[A novel periodontal endoscopy-aided non-incisional periodontal regeneration technique：a case series study].

PURPOSE: To investigate the effect of endoscopy-aided non-incisional periodontal regeneration technique (NIT) in the treatment of alveolar bone angular resorption. METHODS: Thirteen patients with severe periodontitis(13 diseased teeth) were selected. All patients had alveolar bone angular resorption on adjacent surface. The patients received NIT treatment 6 weeks after periodontal primary therapy. The visualization of subgingival environment was acquired by the periodontal endoscopy. Following the removal of the subgingival plaque, calculus and intra-bony granulation tissue, bone grafting materials were placed into the intra-bony defects with the assistance of a delicate gingival protector. No flap was elevated and no sutures were applied. Probing depth (PD), gingival recession (GR), clinical attachment level (CAL), as well as radiographic parameters were evaluated at baseline and 2 years after treatment. SPSS 22.0 software package was used for data analysis. RESULTS: At 2-years follow-up, an average CAL gain of (3.65±2.10) mm (P＜0.001), PD reduction of (4.42±1.66) mm (P＜0.001), and minimal increase in GR of (0.38±0.87) mm (P=0.25) were observed. Alveolar bone was significantly improved at 2-years follow-up on radiographs (P＜0.001). CONCLUSIONS: For angular resorption site of alveolar bone, NIT treatment can obtain good periodontal regeneration results without flap inversion.

Laser Therapy Effects on Periodontal Status: A Randomized Study Using Gaussian Network Analysis and Structural Equation Modeling Approach.

Background and Objectives: This paper aims to assess the role of laser therapy in periodontitis through an innovative approach involving computational prediction and advanced modeling performed through network analysis (Gaussian graphical models-GGMs) and structural equations (SEM). Materials and Methods: Forty patients, exhibiting periodontal pockets with a minimum depth of 5 mm, were randomly divided into two groups: a control group and a laser group. Four specific indicators were measured for each tooth, namely periodontal pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP), and plaque index (PI), and the mean of six measured values was recorded at five time markers (baseline, 6 months, 1 year, 2 years, and 4 years). The assessment algorithm included enrollment, measurements, and differential non-surgical periodontal treatment, according to the group allocation. Scaling, root planing, and chlorhexidine 1% were conducted for the control group, and scaling, root planing and erbium, chromium:yttrium-scandium-gallium-garnet (Er,CR:YSGG) laser therapy were conducted for the laser group. Results: The main results highlight that the addition of laser treatment to scaling and root planing led to notable clinical improvements, decreasing the PPD values, reducing the BOP scores, and increasing the CAL. Conclusions: Notable relationships between the specific indicators considered were highlighted by both the GGMs and by SEM, thus confirming their suitability as proxies for the success of periodontal treatment.

[A prospective cohort study on the effect of implant restoration following micro crestal flap-alveolar ridge preservation at molar extraction sockets with severe periodontitis].

Objective: To evaluate the survival rate, success rate, soft tissue conditions and marginal bone level changes of implants following micro crestal flap-alveolar ridge preservation at molar extraction sockets with severe periodontitis, compared to natural healing. Methods: From March 2015 to January 2017, patients scheduled for molar extraction as a consequence of severe periodontitis and planned implant-retained prostheses from Department of Periodontology Peking University School and Hospital of Stomatology were selected. A total of 40 molar extraction sockets from 40 patients received implant placement following micro crestal flap-alveolar ridge preservation or natural healing. The front consecutive 20 teeth were assigned to the natural healing group, and the back ones were assigned to the micro crestal flap-alveolar ridge preservation (MCF-ARP) group. The superstructures were placed 6 months later. Within 2 weeks (baseline) and 1, 2 and 3 years after implant crown restoration, modified plaque index, probing depth, modified bleeding index and keratinized tissue width were recorded every six months. Parallel periapical radiographs were taken to evaluate the peri-implant marginal bone level and to calculate marginal bone loss. Independent sample t test or Mann-Whitney U test were used to compare the differences in the above clinical and imaging indicators between the two groups. Results: The implant survival rate and success rate of the two groups were both 100% (20/20). There were no significant differences in the modified plaque index, probing depth, modified bleeding index, buccal keratinized tissue width and marginal bone loss between two groups at 1, 2 and 3 years after implant crown restoration (all P>0.05). Marginal bone loss was 0.22 (0.14, 0.34) mm in the natural healing group and 0.21 (0.12, 0.30) mm in the MCF-ARP group at a 3-year post-loading evaluation. Conclusions: Within the limitations of the present study, implants placed at ridge preserved and naturally healed molar extraction sockets with severe periodontitis demonstrate comparable clinical outcomes at a 3-year post-loading evaluation.

