The effect of omega-3 fatty acids on active periodontal therapy: A systematic review and meta-analysis.

AIM: "Host modulatory therapy" (HMT) with ω-3 fatty acids aims at reducing inflammation. With HMT as an adjunct, a better result of periodontal therapy is expected. The aim of this systematic review and meta-analysis (MA) was to examine the additional effect of ω-3 fatty acids to non-surgical periodontal therapy (SRP) on the probing pocket depth (PPD) and the clinical attachment level (CAL). MATERIALS AND METHODS: MEDLINE-PubMed and Cochrane-CENTRAL libraries were searched up to January 2021 for randomized controlled trials in patients with chronic periodontitis, treated with SRP/placebo as controls and SRP/ω-3 fatty acids as the test group. RESULTS: The search identified 173 unique abstracts, and screening resulted in 10 eligible publications. Descriptive analysis showed a significant effect on the PPD and CAL in favour of the groups with ω-3 fatty acids in the majority of comparisons. MA revealed that adjunctive use of ω-3 fatty acids to SRP resulted in 0.39 mm more PPD reduction (95% CI: -0.58; -0.21) and 0.41 mm more CAL gain (95% CI: -0.63; -0.19) than SRP alone. CONCLUSIONS: In patients with periodontitis, dietary supplementation with ω-3 fatty acids as an adjunct to SRP is more effective in reducing the PPD and improving the CAL than SRP alone. If SRP is indicated, the use of ω-3 fatty acids can be considered for a moderate extra added effect on PPD reduction and CAL gain. The strength of this recommendation is moderate.

Java project on periodontal diseases: causes of tooth loss in a cohort of untreated individuals.

OBJECTIVE: To assess the relative contribution of caries and periodontal disease to tooth loss over 24 years in a cohort deprived of regular dental care. MATERIAL & METHODS: The study population consisted of 98 subjects from a tea estate on West Java, Indonesia, that had been part of a prospective longitudinal study and provided full datasets of clinical assessments between 1987, 1994 and 2002. In 2011, complete sets of dental radiographs were made which was combined with the survey forms and clinical slides from the previous assessments in order to estimate reasons for tooth loss. RESULTS: Thirty-seven subjects lost no teeth, whereas 61 subjects lost 185 teeth. In this group, 45.9% lost ≤2 teeth, 32.8% lost 3 to 4 teeth and 19.7% lost ≥5 teeth. The majority of teeth were lost due to caries. In five subjects, tooth loss could be attributed solely to periodontitis, whereas in four subjects teeth were lost due to both caries and periodontits. Analyses of the predictor variables age, gender, smoking, education, presence of caries and severe periodontitis showed that male gender and caries were significantly associated with tooth loss. CONCLUSION: The majority of teeth in this population were lost due to caries.

Adjunctive clinical effect of a water-cooled Nd:YAG laser in a periodontal maintenance care programme: a randomized controlled trial.

BACKGROUND: Various laser systems are currently available for intra-oral use. Neodymium:Yttrium-Aluminium Garnet lasers(Nd:YAG) have been approved by the US Food and Drug Administration for soft tissue treatment in the oral cavity. OBJECTIVES: The aim of this study was to test whether the use of a water-cooled Nd:YAG laser during a maintenance care programme as an adjunct to supragingival and subgingival debridement (scaling and root planing, SRP) with hand and ultrasonic instruments results in clinical improvement compared with SRP alone. MATERIAL AND METHODS: This study was an examiner-blind, randomized and controlled clinical trial using a split-mouth design. Thirty subjects were selected, originally diagnosed with moderate to severe generalized periodontitis, following a periodontal maintenance care programme (PMC). Immediately after SRP in two randomly assigned contra-lateral quadrants, all pockets ≥5 mm were additionally treated with a Nd:YAG laser (1064 nm, 4W, 250-µsec pulse). Clinical assessments [probing pocket depth PPD, bleeding on pocket probing (BOPP)] were performed pre-treatment and at 6 months. Based on these assessments, the periodontal inflamed surface area (PISA) was calculated. RESULTS: At 6 months, the clinical parameters had significantly improved for both regimens. No statistically significant differences between treatment modalities were observed for PPD and BOPP scores at any time. PISA scores supported these findings. CONCLUSIONS: In residual pockets ≥5 mm, treated in a PMC, the adjunctive use of an Nd:YAG laser does not provide a clinically significant additional advantage.

Effect of surface topography of screw-shaped titanium implants in humans on clinical and radiographic parameters: a 12-year prospective study.

