Microbiological and host-derived biomarker evaluation following non-surgical periodontal therapy with short-term administration of systemic antimicrobials: secondary outcomes of an RCT.

Nonsurgical periodontal therapy with adjunctive use of systemic antimicrobials (for 7-14 days) showed improved clinical, microbiological and immunological results over the mechanical protocol alone. Considering the increasing risk for antimicrobial resistance with longer antibiotic regimes, it is important to establish the optimal antibiotic protocol with a maximum antimicrobial benefit and minimum risk for adverse effects. The aim of the study was to evaluate the microbiological and inflammatory outcomes 12-months after a 3-/7-day systemic antibiotic protocol [amoxicillin (AMX) + metronidazole (MET)] adjunctive to subgingival debridement in severe periodontitis compared to mechanical treatment alone. From the initially treated 102 patients, 75 subjects (Placebo group: n = 26; 3-day AMX + MET group: n = 24; 7-day AMX + MET group: n = 25) completed the 12-month examination. Clinical parameters, eight periodontal pathogens and inflammatory markers were determined at baseline and 3-, 6-, 12-months after therapy using real-time PCR and ELISA respectively. After 6 months, several periodontopathogens were significantly more reduced in the two antibiotic groups compared to placebo (p < 0.05). After 1 year, both antibiotic protocols showed significant reductions and detection of the keystone pathogen P. gingivalis compared to placebo. Antibiotic protocols, smoking, disease severity, baseline-BOP, -CAL and -IL-1ß, as well as detection of T. denticola at 12-months significantly influenced the residual number of deep sites. The present data indicate that the systemic use of both short and longer antibiotic protocols (AMX + MET) adjunctive to nonsurgical periodontal therapy lead to higher microbiological improvements compared to subgingival debridement alone. The two investigated antibiotic protocols led to comparable microbiological and inflammatory results.

A comparative scanning electron microscopy study between the effect of an ultrasonic scaler, reciprocating handpiece, and combined approach on the root surface topography in subgingival debridement.

OBJECTIVE: This study aimed to analyze the effectiveness of root-shape inserts mounted on a reciprocating handpiece during the procedure of root surface debridement (RSD) on extracted teeth. Three different approaches were compared: ultrasonic scaling, employment of root-shape inserts mounted on a reciprocating handpiece, and a combination of both. MATERIALS AND METHODS: A total of 51 extracted teeth were divided into three groups. The first group was instrumented with an ultrasonic scaler, the second group with flexible root-shape inserts mounted on a reciprocating handpiece (grain size 40, 15, and 4 µm), whereas the final group underwent a combination of both approaches. The time required for the instrumentation was taken. The specimens were subjected to optical and scanning electron microscopy (SEM), and the photographs were evaluated by three examiners who were blinded to the study. The parameters included were: SEM roughness index (SRI) for the roughness calculation, remaining calculus Index (RCI) to evaluate the residual calculus deposits, and loss of tooth substance index (LTSI) to evaluate the loss of tooth substance caused by instrumentation. RESULT: The results revealed that the time taken for the instrumentation was on average longer when the root-shape inserts were employed alone, meanwhile the combined approach did not show significant difference in comparison with the ultrasonic scaling. The lower average RCI was obtained with a combined approach. The use of root-shape inserts seems to cause a moderate increase in LTSI, especially in a combined approach, whereas it resulted in a better average SRI. CONCLUSION: The employment of root-shape inserts seems to be effective in the RSD for its ability to obtain a smooth and calculus-free instrumented surface, especially when used in combination with an ultrasonic scaler, and their use can so represent a valid approach to be tested in further in vivo studies.

Patient self-care of periodontal pocket infections.

