Minimally invasive periodontal regeneration with the buccal approach: a systematic review and meta-analysis of clinical studies.

OBJECTIVE: The aim of this study was to investigate clinical periodontal parameters after treatment using the Minimally Invasive Surgical Technique (MIST), Modified Minimally Invasive Surgical Technique (M-MIST), and/or any technique for papilla preservation, such as Entire Papilla Preservation (EPP), modified-papilla preservation technique (M-PPT), or simplified-papilla preservation technique (SPPT). METHODS: The focus question was "For patients with periodontal intrabony defects (P), what is the best minimally invasive regenerative approach (I), comparing MIST, M-MIST, and papilla preservation techniques' outcomes (C) to improve PD, CAL, GR, and periodontal stability (O)?" An online search was conducted on PubMed, Cochrane Library, and Embase. Only randomized clinical trials and case series with a minimum of 10 enrolled patients were included. The risk of bias was evaluated using the Critical Appraisal tools in JBI Systematic Reviews. The meta-analysis compared the data obtained for the periodontal parameters analyzed, and the heterogeneity was verified. RESULTS: After the screening, nine articles were included. Seven studies applied MIST and its modifications; two used M-PPT, one SPPT, and one approached EPP. A general statistically significant PD reduction and CAL gain were noted between the groups, comparing baseline and follow-up for all articles, independently of the technique or materials used. Also, all studies showed a non-significant increase in the gingival recession. Four studies had a low risk of bias, four had a moderate risk, and only 1 had a high risk. Moderate heterogeneity was found in one analysis for CAL (65.73%); moderate and substantial heterogeneity was found in the PD results (71.91% and 89.19%); and no heterogeneity was found within all analyses for gingival recession (0%). CONCLUSION: MIST, M-MIST, and papilla preservation techniques demonstrated their potential and efficacy to improve periodontal conditions of sites with intrabony defects with minimal morbidity.

Effects of enamel matrix derivative in nonsurgical periodontal therapy on pro-inflammatory profiles, microbial environment and clinical outcome: a randomized clinical trial.

OBJECTIVES: This study aimed to evaluate the impact of enamel matrix derivative (EMD) application following subgingival instrumentation of residual pockets in periodontitis patients on inflammatory host response, microbiological composition, and clinical outcome. METHODS: In this double-blinded randomized controlled trial, a total of 22 patients with generalized periodontitis stage III or IV presenting with ≥ 6 mm probing pocket depth (PPD) at re-evaluation after initial periodontal therapy were included. Participants were randomly allocated at a 1:1 ratio to subgingival instrumentation with (EMD +) or without (EMD-) non-surgical EMD application into the pocket. PPD, clinical attachment level (CAL), bleeding on probing (BoP), plaque index (PI), as well as a panel of pro-inflammatory cytokines and periodontal pathogen count in the gingival crevicular fluid (GCF) of the respective sites were evaluated at baseline (T0) and six months afterwards (T1). RESULTS: Both treatment groups showed a significant PPD reduction (EMD + 1.33 ± 1.15 mm, p < 0.001; EMD- 1.32 ± 1.01 mm, p < 0.001) as well as CAL gain (EMD + 1.13 ± 1.58 mm, p < 0.001; EMD- 0.47 ± 1.06 mm, p = 0.005) from T0 to T1. While no intergroup differences for PPD reduction were observed, CAL gain was higher in EMD + sites compared to EMD- (p = 0.009). No essential effects on cytokine expression as well as bacterial count were detected. CONCLUSIONS: Application of EMD as an adjunct to subgingival instrumentation of residual pockets yielded benefits regarding CAL gain; however, effects on PPD reduction, inflammatory cytokines, and bacterial count were negligible. TRIAL REGISTRATION: ClinicalTrials.gov (NCT04449393), registration date 26/06/2020. CLINICAL RELEVANCE: Based on the obtained results, additional non-surgical EMD application compared to subgingival instrumentation alone showed no clinically relevant effects on treatment outcome and underlying biological mechanisms.

Association between defect morphology and healing of intrabony defects treated with minimally invasive non-surgical therapy: A pilot exploratory analysis of two cohorts.

