Artificial biofilm removal in a peri-implant mucositis model: Efficacy of air polishing technology as adjunct to ultrasonic debridement alone and impact of the site and the depth of mucosal tunnel-An in vitro study.

AIM: The current in vitro model aims to evaluate the adjunctive effect on artificial biofilm removal determined by the use of a glycine-powder air-polishing procedure (GPAP) over the ultrasonic debridement (USD) alone when the removal of artificial biofilm on abutment surface is performed. The procedures were carried out also evaluating the impact of the site (mesial, distal, vestibular, and oral) and three different mucosal tunnel depths (2 mm, 4 mm, and 6 mm). MATERIALS AND METHODS: Single tooth implant replacement was simulated. Three different abutment heights together with a prosthetic contour were investigated (2 mm, 4 mm, and 6 mm); custom-made gingival masks were created to mimic peri-implant soft tissue. Biofilm was simulated with an indelible ink. The protocol consisted in two intervention stages for each abutment: (a) USD with PEEK tip plus (b) GPAP. At the end of each intervention, abutments were unscrewed, and standardized photographs were taken. Statistical analysis was carried out to compare residual stain percentage between the two intervention stages and among different sites and mucosal tunnels. RESULTS: A total of 30 abutments were instrumented. A significant reduction of the percentage of residual staining (PRS) after the combination of GPAP + USD over USD alone was demonstrated (16% vs. 32%; p < 0.05). Moreover, the better performance of the GPAP + USD protocol was observed regardless of the different mucosal tunnel heights and the sites analyzed. Intragroup analysis unveils that the smaller PRS was observed for shallow mucosal tunnels (2 mm) and vestibular sites for both protocols. CONCLUSION: GPAP + USD provided adjunctive effect on artificial biofilm removal in comparison to the USD alone. Furthermore, proximal surfaces and deeper mucosal tunnels (4 and 6 mm) showed a reduced instrumentation efficacy for both protocols.

Patients' illness perception before and after non-surgical periodontal therapy: A pre-post quasi-experimental study.

BACKGROUND: Patient's illness perception, assessed through the Brief-Illness Perception Questionnaire (Brief-IPQ), plays a decisive role in the treatment effectiveness of a wide range of chronic diseases; nonetheless, evidence is still lacking regarding periodontitis. The aim of the present pre-post quasi-experimental study was to evaluate the change in the Brief-IPQ before and after non-surgical periodontal treatment (NST) and to evaluate its ability to foresee the efficacy of NST. METHODS: A total of 126 periodontitis participants starting NST were asked to participate in the study. The nine-item Brief-IPQ together with a full periodontal chart were recorded at baseline and at the 3-month follow up (reevaluation) after NST. Pre-post comparisons of psychometric and periodontal variables were carried out through the Wilcoxon signed-rank test (α = 0.05). A predictive model was built to test the ability of the Brief-IPQ items to foresee the efficacy of NST. RESULTS: NST led to a significant reduction in all periodontal parameters (P < 0.001); the proportion of pockets closed was 64.18%. Although the overall sum score of the Brief-IPQ remained fairly stable (P = 0.0673), significant changes occurred for items seven ("understanding") (P < 0.001) and 8 ("emotional response") (P < 0.05). The best model (R2  = 0.068, F = 2.15, P = 0.033) obtained from the multivariate linear regression analysis demonstrated that item five ("identity") (ß = 2.340, P = 0.017) and item eight ("emotional response") (ß = -2.569, P = 0.008) significantly predict the efficacy of NST (i.e., the proportion of pockets closed at reevaluation). CONCLUSIONS: NST significantly ameliorates patient's understanding and emotional burden related to periodontitis. Baseline values of perceived symptoms and emotional response are predictive for the short-term efficacy of NST.

Impact of interproximal composite restorations on periodontal tissue health: Clinical and cytokine profiles from a pre-post quasi-experimental study.