Vital root resection with radicular retrograde partial pulpotomy in furcation-involved maxillary molars in patients with periodontitis: Technique description and case series considering clinical and economic aspects.

AIM: Conventional root resection in periodontally compromised furcation-involved maxillary molars requires preceding endodontic treatment and is therefore associated with loss of tooth vitality, higher invasiveness, treatment time and costs, and the risk of endodontic complications. Vital root resection (VRR) could overcome these disadvantages while establishing stable periodontal and endodontic conditions. This case series aimed to introduce the concept of one-stage VRR with radicular retrograde partial pulpotomy (VRRretro). SUMMARY: Seven vital maxillary molars with residual probing pocket depths (PPD) ≥ 6 mm and furcation ≥ class 2 of five patients with stage III/IV periodontitis were treated with VRRretro using mineral trioxide aggregate. Teeth with residual through-and-through furcations were additionally tunnelled. Follow-up up to 2.5 years postoperatively during supportive periodontal care included full periodontal status, percussion and thermal sensitivity testing. Periapical radiographs were obtained to rule out possible periradicular radiolucencies. All seven treated molars were in-situ at an average of 26.84 ± 5.37 months postoperatively and were clinically and radiographically inconspicuous independent of tooth position, the resected root, the need for tunnelling and the restorative status. The mean PPD on the seven treated molars was 4.02 ± 0.85 mm (6-10 mm) preoperatively and 2.62 ± 0.42 mm (3-4 mm) at the last follow-up. Clinical attachment level and bleeding on probing could also be decreased. The teeth showed no mobility over time and furcations class 2 were reduced to class 1 while the tunnelled furcations were accessible with interdental brushes. All molars reacted negatively to percussion and positively to thermal sensitivity testing. KEY LEARNING POINTS: In carefully selected cases considering patient- and tooth-related factors, VRRretro could be a promising treatment option to establish stable periodontal and endodontic conditions in furcation-involved maxillary molars while preserving tooth vitality.

Pretreatment periodontitis is predictive of a poorer prognosis after esophagectomy for esophageal cancer.

BACKGROUND: Poor oral health is an independent risk factor for upper-aerodigestive tract cancers, including esophageal cancer. Several studies have investigated short-term outcomes after esophagectomy and the impact of periodontal disease, but few have examined the impact of periodontal disease on long-term outcomes. The purpose of this study was to investigate the rate of periodontitis among esophagectomy patients and the prognostic value of periodontitis and its effect on prognosis after esophagectomy. METHODS: A total of 508 patients who underwent esophagectomy received oral health care from a dentist before cancer treatment at Akita University Hospital between January 2009 and December 2021. We assessed the presence and severity of the patients' periodontitis and divided them into no-periodontitis, mild periodontitis, severe periodontitis and edentulous jaw groups. We then assessed 10-year overall survival (OS) and disease-specific survival (DSS) and determined whether periodontitis was an independent prognostic factor affecting OS and DSS. RESULTS: We found that 101 (19.9%) patients had no periodontitis, 207 (40.8%) had mild periodontitis, 176 (34.6%) had severe periodontitis requiring tooth extraction, and 24 (4.7%) had edentulous jaw. Both OS and DSS were significantly poorer in the periodontitis than no-periodontitis group (p < 0.001). In detail, the edentulous jaw group had the poorest prognosis (p < 0.001). Multivariate analysis showed that periodontitis was an independent risk factor affecting OS and DSS. CONCLUSION: Esophageal cancer patients had a high prevalence of periodontitis. Moreover, the presence of periodontitis and severity of periodontitis are independent risk factors contributing to a poorer prognosis after esophagectomy.