Treatment of periodontitis aims to control the infection caused by the periodontal pathogenic flora and includes mechanical debridement of root surfaces to disrupt the supragingival and subgingival biofilm. As periodontal pockets of ≤ 5 mm can be perform in a stable condition and may not need additional therapy, the ability and the willingness of the patient to perform good oral hygiene on a long-term basis are of utmost importance for ensuring long-term success of periodontal treatment. In this context, the aim of all home-care measures must be the optimal control of plaque biofilm in order to prevent or treat gingival inflammation as a primary stage of periodontitis. Despite the fact that toothbrushing and other mechanical cleaning practices are the most important elements for preventing periodontal diseases or their progression, other factors, including education, motivation, manual dexterity and compliance with professional recommendation, provision of time and socio-economic status, as well as risk factors, play a role. The present article provides an overview on the various possibilities for self-care of residual pockets in patients with periodontitis.

Role of mechanical curettage with and without adjunct antimicrobial photodynamic therapy in the treatment of peri-implant mucositis in cigarette smokers: A randomized controlled clinical trial.

OBJECTIVE: The aim of the present 12-weeks follow-up randomized clinical trial was to investigate the outcome of mechanical curettage (MC) with or without adjunct antimicrobial photodynamic therapy (aPDT) in the treatment of peri-implant mucositis in cigarette smokers. METHODS: Therapeutically, subjects with peri-implant mucositis were divided into 2 groups: (a) Group-A: MC+aPDT; and (b) Group-B: MC alone (control group). In both groups, peri-implant plaque index (PI), bleeding on probing (BOP) and probing pocket depth (PPD) were gauged at baseline and after 12-weeks follow-up. Group comparisons were performed using the Kruskall-Wallis test. P-values less than 0.05 were considered statistically significant. RESULTS: Fifty-four male patients (28 in Group-A and 26 in Group-B) were included. The mean age of individuals in groups A and B were 50.6±0.8 and 52.2±0.5years, respectively. In groups A and B the participants were smoking 16.5±2.7 and 14.2±1.7 cigarettes daily since 25.2±6.5 and 24.6±4.3years, respectively. Periimplant PI, BOP and PPD were comparable among individuals in both groups at baseline. At 12-weeks follow-up, there was a significant reduction in PI (P<0.001) and PPD (P<0.001) among patients in groups A and B compared with their respective baseline values. At 12-weeks follow-up, PI (P<0.001) and PPD (P<0.001) were significantly higher among patients in Group-B compared with Group-A (P<0.001). BOP was comparable in both groups at baseline and at 12-weeks follow-up. CONCLUSION: In cigarette smokers, MC with adjunct aPDT is more effective in the treatment of peri-implant mucositis compared with MC alone.

Efficacy of periimplant mechanical curettage with and without adjunct antimicrobial photodynamic therapy in smokeless-tobacco product users.

OBJECTIVE: The aim was to investigate the effectiveness of antimicrobial photodynamic therapy (aPDT) as an adjuvant to mechanical curettage (MC) in the treatment of periimplant mucositis in smokeless tobacco (ST) product users. METHODS: Forty-eight ST product users with periimplant mucositis were randomly divided into 2 groups. In the test-group, participants underwent periimplant MC with adjunct aPDT; and in the control-group, the patients underwent MC alone. Periimplant plaque index (PI), bleeding on probing (BOP), and probing depth (PD) were measured at baseline and after 3-months of follow-up. Statistical analysis was performed using the Kruskal-Wallis test. Level of significance was set at P<0.05. RESULTS: At baseline, periimplant PI, BOP and PD were comparable among individuals in the test- and control groups. At 3-months follow-up, scores of periimplant PI (P<0.05), BOP (P<0.05) and PD (P<0.05) were statistically significantly higher among patients in the control-group compared with the test-group. At 3-months follow-up, the percentages of sites of PI, BOP and PD were statistically significantly higher in the control-sites as compared to the test-sites. CONCLUSION: Among patients with periimplant mucositis, MC with adjunct aPDT is more effective in reducing periimplant inflammation in ST product users as compared to MC alone; however, the present result should be interpreted with caution as they were based on a short-term follow-up. Further long-term studies are needed in this regard.

