At least 3 years of self-responsibility for periodontal care after 2 years of supportive periodontal therapy.

OBJECTIVES: This study aimed to investigate the periodontal condition when patients became self-responsible for the continuation of periodontal care, after non-surgical periodontal therapy and 2 years of Supportive Periodontal Therapy (SPT). MATERIALS AND METHODS: Fifty-seven patients completed a previous 2-year SPT study and were afterward advised to seek for dental assistance for maintenance care. After 4.2 ± 0.45 years of self-responsibility for periodontal care (SRPC), 27 patients could be re-examined of which 9 patients had followed the advice to turn to a dental professional for SPT care. Visible Plaque (VPI), Gingival Bleeding (GBI), Periodontal Probing Depth (PPD), Bleeding on probing (BOP), and Clinical Attachment Loss (CAL) were obtained from SPT study: before and after non-surgical treatment, and after 2 years of SPT. The same parameters were reassessed for the present study. General linear models for repeated measures were used for data analysis. RESULTS: At the end of the SRPC period, mean GBI, BOP, and PPD values (43.5%, 55.7%, 2.76 mm, respectively) were back to pre-treatment, whereas VPI (64.3%) and CAL (3.76 mm) became significantly higher. The percentage of sites with PPD ≥5 mm as well as sites with CAL ≥4 or ≥5 mm also returned to pre-treatment values. However, the percentage of sites with PPD ≥4 mm was still significantly lower compared to pre-treatment values but higher than after 2 years of SPT. CONCLUSIONS: Self-responsibility for the continuation of periodontal care after professional treatment should be avoided. CLINICAL RELEVANCE: Clinicians and specialists must be conscious of making all efforts to maintain the patient's frequent recalls.

The use of medium bristle toothbrushes is associated with the incidence of gingival fissures.

OBJECTIVES: The objective of this study was to compare the incidence of gingival fissures (GF) associated with the use of soft and medium bristle toothbrushes over three months. MATERIAL AND METHODS: A blind randomized crossover clinical trial was conducted with 20 high school students (14 females, 14-24 years old) using both toothbrushes type (soft and medium bristle) during 3 months each. Periodontal examinations and photographs of premolars and molars were recorded on days 0, 30, 60, and 90 of 1st phase. Following a 10-day washout period, the 2nd phase was carried out with the participants changing the assigned brush type. Toothbrushing perception was evaluated at the end of study through a questionnaire. A calibrated and blind examiner analyzed the photographs for GF presence. Differences in the GF incidence between toothbrushes type were analyzed by McNemar test, while factors associated with GF incidence were investigated by Poisson regression. RESULTS: Sixty-five percent (n = 13) of participants had at least one GF throughout the study, with 40% (n = 8) of them while using medium brushes only (p = 0.039). GF occurrence was significantly associated with medium brushes (IRR, 3.582; 95% CI 1.459-8.795; p = 0.005). 58.8% of participants reported gingival soreness or bleeding with medium brushes. CONCLUSIONS: Both toothbrushes led to the GF occurrence. Nonetheless, medium bristles toothbrushes determined a 3.58 times greater risk of developing these lesions. Clinical relevance The use of medium bristle brush is associated with greater incidence of gingival fissures. The presence of gingival fissures should be considered by the clinician when evaluating the toothbrushing habits of patients.

Screening of candidate biomaterials for alveolar augmentation using a critical-size rat calvaria defect model.

OBJECTIVE: To screen candidate biomaterials intended for alveolar augmentation relative to their potential to enhance local bone formation using a routine critical-size (ø8-mm) rat calvaria defect model. METHODS: One hundred and forty male Sprague Dawley outbred rats, age 11-12 weeks, weight 325-375 g, obtained from USDA approved breeder, randomised into 14 groups of 10 animals, each received one of the following treatments: sham-surgery (empty control), Bio-Oss (bovine HA/reference control), or candidate biomaterials including bovine HA, synthetic HA/ß-TCP and calcium phosphate constructs, mineralised/demineralised human bone preparations, a ß-TCP/calcium sulphate and an HA/calcium sulphate putty. A 4-week healing interval was chosen to discern local bone formation using incandescent and polarised light microscopy. Statistical analysis used one-way ANOVA followed by Bonferroni for pairwise comparisons. RESULTS: Candidate biomaterials all displayed biocompatibility. They exhibited limited, if any, appreciable bioerosion or biodegradation. No statistically significant differences in mean linear defect closure were observed among experimental groups, sham-surgery displaying the highest score (48.1 ± 24.3%). Sham-surgery also showed a significantly greater bone area fraction than all other groups (19.8 ± 13.9%, p < .001). The HA/calcium sulphate putty showed a significantly greater residual biomaterial area fraction than all other groups (61.1 ± 8.5%, p < .01). CONCLUSION: Within the limitations of this animal model, although biocompatible, none of the tested biomaterials enhanced local bone formation beyond the innate regenerative potential of this craniotomy defect.

Gingival crevicular fluid levels of cytokines/chemokines in chronic periodontitis: a meta-analysis.

AIMS: To compare gingival crevicular fluid (GCF) cytokines/chemokines levels between periodontally healthy subjects and subjects diagnosed with chronic periodontitis (ChP), before and after non-surgical periodontal treatment, and to establish their predictive value for periodontal disease progression. METHODS: Studies indexed in MEDLINE and EMBASE published in English, Portuguese and Spanish were eligible for this review. Database searches up to December 2015, and manual search of the reference list from reviews and selected articles was performed. Only studies providing data on GCF cytokines/chemokines levels in subjects diagnosed with ChP and periodontally healthy controls were included. Cross-sectional, case series, single-arm clinical studies, randomized controlled trials and prospective/retrospective cohort studies were included. Meta-analyses were conducted for those cytokines/chemokines with at least three available studies. RESULTS: GCF levels of IL-1ß, IL-6, IFN-γ and MCP-1/CCL2 were significantly higher in subjects diagnosed with ChP than periodontally healthy subjects. A significant decrease in GCF levels of IL-1ß and IL-17 was observed after non-surgical periodontal treatment, whereas a significant increase was observed for IL-4. CONCLUSION: Evidence for significant differences between periodontal health and ChP was observed for a few cytokines and one chemokine. No conclusions could be drawn with regards to increased risk of disease progression.