Does the use of omega-3 fatty acids as an adjunct to non-surgical periodontal therapy provide additional benefits in the treatment of periodontitis? A systematic review and meta-analysis.

This review aimed to assess the impact of dietary omega-3 fatty acids as an adjunct to non-surgical periodontal treatment when compared with periodontal treatment alone on periodontal clinical parameters of periodontitis patients. We included only randomized clinical trials (RCTs) with at least 3-months follow-up of non-surgical periodontal therapy, in combination with dietary omega-3 fatty acids. The MEDLINE, EMBASE, and LILACS databases were searched for articles published up to October 2021. Random-effects meta-analyses were conducted to determine the change in clinical attachment level (CAL), probing pocket depth (PPD), bleeding on probing (BOP), and gingival index (GI) after therapy. Of the eight hundred eighty-four potentially relevant papers retrieved from the electronic databases, 10 RCTs were selected for qualitative analysis, and of these, 8 RCTs were included in meta-analysis. RCTs showed a significant PPD reduction/CAL gain associated with the use of omega-3 fatty acids. The pooled estimates revealed significant overall PPD reduction of 0.42 mm (95% CI 0.15, 0.68) and CAL gain 0.58 mm (95% CI 0.24, 0.92). In individuals with periodontitis, the use of omega-3 fatty acid dietary supplementation as an adjunct to non-surgical periodontal treatment can provide additional benefits in CAL gain and PPD reduction, compared with non-surgical periodontal treatment alone.

The loss of molars in supportive periodontal care: A 10-year follow-up for tooth- and patient-related factors.

AIM: To determine the impact of the degree of furcation involvement (FI) on the longevity of molar teeth and assess the risk variables (tooth- and patient-related factors) associated with the loss of molars (LM) in individuals treated for periodontitis and monitored in a private programme of supportive periodontal care (SPC). MATERIALS AND METHODS: The present retrospective cohort study included 222 individuals with 1329 molars under a 10-year monitoring period in SPC. Periodontal clinical parameters, FI, the type of molar, pulp vitality, and other variables of interest were collected at approximately 50 days after active periodontal therapy and after 10 years. The association of tooth- and patient-related factors with LM was assessed using a multilevel Cox regression analysis. RESULTS: Two-hundred and thirty-five molars were extracted during the SPC period of 12.4 ± 1.9 years. Age >50 years, male gender, diabetes, smoking, and non-compliance were identified as relevant patient-related factors for LM during SPC (p < .05). Significant tooth-related factors for LM were bleeding on probing (BoP) and probing depth (PD) ≥5 mm, tooth non-vitality, and class II and III FI (p < .05). CONCLUSIONS: Class III FI, tooth non-vitality, higher mean PD and BoP, age, male gender, diabetes, and smoking all strongly influenced the prognosis of molars during SPC.

Association between cumulative smoking exposure, span since smoking cessation, and peri-implantitis: a cross-sectional study.

OBJECTIVES: To investigate the association of cumulative smoking exposure and span since smoking cessation with the occurrence of peri-implantitis. METHODS: A sample of 350 individuals aged ≥ 35 years, with the presence of at least one osseointegrated implant functioning for > 5 years, were enrolled in the study. According to smoking habits, participants were categorized into 3 groups: non-smokers (NS; n = 212), former smokers (FC; n = 66), and current smokers (CS; n = 72). Complete peri-implant and periodontal examinations were evaluated. Associations between the occurrence of peri-implantitis and smoking habits, as well as potential confounders, were evaluated through univariate and multivariate analyses. RESULTS: The occurrence of peri-implantitis in the NS, FS, and CS groups was 18.2%, 19.7%, and 30.5%, respectively. A high prevalence of the overall number of cases with periodontitis (54.2%) was observed in the CS group when compared to the FS and NS groups. After adjusting for confounders, the odds ratio (OR) for the occurrence of peri-implantitis was 2.63 (1.39-6.77; p < 0.001) for CS compared to NS. There was a significant dose-response relationship between pack/year of smoking and the occurrence of peri-implantitis, as well as a significant decrease in the risk as the years of smoking cessation increased. CONCLUSIONS: The occurrence of peri-implantitis among CS was high. The cumulative smoking exposure in an incremental manner and the shorter smoking cessation span was directly associated with a higher risk for peri-implantitis. CLINICAL RELEVANCE: Educational and preventive strategies in general health services must attempt to reduce the adverse effects of cumulative smoking exposure and to explore the beneficial effects of smoking cessation on peri-implant status.