OBJECTIVE: The aim of this study was to explore the associations between defect morphology (defined by clinical and radiographic parameters) and the healing of periodontal intrabony defects treated with minimally invasive non-surgical therapy (MINST). BACKGROUND DATA: MINST has shown to result in favorable clinical and radiographic improvements in intrabony defects. However, it is not clear which types of intrabony defects are most suitable for this treatment. METHODS: Clinical and radiographic analyses were carried out in a total of 71 intrabony defects treated with MINST belonging to two previously published studies. Baseline defect characteristics were analyzed and related to clinical and radiographic outcomes at 12 months post-MINST with or without adjunctive enamel matrix derivative. RESULTS: No associations were detected between defect depth, angle and predicted number of walls and clinical and radiographic healing 12 months post-MINST. CONCLUSIONS: No evidence emerged for associations between defect characteristics and healing following MINST. These data seem to suggest that factors other than defect morphology may influence treatment response to MINST.

The role of rhFGF-2 in periodontal defect bone fill: A systematic review of the literature.

BACKGROUND: Growth factors have been used with success in periodontal regeneration, especially in intrabony defects. Among those, the recombined form of fibroblast growth factor-2 (rhFGF-2) has been also examined. OBJECTIVE: To address the outcomes of periodontal regeneration using rhFGF-2 alone or in combination with bone substitutes primarily in terms of Radiographic Bone Fill (RBF%) and secondary Probing Pocket Depth (PPD), and Probing Attachment Levels (PAL). MATERIAL AND METHODS: A search in MEDLINE and EMBASE using the Ovid interface was conducted from 2000 up to and including the 12th of November 2022. Starting from the initially identified 1289 articles, 34 studies were selected for further analysis. Following the full-text screening, 7 of the 34 studies met the inclusion criteria and thus were included in the systematic review after assessing their quality according to the Newcastle-Ottawa scale (NOS). Clinical and radiographic results (bone gain, pocket depth, and clinical attachment level) after the application of FGF-2 alone or in combination with different carriers were studied in patients with intrabony defects of at least one wall and pocket depth greater than 4 mm. RESULTS: Primary outcomes: RBF% was higher in studies using a combination of rhFGF-2 and bone substitutes (74.6 ± 20.0%) compared to others using the specific growth factor alone or negative controls (22.7 ± 20.7%). In terms of secondary outcomes, the analysis failed to show an additional benefit from the use of the rhFGF-2 alone or in combination with bone substitutes. CONCLUSION: rhFGF-2 can improve RBF% in the treatment of periodontal defects, especially when it is used in combination with a bone substitute.

Entire Papilla Preservation Technique with Enamel Matrix Proteins and Allogenic Bone Substitute for the Treatment of Isolated Intrabony Defects: A Prospective Case Series.

The aim of this study was to evaluate the outcomes of a modified entire papilla preservation technique (EPPT) in the treatment of isolated intrabony defects in patients diagnosed with stage III periodontitis. A total of 18 intrabony defects were treated: 4 one-wall, 7 two-wall, and 7 three-wall. Mean probing pocket depth reductions of 4.33 mm (P < .0001), clinical attachment level gains of 4.87 mm (P < .0001), and radiographic defect depth reductions of 4.27 mm (P < .0001) were observed at 6 months. Changes in gingival recession and keratinized tissue were not statistically significant. It can be concluded that the proposed modification of the EPPT is useful in the treatment of isolated intrabony defects.

Long-term stability of infrabony defects treated with enamel matrix derivative alone: A retrospective two-centre cohort study.

