangular impaction); optimisation of periodontal health prior to surgery; scaling and root planing of the distal second molar at the time of surgery; post-operative antibiotics or chlorhexidine prophylaxis. There were statistically significant correlations between baseline PPD and final PPD. There was improved PPD reduction at 6 months with a three-sided flap compared to others, and regenerative materials and bone grafts improved all periodontal parameters. CONCLUSIONS: Although M3M removal results in modest improvement in periodontal health distally of the second mandibular molar, periodontal defects remain onwards of 6 months. There is limited evidence suggesting a three-sided flap is more beneficial than an envelope flap in PPD reduction at 6 months. Regenerative materials and bone grafts result in significant improvements across all periodontal health parameters. The most important predictive factor in final PPD of the distal second mandibular molar is baseline PPD.

Viruses, periodontitis, and comorbidities.

Seminal studies published in the 1990s and 2000s explored connections between periodontal diseases and systemic conditions, revealing potential contributions of periodontal diseases in the initiation or worsening of systemic conditions. The resulting field of periodontal medicine led to the publication of studies indicating that periodontal diseases can influence the risk of systemic conditions, including adverse pregnancy outcomes, cardiovascular and respiratory diseases, as well as Alzheimer disease and cancers. In general, these studies hypothesized that the periodontal bacterial insult and/or the associated proinflammatory cascade could contribute to the pathogenesis of these systemic diseases. While investigations of the biological basis of the connections between periodontal diseases and systemic conditions generally emphasized the bacteriome, it is also biologically plausible, under an analogous hypothesis, that other types of organisms may have a similar role. Human viruses would be logical "suspects" in this role, given their ubiquity in the oral cavity, association with periodontal diseases, and ability to elicit strong inflammatory response, compromise immune responses, and synergize with bacteria in favor of a more pathogenic microbial consortium. In this review, the current knowledge of the role of viruses in connecting periodontal diseases and systemic conditions is examined. We will also delve into the mechanistic basis for such connections and highlight the importance of those relationships in the management and treatment of patients.