Association between liver cirrhosis and peri-implant diseases: a case-control study on implant- and patient-related risk factors.

OBJECTIVE: The objective of this study was to evaluate the potential association between liver cirrhosis and peri-implant diseases, as well as the influence of different risk indicators on this association. METHODS: This case-control study included 64 cases with liver cirrhosis and 128 controls without liver diseases that presented the same socio-demographic and economic profile. The specific inclusion criteria were the following: aged group of 35-55 years and presenting at least one osseointegrated implant functioning for >5 years. A full-mouth peri-implant and periodontal examination was performed and risk variables were recorded. The association between risk variables and the occurrence of peri-implant diseases was tested through univariate analysis and multivariate logistic regression, stratified by alcohol status. Additionally, a mediation analysis was performed to examine the mediating effect of age with peri-implantitis. RESULTS: A high prevalence of peri-implantitis (29.7%) was observed among cases when compared to controls (18.0%). Individuals with cirrhosis presented ~2.5 higher chance of having peri-implantitis than controls (p<0.001). Significant variables associated with the occurrence of peri-implantitis in the final logistic model were the following: cirrhosis, alcohol use, age (>55 years), male sex, smoking, periodontitis, and number of ≤14. CONCLUSIONS: An important risk association between liver cirrhosis and peri-implantitis was reported. Future studies with a larger sample size controlling for the patient- and implant-related confounders are needed to better understand the link between peri-implantitis and liver cirrhosis. CLINICAL RELEVANCE: Cirrhosis individuals, age, and periodontitis, as well as alcohol use and smoking interaction, should be considered as potential risk indicators for peri-implantitis.

Effect of compliance during periodontal maintenance therapy on c-reactive protein levels: a 6-year follow-up.

AIMS: To longitudinally evaluate the effects of compliance during periodontal maintenance therapy (PMT) on C-reactive protein (CRP) levels and its relation to periodontal status. MATERIALS AND METHODS: A subsample comprising of 30 matched pairs was taken from a previous 6-year longitudinal study under PMT. Pairs were composed of one regular (RC) and one irregular (IC) compliers, matched by age and sex. Periodontal parameters and plasma samples were collected at 3 times: T1[prior to active periodontal therapy (APT)], T2(after APT), and T3(after 6 years). CRP plasma levels were quantified using ELISA. RESULTS: RC presented better clinical periodontal status, lower recurrence of periodontitis (sites with PD ≥4 mm and CAL ≥3 mm, together with the persistence and/or presence of BOP and/or suppuration, during any of the subsequent recall evaluations) and significant reductions in CRP levels over time [(T1: RC = 3.64 ± 2.13 and IC = 3.92 ± 2.02 mg/L) and (T3: RC = 2.12 ± 1.39 mg/L and IC = 3.71 ± 1.82 mg/L)]. Logistic regression analysis demonstrated that individuals with periodontitis recurrence presented 2.19 higher chances of presenting altered CRP levels (values ≥3 mg/L- T2 to T3) than those without periodontitis recurrence (95%CI:1.16-3.27; p = 0.017). CONCLUSIONS: Higher CRP plasma levels were associated with higher recurrence of periodontitis and worse clinical periodontal parameters among IC when compared to RC.

Nonsurgical periodontal therapy decreases the severity of rheumatoid arthritis and the plasmatic and salivary levels of RANKL and Survivin: a short-term clinical study.