AIM: To assess the long-term stability of attachment gain in infrabony defects (IBDs) 10 years after regenerative treatment with an enamel matrix derivative (EMD) alone. MATERIALS AND METHODS: Two centres (Frankfurt [F] and Heidelberg [HD]) invited patients for re-examination 120 ± 12 months after regenerative therapy. Re-examination included clinical examination (periodontal probing depths (PPD), vertical clinical attachment level (CAL), plaque index (PlI), gingival index (GI), plaque control record, gingival bleeding index and periodontal risk assessment) and review of patient charts (number of supportive periodontal care [SPC] visits). RESULTS: Both centres included 52 patients (29 female; median baseline age: 52.0 years; lower/upper quartile: 45.0/58.8 years; eight smokers), each contributing one IBD. Nine teeth were lost. For the remaining 43 teeth, regenerative therapy showed significant CAL gain after 1 year (3.0; 2.0/4.4 mm; p < .001) and 10 years (3.0; 1.5/4.1 mm; p < .001) during which CAL remained stable (-0.5; -1.0/1.0 mm; p = 1.000) after an average SPC of 9 years. Mixed-model regression analyses revealed a positive association of CAL gain from 1 to 10 years with CAL 12 months post operation (logistic: p = .01) as well as a higher probability for CAL loss with an increasing vertical extent of a three-walled defect component (linear: p = .008). Cox proportional hazard analysis showed a positive association between PlI after 12 months and tooth loss (p = .046). CONCLUSION: Regenerative therapy of IBDs showed stable results over 9 years. CAL gain is associated with CAL after 12 months and decreasing initial defect depth in a three-walled defect morphology. Tooth loss is associated with PlI 12 months post operation. CLINICAL TRIAL NUMBER: DRKS00021148 (URL: https://drks.de).

Impact of periodontal treatment on inflammatory oxidative stress in chronic kidney disease subjects: An interventional clinical trial.

PURPOSE: To evaluate the role of improvement in inflammatory oxidative stress by periodontal therapy (NSPT) in chronic kidney disease (CKD) subjects. METHODS: 50 stable subjects of CKD (stage III-IV) and having chronic periodontitis were enrolled for the present study. Group A (control group) subjects who did not receive NSPT and Group B (test group) subjects who received NSPT. Oral hygiene instructions were given to both groups, malondialdehyde (MDA) in gingival crevicular fluid (GCF) and serum, albumin creatinine ratio (ACR), urine protein creatinine ratio (UPCR), pocket depth (PD), clinical attachment loss (CAL), plaque index (PI), gingival index (GI), Interleukin 1-beta (IL-1ß), high sensitivity C-reactive protein (hs-CRP) in serum were assessed at baseline and 6 months. RESULTS: There was a significant difference observed in PD, CAL, PI, GI and MDA-GCF, hs-CRP, IL-1ß in serum following NSPT in the test group compared to the control group at 6 months follow up. Within the limitations of the study, the results revealed that NSPT can be used as an effective method to reduce inflammatory oxidative stress in CKD subjects and improve renal health. Further well-designed longitudinal trials with larger sample size and longer follow ups are needed. CLINICAL SIGNIFICANCE: The non-surgical periodontal intervention showed statistically significant improvement on oxidative and inflammatory stress markers in gingival crevicular fluid and serum in subjects suffering from chronic kidney disease which suggests that periodontal treatment may be beneficial for these subjects.

Clinical efficacy of hyaluronic acid in the treatment of periodontal intrabony defect: a systematic review and meta-analysis.

OBJECTIVE: This systematic review aimed to evaluate the effects of hyaluronic acid (HA) alone or in combination with any bone substitute for the treatment of intrabony defects (IBDs). MATERIAL AND METHODS: Six databases were searched up to April 2022 to find randomized clinical trials comparing the clinical effects of open flap debridement (OFD) + HA versus OFD alone (first group) or OFD + HA + bone substitutes versus OFD + bone substitutes (second group) in the treatment of IBDs with a follow-up of at least 3 months. Random effects models of mean differences were used to determine the clinical attachment level (CAL) gain, probing depth (PD) reduction, and radiographic bone fill (RBF). RESULTS: Of the 276 studies identified, 6 were included in the qualitative synthesis, and 5 in the meta-analyses. The meta-analyses in the first group showed a statistically significant differences for CAL gain (mean difference [MD]:1.00; 95% confidence interval [CI]:0.65 - 1.35; n = 2) and PD reduction (MD: 0.76; 95%CI: 0.34 - 1.17; n = 2) favoring HA + OFD at 6 months. However, in the second group, the meta-analyses did no show additional effect of HA in association with bone substitute was demonstrated for either CAL gain (MD: 0.57; 95%CI: - 0.30 - 1.43; n = 2) or PD reduction (MD: 1.05; 95%CI: - 0.38 - 2.47; n = 2) but did show significant differences for RBF (MD: 0.57; 95%CI: 0.15 - 0.99; n = 2) at 12 months. CONCLUSION: Compared with OFD alone, local application of HA in the treatment of IBDs provided a significant CAL gain and PD reduction at 6 months. However, its combination with bone substitutes showed no statistically significant differences at 12 months. CLINICAL RELEVANCE: The use of OFD + HA improves the CAL and PD in the treatment of IBDs compared to OFD only after 6 months of follow-up. These results are not maintained after 12 months.