Scaling and root planing vs. conservative surgery in the treatment of chronic periodontitis.

A renewed interest in conservative surgical techniques has been fueled by new technology, changes in referral patterns to periodontists and a desire to achieve periodontal health in the least invasive, most cost-efficient manner possible. Trends suggest that an increasing amount of periodontal care is being provided in the offices of general dentists. If true, it is likely that patients receiving care in these offices will be offered simpler surgical treatment modalities that do not require an extensive armamentarium. The purpose of this article was to review the effectiveness of six relatively simple surgical techniques - gingivectomy, flap debridement, modified Widman flap, excisional new attachment procedure, modified excisional new attachment procedure and laser-assisted new attachment procedure - and to compare the results obtained using these procedures with the well-known clinical benefits of scaling and root planing. The intent was to determine whether the benefits of surgical procedures in the hands of most general dentists extend beyond those of conventional nonsurgical therapy.

Maintenance periodontal therapy after systemic antibiotic and regenerative therapy of generalized aggressive periodontitis. A case report with 10-year follow-up.

Aggressive periodontitis (AgP) is an inflammatory disease characterized by rapid attachment loss and bone destruction. This case report presents the 10-year results in a subject with generalized AgP treated by a regenerative periodontal therapeutic approach and the adjunctive use of antibiotics, following a systematic maintenance periodontal therapy. The use of enamel matrix derivatives (EMD) and adjunctive antibiotic therapy to treat AgP yielded improvements in clinical parameters and radiographic bony fill. This combined therapeutic approach following a systematic supportive periodontal therapy supports the long-term maintenance of teeth with previous advanced periodontal defects, demonstrating successful stability after 10-years follow-up. Clinical Relevance: The combined treatment protocol using EMD plus adjunctive antibiotic therapy, associated with a systematic supportive periodontal therapy, benefits the long-term maintenance of teeth with previous advanced periodontal defects in subjects presenting AgP, supporting this approach as an alternative in the treatment of AgP.

Effects of non-equilibrium plasma in the treatment of ligature-induced peri-implantitis.

AIM: To evaluate the effects of non-equilibrium plasma in the treatment of ligature-induced peri-implantitis in beagle dogs. MATERIALS AND METHODS: Six beagles received 12 implants installed in the position of the fourth mandibular premolars. Ligature-induced peri-implantitis was initiated at 3 months post-implantation. When approximately 40% of the supporting bone was lost, the ligatures were removed. The implants were subjected to the muco-periosteal scaling and chlorhexidine irrigation with or without plasma irrigation. Three months later, clinical, radiographic and microbiological analyses were performed. Block biopsies were prepared for micro-CT and histomorphometric analysis. The primary outcome was the difference in bone healing of peri-implant sites, and the secondary outcomes included changes in clinical parameters (SBI, PD) and bacterial detection. RESULTS: At baseline, no significant differences were observed between the two groups. At 3 months post-treatment, the plasma group showed a significantly higher bone level than the control group (p < 0.05), a significantly decreased detection of bacteria (Porphyromonas gingivalis and Tannerella forsythia) (p < 0.05), and a significant improvement in clinical examination (p < 0.05). CONCLUSIONS: Within the limits of this study, non-equilibrium plasma treatment as an adjunct to the conventional therapy is a feasible approach for the treatment of peri-implantitis.

Clinical efficacy of subgingival debridement with adjunctive erbium:yttrium-aluminum-garnet laser treatment in patients with chronic periodontitis: a randomized clinical trial.