AIM: To investigate the influence of nonsurgical periodontal treatment (NSPT) on clinical periodontal status, rheumatoid arthritis (RA) activity, and plasmatic and salivary levels of biomarkers through a controlled clinical trial on individuals with RA and periodontitis (PE). METHODS: Sixty-six individuals from a convenience sample were considered eligible and consecutively allocated in 3 groups: (1) individuals without PE and RA (-PE-RA, n = 19); (2) individuals without PE and with RA (-PE+RA, n = 23), and (3) individuals with PE and RA (+PE+RA, n = 24). Full-mouth periodontal clinical examinations, Disease Activity Score (DAS-28) evaluations, and analysis in plasma and saliva of RANKL, OPG, RANKL/OPG, and Survivin were performed at baseline (T1) and 45 days after NSPT (T2). RESULTS: NSPT in the +PE+RA group was very effective to improve periodontal condition. At T2, significant reductions in DAS-28 were observed in +PE+RA (p = 0.011). Significantly higher levels of Survivin and RANKL were observed in saliva and plasma from RA individuals (with and without PE) compared to controls. Additionally, Survivin e RANKL demonstrated positive correlations with DAS-28 and an expressively significant reduction in +PE+RA at T2 (p < 0.001). CONCLUSIONS: NSPT was effective on improving both the periodontal and the RA clinical status and reducing the concentration of Survivin and RANKL in saliva and plasma. PRACTICAL IMPLICATIONS: Nonsurgical periodontal treatment was effective on reducing the concentration of Survivin and RANKL and on improving both the periodontal and the RA clinical status of affected individuals. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (ReBEC) protocol #RBR-8g2bc8 ( http://www.ensaiosclinicos.gov.br/rg/RBR-8g2bc8/ ).

Comparison of miRNA expression profiles in individuals with chronic or aggressive periodontitis.

OBJECTIVES: MicroRNAs (miRNAs) may play an important role in inflammatory response. However, the involvement of miRNAs in the pathogenesis of periodontitis is unclear. The present study aimed to compare the miRNA expression profiles in individuals with chronic (CP) or aggressive (AP) periodontitis. MATERIALS AND METHODS: Eighteen non-smoker individuals (CP = 9 and AP = 9) without any history of systemic diseases or previous periodontal therapies were selected at the Clinics of Periodontology from the Federal University of Minas Gerais. Gingival tissue samples were collected during the initial periodontal therapy. miRNAs were isolated, and expression patterns of 754 miRNAs were assessed with a quantitative miRNA PCR array. miRNAs expression profiles were compared between CP and AP groups. RESULTS: There were no differences observed in the miRNAs expression profiles between CP and AP (p > 0.05). According to the microarray analyses, the most expressed miRNAs in both groups were hsa-miR-1274b, hsa-let-7b-5p, hsa-miR-24-3p, hsa-miR-19b-3p, hsa-miR-720, hsa-miR-126-3p, hsa-miR-17-3p and hsa-miR-21-3p. CONCLUSION: Findings suggested no differences in miRNAs expression profiles between chronic and aggressive forms of periodontitis. The overexpression of specific miRNAs could provide insights into the pathogenesis of both forms of the disease.

Microbiological profile associated with peri-implant diseases in individuals with and without preventive maintenance therapy: a 5-year follow-up.

OBJECTIVES: Clinical and microbiological longitudinal changes in individuals with peri-implant mucositis (PM) with or without preventive maintenance therapy (PMT) have not been reported, especially in long periods of monitoring. This 5-year follow-up study aimed to assess the clinical and microbiological changes along time in individuals initially diagnosed with PM. MATERIALS AND METHODS: Eighty individuals diagnosed with PM (T1) and followed during 5 years (T2) were divided into one group with PMT during the study period (GTP; n = 39) and another group without PMT (GNTP; n = 41). Full-mouth periodontal/peri-implant examinations were performed. Peri-implant microbiological samples were collected and analyzed through qPCR for Tannerella forsythia, Treponema denticola, Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum, and Actinomyces naeslundii at T1 and T2. RESULTS: GNTP presented higher incidence of peri-implantitis than GTP. Moreover, GNTP showed significantly higher total bacterial load and higher frequency of the evaluated orange complex bacteria than GTP. Individuals who progressed to peri-implantitis presented significantly higher total bacterial load and higher frequencies of P. gingivalis, T. denticola, and F. nucleatum. CONCLUSIONS: The absence of regular appointments for PMT was associated with a higher incidence of peri-implantitis and a significant increase in total bacterial load. CLINICAL RELEVANCE: Regular visits during PMT positively influenced subgingival microbiota and contributed to peri-implant homeostasis and clinical status stability during a 5-year monitoring period. Compliance with PMT programs should be reinforced among individuals rehabilitated with dental implants.