Bifidobacterium animalis subsp. lactis as adjunct to non-surgical periodontal treatment in periodontitis: a randomized controlled clinical trial.

OBJECTIVES: The purpose of this study is to investigate the clinical and microbiological effects of Bifidobacterium animalis subsp. lactis DN-173010 containing yogurt as an adjunct to non-surgical periodontal treatment in periodontitis patients. MATERIALS AND METHODS: This is a prospective randomized controlled clinical study registered with NCT05408364 under clinical trial registration. Thirty periodontitis patients were divided into 2 groups at random. As adjunctive to supra and subgingival instrumentation, the test group consumed Bifidobacterium animalis subsp. lactis DN-173010 containing yogurt while the control group consumed natural yogurt, once daily for 28 days. The plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL) were recorded at baseline, 28th day, and 3rd month. Microbiological analysis was performed using culture method by obtaining subgingival plaque samples from 2 periodontal sites with 4≤PD≤6 mm at the same time points. RESULTS: The inter-group comparisons of PI, GI, and BOP as well as the changes between the measurement time points were statistically significant in favor of the test group. There were no significant differences in terms of PD and CAL changes between the study groups at all times (∆baseline-28 days, ∆baseline-3 months) (p>0.05). The number of patients presenting subgingival Bifidobacterium species was significantly greater in the test group than the control group at the 28th day (p<0.05). CONCLUSIONS: The administration of probiotics has shown beneficial effects, albeit limited, on clinical and microbiological outcomes in the management of periodontitis patients. CLINICAL RELEVANCE: Daily consumption of probiotic yogurt may be supportive for supra and subgingival instrumentation.

Collagen matrix biofunctionalized with injectable platelet-rich fibrin for the treatment of single gingival recession: A case report.

INTRODUCTION: Collagen matrices have been used as connective tissue graft (CTG) substitutes. However, they do not have the same efficacy compared to CTG. Adding biological agents may increase collagen matrices' efficacy. The present case reports the use of a biofunctionalized volume-stable collagen matrix (VCMX) with injectable platelet-rich fibrin (iPRF) associated with the coronally advanced flap (CAF) to treat single gingival recession (GR) defect. CASE PRESENTATION: A Recession Type 1 (RT1 A-) defect at maxillary left canine in a male patient was treated using a VCMX biofunctionalized with iPRF associated with CAF. No swelling or edema was observed during the first 14 days after surgery. Complete root coverage was observed (RecRed of 4.0 mm) after 6 months. Gingival thickness (GT) increased (1.0 mm) by the end of the follow-up. CONCLUSION: The present case report shows that CAF associated with VCMX+iPRF presents good clinical outcomes for single GR defect. KEY POINTS: Why is this case new information? This case is the first one to our knowledge to describe the biofunctionalization of VCMX with iPRF to treat single gingival recession. What are the keys to successful management of this case? Proper material handling. Proper iPRF protocol execution. What are the primary limitations to success in this case? Need of venipuncture. Correct preparation of VCMX+iPRF. Patient compliance.

Evaluation of biphasic hydroxapatite and ß-tricalcium phosphate as a bone graft material in the treatment of periodontal vertical bony defects - A clinical and digital radiological measurement study.