BACKGROUND: The efficacy of erbium:yttrium-aluminum-garnet (Er:YAG) laser application as an adjunct to subgingival debridement in the treatment of chronic periodontitis (CP) is controversial. This study assesses the efficacy of combining full-mouth subgingival debridement with Er:YAG laser application in the treatment of patients with CP. METHODS: In this 12-month, single-masked, parallel-group clinical trial, 40 patients with moderate CP were selected and randomly assigned to a test group (one session of full-mouth ultrasonic subgingival debridement followed 1 week later by Er:YAG application in sites with initial probing depths [PDs] of ≥4.5 mm) and a control group (two sessions of ultrasonic debridement within 1 week). The main outcome variable was change in PD; the secondary outcomes were change in clinical attachment level and proportion of sites with bleeding on probing. Outcomes were assessed at baseline and after 3, 6, and 12 months. Data were analyzed as intention to treat using analysis of variance to assess intergroup differences. RESULTS: Both treatments resulted in significant clinical improvements. The test group achieved, in comparison with the control, a significantly lower percentage of sites with PD ≥4.5 mm (17.44% versus 22.83%, respectively; P = 0.004) and a tendency for a lower percentage of sites with PD ≥4.5 mm and bleeding on probing (9.78% versus 12.69%; P = 0.052). CONCLUSION: This limited added clinical effect may justify the use of a protocol combining full-mouth ultrasonic debridement with laser therapy in the treatment of initial moderate CP.

Trauma from instrumentation after non-surgical periodontal treatment with ultrasonic scalers and Nd:YAG laser.

OBJECTIVE: Periodontal therapies aimed at altering the progression of periodontal diseases must include meticulous mechanical debridement during both the non-surgical and the surgical phases of periodontal treatment. The aim of this study was to evaluate and compare the immediate effect of trauma from instrumentation on clinical attachment level after non-surgical periodontal treatment with ultrasonic scalers and a Nd:YAG laser. MATERIALS AND METHODS: Twenty-four patients with untreated chronic periodontitis, presenting probing depths of 4-6 mm on anterior teeth, upper and lower, were entered into the study. The selected teeth were probed with a pressure-controlled probe, guided by stents. Each quadrant was randomly allocated in a split-mouth design either to treatment with Nd:YAG laser using an energy of 1W, 100mj, 1064nm (test group) or to periodontal treatment using ultrasonic scalers (control group). Clinical parameters, including plaque index (PI), bleeding on probing (BOP), probing pocket depth (PPD) and probing attachment level (PAL) were acquired prior to and immediately after treatment. RESULTS: Statistical analysis demonstrated no differences between groups at baseline for all parameters (p > 0.05). Immediately after treatment, the control group showed a greater PAL loss than the test group (p < 0.05). For the control group, there were statistically significant differences between PAL immediately before and after treatment (p < 0.05), but not test group (p > 0.05). CONCLUSIONS: Within the limits of the present study, it may be concluded that non-surgical periodontal treatment with ultrasonic scalers causes a mean immediate attachment loss of 0.68 mm and that a Nd:YAG laser seems to reduce significantly the trauma the instrumentation produced.

Periodontal Examination Profiles and Treatment Approaches of a Group of Turkish General Dentists.

PURPOSE: To investigate the periodontal examination profiles and treatment approaches of a group of Turkish general dentists. MATERIALS AND METHODS: 457 general dentists were called and 173 dentists agreed to participate in the study. The questionnaire comprised 10 questions including gender, years of experience, periodontal probing during examination, oral hygiene motivation methods (do you perform, yes/no; the oral hygiene motivation method; verbal expression or using visual materials), periodontal treatments (supragingival scaling, subgingival scaling and planing or surgery) and knowledge about diagnosis and treatment for aggressive and chronic periodontitis. The participants were grouped according to their years of clinical experience: group 1: 0 to 10 years of clinical practice (n = 58); group 2: 10 to 20 years (n = 68); group 3: >20 years (n = 47). RESULTS: The 'periodontal probing' performance percentages were 70.69%, 26.47% and 40.43% in groups 1, 2 and 3, respectively. The oral hygiene motivation rate was high in the first 10 years of clinical practice (60.3%). In addition, 72.4% of the dentists in group 1 used visual materials in addition to verbal expression during oral hygiene motivation. 72.25% of the general dentists performed supragingival scaling. The knowledge of diagnosis and treatment of chronic periodontitis was present in >90% of the dentists surveyed. In contrast, >50% of the general dentists were not knowledgeable in the diagnosis and treatment of aggressive periodontitis. CONCLUSION: Periodontal probing is a gold standard for periodontal diagnosis, but as the dentists' clinical experience increases, the frequency of its performance decreases. The percentage of the knowledge and treatment of chronic periodontitis is higher than that of aggressive periodontitis. Postgraduate education in periodontology is important to keep general dentists up to date on current periodontal practice and improve awareness of periodontal diseases.