BACKGROUND: The aim of this study is to clinically and molecularly evaluate the effect of an interproximal iuxta/subgingival direct composite restoration on periodontal tissue healing. METHODS: Individuals in need of a posterior iuxta/subgingival interproximal restoration were consecutively enrolled. After enrollment, a test (site with tooth decay) and a control site (intact contralateral tooth) were identified. After a periodontal examination (probing depth [PD], clinical attachment level, recession, plaque, and bleeding on probing [BOP]) and a sampling of gingival crevicular fluid, the composite restoration was performed (T0 ). Clinical and molecular assessments were repeated at 3 (T3 ), 6 (T6 ), and 12 (T12 ) months after the restoration. Intragroup pre-post comparisons for quantitative variables were performed either through one-way ANOVA or Kruskal-Wallis test. A multivariate linear regression analysis was then modeled. With α = 0.05, a power of 80% will be reached with the inclusion of 41 individuals. RESULTS: Biometric parameters demonstrated an increased mean PD (ΔPDT0 -T12 = -0.83 mm; P = 0.001) and loss of attachment (AL) (ΔCALT0 -T12 = -0.91 mm; P = 0.005) in the test site at 12 months. Accordingly, in the final multivariate regression model the radiographic distance between the bone crest and the restorative margin at baseline accounted for the dependent variable "attachment loss (AL)" (ΔCALT0 -T12 ) (P <0.05). CONCLUSIONS: Iuxta/subgingival interproximal restorative margins jeopardized clinically and molecularly the periodontal tissue healing at least up to 1 year of follow-up.

Efficacy of Behaviour Change Techniques to improve oral hygiene control of individuals undergoing orthodontic therapy. A systematic review.

AIM: This study aims to review the available evidence on the efficacy of behaviour change techniques to improve compliance in young orthodontic patients and to compare these with conventional oral hygiene instructions. METHODS: The review was conducted according to the PRISMA statement. PICO method was used to define eligibility criteria. Two independent reviewers performed the research, examined electronic databases (MEDLINE, Scopus and CENTRAL) and manually checked relevant journals. Only RCTs with more than 10 participants and 3 months follow-up were included. Data extraction and their qualitative analysis were performed for included studies. RESULTS: Search strategy identified 320 articles. After screening for titles, abstracts and full texts, 10 articles were then selected for qualitative analysis. High methodological heterogeneity was present among studies and therefore no meta-analysis was performed. Low risk of bias was detected for one study only. The most common intervention was "mobile phone communication," which was investigated in five studies. Motivational interviewing, repeated reinforcements and visual-aided approach were also examined. CONCLUSION: The interest in remote control of patients compliance appears to be fruitful, nonetheless there is no consensus as to a unique treatment protocol. Every other treatment looks beneficial but higher methodological homogeneity should be sought for in future investigations.

Efficacy of Enamel Derivatives to Improve Keratinized Tissue as Adjunct to Coverage of Gingival Recessions: A Systematic Review and Meta-Analysis.

BACKGROUND: The systematic review was designed to answer the following focused question: Are enamel matrix derivatives able to improve the quantity of keratinized tissue (KT) around natural dentition in patients with recessions defects after their treatment with periodontal plastic procedures? METHODS: Only Randomized Clinical Trials (RCT) in English language evaluating root coverage procedures in combination with enamel matrix derivatives (commercially known as Emdogain®-EMD), with at least 10 subjects and a minimum duration of six months, were included. The search was applied to PUBMED and SCOPUS and it consists of a combination of MeSH terms and free text words (from January 2000 to June 2019). Risk of bias in individual studies and across studies was also evaluated. RESULTS: After the full text analysis and the exclusion of further 18 articles, 12 articles were finally included. In total 639 recessions were treated (334 tests and 305 control). The recessions defects were classified according to the classification of Miller (Class I, II, III, IV). Only one trial included Miller Class III recessions (7 in total). Enamel matrix derivatives were applied in conjunction with Coronally Advanced Flap (CAF), Coronally Advanced Flap + Sub Epithelial Connective Tissue Graft (CAF + CTG), Semilunar Flap (SF). For the group CAF vs CAF + EMD the mean difference between the keratinized tissue gain in the two procedures was 0.40 mm (95% Confindence Interval Lower/Upper: 0.014-0.81) (p < 0.058); for the comparison CAF + CTG + EMD vs. CAF + CTG the mean difference between the two groups resulted in -0.06 mm (95% Confindence Interval Lower Upper -0.45 to 0.33) (p = 0.7603). DISCUSSION: Randomized clinical trials included medium-low quality evidence. The application of Enamel Matrix Derivatives to surgical procedures aimed to cover gingival recessions does not add robust clinical benefit to conventional plastic procedure alone.