Cytokine levels in crevicular fluid associated with compliance during periodontal maintenance therapy.

OBJECTIVES: To longitudinally evaluate the effects of compliance during periodontal maintenance therapy (PMT) on cytokines levels and its relation to periodontal status. MATERIALS AND METHODS: Ninety-one eligible individuals were selected from a 6-year prospective study with 212 individuals in PMT. From this total, 28 regular compliers (RC) were randomly selected and matched for age and gender with 28 irregular compliers (IC). All participants were non-smokers and non-diabetic. Periodontal parameters and gingival crevicular fluid samples were collected in 5 times: T1 [prior to active periodontal therapy (APT)], T2 (after APT), T3 (2 years), T4 (4 years), and T5 (6 years). Levels of IL-6, IL-10, IL-1ß, TNF-α, and MMP-8 were quantified through ELISA. RESULTS: RC presented better clinical periodontal status over time when compared to IC. A significant reduction in the levels of IL-1ß, TNF-α, MMP-8, and IL-6 was observed among RC along time (from T1 to T5). Levels of IL-1 were similar among groups. By contrast, levels of IL-6 and TNF-α increased over time in IC individuals. Levels of IL-10 increased among RC and reduced among IC. CONCLUSIONS: The inflammatory cytokines IL-1, TNF-α, IL-6, and MMP-8 were correlated with worse clinical parameters among IC, while IL-10 was associated with an improvement in clinical parameters among RC. These results reinforce the role of these cytokines in the pathogenesis of periodontitis, as well as their role as markers to monitoring the progression of the periodontitis. CLINICAL RELEVANCE: Regular compliance during 6-year period the PMT sustained clinical and immunological benefits obtained after active periodontal therapy.

The effects of essential oil mouthrinses with or without alcohol on plaque and gingivitis: a randomized controlled clinical study.

BACKGROUND: The efficacy of several variants of essential oil mouthrinses has been studied extensively. This is the first study to compare the anti-plaque and anti-gingivitis efficacy of two marketed essential oil mouthrinses: one is an alcohol containing mouthrinse and the other one is an alcohol-free mouthrinse. METHODS: This examiner-blind, parallel-group study randomized subjects to three groups: 1) Mechanical Oral Hygiene (MOH) only; 2) MOH plus Alcohol-Containing essential oil Mouthrinse (ACM); 3) MOH plus Alcohol-Free essential oil Mouthrinse (AFM). Primary endpoint was whole-mouth mean Modified Gingival Index (MGI) at six months. Secondary endpoints included whole-mouth mean MGI at one and three months, and whole-mouth mean Plaque Index (PI) and whole-mouth mean Bleeding Index (BI) at one, three and six months. Safety assessments were conducted at all time points. RESULTS: A total of 370 subjects were enrolled; 348 subjects completed the study. After six months, subjects using essential oil mouthrinses with or without alcohol showed significant reduction (p < 0.001) in gingivitis (28.2% and 26.7%, respectively) and significant reduction (p < 0.001) in plaque (37.8% and 37.0%, respectively), compared to those performing MOH only. Significant reductions in MGI, PI, and BI (p < 0.001) were observed at one and three months and also at six months for mean BI. No statistically significant differences were observed for all measured indices between ACM and AFM groups at any time point. Both mouthrinses were well tolerated. CONCLUSIONS: No significant differences were observed in the efficacy of ACM and AFM to reduce plaque and gingivitis, when used in addition to MOH, over six months. TRIAL REGISTRATION: The trial was registered on clinicaltrials.gov on November 30, 2016. The registration number is NCT02980497 .