Aims and Objective: The present study aimed to evaluate 2 bone graft materials, that is, biphasic hydroxyapatite and ß-tricalcium phosphate, in the treatment of periodontal vertical bony defects. In term of attachment level, probing depth and radiographic bone level changes. Also, a new digital method of radiographic assessment was used for measurement of vertical bone defect. Material and Methods: Ten subjects with periodontitis and having two or more vertical bony defects were enrolled in the study. Patients were classified randomly into 2 groups. Group I consisted of the experimental site where defect was filled with biphasic hydroxyapatite and ß-tricalcium phosphate graft and Group II consisted of control site where only the open flap debridement (OFD) was carried out. Clinical parameters were evaluated at baseline, 3 and 6 months; Radiographs were taken at baseline and 6 months after surgery. Results: Overall, by the end of 6 months, biphasic hydroxyapatite and ß-tricalcium phosphate and OFD treatment groups exhibited a significant reduction in probing depth almost by 75% and gain in clinical attachment level at follow-up. In the biphasic hydroxyapatite and ß-tricalcium phosphate group, radiographic bone level gain appeared to be greater than in the OFD group. Conclusion: In the present study, biphasic hydroxyapatite and ß-tricalcium phosphate have shown promising results and have showed reduction in probing depth, a resolution of osseous defects and gain in clinical attachment level when compared to open flap debridement.

To Explore and Analyze the Safety and Clinical Efficacy of Periocline-Assisted Periodontal Basic Therapy on Chronic Periodontitis.

Objective: This study aimed to investigate and analyse the clinical efficacy and safety of periocline-assisted periodontal foundation in the therapy of chronic periodontitis. Methods: From May 2018 to January 2021, 108 patients with chronic periodontitis were treated at our institution and randomly assigned equally to either the control or the experimental group. The plaque index (PLI), sulcus bleeding index (SBI), probing depth (PD), and periodontal attachment level (AI) were evaluated before and after periodontal basic therapy in the control group and periocline as an adjunct in the experimental group. Lactobacillus (LB) and Porphyromonas gingivalis (PG) concentrations in saliva were measured before and after therapy, and adverse responses during treatment were noted. Results: The levels of PLI, SBI, PD, and AI in the two groups were significantly lower in both groups at 1 and 3 months posttreatment compared to baseline; the levels of PLI and SBI were higher, and the levels of PD and AI were lower at 3 months after treatment compared to 1 month after treatment; compared with the control group at 1 month and 3 months after treatment, the levels of PLI, SBI, PD, and AI in the experimental group were lower than those in the control group (P < 0.05). The LB level was higher and the PG level was lower in both groups compared to baseline at 1 and 3 months posttreatment. The LB level was higher and the PG level was lower at 3 months posttreatment compared to 1 month after treatment. Compared with the control group at 1 month and 3 months after treatment, the LB level was higher, and the PG level was lower in the experimental group (P < 0.05). No significant adverse effects were observed in either group during the treatment period. Only 1 patient in the experimental group had mild gastrointestinal reactions, mainly nausea, without obvious neurological symptoms or abnormal blood changes, which did not affect the treatment. Conclusion: Periodontal fundamental therapy with perioclines may be a potential treatment for persistent periodontitis. It improves the primary clinical indicators, increases dysbacteriosis control, and has a strong safety profile. It could effectively control the development of clinical symptoms of periodontitis and reduce tissue destruction, with obvious clinical treatment effects. It could be used as the first choice for topical treatment of chronic periodontitis. It is recommended for further study by a wide range of researchers.

Effects of artificial intelligence-assisted dental monitoring intervention in patients with periodontitis: A randomized controlled trial.

AIM: To evaluate the effects of an at-home artificial intelligence (AI)-assisted dental monitoring application on treatment outcomes in patients with periodontitis. MATERIALS AND METHODS: Participants with periodontitis were recruited and randomly assigned to an AI (n = 16), AI and human counselling (AIHC; n = 17), or control (CG; n = 20) group. All participants received non-surgical periodontal treatment. We employed an AI-assisted tool called DENTAL MONITORING® (DM) intervention, a new technological AI monitoring product that utilizes smartphone cameras for intra-oral scanning and assessment. Patients in the AI and AIHC groups received additional (a) DM or (b) DM, respectively, with real-person counselling over 3 months. Periodontal parameters were collected at baseline and follow-ups. A mixed-design model analysed the follow-up effects over time. RESULTS: The AI and AIHC groups, respectively, exhibited greater improvement in probing pocket depth (PPD) (mean diff = -0.9 ± 0.4 and -1.4 ± 0.3, effect size [ES] = 0.76 and 1.98), clinical attachment level (mean diff = -0.8 ± 0.3 and -1.4 ± 0.3, ES = 0.84 and 1.77), and plaque index (mean diff = -0.5 ± 0.2 and - 0.7 ± 0.2, ES = 0.93 and 1.81) at 3-month follow-up than the CG did. The AIHC group had a greater reduction in PPD (ES = 0.46) and clinical attachment level (ES = 0.64) at the 3-month follow-up compared with the AI group. CONCLUSIONS: Using AI monitoring at home had a positive effect on treatment outcomes for patients with periodontitis. Patients who received AI-assisted health counselling exhibited better treatment outcomes than did patients who received AI monitoring alone.