Entire papilla preservation technique for treatment of periodontal intrabony defects: a series of cases.

OBJECTIVE: Periodontitis is characterized by bone resorption. Vertical bone loss results in an intraosseous defect. Multiple surgical approaches for treating intrabony defects have shown different grades of effectiveness. Recently, the entire papilla preservation technique has been proposed, improving clinical parameters, such as pocket depth and clinical attachment level. This series of cases aimed to describe the use of the entire papilla preservation surgical technique without using biomaterials to regenerate periodontal intrabony defects. The influence on the clinical periodontal parameters and radiographic parameters was measured through CBCT, the latter not described until now, and analyzed the possible postoperative complications. METHOD AND MATERIALS: A total of six intrabony periodontal defects associated with at least one periodontal pocket with probing depths equal to or greater than 6 mm were treated with the entire papilla preservation technique. The clinical and radiographic parameters were evaluated at the beginning and 6 months after surgery. RESULTS: The mean probing pocket depth reduction was 4.00 ± 0.63 mm, the mean clinical attachment level gain was 3.67 ± 1.03 mm, and the mean radiographic intrabony filling was 2.41 ± 2.03 mm. Early healing was uneventful; the mean visual analog scale at 7 days was 0. CONCLUSIONS: This minimally invasive technique results in an improvement in clinical and radiographic parameters, the latter showing a filling of the bone defect observed during the 6-month evaluation after surgical treatment. These results confirm the importance of clot and flap stability in regenerating intraosseous defects.

Does smoking exposure alter the effect of non-surgical periodontal therapy?

DESIGN: This prospective longitudinal observational study aimed to explore the impact of varying levels of smoking exposure on periodontal healing over a 12-month period following non-surgical periodontal therapy. COHORT SELECTION: The study included 80 individuals in the age range of 20-70 years, who were both, smokers at baseline, and also diagnosed with periodontitis. Initially, all participants were enrolled in a smoking cessation program and were provided with non-surgical periodontal therapy (NSPT). Subsequently, all patients were recalled after every 3 months for supportive periodontal care and data collection. Socio-demographic features and periodontal health parameters were recorded, which included clinical attachment level (CAL), periodontal pocket depth (PPD), bleeding on probing, etc. For smoking, data about frequency, duration and salivary carbon monoxide and cotinine levels were recorded. DATA ANALYSIS: Descriptive statistics was used to depict and compare periodontal health and smoking parameters at different time intervals. In addition, exploratory factor analysis method was employed to identify distinct patterns of smoking behavior over a 1-year study period. Accordingly, patients were classified into three categories. Lastly, in order to assess the impact of NSPT among patients in different smoking categories, mixed-effects regression modeling was used. RESULTS: The distribution of smokers was light smokers/quitters (46 individuals), moderate smokers (17 individuals) and heavy smokers (17 individuals). With NSPT an improvement in the mean CAL, PPD, and number of sites with PPD ≥4/5/6/7 mm was observed in all light, moderate and heavy smokers. Mean CAL (±SD) changed from 3.2 ± 1.5 to 2.5 ± 1.3, 3.5 ± 1.6 to 2.6 ± 1.3, and 4.2 ± 1.5 to 3.6 ± 1.3 and mean PPD changed from 2.5 ± 0.8 to 1.9 ± 0.4, 2.6 ± 1.0 to 2.0 ± 0.7, and 2.7 ± 0.8 to 2.1 ± 0.5 in light, moderate and heavy smokers respectively. Similar changes were observed in other periodontal and smoking parameters, e.g., salivary cotinine levels changed from baseline to 1 year, from 276.0 ± 155.7 to 213.8 ± 160.6, 564.8 ± 77.8 to 518.6 ± 197.6, and 764.0 ± 205.9 to 728.9 ± 116.7 in different smoking categories. Lastly, regression coefficients (RCs) were evaluated using regression modeling. RCs (and confidence intervals) for light and moderate smokers were CAL = -0.7 (-0.9 to -0.6), PPD -0.6 (-0.7 to -0.5) and CAL -0.4 (-0.1 to 0.3), PPD -0.4 (-0.8 to -0.1) respectively. In heavy smokers, a positive value of the regression coefficient for CAL was observed, indicating a trend of "increase in CAL value" (RC = 0.5, -0.1 to 1.2). CONCLUSIONS: The study concluded that in smokers, NSPT done along with SPC yielded positive results. However, these results were influenced by the level of smoking exposure in a dose-response manner.

