Immediate Implant and Customized Healing Abutment Promotes Tissues Regeneration: A 5-Year Clinical Report.

Significant alveolar bone resorption follows tooth extraction. Immediate implant placement alone is not sufficient to prevent this phenomenon. The present study aims at reporting the clinical and radiologic outcome of an immediate implant with a custom healing abutment. In this clinical case, a fractured upper first premolar was replaced by an immediate implant and a customized healing abutment designed on the perimeter of the extractive alveolus. After 3 months, the implant was restored. The facial and interdental soft tissue was maintained with appreciable success after 5 years. The pre-and 5-year post-treatment computerized tomography scans showed bone regeneration of the buccal plate. Use of an interim customized healing abutment helps prevent hard- and soft-tissue collapse and promotes bone regeneration. This technique is straightforward and may represent a smart preservation strategy when there is no indication for adjunctive hard or soft tissue grafting. Given the limited nature of this case report, further studies are needed to confirm the present findings.

Immediate Implant and Customized Healing Abutment Promotes Tissues Regeneration: a 5-year Clinical Report.

INTRODUCTION: Significant alveolar bone resorption follows tooth extraction. Immediate implant placement alone is not sufficient to prevent this phenomenon. CASE PRESENTATION: In this clinical case, a fractured upper first premolar was replaced by an immediate implant and a customized healing abutment designed on the perimeter of the extractive alveolus. After 3 months, the implant was restored. The facial and interdental  soft  tissue  was maintained with  appreciable  success after 5 years. The pre- and 5-year-post-treatment CT scans showed no bone loss. CONCLUSION: The use of an interim customized healing abutment helps preventing hard and soft tissues collapse.  This technique is very straightforward and might represent a smart preservation strategy when there is no indication for adjunctive hard or soft tissue grafting.

Immediate restoration of fixed full-arch prostheses placed on implants in both fresh and healed sockets using the flat one-bridge technique: a 7-year retrospective study.

BACKGROUND: The aim of this retrospective study was to document the long-term clinical efficacy of a surgical-prosthetic technique (the flat one-bridge technique) involving the immediate restoration of both postextraction and nonpostextraction implants supporting full-arch restorations. METHODS: Implants were placed by adapting the axis to the available bone. Flat definitive abutments were connected during surgery and never disconnected to compensate for eventual implant disparallelism. Bone grafting was performed when needed. The patients received a screw-retained provisional restoration within 48 h of surgery and a final screw-retained prosthesis within 1 year. RESULTS: Sixty-six patients received 494 implants distributed in 75 prostheses. The median follow-up was 86 months (range 82-168 months). Only three implants had failed at the last follow-up. Implant survival was 99.6%. CONCLUSION: The flat one-bridge prosthetic protocol is a viable procedure with excellent long-term outcomes. No difference in clinical success could be observed between postextractive and nonpostextractive implants.

A New Approach for Lateral Sinus Floor Elevation.

The lateral sinus lift procedure has been extensively investigated and described as a reliable surgical solution aimed at facilitating implant placement and rehabilitation when the posterior upper maxilla is atrophic. The standard technique consists in a lateral antrostomy, the careful raising of the sinus membrane, and following apposition of a bone substitute between the membrane and the sinus floor. The present technical note illustrates a new conservative technique enabling lateral sinus lift without the use of bone substitutes and with predictable outcomes.

Clinical Success of Dental Implants Placed in Posterior Mandible Augmented With Interpositional Block Graft: 3-Year Results From a Prospective Cohort Clinical Study.

PURPOSE: The purpose of the present cohort study was to investigate the 3-year efficacy and clinical performance of implant-supported rehabilitations in posterior mandibles augmented with the sandwich osteotomy technique. MATERIALS AND METHODS: Twenty-three partially edentulous patients who developed atrophy of the posterior mandible (residual ridge height, 3 to 7 mm) were treated (32 surgical sites) with vertical bone augmentation using interpositional equine cancellous bone blocks and porcine corticocancellous bone particulate. All implants were placed 4 months after augmentation and were loaded with fixed dental prostheses. One side per patient was selected and followed for 3 years, and the patient was the unit of analysis. Linear radiographic vertical bone gain and peri-implant marginal bone loss were assessed; secondary outcomes-complication rates after surgery, prosthesis and implant failure rates, width of keratinized mucosa, and patient satisfaction-were evaluated. RESULTS: All patients reported postoperative paresthesia that resolved over a period of 2 months after the augmentation procedure. The mean vertical bone gain was 5.6 mm after 4 months. Ninety-one dental implants were positioned into the augmented areas. The global 3-year survival rate was 95.5%. The mean peri-implant marginal bone loss around implants was 1.06 ± 0.37 mm 3 years after loading, whereas the width of keratinized mucosa had an overall increase of 0.39 ± 0.36 mm. CONCLUSION: The results of the present 3-year study suggested high success rates for implants placed in areas augmented with the osteotomy sandwich technique. This surgical approach could be helpful in the presence of a low residual vertical height in the posterior mandible before implant placement.