Effect of non-surgical periodontal treatment by full-mouth disinfection or scaling and root planing per quadrant in halitosis-a randomized controlled clinical trial.

OBJECTIVE: The objective of this study was to compare the effect of one-stage full-mouth disinfection (FMD) and conventional quadrant scaling in four weekly sessions (QS) on periodontal clinical parameters and halitosis among individuals with advanced chronic periodontitis. MATERIALS AND METHODS: In this randomized controlled clinical trial, 30 individuals were divided into two groups: FMD (n = 15) and QS (n = 15). The following data were collected at the baseline and 90 days after treatment: plaque index, tongue-coating index (TCI), bleeding on probing, probing depth, and clinical attachment level. Halimetry was performed by the organoleptic method, and the levels of volatile sulfur compounds (H2S and CH3SH) were measured by gas chromatography. The Chi-square, Fisher's exact, the Mann-Whitney, the McNemar, and the Wilcoxon tests were used for statistical analysis. RESULTS: Both groups showed statistically significant improvements in periodontal clinical parameters, reduction in TCI, organoleptic scores, and in CH3SH levels between times. However, major reduction was observed in FMD group. CONCLUSION: Non-surgical periodontal therapy, regardless of the protocol, was effective in improving periodontal clinical status of individuals, decreasing organoleptic scores and CH3SH levels between times, as well as reducing halitosis. CLINICAL RELEVANCE: This study contributed to the knowledge that non-surgical periodontal therapy, whether by FMD or QS, was effective in reducing halitosis in individuals with advanced chronic periodontitis.

Sense of coherence and periodontal health outcomes.

OBJECTIVE: Sense of Coherence (SOC) has been associated with perceived oral health measures, but the contribution of SOC to clinical measures is still unclear. The aim of the present cross-sectional study was to evaluate the potential association between periodontal health outcomes, such as periodontal clinical parameters and perceived periodontal health, and SOC. MATERIALS AND METHODS: The study sample comprised 276 individuals, aged 18-60 years, from Belo Horizonte, Brazil. Participants answered questionnaires covering sociodemographic variables, self-perceived periodontal health and SOC. Full-mouth periodontal examinations were performed. The sample was divided into three groups according to SOC score: (a) SOC1 = weak (24-46); (b) SOC2 = moderate (47-51); (c) SOC3 = strong (52-65). Multivariate analyses including appropriate logistic or linear regression models were performed to evaluate the association between periodontal health outcomes and biological, sociodemographic and behavioural variables. RESULTS: Perceived general oral health was associated with family income bracket (p = 0.010), smoking (p = 0.004), dental flossing (p = 0.017) and SOC (weak SOC: p = 0.005). Perceived gum disease and perceived periodontal disease were associated with SOC (weak SOC: p = 0.001 and p = 0.015, respectively). CONCLUSIONS: Overall, perceived periodontal health outcomes were associated with SOC. However, no association between clinical periodontal health outcomes and SOC were observed.

Pre- and post-treatment experiences of fear, anxiety, and pain among chronic periodontitis patients treated by scaling and root planing per quadrant versus one-stage full-mouth disinfection: a 6-month randomized controlled clinical trial.

AIM: To relate the clinical effects of two different forms of non-surgical periodontal therapy - scaling and root planing per quadrant (SRP-Q) and one-stage full-mouth disinfection (FMD) - to patient-based outcomes such as fear, anxiety, and pain of moderate chronic periodontitis patients. METHODS: Dental Fear Survey (DFS) and Dental Anxiety Scale (DAS) questionnaires and Visual Analogue Scale (VAS) were applied to 78 patients randomized into two groups: SRP-Q (n = 37) and FMD (n = 41). Periodontal clinical parameters: probing pocket depth (PD), clinical attachment level (CAL), plaque index (PI), and gingival index (GI) were monitored at baseline and 6 months after treatment. Data were statistically analysed by chi-square, Fisher's exact, Mann-Whitney, Wilcoxon tests, Pearson's correlation, and Cluster analysis. RESULTS: All periodontal clinical parameters improved from baseline to 6 months. Patients with higher fear and anxiety showed a worse clinical periodontal status before and after treatment (mean CAL, PI, and GI). After both types of treatment, fear and anxiety decreased (FMD: p = 0.019; SRP-Q: p = 0.043) with no differences between the groups. Pain did not differ between groups (FMD: 20.6 ± 19.0 and SRP: 20.7 ± 20.0; p = 0.930). CONCLUSIONS: In moderate chronic periodontitis patients, SRP-Q and FMD provided periodontal clinical improvements and similar experiences of fear, anxiety, and pain.