Effect of locally applied simvastatin on clinical attachment level and alveolar bone in periodontal maintenance patients: A randomized clinical trial.

BACKGROUND: The purpose of this double-masked, randomized, controlled trial was to determine if the local application of simvastatin (SIM), combined with minimally invasive papilla reflection and root planing (PR/RP), is effective in improving clinical attachment level (CAL), probing depth (PD) reduction, and increasing interproximal bone height (IBH) in persistent 6-9 mm periodontal pockets in patients receiving periodontal maintenance therapy (PMT). METHODS: Fifty patients with Stage III, Grade B periodontitis presenting with a 6-9 mm interproximal PD with a history of bleeding on probing (BOP) were included in the study. Experimental [PR/RP+SIM/methylcellulose (MCL); n = 27] and control (PR/RP+MCL; n = 23) therapies were randomly assigned. Root surfaces were accessed via reflection of interproximal papillae, followed by RP assisted with endoscope evaluation, acid etching, and SIM/MCL or MCL application. CAL, PD, BOP, plaque presence, and IBH (using standardized vertical bitewing radiographs) were evaluated at baseline and 12 months. Measurements were compared by group and time using Chi-square, Wilcoxon rank-sum, and t-tests. RESULTS: Both PR/RP+SIM/MCL and PR/RP+MCL, respectively, resulted in improvements in clinical outcomes (CAL: -1.9 ± 0.3 mm, p < 0.0001; -1.0 ± 0.3 mm, p < 0.003; PD: -2.3 mm ± 0.3, p < 0.0001; -1.3 mm ± 0.3, p < 0.0001; BOP: -58.7%; -41.7%, p < 0.05) and stable IBH (-0.2 ± 0.12, -0.4 ± 0.2, p = 0.22) from baseline to 12 months post-therapy. PR/RP+SIM/MCL had more improvement in CAL (p = 0.03), PD (p = 0.007), and BOP (p = 0.047). CONCLUSIONS: The addition of SIM/MCL to PR/RP improved CAL, PD, and BOP compared with PR/RP alone in periodontal maintenance patients.

Combination Therapy with Connective Tissue Graft, Amelogenins, and Bone Substitutes for Treatment of Deep Intrabony Defects Associated with Gingival Recession: 1-Year Follow-up of 12 Cases.

Combined surgical procedures have been introduced that combine periodontal regenerative/reconstructive procedures in intrabony defects with a connective tissue graft to compensate for a deficient bone wall and limit soft tissue shrinkage, but little is known about the reproducibility of these advanced surgical techniques. This 12-case series applies a combined surgical procedure, combining amelogenins, bone substitutes, and connective tissue graft to treat deep intrabony defects associated with gingival recession. Twelve deep intrabony defects with a mean clinical attachment loss of 9.9 ± 2.1 mm, mean probing depth (PPD) of 7.8 ± 1.5 mm, mean recession of the tip of the interdental papilla (TP) of 2.1 ± 1.5 mm, and mean buccal recession (REC) of 2.3 ± 1.8 mm were treated. At 1 year, the average attachment gain was 5.1 ± 1.8 mm (P < .001), the residual PPD was 2.9 ± 0.7 mm (P < .001), no change was observed in the TP (-0.4 ± 0.8 mm, P = .078), and the REC slightly decreased to 1.7 ± 1.5 mm (P = .047). These results suggest that the proposed technique led to predictable clinical outcomes that support regeneration while maintaining or improving the position of the soft tissue margin for the interdental and buccal aspects in deep intrabony defects associated with gingival recession.