Nonsurgical Treatment of Peri-implantitis Without Eliminating Granulation Tissue: A 3-Year Study.

OBJECTIVES: The purpose of this study was to evaluate a nonsurgical approach toward peri-implantitis by means of mechanical debridement and local detoxification leaving granulation tissue into the peri-implant pockets. MATERIALS AND METHODS: An analysis was performed on the outcomes of 2 nonsurgical protocols: mechanical debridement plus chemical detoxification with 0.2% chlorhexidine and chlortetracycline hydrochloride (test), and mechanical debridement alone (control). Measures were collected at baseline, 3, 24, and 36 months after treatment. RESULTS: Seventy-five implants with peri-implantitis were included. At a 36-month evaluation, mean pocket probing depth was 3.15 ± 0.32 mm for the test group and 5.97 ± 0.90 mm for the control group, the difference being significant. An improvement of marginal bone level was recorded for the test group, whether the control group showed a further marginal bone loss. Treatment success was 100% in the test group and 31.4% in the control group. CONCLUSION: Nonsurgical implant debridement alone seemed not efficient in the treatment of peri-implantitis. Further longitudinal studies are required to evaluate the efficacy of mechanical debridement with chemical detoxification and removal of granulation tissues against mechanical debridement with chemical detoxification alone.

Local Formula with Mucoadhesive Property: A Randomized Clinical Trial of a Therapeutic Agent for the Treatment of Oral Aphthous Ulcers.

BACKGROUND: Recurrent or occasional aphthous lesions represent a painful oral condition with high prevalence. Since the etiology is still unclear and most likely related to a dysfunction in the local immune system, several treatment strategies have been proposed, including systemic agents, local agents, and laser therapy, to reduce the pain and discomfort for the patient without acting on the causes. MATERIALS AND METHODS: The purpose of the present randomized study was to assess the clinical efficacy of a new topical gel with mucoadhesive property to reduce the pain and the dimension of the aphthosis lesions. Fifty patients presenting at least one minor ulcer were randomized to a control group (placebo prescription), a first test group (topical agent with laser), and a second test group (topical agent only). The healing rate, the visual analog scale (VAS) score for pain, and the diameter reduction were monitored for 10 days. RESULTS: Both test groups showed better results than control group, significant clinical efficacy, and a median total reduction time of 4 days with no significant adjunctive benefit from the use of laser. CONCLUSION: The clinical results are encouraging; nevertheless other studies are needed to valid this kind of treatment. CLINICAL SIGNIFICANCE: The present randomized clinical study suggested that the use of topical mucoadhesive agents could represent a valid therapy for minor aphthous lesions. How to cite this article: Giammarinaro E, Cosola S, Oldoini G, et al. Local Formula with Mucoadhesive Property: A Randomized Clinical Trial of a Therapeutic Agent for the Treatment of Oral Aphthous Ulcers. J Contemp Dent Pract 2019;20(11):1249-1253.

Odontogenic Orofacial Infections.

Acute dental abscess is a frequent and sometimes underestimated disease of the oral cavity. The acute dental abscess usually occurs secondary to caries, trauma, or failed endodontic treatment. After the intact pulp chamber is opened, colonization of the root canals takes place with a variable set of anaerobic bacteria, which colonize the walls of the necrotic root canals forming a specialized mixed anaerobic biofilm. Asymptomatic necrosis is common. However, abscess formation occurs when these bacteria and their toxic products breach into the periapical tissues through the apical foramen and induce acute inflammation and pus formation. The main signs and symptoms of the acute dental abscess (often referred to as a periapical abscess or infection) are pain, swelling, erythema, and suppuration usually localized to the affected tooth, even if the abscess can eventually spread causing a severe odontogenic infection which is characterized by local and systemic involvement culminating in sepsis syndrome. The vast majority of dental abscesses respond to antibiotic treatment, however, in some patients surgical management of the infection may be indicated. In the present work, a retrospective analysis of the patients with dental orofacial infections referred to the Unit of Dentistry and Maxillofacial Surgery of the University of Verona from 1991 to 2011 has been performed.