OBJECTIVES: Although implants with a roughened surface are widely used today, little is known about the long-term effect of a roughened surface compared with the conventional machined surface on clinical and radiographic parameters. The purpose of this study is to investigate the long-term differences between moderately rough (tioblasted) titanium implants and minimally rough machined/turned surfaces with respect to marginal bone resorption and the peri-implant soft tissues in the same patient. MATERIAL AND METHODS: In 20 fully edentulous patients, with severely resorbed mandibles, a total of 80 Astra Tech dental implants were placed in the mandible to support a bar construction with a full overdenture. In each patient two minimally rough-surfaced (turned) and two moderately rough-surfaced (tioblast) implants were placed alternately. Clinical evaluation was carried out at base line (prosthetic installation), 6 months, 1, 2, 3, 4, 5 and 12 years. Radiographic evaluation using standardized individual filmholders was carried out at base line (prosthetic installation), 6 months, 1, 5 and 12 years. RESULTS: In two patients, during the abutment surgery, one turned implant showed insufficient osseointegration and was replaced. One implant showed an abutment fracture after 9 years and was kept as a sleeper. From base line up to 12 years, no implant was lost. No significant differences were found between both implant surfaces concerning the clinical parameters such as plaque, calculus, bleeding and probing pocket depth. The mean (SD) marginal bone changes up to 12 years varied between -0.11 and +0.01 mm for the turned and -0.2 and +0.01 mm for the tioblast implants. No significant difference in marginal bone loss was found between both implant surfaces. CONCLUSION: We conclude that after 12 years of follow-up, no differences could be found between the turned and the tioblasted implants, both for soft and for hard tissue parameters.

Water coolant supply in relation to different ultrasonic scaler systems, tips and coolant settings.

OBJECTIVE: This study evaluated "in vitro" the consistency of the water coolant supply for five ultrasonic scaler systems in relation to the tip type and different coolant settings. MATERIAL AND METHODS: The systems were: EMS PM-400, EMS PM-600, Satelec P-max, Dürr Vector and Dentsply Cavitron. For each system, three units were used and on each unit various tips were tested. The tips were run unloaded for 1 min. at full and medium water supply setting. RESULTS: At full water coolant setting, the PM-400, PM-600 and Cavitron supplied on average >45 ml/min. of water coolant (51.5, 46.3 and 46.9 ml/min., respectively). The P-max supplied 25 ml/min. and the Vector supplied 4.9 ml/min. At medium setting, the PM-400 and PM-600 supplied approximately 50% of the volume given at the full coolant setting (25.0 and 26.3 ml/min., respectively). The Cavitron supplied approximately 40% at medium setting (18.2 ml/min.) and the P-max supplied approximately 25% (5.7 ml/min.). CONCLUSION: The coolant control system of the different units did not provide a reliable indication of the water flow. Also, some perio tips gave less water coolant as compared with other tips of the same brand. Consequently, a change of tips during treatment may require adjustment of the water coolant supply.

Detection of the cemento-enamel junction with three different probes: an "in vitro" model.

AIM: The purpose of the present study was to test the accuracy and precision with which the cemento-enamel junction (CEJ) can be assessed using three commercially available periodontal probes with different tip endings in both deciduous and permanent teeth. MATERIAL AND METHODS: An "in vitro" model was developed, consisting of 70 extracted permanent and 30 deciduous human teeth mounted in plaster with an artificial gingiva made of silicone rubber. The probes tested were the Merritt-B probe, the ball-ended CPITN probe and the Vivacare TPS beveled-ball probe. With each probe, duplicate CEJ assessments were carried out at six sites per tooth by four examiners. Upon completion, the distance between the CEJ and the artificial gingival margin was determined using a stereomicroscope. RESULTS: The mean difference between the microscopic assessment and the mean clinical probe measurements in permanent teeth was -0.05 mm with the Merritt-B, 0.11 mm for the CPITN and 0.19 mm with the TPS probe. In deciduous teeth, the differences were -0.02, 0.35 and 0.63 mm, respectively. In both permanent and deciduous teeth, only the Merritt-B did not differ from the microscopic assessment. CONCLUSIONS: Results showed that the use of the Meritt-B probe offered the most accurate location of the CEJ in both permanent and deciduous teeth.

Comparison of the use of different modes of mechanical oral hygiene in prevention of plaque and gingivitis.

BACKGROUND: The objective of this study was to evaluate the effect of an oscillating/rotating/pulsating powered toothbrush on plaque and gingivitis prevention over a 9-month period. METHODS: The study had an examiner-masked, randomized, three-group parallel design. A total of 122 subjects >or= 18 years of age in good general health and with at least five teeth per quadrant and no pockets >or= 5 mm were included. A 3-week preexperimental period of extensive oral home care, including rinses, was started to improve gingival health. Professional oral hygiene instruction with a manual brush was provided. At baseline, subjects were assigned to one of three regimens: twice daily brushing with a manual toothbrush, a manual toothbrush and the use of floss, or a powered toothbrush. Subjects were professionally instructed in their regimen and given a prophylaxis. Two weeks later, oral hygiene reinforcement was provided. Gingival bleeding, plaque, staining, and gingival abrasion were assessed during the preexperimental period and at baseline, 10 weeks, and 6 and 9 months. RESULTS: There was a significant reduction in plaque and gingivitis from the preexperimental period to baseline. At 10 weeks and 6 and 9 months, the level of plaque was statistically significantly lower with the powered toothbrush versus the other two regimens (P

Clinical efficacy of a chlorhexidine-delivering toothbrush.