Full-mouth esthetic rehabilitation with acellular dermal matrix.

Treatment of multiple recession defects with the adjunct use of a connective tissue graft (CTG) represents a challenge when diagnosed in several teeth of the mouth. The amount of CTG harvested from the palate may not be adequate to address this condition. In such scenarios, alternative sources such as acellular dermal matrix (ADM) are preferred due to the unlimited availability. A case report is presented, dealing with the treatment of multiple gingival recessions affecting the majority of dentition using ADM, with a 6-month follow-up.

Effects of root surface debridement using Er:YAG laser versus ultrasonic scaling - a SEM study.

OBJECTIVE: Despite promising results of Er:YAG laser in periodontal debridement, to date there is no consensus about the ideal settings for clinical use. This experimental clinical trial aimed to determine the effects of debridement using Er:YAG laser and to compare with ultrasonic treatment. MATERIALS AND METHODS: Sixty-four teeth were divided into two in vivo and in vitro subgroups. Each tooth received ultrasonic treatment on one side and Er:YAG laser debridement at either 60, 100, 160 or 250 mJ pulse(-1) and at 10 Hz on the other side on a random basis. All samples were morphologically analyzed afterwards under scanning electron microscope for surface changes and dentinal tubules exposure. Treatment duration (d) was also recorded. RESULTS: Laser debridement produced an irregular, rough and flaky surface free of carbonization or meltdown while ultrasound produced a relatively smoother surface. The number of exposed dentinal tubules (n) followed an energy-dependent trend. The number of exposed tubules among the in vivo laser groups was n 60 mJ = n 100 mJ < n 160 mJ < n 250 mJ (P < 0.001). Also 160 and 250 mJ lasers led to significantly more dentinal exposure than ultrasound under in vivo condition. Within the in vitro laser groups, dentinal tubules exposure was n 60 mJ < n 100 mJ < n 160 mJ < n 250 mJ (P ≤ 0.0015). Furthermore, in vitro laser treatments at 100, 160 and 250 mJ led to significantly more dentinal denudation than ultrasound. Treatment duration (d) for the in vivo groups was d 60 mJ > d 100 mJ > d Ultrasound = d 160 mJ > d 250 mJ (P ≤ 0.046), while for the in vitro groups it was d 60 mJ > d 100 mJ = d Ultrasound = d 160 mJ >d 250 mJ (P ≤ 0.046). CONCLUSIONS: Due to excessive treatment duration and surface damage, Er:YAG laser debridement at 60 and 250 mJ pulse(-1), respectively, is not appropriate for clinical use. Although laser debridement at 100 and 160 mJ pulse(-1) seems more suitable for clinical application, compared to ultrasound the former is more time-consuming and the latter is more aggressive. Using a feedback device or lower pulse energies are recommended when using laser in closed field.

Periodontal pathogens and associated factors in aggressive periodontitis: results 5-17 years after active periodontal therapy.