Distribution and influencing factors on residual pockets of the teeth in patients with periodontitis following non-surgical periodontal treatment: a retrospective observational study.

BACKGROUND: Periodontitis is a chronic and multi-factorial infectious disease. A notable difference exists in the prognosis of patients with severe periodontitis after non-surgical periodontal treatment. Thus, a retrospective study was conducted to identify common and specific factors that impact the prognosis of patients with periodontitis stage III-IV following non-surgical periodontal treatment at different tooth sites. METHODS: A total of 977 teeth were included in the study, comprising 266 patients diagnosed with periodontitis stage III-IV. This sample included 330 anterior teeth, 362 maxillary posterior teeth, and 285 mandibular posterior teeth. Following treatment, the teeth were categorized into two groups based on residual pocket depth [probing depth (PD) ≥ 5 mm] at 3 months post-treatment. The prognosis of periodontitis stage III-IV was assessed through multivariate analysis employing logistic regression to determine the association of various risk factors. RESULTS: The PD values of each site and the deepest PD values of each tooth significantly decreased at 3 months post-treatment. Residual pockets were predominantly found in the mesio/disto-buccal and mesio/disto-lingual regions. Multivariate analysis revealed that gender, PD, sulcus bleeding index (SBI) and plaque index (PLI) at baseline, and crown-root ratio in anterior teeth had a significant influence on periodontitis stage III-IV (P < 0.05). Smoking, PD, PLI and furcation involvement (FI) at baseline, PLI at 3 months post-treatment, grades of periodontitis, and crown-root ratio were prediction factors for maxillary posterior teeth. Factors such as PD, PLI and FI at baseline, PLI at 3 months post-treatment, and crown-root were significant in mandibular posterior teeth. CONCLUSIONS: The outcome of non-surgical treatment varies depending on the tooth positions for patients with periodontitis stage III-IV. Dentists must accurately identify the affected teeth that have periodontal pockets of more than 5 mm, taking into consideration the positions of the affected teeth, as well as various local and systemic factors. This comprehensive assessment will enable dentists to develop a customized and effective treatment plan.

DIFFERENTIAL DRUG CORRECTION CYTOKINE AND PROSTAGLANDIN CONTENT IN BLOOD AND GINGIVAL FLUID IN GENERALIZED PERIODONTITIS AGAINST THE BACKGROUND OF DIFFERENT RESPONSIVENESS OF THE ORGANIZATION.