A New Radiologic Protocol and a New Occlusal Radiographic Index for Computer-Guided Implant Surgery.

A minimum interarch space of 40 mm along the planned direction of the implant is physically mandatory to allow computer-guided implant placement with the NobelGuide technique. The aim of this paper was to describe a novel radiologic protocol and a new occlusal radiographic index that give the clinician the possibility of identifying patients with limited interarch space. Three patients undergoing NobelGuide treatment of the edentulous upper jaw were selected as candidates for this study. In the first patient, the radiographic occlusal index was built using an addition silicone material to occupy the space between the 2 arches forced into the maximum opening position. In the other 2 patients different silicone materials were used and 2 interpositional wedges were placed in between 2 silicone bites to ensure maximum mouth opening. In the first patient, the bite made with addition silicone alone resulted in distinct noise on computer tomography since the patient was not forced to achieve his maximum opening position. In the second patient the mandibular addition silicone was still quite visible, while in the third patient the condensation silicone was invisible and the quality of the image was excellent with the possibility of measuring maximum opening position and virtually predicting interference with the opposite arch. The new radiological occlusal index made with condensation silicone (Sandwich Index) proved to be effective in reproducing the maxillary forced maximum opening position during the initial planning phase, preventing errors in the inclusion or exclusion of patients suitable for NobelGuide treatment.

Gene Expression of Human Mesenchymal Stem Cells Cultured on Titanium Dental Implant Surfaces.

OBJECTIVE: The study shows how the influence of titanium surfaces on human mesenchymal stem cells differentiates toward osteocytes lineage and how, after growth, on machined titanium disk or etched titanium disk, changes, in gene expression for RUNX1, CTNNB1, SP7, and DLX5. METHODS: Genes were analyzed by means of quantitative real-time polimerase chain reaction. Osseo genic lineage differentiation was also tested by means of the catenin-ß1 immunofluorescence, induced osteoblasts, which represented the internal control. RESULTS: The RUNX1 and SP7 expressions in the induced osteoblasts prove to be different, compared with cells cultured on metallic supports. Moreover, the levels of expression of the runt-related transcription factor 1 and the osterix appeared more down-regulated in cells that grew on a machined titanium surface. In the present experimental model, mRNA expression of DLX5 and CTNNB1 in human mesenchymal stem cells, cultured on each of the titanium surfaces, showed no differences, compared with osteoblast-induced cells. The immunofluorescence scores, for protein expression of beta-catenin in human mesenchymal stem cell treated cells, illustrates significantly improved results with the etched surface. CONCLUSIONS: Present results suggested that different titanium surfaces might induce some differences in terms of gene expression. The only gene analyzed, which proved significant differences between the 2 titanium supports, was SP7; however, the other 3 genes indicating the existence of differences between the 2 titanium groups.

Extensive keratinized tissue augmentation during implant rehabilitation after Le Fort I osteotomy: using a new porcine collagen membrane (Mucoderm).

The aim of this study was to test a new collagen matrix (Mucoderm) positioned during oral implant abutment connection. A patient previously treated with Le Fort I for bone augmentation and 8 implants showing minimal amount of keratinized tissue was selected for an extensive keratinized tissue augmentation and deepening of the oral vestibule by apically positioning a split palatal flap and palatal grafting with Mucoderm. Clinical data at 9 and 14 days and 1 and 2 months showed resorption of the collagen graft, augmentation of the keratinized tissue around the implants, and deepening of the vestibule, with minimal morbidity and reduced surgical treatment time. However, some vestibular keratinized tissue contraction was evident. The new collagen matrix may be a promising material as a substitute for an autologous gingival/connective tissue graft. Despite the preliminary results of this innovative article, before drawing any general conclusion, the benefit of the procedure should be further evaluated by prospective clinical trials.

Posttraumatic use of dental implants immediately after tooth extraction: clinical study.

