Network meta-analysis of studies included in the Clinical Practice Guideline on the nonsurgical treatment of chronic periodontitis.

AIM: The recent ADA-commissioned Clinical Practice Guideline on the nonsurgical treatment of chronic periodontitis has provided the most exhaustive library of clinical trials on scaling and root planing (SRP) with or without adjuncts. This network meta-analysis (NMA) compared the adjuncts against each other. MATERIALS AND METHODS: A star-shaped NMA was performed based on 36 indirect comparisons of clinical attachment-level (CAL) gains among nine adjuncts in 74 studies from the Clinical Practice Guideline. RESULTS: All pairwise differences were accompanied by wide confidence intervals, and none of the adjuncts were statistically significantly superior to another. Local doxycycline hyclate and photodynamic therapy with a diode laser had the highest probabilities for ranking first and second, respectively. Publication bias was evident, with fewer than expected studies with small effects. The lack of these studies inflated the treatment effects by an estimated by 20%. CONCLUSIONS: Adjuncts improve CAL gain by about a third of a mm over 6-12 months compared with SRP alone, but no significant differences were found among the adjuncts. The patient-perceived benefit of this gain is unclear because CAL is a physical measure made by the clinician and not a patient-oriented outcome. Publication bias inflated the observed treatment effects.

Evidence-based clinical practice guideline on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts.

BACKGROUND: A panel of experts convened by the American Dental Association Council on Scientific Affairs presents an evidence-based clinical practice guideline on nonsurgical treatment of patients with chronic periodontitis by means of scaling and root planing (SRP) with or without adjuncts. METHODS: The authors developed this clinical practice guideline according to the American Dental Association's evidence-based guideline development methodology. This guideline is founded on a systematic review of the evidence that included 72 research articles providing clinical attachment level data on trials of at least 6 months' duration and published in English through July 2014. The strength of each recommendation (strong, in favor, weak, expert opinion for, expert opinion against, and against) is based on an assessment of the level of certainty in the evidence for the treatment's benefit in combination with an assessment of the balance between the magnitude of the benefit and the potential for adverse effects. PRACTICAL IMPLICATIONS AND CONCLUSIONS: For patients with chronic periodontitis, SRP showed a moderate benefit, and the benefits were judged to outweigh potential adverse effects. The authors voted in favor of SRP as the initial nonsurgical treatment for chronic periodontitis. Although systemic subantimicrobial-dose doxycycline and systemic antimicrobials showed similar magnitudes of benefits as adjunctive therapies to SRP, they were recommended at different strengths (in favor for systemic subantimicrobial-dose doxycycline and weak for systemic antimicrobials) because of the higher potential for adverse effects with higher doses of antimicrobials. The strengths of 2 other recommendations are weak: chlorhexidine chips and photodynamic therapy with a diode laser. Recommendations for the other local antimicrobials (doxycycline hyclate gel and minocycline microspheres) were expert opinion for. Recommendations for the nonsurgical use of other lasers as SRP adjuncts were limited to expert opinion against because there was uncertainty regarding their clinical benefits and benefit-to-adverse effects balance. Note that expert opinion for does not imply endorsement but instead signifies that evidence is lacking and the level of certainty in the evidence is low.

[Clinical, biochemical and histopatological correlación in diabetic patiens with periodontal disease]. / Correlación clinica, bioquímica e histopatólogica en pacientes periodontales diabéticos.