OBJECTIVE: The aim is to study the dynamics of prostaglandins and cytokines in the blood and gingival fluid against the background of differential drug correction in patients with generalized periodontitis with different body reactivity. PATIENTS AND METHODS: Materials and methods: 216 people aged 45 between 55 years with a diagnosis of generalized periodontitis of II, III degree of severity, chronic course were examined. Depending on the state of reactivity of the organism, the patients were divided into three groups: the first one consisted of people with normoreaction; the second group included patients with hyperreaction; the third group was made up of people with hyporeaction. The patients underwent patch surgery after the initial therapy. Initially, on the 1st, 2nd, 4th, 6th and 9th day after the operation, the content of prostaglandins (PG) E, E2, F2alpha and cytokines (IL-1ß, IL-6, TNF, IL-4) in the blood and gingival fluid was performed. Patients with impaired body reactivity were treated with the proposed differential drug correction of cytokines and prostaglandins. Statistical processing of the obtained digital data was performed using the computer program Statistica 8.0. RESULTS: Results: The proposed differential drug correction in patients with generalized periodontitis against the background of hyper- and hyporeactivity of the body brings the content of IL-1ß, IL-6, TNF, IL-4 to that of normal body reactivity, which ultimately restores the disturbed balance of pro- and anti-inflammatory cytokines in the blood and gingival fluid. On the 9th day, the content of all proinflammatory cytokines in the main groups was normalized and was commensurate with that of the body's normal response (p>0.05). Differential drug correction led to normalization of the prostaglandin balance index on day 9 after flap surgery (p>0.05), indicating the establishment of a normal balance of eicosanoids in the blood and approximating the values of pro- and anti-inflammatory fractions of prostaglandins to those of normal body reactivity. CONCLUSION: Conclusion: Correction of altered parameters in patients with generalized periodontitis accompanied by impaired (hyper- and hypo-) reactivity of the body with bringing them to values that are typical for normoreactivity is considered to be a condition for optimizing mucosal wound healing after surgery and further stabilization of periodontal tissues.

Quantitative Evaluation of Periodontitis for Predicting the Occurrence of Postoperative Pneumonia After Oncologic Esophagectomy.

BACKGROUND: Periodontitis is a biofilm-associated inflammatory periodontal disease associated with postoperative complications after esophagectomy. However, few studies have evaluated the inflammatory burden posed by periodontitis quantitively for patients undergoing oncologic esophagectomy. This study aimed to clarify the relationship between periodontitis and postoperative pneumonia using periodontal inflammatory surface area (PISA). METHODS: The study analyzed 251 patients who underwent esophagectomy for esophageal cancer. The patients were classified into low-PISA and high-PISA groups according to preoperative PISA, and the relationship between the occurrence and severity of postoperative pneumonia was investigated. RESULTS: The high-PISA group (n = 69) included more males (P < 0.001) and patients with poor performance status (P < 0.024). Postoperative pneumonia occurred more frequently in the high-PISA group than in the low-PISA group (31.9 % vs. 15.9 %; P = 0.008), whereas the incidences of other complications did not differ significantly. In addition, the incidence of severe pneumonia was significantly higher in the high-PISA group (7.2 % vs. 1.6 %; P = 0.038). In the multivariable analysis for adjustment of preoperative confounders, age older than 70 years (odds ratio [OR], 2.62; P = 0.006), high PISA (OR, 2.45; P = 0.012), and smoking history (OR, 2.78; P = 0.006) were the independent variables predicting postoperative pneumonia. CONCLUSION: Preoperative higher PISA was significantly associated with the occurrence of overall and severe postoperative pneumonia. The quantitative evaluation of periodontitis using PISA is a useful measure for predicting postoperative pneumonia, and intensive periodontal intervention may contribute to decreasing postoperative pneumonia.

Risk factors impacting the survival of implants replaced following failure: A retrospective study.

AIM: This study aimed to investigate factors influencing the survival of replaced dental implants. MATERIALS AND METHODS: Charts from 2005 to 2021 were reviewed. Replaced implants after removal for the first time were identified. Depending on their survival, the replaced group was divided into the surviving and second-removal groups. Risk factors affecting survival of replaced implants were evaluated considering clustering of multiple implants within patients. RESULTS: The present study included 464 replaced implants of 370 patients, of which 429 and 35 implants were categorized into the surviving group and the second-removal group. The 5-year survival rate was 90.2 ± 0.18% in replaced implants at sites with a periodontitis history and 97.0 ± 0.15% at sites without a periodontitis history (p = 0.008). The 5-year survival rate was 89.1 ± 0.27% in replaced implants with guided bone regeneration (GBR) at first implant placement and 93.9 ± 0.14% at non-GBR (p = 0.032). The 5-year survival rate was 97.6 ± 0.13% in replaced implants with GBR and 90.3 ± 0.17% in replaced implants without GBR (p = 0.026). In the multivariable analysis adjusted for clinical variables, periodontitis history (adjusted hazard ratio [aHR] = 3.417; 95% confidence interval [CI] = 1.161-10.055), GBR at first implant placement (aHR = 2.152; 95% CI = 1.052-4.397) and non-GBR at primary implant replacement (aHR = 0.262; 95% CI = 0.088-0.778) were identified as independent risk factors for second implant removal. CONCLUSIONS: Periodontitis history, GBR at first implant placement and non-GBR at primary implant replacement were identified as risk factors affecting the survival of replaced implants.