PURPOSE: Root fracture is a combined injury of cementum, dentin, and pulp. Many of these traumas remain untreated, mistreated, or overtreated. It leads to a more complicated treatment in case of tooth loss. Many different treatment procedures, with a very changeable success rate, have been proposed for years to treat teeth with root fractures. The objective of the following clinical studies was to evaluate the clinical effectiveness of implants placed in fresh extraction sites to treat teeth with horizontal root fracture. METHODS: The study group included 25 patients (15 men and 10 women) between the ages of 20 and 65 years. After an initial examination and a treatment planning, all of the patients underwent periodontal treatment, which was deemed necessary to favor wound healing. All the 25 teeth were extracted because of horizontal root fracture located at the level of the middle third. The second-stage surgery was performed 6 months after the initial procedure. The following clinical parameters, presence or absence of mobility, presence or absence of pain, and presence or absence of suppuration, were evaluated in each patient at 6 and 12 months after implant placement. Radiographs were taken using the standard method to evaluate the marginal bone loss. RESULTS: The healing period was uneventful for all patients. All implants had osseointegrated. After 12 months, patients were asymptomatic and showed no signs of infection or bleeding when probed. CONCLUSIONS: On the basis of this study, implants placed right after tooth extraction are a valid treatment procedure, which induces predictable results as treatment of fractured teeth.

Immediate implant and socket preservation using sticky bone and leukocyte-platelet-rich fibrin in the anterior maxilla: A 3-year case report.

INTRODUCTION: Immediate implant in the esthetic area is a challenging procedure. Chronic infection often contributes to extensive bone loss and acute infection often precludes a safe, clean surgery. However, it is quite common to come across failing teeth in the esthetic area, where the patient often demands a faster rehabilitation. CASE PRESENTATION: In this clinical case, a fractured upper central incisor was replaced by an immediate implant, and the perimetrical area was filled with heterologous bone blended with patient-derived leukocyte- and platelet-rich fibrin (L-PRF) in the form of sticky bone. A Maryland bridge was bonded to the adjacent teeth with the intent to guarantee minimum esthetic to the patient. After 5 months, the implant was connected to a definitive abutment and crown. The facial and interdental soft tissue was maintained with appreciable success after 2 years. The pre-treatment and 2-year- post-treatment computed tomography scans revealed marginal bone preservation. CONCLUSION: The use of sticky bone and L-PRF in immediate implant sites helps prevent hard and soft-tissue collapse and may favor faster and sounder healing. KEY POINTS: Why is this case new information? It provides support to the efficacy of immediate implant placement with simultaneous use of L-PRF. What are the keys to successful management of this case? Having L-PRF supporting wound healing. What are the primary limitations to success in this case? Having sufficient bone apical to the existing socket and at adjacent teeth.

Bone Volume Assessment Around Immediate Dental Implant in the Esthetic Area with Immediate Tooth-Like Single Crown Provisionalization: A Laser and Computed Tomography 1-Year Retrospective Study.

PURPOSE: To examine the remodeling process of both the soft and hard tissue components of the postextraction socket around immediately loaded dental implants after tooth extraction in maxillary esthetic areas. MATERIALS AND METHODS: Subjects underwent immediate placement of single implants in postextraction sockets without bone grafting, and their immediate provisionalization with custom tooth-like interim crowns were fabricated using digital diagnostic impressions and a dental milling machine. Intraoperative and 1-year follow-up layered scans of the postextraction sockets after implantation were acquired using a 3D optical system. In the short term, subjects underwent computed tomographic scans. Digital impressions for gingival contours, originally stored as STL (standard tessellation language) files, were converted to DICOM (Digital Imaging and Communications in Medicine) files with the implant shoulder working as a referral point, which were then superimposed to 3D radiologic images. The observed volumetric and linear outcomes were measured using a program known as DentaScan. The width of the alveolar crest at the level of the implant shoulder and marginal bone levels were acquired. Nonparametric tests were applied with a level of significance set at P < .01. RESULTS: No failure was reported after a follow-up of 1 year. Little or no inflammation of the treated areas was registered, and there were practically no signs of suppuration. The areas showed a significant reduction in the overall volumes for both soft and bone tissue, with a P value < .0001 from the baseline (0.983 ± 0.172 cm3) to the 1-year survey (0.865 ± 0.156 cm3). If the soft and bone tissue changes were separately evaluated, a significant loss (with a P value < .0001) was registered for only the bone tissues (from 0.434 ± 0.075 to 0.355 ± 0.061 cm3). Moreover, changes in gingival tissue from baseline to the 1-year survey (-0.040 ± 0.067) appeared to be significantly different from the overall volume loss (-0.118 ± 0.083 cm3). A shrinkage in width (-0.5 ± 0.7 mm) was found from baseline (12.6 ± 0.6 mm) to the 1-year follow-up (12.1 ± 0.9 mm). Marginal bone levels were 0.97 ± 0.70 mm and 0.39 ± 0.78 mm, respectively, at the mesial and distal aspects of the implants. CONCLUSIONS: The present analysis suggested that immediately customized provisionalization was effective enough to prevent both volume loss and linear shrinkage at the layers of the treated areas. Moreover, the buccal aspects seemed to be the areas most affected by the loss of volume. The mean loss in width, which amounted to roughly 0.5 mm, appeared to be negligible when compared to the overall width measured before surgery.