Modified minimally invasive surgical technique in human intrabony defects with or without regenerative materials-10-year follow-up of a randomized clinical trial: Tooth retention, periodontitis recurrence, and costs.

AIM: The modified minimally invasive surgical technique (M-MIST) optimizes wound stability in the treatment of intrabony defects. Short-term observations show similar results as with flap alone or adjunctive regenerative materials. This study aims to compare the stability of the long-term outcomes, complication-free survival, and costs of the three treatment options. MATERIALS AND METHODS: Forty-five intrabony defects in 45 patients were randomized to M-MIST alone (N = 15), combined with enamel matrix derivative (M-MIST + EMD, N = 15), or EMD plus bone-mineral-derived xenograph (M-MIST + EMD + BMDX, N = 15). Supportive periodontal care (SPC) and necessary re-treatment were provided for 10 years. RESULTS: Three subjects were lost to follow-up. Clinical attachment level differences between 1 and 10 years were -0.1 ± 0.7 mm for M-MIST, -0.1 ± 0.8 mm for M-MIST + EMD, and -0.3 ± 0.6 mm for M-MIST + EMD + BMDX (p > .05 for within- and between-group differences). Four episodes of recurrence occurred in the M-MIST group, four in the M-MIST + EMD group, and five in the M-MIST + EMD + BMDX group. No significant differences in complication-free survival were observed between the three groups (p = .47). Complication-free survival was 7.46 years (95% confidence interval: 7.05-7.87) for the whole population. The M-MIST + EMD + BMDX group lost one treated tooth. Data indicated no significant inter-group difference of the total cost of recurrence over 10 years. When the baseline cost of treatment was considered, the total cost was lower for M-MIST alone. CONCLUSIONS: Teeth with deep pockets associated with intrabony defects can be successfully maintained over the long term with either M-MIST alone or by adding a regenerative material in the context of a careful SPC programme. M-MIST alone provided similar short- and long-term benefits as regeneration, at a lower cost. These findings need to be confirmed in larger, independent studies.

Adjunctive efficacy of systemic metronidazole in the surgical treatment of periodontitis: a double-blind parallel randomized clinical trial.

OBJECTIVES: The purpose of this study was to evaluate the clinical and microbiological impact of adjunctive metronidazole to periodontal surgery. MATERIALS AND METHODS: Systemically healthy patients, with stages III-IV, grades B-C periodontitis, were randomly assigned to receive metronidazole or placebo adjunctive to periodontal surgery, after subgingival instrumentation. Clinical variables were recorded at the initial visit, 6 weeks after subgingival instrumentation, and 3, 6, and 12 months after surgery. Microbiological samples were taken at initial and final visits and analyzed by quantitative polymerase chain reaction. RESULTS: Our results showed no statistically significant differences in the reduction of probing depth between the initial and final (1 year) visits in the two treatment groups. Additionally, no statistically significant differences were observed between study groups when comparing the post-subgingival instrumentation and final visits. However, 3 months after surgery, probing depth (mean difference, MD = 0.31 mm, 95% confidence interval, CI [0.13; 0.49]; p = 0.001) and clinical attachment level (MD = 0.64 mm, 95% CI [0.02; 1.27]; p = 0.044) were significantly lower in the test group. CONCLUSIONS: The adjunctive use of systemic metronidazole to periodontal surgery has a limited clinical and microbiological impact in the present study, and therefore, its use is not recommended. CLINICAL RELEVANCE: There are no studies that have evaluated the clinical and microbiological impact of the adjunctive use of systemic metronidazole to periodontal surgery (step 3 of periodontal therapy). The results of the present study do not support the adjunctive use of systemic metronidazole to periodontal surgery.

Added effect of 1% topical alendronate in intra-bony and inter-radicular defects as part of step II periodontal therapy: a systematic review with meta-analysis and trial sequential analysis.