Gingival health benefits of essential oil, 0.075% cetylpyridinium chloride and control mouthrinses: A 4-week randomized clinical study.

PURPOSE: This randomized, single center, examiner-blind, controlled, parallel-group, 4-week clinical study compared the antiplaque/anti-gingivitis efficacy of an essential oil (EO) containing mouthrinse versus a 0.075% cetylpyridinium chloride (CPC) containing mouthrinse. A 5% hydroalcohol solution was included as a control group. METHODS: 165 systemically healthy volunteers (18-72 years of age), with mild to moderate plaque-related gingivitis were enrolled in this clinical trial; 162 subjects completed the study. At baseline and 4-week visits, subjects received an oral examination, gingivitis (MGI), gingival bleeding (BI) and plaque (PI) assessments. Following randomization, subjects began rinsing with 20 mL of the assigned mouthrinse for 30 seconds, in conjunction with their usual oral hygiene, twice daily for the duration of the study. RESULTS: All rinses were well tolerated by the subjects. EO was statistically significantly superior to CPC with a reduction in mean MGI of 5.9%, and in mean PI of 6.4%. Statistically significant reductions in gingivitis, bleeding and plaque were observed for both EO and CPC when compared to the negative control; mean MGI and mean PI were reduced by 13.0% and 18.9% for EO and by 7.6% and 13.3% for CPC. EO also statistically significantly reduced the proportion of gingival bleeding sites compared to CPC by 7.6% (P = 0.012) and compared to control by 10.6% (P < 0.001). For the post hoc sitewise analyses, at 4 weeks, the mean percentage of healthy sites for EO, CPC and Control were 7.4%, 1.1% and 0.8%, respectively and the mean percentage of virtually plaque free sites for EO, CPC and control were 5.4%, 3.8% and 0.4% respectively. The mean percentages of more inflamed gingival sites for EO, CPC and control were 20.4%, 26.2% and 45.7%, respectively. The mean percentage of tooth surfaces with heavier accumulations of plaque (PI scores ≥ 3) was 50.9% for EO, 56.1% for CPC and 81.1% for control. Reduction of gingival inflammation and dental plaque was statistically significantly superior for EO compared to both 0.075% CPC and negative control. Both marketed antimicrobial mouthrinses showed a beneficial result in gingival health and in reducing plaque accumulation as early as 4 weeks.

Gingival health benefits of essential-oil and cetylpyridinium chloride mouthrinses: a 6-month randomized clinical study.

PURPOSE: This randomized, single center, examiner-blind, controlled, parallel-group, 6-month clinical study compared the antiplaque/antigingivitis potential of an essential oil (EO) versus a 0.07% cetylpyridinium chloride (CPC)-containing mouthrinse. A 5% hydroalcohol solution was included as a control group. METHODS: 354 healthy volunteers (18-71 years of age) were enrolled in this clinical trial; 338 subjects completed the study. At baseline, 1-, 3-, and 6-month visits, subjects received an oral examination, gingivitis (MGI), gingival bleeding (BI) and plaque assessments (PI). Following randomization, subjects received a prophylaxis and began brushing twice daily with the provided fluoride toothpaste and rinsing twice daily with 20 mL of the assigned mouthrinse for 30 seconds. RESULTS: All rinses were well tolerated by the subjects, with the exception of extrinsic tooth stain complaints in 13 subjects in the CPC group between the 3- and 6-month exams. Statistically significant reductions in gingivitis, bleeding and plaque were observed for both EO and CPC at all post-baseline time-points when compared to the negative control. At 6 months MGI and PI were reduced by 42.6% and 42.0% for EO and by 17.1% and 13.9% respectively, for CPC vs. control. When compared to CPC, EO was statistically significantly superior at all post-baseline time-points. EO showed increasing reductions in MGI of 10.5%, 20.3% and 30.7% as well as reductions in PI of 12.7%, 23.7% and 32.6% at 1, 3 and 6 months, respectively. When analyzing the number of healthy sites (MGI scores of 0 or 1), the beneficial effect of the EO-containing mouthrinse is 45.8% greater than using a CPC-containing mouthrinse and 59.8% greater than placebo.