Minimally invasive flap compared to a trapezoidal flap in lateral approach maxillary sinus elevation procedures: Four-month post-loading results from a split-mouth randomised controlled trial.

PURPOSE: To test a minimally invasive flap in the lateral approach for maxillary sinus floor elevation when compared to a trapezoidal flap. MATERIALS AND METHODS: Each patient received a bilateral sinus elevation procedure based on two different randomly allocated surgical approaches according to a split-mouth design: in the test side, a horizontal incision at mucogingival line was realised; in the control side, a trapezoidal flap was elevated to prepare the lateral window. Each sinus was filled using deproteinised bovine bone and the window covered with a collagen membrane. Implants were inserted according to a two-stage technique 6 months after sinus elevation procedures, submerged and then loaded after 6 months with definitive screw-retained metal-ceramic prostheses. Patients were followed up to 4 months post-loading. Outcome measures included: implant and prosthesis failures, complications, peri-implant marginal bone level changes, residual bone height and width, recorded before sinus augmentation and 180 days post-intervention by computed tomography (CT) scans, surgical times and patient discomfort data, assessed using a visual analogue scale (VAS) diagram for each treated side at 1, 7, 14 and 30 days of follow-up. RESULTS: Seventeen patients were enrolled in this trial and none dropped out. Five completely edentulous patients were treated with full-arch prosthetic restorations (Toronto dental prosthesis) and 12 patients with partial metal-ceramic screw-retained prostheses. In total 72 implants were inserted, 37 in the test group and 35 in the control group. No prosthesis or implant failures occurred. A total of seven patients showed complications: five of them had complications in both test and control sides. Eight complications were detected in each group. During maxillary sinus elevation procedures, nine interventions (four from the test group and five from the control group) were affected by intrasurgical complications (six membrane perforations and three severe bleedings); post-surgical complications occurred to three patients (one submucosal emphysema in a patient from the test group, one wound dehiscence and a graft infection both recorded in the control group); a total of four implants in two patients in the test group, versus three implants from one patient in the control group showed peri-implant mucositis. There were no statistically significant differences in complications between the two groups (P = 1.00; 95% confidence interval [CI]: 0.15-3.11). Patients from the control group, at 4 months after loading, lost on average 0.53 mm (standard deviation [SD] 0.27; 95% CI: 0.40-0.65), and patients from the test group lost on average 0.66 mm (SD 0.27; 95% CI: 0.53-0.78); the difference was not statistically significant (mean difference: 0.07 mm; SD 0.34; 95% CI: -0.03-0.17; P = 0.102). Significant values for bone augmentation in height, 9.26 mm (SD 1.46; 95% CI: 8.56-9.95) in the test group and 9.38 mm (SD 1.95; 95% CI: 8.45-10.30) in the control group, and width, 1.68 mm (SD 1.04; 95% CI: 1.18-2.20) in the test group and 1.60 mm (SD 1.27; 95% CI: 0.99-2.20) in the control group, were found from the 180-day CT scans. No statistically significant differences were detected between the two groups, either for the bone augmentation data (difference: 0.27 mm; 95% CI: 0.15-0.38; P = 0.60) or for the bone width values (difference: 0.02 mm; 95% CI: 0.07-0.11; P = 0.67). A significant reduction in the total surgical time was found in the test group (mean difference: 6.64 minutes; SD 4.32; 95% CI: 4.58-8.69), with the difference being statistically significant (P = 0.009). Evaluation of patients' postoperative discomfort showed a significant preference for the test procedure: at 1 day the VAS value was 4 (interquartile range [IQR] 2 to 5) in the test group; in the control group the VAS score was 5 (IQR 4 to 8). The intergroup difference was statistically significant (P = 0.002). At the 7-day follow-up, the VAS value was 1 in the test group (IQR 0 to 3) and 3 in the control group (IQR 0 to 7), this difference was statistically significant (P = 0.003). No differences were detected at 14 and 30 days (P > 0.05). CONCLUSIONS: A minimally invasive approach to access the sinus cavity can be as successful as a conventional trapezoidal flap in maxillary sinus floor elevations.