Two-stage method of free gingival graft prior to periodontal regenerative surgery for the treatment of intrabony defects with insufficient keratinised tissue width: a study protocol for an open-label randomised controlled trial.

INTRODUCTION: Guided tissue regeneration (GTR) combined with bone grafting for periodontal regenerative surgery has ideal clinical results for intrabony defect. However, some sites of intrabony defects often suffer from insufficient keratinised gingival width, which affects the efficacy and long-term prognosis of periodontal tissue regeneration. Free gingival graft (FGG) is an effective surgical procedure to widen the keratinised gingiva, but there are few clinical studies on FGG prior to GTR combination with bone grafting to improve clinical outcomes. METHODS: This study is an open-label randomised controlled trial. 68 patients with periodontitis with at least one intrabony defect depth with ≥3 mm are recruited and randomly grouped. In the test group, FGG is performed first, followed by GTR and bone grafting 3 months later; while in the control group, only periodontal tissue regenerative procedures are performed. After completion of all procedures, the patients will be recalled at 3 months, 6 months and 12 months and the relevant clinical and radiographic examinations will be carried out and statistical analysis of the data will also be performed. The present research has received approval from the Ethics Committee of Shanghai Stomatological Hospital (No.2022-007) on 4 August 2022. DISCUSSION: Exploring the effectiveness of the two-stage approach of FGG prior to periodontal tissue regenerative surgery for the treatment of keratinised gingival width deficient intrabony defects can provide a high-level evidence-based basis for the formulation of relevant treatment strategies in clinical practice. ETHICS AND DISSEMINATION: The present research has received approval from the Ethics Committee of Shanghai Stomatological Hospital (No.2022-007) on 4 August 2022. The patients will be incorporated into this trial only after their written informed consent has been obtained. The study will be performed according to the 2013 revision of the Helsinki Declaration of 1975. Personal information of all subjects will be stored in the Department of Periodontology of Shanghai Stomatological Hospital. Data of the present research will be registered with the Clinical Trials Registry Platform. Additionally, we will disseminate the results through scientific journals. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ID: ChiCTR 2200063180. Registered on 1 September 2022.

Clinical And Radiographic Assessment Of Autogenous Dentin Nanoparticles In Treatment Of Stage Iii Periodontitis: A Split-Mouth Clinical Study.

Objectives: To compare autogenous dentin nanoparticles with allograft bone grafts in the treatment of stage III periodontitis. Method: The randomised study was conducted at the Department of Oral Medicine and Periodontology, Faculty of Oral and Dental Medicine, Kafrelsheikh University Hospital, Egypt, from January 2021 to January 2022, and comprised adult patients of either gender with stage III periodontitis. Each patient's bilateral intrabony defect was randomly treated with an allograft on one side and a graft made of dentin nanoparticles on the testside. Each patient'sremoved tooth was ground into these nanoparticles. Both groups had their probing pocket depth and clinical attachment loss evaluated at baseline and six months aftersurgery. Additionally, digital periapical films were collected in both groups at baseline and six months after therapy to assess vertical bone loss. Data was analysed using SPSS 20. RESULTS: Of the 20 patients, 8(40%) were males and 12(60%) were females with overall mean age 31.00±4.06 years(range: 18-50 years). Of the 40 sites, 20(50%) each were in test and control groups. Compared to baseline values, both groups showed significant improvement in probing pocket depth, clinical attachment loss and vertical bone loss post intervention (p<0.05). There was no significant difference between the postoperative outcomes of the two groups(p>0.05). CONCLUSIONS: Autogenous dentin nanoparticles were found to be an effective and promising biomaterial for bone regeneration in intrabony defects. Clinical Trial: NCT05258006 link: https://clinicaltrials.gov/ct2/show/NCT05258006, Registration date of the Trial 10/2/2022.