The association between periodontitis and the impact of oral health on the quality of life of individuals with psoriasis and psoriatic arthritis.

OBJECTIVE: To evaluate the association between psoriasis (PSO), psoriatic arthritis (PsA) and periodontitis (PE), and the Oral Health-Related Quality of Life (OHRQoL) impacts on individuals with psoriatic disease's daily activities compared to the non-psoriatic ones. MATERIALS & METHODS: 296 individuals with psoriatic disease (PSO n = 210, APS n = 86) (cases) and 359 without these diseases (controls) were included. Complete periodontal examinations and collection of variables of interest were performed. The Brazilian version of the Oral Impacts on Daily Performance (OIDP) instrument was applied. RESULTS: The prevalence of PE was higher in PsA (57.0%; OR = 2.67 95%CI 1.65-4.32; p<0.001) than in PSO (34.3%; OR = 1.05 95% CI 0.73-1.51; p<0.001) compared to controls (33.1%). Both PsA and PSO groups showed more sites and teeth with 4-6mm probing depth (PD) and had higher OIDP scores than controls (p<0.001), thus indicating worse self-reported quality of life. PE, PSO+PE and consumption of alcohol/anxiolytics significantly influenced OHRQoL (p<0.05). The influence of periodontal parameters on OHRQoL was observed for the presence of PE; PD >6 mm; clinical attachment level >6 mm; higher plaque index, % sites and teeth with bleeding on probing (p<0.05). CONCLUSION: Negative impacts of PE on the OHRQoL were demonstrated. The ones having PSO and especially PsA and PE presented significantly worse indicators.

Long-term management of plaque and gingivitis using an alcohol-free essential oil containing mouthrinse: a 6-month randomized clinical trial.

PURPOSE: This 6-month, examiner-blind, single center, randomized, parallel group, controlled clinical trial compared the antiplaque/antigingivitis effects of an alcohol-free EO mouthrinse (LISTERINE Zero) to a negative control (5% flavored, colored hydroalcohol) and to an alcohol-free CPC-containing mouthrinse (Colgate Plax). METHODS: 337 gingivitis subjects were clinically examined to determine Modified Gingival Index (MGI) and Plaque Index (PI) at baseline, 3 and 6 months. The primary efficacy variables were mean MGI and mean PI at 6 months (statistically analyzed by ANCOVA). After professional dental prophylaxis, subjects were randomly assigned to 6-month twice daily unsupervised use of alcohol-free EO, alcohol-free CPC or a negative control rinse, in conjunction with normal brushing and flossing. Safety was monitored throughout the study. RESULTS: 311 subjects completed the study. After 6 months of use, EO significantly reduced plaque (31.6%) and gingivitis (24.0%) compared to negative control. At 6 months, CPC also significantly reduced plaque (6.4%) and gingivitis (4.4%) compared to negative control. EO provided a 26.9% decrease in plaque and a 20.5% decrease in gingivitis compared to CPC (P < 0.001). All rinses were well tolerated. The alcohol-free EO mouthrinse demonstrated superior efficacy in reducing plaque and gingivitis over 6 months compared to both negative control and alcohol-free CPC mouthrinse.

Subepithelial connective tissue graft: an alternative application for treating endoperiodontal lesions.