BACKGROUND: This systematic review and meta-analysis aimed to investigate the role of alendronate combined with step 2 of periodontal therapy in reducing probing pocket depth, improving clinical attachment level, and reducing bone defect depth in intra-bony and inter-radicular defects. METHODS: RCTs with more than 6 months follow-up were included in this study. Risk of bias assessment was performed using the Cochrane collaboration tool. In addition, meta-analysis and trial sequential analysis were used to aggregate the available evidence. RESULTS: Seven studies met the inclusion criteria and were included in the systematic review. Topical application of alendronate during second step of periodontal therapy significantly improved PD and CAL. CONCLUSION: Local application of alendronate may confer a beneficial effect when applied during step II of periodontal therapy even if long term studies are needed to confirm these results. CLINICAL RELEVANCE: Considering the emerging role of host-inflammatory response in treatment of periodontitis and the antiresorptive and osteostimulative properties of bisphosphonates, several studies are focusing on the role of alendronate as an addition to non-surgical periodontal therapy.

Periodontal disease progression in the second half of life and following a single episode of scaling and root planing: A clinical study in the Sri Lankan tea plantation cohort with documented clinical parameters for more than 40 years.

BACKGROUND: To evaluate periodontal disease progression (PDP) and potentially detectable effects of a single episode of scaling and root planing (se-SRP) in subjects lacking professional dental care and oral hygiene practices for >40 years. METHODS: In 2013, se-SRP was offered to all available subjects from the original cohort of 480 males initially established in 1970. From a total of 75 attending the previous examination in 2010 (baseline), 27 consented to receive the intervention while 18 declined and served as controls. Clinical data were recorded again in 2014 (follow-up) similarly to the previous surveys (1970 to 2010). RESULTS: Subjects' mean age in 2010 was 62.5 (± 3.6, test) and 61.9 (± 3.8, control) years. At follow-up, both groups presented with elevated tooth loss of 1.2 (from 15.5 ± 9.0, test) and 1.5 (from 17.9 ± 6.6, control) resulting in 1,392 (test) and 1,061 (control) sites available for further analysis. In both groups, clinical attachment level (CAL) loss and probing depths (PD) deteriorated. PD increase of 0.22 mm (± 1.70) in the test group was significantly higher compared with the control group (0.08 mm ± 1.30) (P <0.0001) demonstrating unaffected PDP. Computed estimates of further PDP revealed CAL and PD reductions in subjects aged ≥40 years. Specifically, the latter was positively correlated with tooth loss in subjects aged ≥40 years (P = 0.69, P = 0.0012) and ≥50 years (r = 0.62, P <0.0001). CONCLUSION: se-SRP in previously untreated periodontitis subjects aged ≥50 years may be ineffective in reducing PDP thus demanding advanced preventive measures, treatment in the first half of life, and sustained access to supportive care.

Long-term clinical outcomes of periodontal regeneration with enamel matrix derivative: A retrospective cohort study with a mean follow-up of 10 years.

BACKGROUND: Despite the large body of evidence on the efficacy of enamel matrix derivative (EMD) in the treatment of periodontal intrabony defects, few studies reported long-term data (≥10-year). METHODS: Periodontal patients treated with regenerative surgery with EMD between 1999 and 2012 were invited to participate in a clinical examination. The following clinical parameters were recorded and compared at baseline (T0), 6 months after surgery (T1) and after at least 8 years of follow-up (T2): probing depth (PD), gingival recession (GR), clinical attachment level (CAL), plaque and bleeding scores. The primary outcome variable was CAL change. RESULTS: Forty-one patients with 75 treated teeth were available for analysis. Out of these, 68 (tooth survival rate: 90.7%) reached the latest follow-up with a mean observation period of 10.3 years (range: 8.0 to 21.3). The most frequent reason for tooth loss was recurrence of periodontal disease. Tooth survival curves showed a statistically significant difference between smokers and non-smokers (P = 0.028). Mean CAL changed from 8.43 ± 1.86 (T0) to 6.47 ± 1.70 (T1) (P < 0.001) and to 5.91 ± 1.83 (T2) (P < 0.001). At T1, a CAL gain of ≥3 mm was measured in 35% of the defects whereas at T2 it was detected in 51% of cases. CONCLUSIONS: Within their limitations, the present results have shown that in intrabony defects, the clinical improvements obtained following regenerative surgery with EMD can be maintained on a mean period of 10 years. Smoking status and maxillary molars were correlated with an increased risk for tooth and CAL loss, respectively.