Complications and treatment errors related to regenerative periodontal surgery.

Regenerative periodontal surgical procedures are an important component in the treatment of advanced periodontitis. They aim to improve the long-term prognosis of teeth that are periodontally compromised by the presence of intrabony and/or furcation defects, resulting biologically in formation of root cementum, periodontal ligament, and alveolar bone and evidenced clinically by reduction of deep pockets to maintainable probing depths and/or improvements of vertical and horizontal furcation depth. Over the last 25 years, substantial clinical evidence has been accumulated to support the value of regenerative procedures in periodontally compromised dentitions. However, treatment success requires close attention to certain factors on the level of the patient, the tooth/defect, and the operator. Ignoring these factors in case selection, treatment planning, and treatment execution will increase the risk of complications that may jeopardize clinical success and may even be considered as treatment errors. Based on the currently available evidence from clinical practice guidelines, treatment algorithms, and on expert opinion, the present article provides an overview on the main factors, which influence the outcomes of regenerative periodontal surgery and gives recommendations on how to prevent complications and treatment errors.

Unraveling the effectiveness of antibiotics for peri-implantitis treatment: A scoping review.

BACKGROUND: Antibiotics are the most effective adjuncts in the treatment of periodontitis. However, the benefits of these agents in treating peri-implantitis are still debatable and demand further analysis. PURPOSE: The aim of this review was to critically appraise the literature on the use of antibiotics to treat peri-implantitis, with the ultimate goal of supporting evidence-based clinical recommendations, defining gaps in knowledge and guiding future studies on this topic. METHODS: A systematized literature search was conducted in MEDLINE/PubMed and Cochrane Library databases for randomized clinical trials (RCTs) on patients with peri-implantitis treated by mechanical debridement-only or with adjunctive use of local or systemic antibiotics. Clinical and microbiological data were extracted from the RCTs included. The findings were critically reviewed, interpreted, and discussed. An overview of antibiotic-loaded dental implant materials in peri-implantitis treatment was also provided. RESULTS: Twelve RCTs testing local/systemic antibiotics were included. Although not always statistically significant, all antibiotic-treated groups had greater reductions in mean PD than those treated by mechanical debridement-only. The only clinically relevant antibiotic protocol supported by one RCT with low risk of bias and long-lasting benefits was systemic metronidazole (MTZ). Studies using ultrasonic debridement reported better outcomes. No RCTs to date have tested MTZ-only or with amoxicillin (AMX) as adjuncts to open-flap implant debridement. In vitro/animal studies suggested that biomaterials with antimicrobial properties are promising to treat peri-implantitis. CONCLUSION: There are insufficient data to support a particular evidence-based antibiotic protocol to treat peri-implantitis using surgical or nonsurgical therapy, but some conclusions may be drawn. Systemic MTZ adjunct to ultrasonic debridement is an effective protocol to improve the outcomes of nonsurgical treatment. Future studies should assess the clinical and microbiological effects of MTZ and MTZ + AMX as adjuncts to optimal nonsurgical implant decontamination protocols or open-flap debridement. In addition, new locally delivered drugs and antibiotic-loaded surfaces should be assessed by RCTs.

DYNAMICS OF PRO- AND ANTI-INFLAMMATORY CYTOKINES IN PATIENTS WITH GENERALIZED PERIODONTITIS ACCOMPANIED BY DIFFERENT REACTIVITY OF THE ORGANISM.