INTRODUCTION: The aim of this paper was to study the clinical, biochemical and histopathological correlation caused by scaling and root planning in diabetic patients with periodontal disease. MATERIAL AND METHODS: The study was conducted on 80 patients, both males and females, (age 25-60 years). Fourty patients had type 1 and type 2 diabetes, while 40 were non-diabetic patients. According to the medical examination, the subjects including in the study were well-compensated. After studying the periodontal field, patients with real pockets measuring 5 mm or less were selected. LABORATORY CRITERIA: The subjects were considered to be diabetic when their basal glycemia was equal to or above 140 mg/dl, and the HbA1C equal to or above 8%. Patients whose glycemia was below 115 mg/dl, and their HbA1C below 8% were considered to be non-diabetic. Free and inserted biopsies of the gingiva were done after the administration of 2 g of amoxicilin. Scaling and planing of all the teeth was carried out and periodontal protection was placed. Supervised dental sessions were held weekly. Clinical and biochemical criteria for selection were used again at 40 days and at 120 days. Biopsies were done and analyzed microscopically. RESULTS: At 40 days and mainly at 120 days it was found that in 90% of the selected patients glycemia values had decreased. In 70% of the cases studied HbA1C values were stable and the clinical signs of the periodontal disease were reversed in 80% of the subjects. Histological analysis at time 0 revelead mononuclear infiltrate, congestion and proliferation of the middle layer of the vessels when compared with non-diabetic values with deposits of PAS + material. At 40 days and at 120 days there was also a decreased of infiltrate and of the deposits PAS + on the wall of the small vessels. CONCLUSION: Scaling and planning is proposed as an effective method to reverse glycemic values, HbA1C, gingival microangiopathies and clinical signs in diabetic patients with periodontal disease.

Correlación clínica, bioquímica e histopatológica en pacientes periodontales diabéticos / Clinical, biochemical and histopatological correlación in diabetic patients with periodontal disease

Introducción - El objetivo de este trabajo fue estudiar la correlación clínica, histológica y Bioquímica por efecto del raspaje y alisado radicular en pacientes diabéticos con enfermedad periodontal. Materiales y Métodos.- Se seleccionó una población total de 80 pacientes de ambos sexos (edad 25-60 años), 40 diabéticos 1 y 2, Y 40 no diabéticos. Se eligieron los s~etos compensados, según examen médico. Se examinó el terreno periodontal, seleccionándose pacientes con bolsas reales iguales o menores a 5 mm. Criterio de laboratorio: se consideraron diabéticos sujetos con glucemia igualo mayor a 140 mg.'dl, y HbAIC igual o mayor a 8 %. No diabéticos, los de glucemias inferiores a 115 mg.'dl, y HbAIC menor a 8 %. Previa administración de 2 g. de amoxicilina, se tomaron biopsias de encía libre e insertada a todos los pacientes,. Se realizó raspaje y alisado de todos los elementos dentarios, y se colocó protector periodontal. Se realizaron sesiones de higiene supervisada semanalmente. A los 40 Y 120 días se aplicaron nuevamente los criterios de selección clínicos y bioquímicos. Se tomaron biopsias, las que fueron analizadas microscópicamente. Se aplicaron las coloraciones HjE, PAS, y Tricrómico de Masson. Resultados.- Al tiempo 40, y principalmente 120 se encontró que en el 90 % de los pacientes seleccionados disminuyeron los valores de glucemia. En un 70 % de los casos estudiados se estabilizaron los valores de HbAIC, y se revirtieron los signos clínicos de enfermedad periodontal en un 80 % de los pacientes. El análisis histológico al tiempo demostró infiltrado mononuclear, congestión y proliferación de la capa media de los vasos, cuando se comparó con los controles no diabéticos. Al tiempo 40 y al 120, disminución del infiltrado y de los depósitos sensibles a Pas en las paredes de los pequeños vasos. Conclusión.- Se propone que el raspaje y alisado es un método eficaz para revertir los valores de glucemia, HbA 1 C, las microangiopatías gingivales y los signos clínicos en pacientes periodontales diabéticos.