OBJECTIVES: To assess the association between presence of periodontal pathogens and recurrence of disease in patients with aggressive periodontitis (AgP) after active periodontal therapy (APT) and further influencing factors. MATERIAL & METHODS: Microbiological samples were taken from 73 patients with AgP 5-17 years after APT at 292 sites (deepest site per quadrant). Real-time polymerase chain reactions were used to detect the periodontal pathogens Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola. Uni- and multivariate analyses evaluated the associations between pathogens and recurrence of disease, smoking and adjunctive antibiotic therapy. RESULTS: At re-examination A. actinomycetemcomitans could be detected in six patients (8.2%), P. gingivalis in 24 (32.9%), T. forsythia in 31 (42.5%) and T. denticola in 35 (48.0%). Increased levels of T. forsythia and T. denticola at re-examination were significantly associated with recurrence of disease in multivariate analyses (OR: 12.72, p < 0.001; OR 5.55, p = 0.002 respectively). Furthermore, high counts of T. denticola were found in patients with increased percentage of sites with clinical attachment levels (CAL) ≥ 6 mm compared to those with low counts (13.8% versus 3.2%, p = 0.005). CONCLUSION: In patients with recurrence of disease T. forsythia and T. denticola were detected more frequently and in higher counts. Furthermore, T. denticola was found more frequently in patients with increased CAL.

Comparing semilunar coronally positioned flap to standard coronally positioned flap using periodontal clinical parameters.

This study compared the effectiveness of 2 surgical root coverage techniques--semilunar coronally positioned flap and coronally advanced flap--using the clinical parameters of periodontal tissues from patients with Miller Class I gingival recession. Twenty patients (20-50 years of age) were selected. Basic periodontal treatment was performed, and plaque index, gingival index, probing depth, clinical attachment level, and height of the attached gingiva were determined. Each patient was placed into 1 of 2 groups: Group 1 patients underwent the semilunar coronally positioned flap technique, and Group 2 patients underwent the coronally advanced flap technique. Patients were assessed for 180 days. Both groups showed significant reduction of plaque and gingival indices and an improvement in clinical attachment levels and probing depth. However, results showed the standard coronally positioned flap technique was deemed more effective due to significant clinical attachment level gains.

Collaborative management of a young patient with generalized aggressive periodontitis.

What are the orthodontic treatment possibilities, limitations and risks inherent in patients with periodontal disorders, particularly active periodontal disease? This case report describes the interface between orthodontics, periodontics and restorative dentistry in the management of a 25-year-old young man with generalized aggressive periodontitis.

Chronic inflammatory gingival enlargement associated with orthodontic therapy--a case report.

PURPOSE: Gingival enlargement, also synonymous with the terms gingival hyperplasia or hypertrophy, is defined as an abnormal overgrowth of gingival tissues. A case of a 19-year-old male presenting with maxillary and mandibular chronic inflammatory gingival enlargement associated with prolonged orthodontic therapy is reported here. Surgical therapy was carried out to provide a good aesthetic outcome. No recurrence was reported at the end of 1 year. The importance of patient motivation and compliance during and after therapy as a critical factor in the success of treatment has also been highlighted through this case report.

Clinical and microbiological effects of ozone nano-bubble water irrigation as an adjunct to mechanical subgingival debridement in periodontitis patients in a randomized controlled trial.

AIM: Ozone nano-bubble water (NBW3) seems to be suitable as an adjunct to periodontal treatment owing to its potent antimicrobial effects, high level of safety, and long storage stability. The aim of the present study was to evaluate the clinical and microbiological effects of NBW3 irrigation as an adjunct to subgingival debridement for periodontal treatment. METHODS: Twenty-two subjects were randomly assigned to one of the two treatment groups: full-mouth mechanical debridement with tap water (WATER) or full-mouth mechanical debridement with NBW3 (NBW3). Clinical examination was performed at baseline and 4 and 8 weeks after treatment. Microbiological examination was carried out just before and after treatment and at 1 and 8 weeks posttreatment. RESULTS: There were significant improvements in all clinical parameters after 4 weeks in both groups. The reduction in the probing pocket depth and the clinical attachment gain after 4 and 8 weeks in the NBW3 group were significantly greater than those in the WATER group. Moreover, only the NBW3 group showed statistically significant reductions in the mean total number of bacteria in subgingival plaque over the study period. CONCLUSIONS: The present study suggests that subgingival irrigation with NBW3 may be a valuable adjunct to periodontal treatment. CLINICAL RELEVANCE: This study verified the potential of new antimicrobial agent, MNW3, as an adjunct to periodontal treatment.