Electron Microscopy (EM) Analysis of Collagen Fibers in the Peri-Implant Soft Tissues around Two Different Abutments.

The design of the implant prosthesis-abutment complex appears crucial for shaping healthy and stable peri-implant soft tissues. The aim of the present animal study was to compare two implants with different healing abutment geometries: a concave design (TEST) and a straight one (CTRL). Transmission electron microscopy (TEM) was used to quantify the three-dimensional topography and morphological properties of collagen at nanoscale resolution. 2 swine were included in the experiment and 6 implants per animal were randomly placed in the left or right hemimandible in either the physiologically mature bone present between the lower canine and first premolar or in the mandibular premolar area, within tooth extraction sites. Each CTRL implant was positioned across from its respective TEST implant on the other side of the jaw. After 12 weeks of healing, 8 specimens (4 CTRL and 4 TEST) were retrieved and prepared for histological and TEM analysis. The results showed a significantly higher percentage of area covered by collagen bundles and average bundle size in TEST implants, as well as a significant decrease in the number of longitudinally oriented bundles with respect to CTRL implants, which is potentially due to the larger size of TEST bundles. These data suggest that a concave transmucosal abutment design serves as a scaffold, favoring the deposition and growth of a well-organized peri-implant collagen structure over the implant platform in the early healing phase, also promoting the convergence of collagen fibers toward the abutment collar.

Alveolar Bone Remodeling with or without Collagen Filling of the Extraction Socket: A High-Resolution X-ray Tomography Animal Study.

The healing process of the tooth extraction socket often leads to significant resorption of the alveolar bone, eventually causing clinical difficulties for future implant-supported rehabilitations. The aim of the present animal study was to evaluate alveolar bone remodeling after tooth extraction in a rabbit model, either with or without the use of a plain collagen plug inside the socket, by means of micro-computed tomography. The study included the micro-tomography analysis of 36 rabbits' incisor extraction sockets, either left empty or filled with a collagen plug. All animals were euthanized in a staggered manner, in order to address molecular, histologic, and radiographic analyses at different time-points, up to 90 days after surgery. The three-dimensional evaluation was carried out using micro-computed tomography technology on excised bone blocks including the alveolus and the contralateral bone. Both linear and volumetric measures were recorded: the percentage of bone volume change (ΔBV) within the region of interest was considered the primary endpoint of the study. The micro-CT analysis revealed mean volumetric changes of -58.1% ± from baseline to 3 months for the control group, and almost no bone loss for the test group, -4.6%. The sockets treated with the collagen plug showed significantly less dimensional resorption, while the natural-healing group showed an evident collapse of the alveolar bone three months after extraction surgery.

Amino Acid-Enriched Formula for the Post-Operative Care of Extraction Sockets Evaluated by 3-D Intraoral Scanning.

BACKGROUND: Hyaluronic acid and amino acids play an important role in the wound healing process, stimulating the development of the connective tissue and the activity and proliferation of fibroblasts. The aim of the present controlled clinical study was to evaluate the clinical efficacy of a topical gel formula containing hyaluronic acid and amino acids in terms of wound closure rate, painkiller intake, and patients' reported pain and edema. METHODS: This study included patients in need of a single tooth extraction. Patients were randomized into two groups with differing post-operative care regimens. Patients in the test group used the amino acid and hyaluronic acid-based gel, while the control group did not use any product. Each parameter was measured in both groups at different time points: immediately after surgery, and after 7, 14, 30, and 60 days. RESULTS: A total of 40 patients (46.52 ± 9.84 years old) completed the observational period, and 40 extraction sockets were examined. After 7 days, the edema was significantly lower in the test group. The reported pain was lower in the test group without a significant difference, except for the first time point at 7 days. With the follow-up questionnaire, patients declared to have taken painkillers mainly during the first 7 days after surgery; however, the test group showed a lower need for painkillers than the control group. CONCLUSION: The post-operative and domiciliary use of an amino acid and hyaluronic acid-based gel for the management of soft tissue closure after tooth extraction is a valid coadjutant to reduce swelling, pain, and the need for painkillers. Additional studies are required to support the results of the present study.