Introduction - The aim of this paper was to study the clinical, biochemical and histopathological correlation caused by scaling and root planning in diabetic patients with periodonta1 disease. Material and Methods.- The study was conducted on 80 patients, both males and females, (age 25-60 years). Fourty patients had type 1 and type 2 diabetes, while 40 were non-diabetic patients. According to the medical examination, the subjects including in the study were well compensated. After studying the periodontal field, patients with real pockets measuring 5 mm or less were selected. Laboratory Criteria.- The subjects were considered to be diabetic when their basal…

Correlación clínica, bioquímica e histopatológica en pacientes periodontales diabéticos / Clinical, biochemical and histopatological correlación in diabetic patients with periodontal disease

Introducción - El objetivo de este trabajo fue estudiar la correlación clínica, histológica y Bioquímica por efecto del raspaje y alisado radicular en pacientes diabéticos con enfermedad periodontal. Materiales y Métodos.- Se seleccionó una población total de 80 pacientes de ambos sexos (edad 25-60 años), 40 diabéticos 1 y 2, Y 40 no diabéticos. Se eligieron los s~etos compensados, según examen médico. Se examinó el terreno periodontal, seleccionándose pacientes con bolsas reales iguales o menores a 5 mm. Criterio de laboratorio: se consideraron diabéticos sujetos con glucemia igualo mayor a 140 mg.dl, y HbAIC igual o mayor a 8 %. No diabéticos, los de glucemias inferiores a 115 mg.dl, y HbAIC menor a 8 %. Previa administración de 2 g. de amoxicilina, se tomaron biopsias de encía libre e insertada a todos los pacientes,. Se realizó raspaje y alisado de todos los elementos dentarios, y se colocó protector periodontal. Se realizaron sesiones de higiene supervisada semanalmente. A los 40 Y 120 días se aplicaron nuevamente los criterios de selección clínicos y bioquímicos. Se tomaron biopsias, las que fueron analizadas microscópicamente. Se aplicaron las coloraciones HjE, PAS, y Tricrómico de Masson. Resultados.- Al tiempo 40, y principalmente 120 se encontró que en el 90 % de los pacientes seleccionados disminuyeron los valores de glucemia. En un 70 % de los casos estudiados se estabilizaron los valores de HbAIC, y se revirtieron los signos clínicos de enfermedad periodontal en un 80 % de los pacientes. El análisis histológico al tiempo demostró infiltrado mononuclear, congestión y proliferación de la capa media de los vasos, cuando se comparó con los controles no diabéticos. Al tiempo 40 y al 120, disminución del infiltrado y de los depósitos sensibles a Pas en las paredes de los pequeños vasos. Conclusión.- Se propone que el raspaje y alisado es un método eficaz para revertir los valores de glucemia, HbA 1 C, las microangiopatías gingivales y los signos clínicos en pacientes periodontales diabéticos.(AU)

Introduction - The aim of this paper was to study the clinical, biochemical and histopathological correlation caused by scaling and root planning in diabetic patients with periodonta1 disease. Material and Methods.- The study was conducted on 80 patients, both males and females, (age 25-60 years). Fourty patients had type 1 and type 2 diabetes, while 40 were non-diabetic patients. According to the medical examination, the subjects including in the study were well compensated. After studying the periodontal field, patients with real pockets measuring 5 mm or less were selected. Laboratory Criteria.- The subjects were considered to be diabetic when their basalO(AU)

[Severe complications caused by inattention to endocarditis prevention during dental procedures in adults with congenital heart abnormalities]. / Schwere Komplikationen durch Nichtbeachtung der Endokarditisprophylaxe während zahnärztlicher Eingriffe bei Erwachsenen mit angeborenen Herzfehlern.