This article presents an endoperiodontal lesion treated with a subepithelial connective tissue graft technique using periosteum. A patient with a right lateral maxillary incisor that had been retracted endodontically had gingival fenestration and recession, as well as an extensive apical lesion. Surgery was performed, and 5 months later a metal-ceramic crown was installed. At 6 years post-treatment, the periodontal tissues were stable and there was satisfactory new apical bone formation.

Effect of supragingival plaque control on recurrent periodontitis and clinical stability among individuals under periodontal maintenance therapy: 10-year follow-up.

BACKGROUND: The aim of this study was to evaluate the effect of supragingival plaque control on the recurrence of periodontitis (RP) and the achievement of a stable periodontal clinical endpoint after 10 years of periodontal maintenance therapy (PMT). METHODS: The present retrospective cohort study included 225 individuals in continuous PMT. The plaque index (PI) determining the oral hygiene (OH) status, periodontal clinical parameters, and other variables of interest were collected at three time points: T1 (prior to active periodontal therapy [APT]), T2 (after APT), and T3 (10 years after T2). According to PI records at T3, participants were categorized into: (1) good OH (GOH; PI ≤ 30%, n = 63); (2) fair OH (FOH; PI > 30% and ≤40%, n = 73); and (3) poor OH (POH; PI > 40%, n = 88). Data were analyzed using the chi-square and Student t tests, analysis of variance (ANOVA), and mediation and regression analyses. RESULTS: Significant differences in all periodontal clinical parameters between the GOH, FOH, and POH groups were observed at T3. The POH group exhibited higher mean bleeding on probing (BOP), periodontal probing depth (PD), and clinical attachment level (CAL), as well as higher tooth loss (POH > FOH > GOH; P < .001). There was an increased risk for RP in the FOH (odds ratio [OR] 2.02; CI, 1.10-4.38) and POH (OR 4.33; CI, 2.17-8.65) groups. Moreover, the FOH and POH groups had an approximately 2.5 and 6.0 times greater chance of not achieving a stable periodontal clinical endpoint, respectively. CONCLUSIONS: After 10 years of monitoring in PMT, individuals with higher PI scores (>30%) presented an unhealthier periodontal status, a higher risk for RP, and a lower chance of achieving ≤4 sites with PD ≥ 5 mm.

Adjunctive effects of photodynamic therapy using indocyanine green in residual pockets during periodontal maintenance therapy: A split-mouth randomized controlled trial.

BACKGROUND: Prospective studies have reported conflicting results regarding the adjunctive effect of antimicrobial photodynamic therapy (aPDT) on clinical and microbiological parameters in individuals under periodontal maintenance therapy (PMT). This study aimed to evaluate the clinical and microbiological adjunctive effects of aPDT using indocyanine green (ICG) in residual sites with probing depth (PD) ≥5 mm during PMT in comparison with scaling and root planing (SRP) alone. METHODS: A split-mouth randomized controlled clinical trial was conducted with 24 individuals in a PMT program. Contralateral quadrants with eligible residual sites were randomly assigned to either SRP + aPDT (test group) or SRP alone (control). aPDT included ICG dye and diode laser (909 nm) performed together with SRP and repeated 15 days after. Periodontal clinical parameters, periodontal inflamed surface area (PISA) index, and subgingival biofilm samples were collected at baseline (T1), 3 (T2), and 6 months later (T3). Microbiological analyses were performed by quantitative real-time polymerase chain reaction. RESULTS: Significant improvements were observed in all clinical and microbiological parameters in both groups from T1 to T3. However, no significant differences were observed regarding plaque index, PD, and clinical attachment level. Test group showed significantly greater reductions in bleeding on probing (BOP), PISA index, and Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans levels, when compared with controls. CONCLUSIONS: Both treatments resulted in significant clinical periodontal improvements, but with no significant differences between groups except from inflammation parameters. aPDT using ICG resulted in significant reductions in BOP and PISA index, as well as in P. gingivalis and A. actinomycetemcomitans levels.