The effectiveness of the information-motivation model and domestic brushing with a hypochlorite-based formula on peri-implant mucositis: A randomized clinical study.

OBJECTIVE: Management of mucositis is essential for the long-term maintenance of dental implants. This study determined the efficacy, in terms of clinical parameters, of an adjunctive domiciliary agent paired with non-surgical periodontal therapy (NSPT) for patients with peri-implant mucositis. MATERIALS AND METHODS: Patients involved in a periodontal maintenance program were randomly distributed to the domestic use of a chlorhexidine toothpaste and mouthwash (control) or a hypochlorite-based formula brushing solution (test) after diagnosis of peri-implant mucositis. A modified approach towards NSPTwas performed after 10 days of domestic use of the assigned maintenance product in both groups. Clinical and patient-related outcomes were recorded during a 90-day follow-up period. RESULTS: Forty patients completed the three-month study (20 patients per group). Both groups showed relevant clinical and patient outcome improvements after the NSPT (T2) and between T1 and T2 (p < 0 0.01), except for PPD. For the test group, the clinical improvement was significantly greater than that for the control group at the seventh-day evaluation (T1 ) in the gingival index (0-3) and FMBS (%). Favorable outcomes were maintained during the entire follow-up period. CONCLUSION: The present study showed that the modified NSPT paired with the domestic use of nitradine-based formula helps resolve peri-implant mucositis and that nitradine might represent an alternative to chlorhexidine in these cases. CLINICAL RELEVANCE: The gold standard for nonsurgical maintenance is full-mouth disinfection. A previous decontamination of the oral cavity with chlorhexidine or nitradine domiciliary for 10 days could reduce plaque and inflammation, resulting in a painless operative session. This protocol may help reduce airborne contamination and the risk of cross-infection, and during the pandemic, the protocol is safer for clinicians. In the same clinical cases, nitradine may be more efficient than chlorhexidine, and the former has no side effects such as discolouration.

Radiographic and Histomorphologic Evaluation of the Maxillary Bone after Crestal Mini Sinus Lift Using Absorbable Collagen-Retrospective Evaluation.

BACKGROUND: After tooth extraction, the alveolar bone loses volume in height and width over time, meaning that reconstructive procedures may be necessary to perform implant placement. In the maxilla, to increase the bone volume, a mini-invasive surgery, such as a sinus lift using the crestal approach, could be performed. METHODS: A crestal approach was used in this study to perform the sinus lift, fracturing the bone and inserting collagen (Condress®). The single dental implant was placed in the healed bone after six months. RESULTS: The newly formed bone was histologically analyzed after healing. Histomorphological analyses confirmed the quality of the new bone formation even without graft biomaterials. This is probably due to the enlargement of the space, meaning more vascularization and stabilization of the coagulum. CONCLUSION: Using just collagen could be sufficient to induce proper new bone formation in particular clinical situations, with a minimally invasive surgery to perform a sinus lift.

Effects of Non-Surgical Periodontal Treatment on Reactive Oxygen Metabolites and Glycemic Control in Diabetic Patients with Chronic Periodontitis.

BACKGROUND: Periodontal infection may contribute to poor glycemic control and systemic inflammation in diabetic patients. The aim of the present study is to evaluate the efficacy of non-surgical periodontal treatment in diabetic patients by measuring oxidative stress outcomes. METHODS: Sixty diabetic patients with periodontitis were enrolled, treated with scaling and full-mouth disinfection, and randomly prescribed chlorhexidine mouthwash, antioxidant mouthwash, or ozone therapy. Reactive oxygen metabolites (ROMs), periodontal parameters, and glycated hemoglobin were measured at baseline and then at 1, 3, and 6 months after. RESULTS: At baseline, all patients presented with pathologic levels of plasmatic ROM (388 ± 21.36 U CARR), higher than the normal population. Probing depth, plaque index, and bleeding on probing values showed significant clinical improvements after treatment, accompanied by significant reductions of plasma ROM levels (p < 0.05). At the 6-month evaluation, the mean ROM relapsed to 332 ± 31.76 U CARR. Glycated hemoglobin decreased significantly (∆ = -0.52 units) after treatment. Both the test groups showed longer-lasting improvements of periodontal parameters. CONCLUSION: In diabetic patients, periodontal treatment was effective at reducing plasma ROM, which is an indicator of systemic oxidative stress and inflammation. The treatment of periodontal infection might facilitate glycemic control and decrease systemic inflammation.