BACKGROUND AND OBJECTIVE: Despite new guidelines on antibiotic prophylaxis to prevent bacterial endocarditis there is still confusion about the forms of dental procedures requiring antibiotic prophylaxis. Aim of this study was to determine the incidence of bacterial endocarditis following dental procedures in adults with congenital heart disease during a one-year period, and to assess connections with prophylaxis. PATIENTS AND METHODS: The case notes of all adults with congenital heart disease (CHD) treated in hospital during a one year period were analyzed retrospectively to identify cases of endocarditis, and all adults with CHD admitted to hospital for other reasons than endocarditis were interviewed about their knowledge of antibiotic prophylaxis against bacterial endocarditis. RESULTS: Among the 456 adults with CHD 351 (78%) knew about the need for antibiotic prophylaxis against bacterial endocarditis. Three patients developed endocarditis, in each case after a visit to the dentist. The disease started 11-16 days after dental descaling had been performed without antibiotic covering, one patient developing a brain abscess. The patients had to be treated in the hospital for 42-49 days. Despite presentation by the patient of a leaflet with recommendations for prophylaxis, the dentist refused to give antibiotics. CONCLUSIONS: Knowledge of adults with CHD is satisfactory but can still be improved. Even more important is better training of dentists who treat patients with CHD with special emphasis on the specific procedures including dental descaling, which require antibiotic prophylaxis.

Quantitative evaluation of the cutting quality and abrasive resistance of scalers.

An automatic scaling apparatus that simulated the scaling process of hand instrumentation was developed to quantitatively analyze the cutting quality and abrasive resistance of scalers. We first tested 4 synthetic resins as the abraded material. Of the 4 synthetic resins tested, polycarbonate resin proved most similar to dentin. The effects of lateral scaling forces (700, 500, and 300 dyne) and scaler angles (70 degrees to 95 degrees) on the cutting quality and abrasive resistance of scalers were evaluated quantitatively by the amount of the abraded material worn away in 1,000 strokes. Comparison of the 3 scaling forces showed a greater amount of abrasion at higher force than that at lower force. This suggests that the decrease in the amount due to abrasion could be compensated by increasing the lateral scaling force. Regarding the scaler angle, results indicated that the amount of material removed increased with an increase of the scaler angle up to 70 degrees, but then rapidly decreased at an angle of 90 degrees or more. The most effective scaling angle was 87 degrees, and this was not affected by scaling force. These results suggest that a greater amount of removal could be obtained at a scaling angle of 87 degrees and a scaling force of 700 dyne. The present findings suggested the automatic scaling apparatus could be a useful tool for quantitatively evaluating the cutting quality and abrasive resistance of scalers.

Variability of sonic scaling tip movement.

The sonic scaler operates at frequencies of 2 to 6 kHz and is powered by pressurised air from the dental unit. Variables likely to affect how these instruments perform include the air pressure input and load applied by the operator. Other variables include the brand of scaler used and the clinical technique of the operator. The aim of this study was to investigate differences in instrument performance within a dental teaching hospital. Light microscopy was used to measure the displacement amplitudes in air of 32 Sonic scalers which were in regular clinical use in three departments (Periodontal Unit, Restorative Unit and School of Hygiene). During operation, the air pressure was kept at a constant 2.8 kg cm-2 and measurements were made on each instrument with three scaling tips (universal, sickle and periodontal). The periodontal scaling tip exhibited the greatest vibration although this was not significant (p > 0.1). There was a significant difference in performance between the different clinical environments where the scalers were used (p < 0.01). 4 new sonic scaling instruments made by different manufacturers were selected for displacement amplitude measurements. One brand of sonic scaler demonstrated a significantly greater displacement amplitude in comparative measurements between instruments (p < 0.01). This study demonstrated differences in the oscillation of sonic scalers which should be recognised by clinicians when using these instruments, since they may influence clinical performance.

The effects of two ultrasonic instruments on root surfaces.

The Orbison ultrasonic instrument and the Cavitron ultrasonic dental unit were compared for the smoothness of the root surfaces they produced. Twenty teeth were analyzed with the scanning electron microscope and classified as to rough or smooth. Both instruments produced similar degrees of smoothness on the root surfaces with minimal scarring. Application of these instruments to the root surface apical to the epithelial attachment produced residual smearing of some of the collagenous fibrils.