Histological evaluation of human intrabony periodontal defects treated with an unsintered nanocrystalline hydroxyapatite paste.

OBJECTIVES: The aim of the study was to clinically and histologically evaluate the healing of human intrabony defects treated with open flap surgery (OFD) and application of a new, resorbable, fully synthetic, unsintered, nanocrystalline, phase-pure hydroxyapatite (nano-HA). MATERIALS AND METHODS: Six patients, each of them displaying very advanced intrabony defects around teeth scheduled for extraction due to advanced chronic periodontitis and further prosthodontic considerations, were included in the study. Following local anaesthesia, mucoperiosteal flaps were reflected; the granulation tissue was removed, and the roots were meticulously debrided by hand and ultrasonic instruments. A notch was placed at the most apical extent of the calculus present on the root surface or at the most apical part of the defect (if no calculus was present) in order to serve as a reference for the histological evaluation. Following defect fill with nano-HA, the flaps were sutured by means of mattress sutures to allow primary intention healing. At 7 months after regenerative surgery, the teeth were extracted together with some of their surrounding soft and hard tissues and processed for histological analysis. RESULTS: The postoperative healing was uneventful in all cases. At 7 months following surgery, mean PPD reduction and mean CAL gain measured 4.0 ± 0.8 and 2.5 ± 0.8 mm, respectively. The histological analysis revealed a healing predominantly characterized by epithelial downgrowth. Limited formation of new cementum with inserting connective tissue fibers and bone regeneration occurred in three out of the six biopsies (i.e. 0-0.86 and 0-1.33 mm, respectively). Complete resorption of the nano-HA was found in four out of the six biopsies. A few remnants of the graft particles (either surrounded by newly formed mineralized tissue or encapsulated in connective tissue) were found in two out of the six biopsies. CONCLUSION: Within their limits, the present results indicate that nano-HA has limited potential to promote periodontal regeneration in human intrabony defects. CLINICAL RELEVANCE: The clinical outcomes obtained following surgery with OFD + nano-HA may not reflect true periodontal regeneration.

Wound healing of dehiscence defects following different root conditioning modalities: an experimental study in dogs.

OBJECTIVE: The purpose of this study was to investigate the periodontal healing pattern of dehiscence-type defects following different chemical root conditioning modalities. MATERIALS AND METHODS: Buccal osseous dehiscence defects were created on six teeth of seven dogs. After dental plaque accumulation, defects were treated with sterile saline solution (control group) or one chemical conditioning modality: citric acid (CA group), ethylenediaminetetraacetic acid (EDTA group), tetracycline (TTC group), citric acid + tetracycline (CA + TTC group), or tetracycline + citric acid (TTC + CA group). After 3 months of healing, clinical parameters were evaluated, and the animals were killed. Histological sections were processed, and a computer-assisted histometric analysis was used to evaluate the formation of new cementum, new bone, and epithelial apical migration. RESULTS: All treatments yielded significant improvements in terms of probing depth decrease and clinical attachment level gain compared to baseline values; however, without significant differences among the groups (p > 0.05; one-way ANOVA). The highest amount of new cementum was noted in the EDTA group (3.72 ± 0.83 mm, 77.6 %), while the lowest amount of new bone was observed in the TTC group (0.7 ± 0.94 mm, 14.3 %). However, no statistically significant differences could be observed among the groups regarding epithelial apical migration, new cementum, and alveolar bone formation (p > 0.05). CONCLUSION: Chemical root surface conditioning did not promote any significant improvement in periodontal healing pattern of dehiscence-type defects in dogs. CLINICAL RELEVANCE: Chemical root surface conditioning after surgical debridement did not promote positive or negative effects on periodontal healing pattern of dehiscence-type defects.