The aim of this research was to study the dynamics of pro- and anti-inflammatory cytokines in the blood and gingival fluid of patients with generalized periodontitis accompanied by different reactivity of the body after patch surgery. The study included 216 people aged 45 between 55 years with a diagnosis of generalized periodontitis were examined. Depending on the condition of reactivity of the body, the patients were divided into three groups: 1 - normoreaction; 2- hyperreaction; 3 - hyporeaction. After the initial therapy, the patch was performed according to the indications. Blood sampling was performed after surgery on days 1, 2, 4, 6 and 9. The content of pro- (IL-1ß, IL-6, TNFα) and anti-inflammatory (IL-4) cytokines in blood and gingival fluid was defined by solid-phase enzyme-linked immunosorbent assay. The results have shown that the normal reactivity of the organism is characterized by an increase in proinflammatory cytokines IL-1ß, IL-6, TNFα at the time of increasing necrosis of periodontal tissues, their decrease and increase in IL-4 with the appearance of markers of reparative processes in blood and gingival fluid. Hyperreactivity is characterized by a more pronounced early increase in pro- and anti-inflammatory cytokines of blood and gingival fluid (IL-1ß, IL-6, TNFα, IL-4) with a subsequent decrease below the initial values during the development of young connective tissue. In the case of hyporeactivity we can observe a late and less pronounced increase in all the cytokines in the blood and gingival fluid. Correction of altered parameters in patients with generalized periodontitis accompanied by impaired (hyper- and hypo-) reactivity of the body with bringing them to the values which are typical for normoreactivity is considered to be a condition for optimizing wound healing after surgery and further stabilization of the periodontal tissues.

Supra-Alveolar Periodontal Tissue Reconstruction in a Case with Severe Periodontitis: Case Report with a 2-Year Follow-up.

Periodontal regeneration therapy has developed tremendously since its inception, becoming a clinical tool to preserve the periodontally compromised natural dentition. More challenging esthetic defects can often benefit from the combination of bone and soft tissue regeneration, such as the application of connective tissue grafts (CTGs) and techniques that approach the bone defect without interdental papillae incisions. However, periodontal tissue regeneration vertical to the alveolar bone crest in cases of severe periodontitis, with loss of both soft and hard tissues, has not been predictably established. This case report describes a patient with severe periodontitis that was treated with in supra-alveolar periodontal tissue reconstruction. This innovative surgical technique requires both horizontal buccal incisions and several vertical palatal incisions, avoiding the interdental papillae on the periodontal defect. Then, a space is created by suspending and fixating the flap coronally, and CTG and regenerative materials (such as recombinant human fibroblast growth factor-2) and bone graft material are applied. This technique has the potential to gain clinical attachment, achieve supra-/intraperiodontal regeneration, and enhance esthetic outcomes, including a reduced gingival recession and interdental papillae reconstruction. The clinical results of the present case were well maintained over the 2-year follow-up. Int J Periodontics Restorative Dent 2023;43:213-221. doi: 10.11607/prd.6241.

Long-term stability of regenerative periodontal surgery and orthodontic tooth movement in stage IV periodontitis: 10-year data of a retrospective study.

BACKGROUND: This study aimed to evaluate the long-term effectiveness of regenerative treatment of intra-bony defects in combination with consecutive orthodontic therapy (OT) in stage IV periodontitis. METHODS: Twenty-two patients with a total of 256 intra-bony defects were analyzed after regenerative surgery followed by OT initiated 3 months later. Changes in radiographic bone level (rBL) and probing pocket depths (PPD) were evaluated after 1 year (T1), final splinting (T2), and 10 years (T10). RESULTS: Mean rBL gain was significant with 4.63 mm (±2.43 mm) after 1 year (T1), 4.19 mm (±2.61 mm) at final splinting (T2), and 4.48 mm (±2.62 mm) after 10 years (T10). Mean PPD was significantly reduced from 5.84 mm (±2.05 mm) at baseline to 3.19 mm (±1.23 mm) at T1, to 3.07 mm (±1.23 mm) at T2, and to 2.93 mm (±1.24 mm) at T10. Pocket closure (PPD ≤ 4 mm) was achieved in 90% of all defects. Tooth loss amounted to 4.5%. CONCLUSIONS: Within the limitations of this retrospective study design, these 10-year findings suggest that in motivated and compliant patients with stage IV periodontitis and in need of OT an inter-disciplinary treatment can lead to favorable and stable long-term results.