OBJECTIVES: Evaluate the efficacy and safety of an experimental toothbrush with a slow-release system of chlorhexidine (CHX) and determine its ability to inhibit plaque, bleeding, staining and oral tissue abnormalities during 6 weeks of use. MATERIAL AND METHODS: One hundred and fifty healthy volunteers were randomly assigned to one of three groups: the Test Brush group with a template slow-delivery system of CHX (Ttb), the Control Brush group without CHX (Ctb) and the Control Brush group without CHX but rinsing post-brushing with a 0.2% CHX mouthrinse (Ctb+R). At baseline as well as at 3 and 6 weeks, all clinical parameters were assessed. Following the baseline assessment, a supragingival prophylaxis was provided. RESULTS: One hundred and forty subjects completed the study. The Ctb+R group had lower plaque and bleeding scores than the Ttb and the Ctb group and significantly (p=0.0001) higher stain scores. There were no significant differences in plaque, bleeding and stain scores between the Ttb and the Ctb group. No differences were detected in oral tissue changes, except for discoloration of the tongue. CONCLUSIONS: In the present study, no beneficial effect could be demonstrated for the experimental CHX-releasing toothbrush. The use of a 0.2% CHX mouthrinse (in combination with brushing) remains the gold standard for additional chemical plaque control.

Penetration depths with an ultrasonic mini insert compared with a conventional curette in patients with periodontitis and in periodontal maintenance.

AIM: The aim of the study was to test whether a slim Ultrasonic Tip reaches a more apical position when penetrating a periodontal pocket compared with the working blade of a conventional Gracey Curette in both untreated periodontitis and periodontal maintenance patients. MATERIAL AND METHODS: Twenty untreated and 15 periodontal maintenance patients were selected based on the presence of at least one site a pocket of > or =5 mm in each quadrant. Recordings were made at the four approximal sites of four experimental teeth in each patient. First, the probing pocket depth was measured with the Jonker Probe. Second in randomized order, the penetration depth was assessed with an EMS PS Ultrasonic Tip and a Gracey Curette. RESULTS: In the periodontitis group, the Ultrasonic Tip penetrated significantly deeper than the Jonker Probe and the Gracey Curette. In the maintenance group, no differences were observed. Comparing the penetration of the instruments between groups, as related to the Jonker Probe measurements, only in the periodontitis group did the Ultrasonic Tip reach a significantly more apical level. CONCLUSION: The results of the present study show that in untreated periodontitis patients, the Ultrasonic Tip penetrated the pocket deeper than the pressure-controlled probe and the Gracey Curette.

Comparison of 2 commercially available chlorhexidine mouthrinses.

BACKGROUND: It has been shown that lowering the concentration of chlorhexidine (CHX) in mouthrinses from 0.2% to 0.12% does not adversely affect inhibition of plaque accumulation. The aim of this study was to evaluate the inhibition of plaque growth by 2 commercially available mouthrinses used according to the manufacturers' instructions, one with a 30-second and one with a 60-second rinsing time. METHODS: The clinical investigation was a single-blind, randomized study involving 80 volunteers (40 female, 40 male; mean age 25.7 years). At the start of the trial, all participants received a dental prophylaxis to remove all plaque deposits. Subjects refrained from all mechanical oral hygiene procedures, but rinsed twice a day with the allocated CHX mouthrinse over a period of 72 hours. The chlorhexidine preparations compared were a 0.12% concentration used at a 15 ml dose for a rinsing time of 30 seconds and a 0.2% concentration used at a dose of 10 ml for 60 seconds. After 72 hours, the plaque index (PI) from all volunteers was recorded at 6 sites per tooth. All participants received a questionnaire to evaluate their perception of the mouthrinses. RESULTS: After 72 hours, the 15 ml/30 second/0.12% CHX group had a mean whole mouth PI of 1.65 (SD 0.31) compared with a mean PI of 1.60 (SD 0.40) for the 10 ml/60 second/0.2% CHX group. The difference in plaque scores between the groups was not statistically significant. Results from the questionnaire showed no significant difference between the groups for taste perception, duration of taste, alteration in taste, or perceived plaque reduction; however, the panelists preferred the shorter rinsing time of 30 seconds and, for this parameter, the difference was statistically significant (P = 0.048). CONCLUSIONS: The results of this short-term study showed that there was no statistically significant difference between both commercially available CHX mouthrinses with respect to plaque inhibition, although both differed in concentration and rinsing time. The subject preference phase of the study indicated that the shorter rinsing time of 30 seconds was favored.