The efficacy of subgingival air polishing and subgingival debridement in periodontal support therapy: a meta-analysis.

OBJECTIVE: To assess whether there is sufficient evidence of a difference in efficacy between subgingival air polishing (SubAP) and subgingival debridement as periodontal support treatment. The systematic review protocol was registered in the PROSPERO database under no. CRD42020213042. METHODS: A comprehensive search was conducted using eight online databases to develop straightforward clinical questions and search strategies, from their inception to 27 January 2023. The references of identified reports were also retrieved for inclusion in the analysis. The risk-of-bias of the included studies was evaluated using the Revised Cochrane Risk-of-Bias tool (RoB 2). A meta-analysis was performed on five clinical indicators using the Stata 16 software. RESULTS: Twelve randomized controlled trials were ultimately included, and most included studies had varying degrees of risk-of-bias. The results of the meta-analysis indicated that there was no significant difference between SubAP and subgingival scaling in terms of improving probing depth (PD), clinical attachment loss (CAL), plaque index (PLI), and bleeding on probing% (BOP%). The results of the visual analogue scale score analysis indicated that SubAP produced less discomfort than did subgingival scaling. DISCUSSION: SubAP can provide better treatment comfort than subgingival debridement. There was no significant difference in the efficacy of the two modalities in improving PD, CAL, and BOP% in supportive periodontal therapy. CONCLUSION: Currently, evidence for assessing the difference in the efficacy of SubAP and subgingival debridement in improving the PLI is insufficient, and further high-quality clinical studies are needed.

Efficacy of Er:YAG Laser as a Debridement Method in Surgical Treatment for Peri-Implantitis: A Systematic Review.

PURPOSE: The present study systematically reviewed randomised controlled trials (RCT) to investigate the efficacy of Er:YAG laser (ERL) as a debridement method in surgical treatment of advanced peri-implantitis. MATERIALS AND METHODS: An electronic database search and a manual search were performed until March 2022. Outcome measures were clinical attachment level (CAL) gain, probing depth (PD) reduction, plaque index (PI) and bleeding on probing (BOP). The addressed PICO question was: Is ERL an effective debridement tool in the surgical treatment of advanced peri-implantitis? RESULTS: Five eligible randomised clinical trials (RCTs) were included in the qualitative analysis, one of which had unclear risk of bias. One study reported a statistically significant difference in terms of implant CAL gain and PD reduction in favour of the experimental group vs the control group, while four studies did not report any difference between the two groups. CONCLUSION: Due to methodological heterogeneity, such as non-standard control groups and laser parameters, this systematic review demonstrated inconclusive findings in terms of the efficacy of Er:YAG laser as a debridement method in surgical treatment of advanced peri-implantitis. The results of this review should be considered preliminary and further, well-designed studies with standardised comparators with laser parameters are warranted.

Administração de Lactobacillus para casei 28.4 como terapia adjuvante no tratamento da periodontite: desenvolvimento in vitro de formulação probiótica usando gellan gum e ensaio clínico randomizado placebo controlado / Administration of Lactobacillus paracasei 28.4 as adjuvant therapy in the treatment of periodontitis: in vitro development of the probiotic formulation using gellan gum and placebo-controlled randomized clinical trial

A periodontite é uma doença inflamatória do periodonto associada ao acúmulo de biofilme dental, com consequente disbiose da microbiota oral e alteração da resposta imuno-inflamatória. O controle da periodontite realizado por meio do tratamento periodontal não-cirúrgico altera o ambiente subgengival e pode ser associado a terapias adjuntas. O uso de probióticos como terapia adjuvante a esse tratamento parece favorecer a modificação do biofilme bacteriano e resposta imuno-inflamatória. Entretanto, os probióticos empregados até o momento não são próprios da cavidade oral e, por isso, a busca por cepas originadas da microbiota oral tem ganhado espaço na tentativa de favorecer a aderência e colonização permanente dessas bactérias. Recentemente, a cepa de Lactobacillus paracasei 28.4 foi isolada da cavidade oral, exibindo atividades antimicrobianas promissoras sobre o controle de patógenos orais. O presente estudo teve como objetivos o desenvolvimento de uma formulação probiótica de L. paracasei 28.4 incorporado em gellan gum para uso humano, bem como a avaliação dos efeitos clínicos da administração desta formulação como adjuvante no tratamento periodontal. Para tal, o trabalho foi dividido em 2 etapas, contemplando uma etapa laboratorial (parte A), para desenvolvimento da formulação probiótica; e um ensaio clínico randomizado (parte B, n=40), envolvendo um protocolo de tratamento periodontal não cirúrgico associado à terapia adjunta probiótica ou placebo. Os resultados da parte A permitiram encontrar a melhor forma de apresentação e armazenamento da formulação de gellan gum. Na parte B, aos 3 e 6 meses de acompanhamento, os dois grupos apresentaram melhoras significativas dos parâmetros periodontais (índice de sangramento, índice gengival, profundidade de sondagem e ganho de nível de inserção) em relação ao baseline, sem diferença estatística na comparação intergrupo. Como conclusão, uma formulação probiótica segura e possível de ser aplicada na prática clínica foi obtida; no entanto, sua administração não promoveu efeitos clínicos adicionais ao tratamento de pacientes com periodontite generalizada estágios III/IV e graus B/C (AU)

Periodontitis is an inflammatory disease of the periodontium associated with the accumulation of dental biofilm, with consequent dysbiosis of the oral microbiota and alteration of the immune-inflammatory responseThe control of periodontitis carried out through non-surgical periodontal treatment alters the subgingival environment and can be associated with adjunctive therapies.The use of probiotics as an adjuvant therapy in the periodontal treatment seems to favor the modification of the bacterial biofilm and modulation of the immuneinflammatory response. However, the probiotics used so far are not specific to the oral cavity and, therefore, the search for strains originating from the oral microbiota has gained space to favor the adherence and permanent colonization of these bacteria. Recently, strain of Lactobacillus paracasei 28.4 was isolated from the oral cavity itself, showing promising antimicrobial activities in the control of oral pathogens. The present study aimed to develop and characterize a probiotic formulation of L. paracasei 28.4 incorporated into gellan gum for human use, as well as to evaluate the clinical effects of administering this formulation as an adjuvant in the treatment of periodontitis. To this end, the study was divided into 2 stages, comprising a laboratory stage (part A), for the development of the probiotic, and a randomized clinical trial (part B, n=40) contemplating a non-surgical periodontal treatment protocol associated with adjunctive probiotic therapy or placebo. The results from part A made it possible to find the best way to present and store the gellan gum formulation. In part B, at 3 and 6 months of follow-up, both groups showed significant improvements in periodontal parameters (bleeding index, gingival index, probing depth and attachment level gain) in relation to baseline, with no statistical difference in the intergroup comparison. In conclusion, a safe probiotic formulation that can be applied in clinical practice was obtained; however, its administration did not promote additional clinical effects in the treatment of patients with stage III/IV and grades B/C generalized periodontitis (AU)

Melhora na qualidade de vida de pacientes adultos diabéticos acometidos de doença periodontal após terapia periodontal não-cirúrgica: uma revisão sistemática [ / Improvement in the quality of life of adult diabetic patients with periodontal disease after non-surgical periodontal therapy: a systematic review

Algumas doenças comuns da cavidade bucal, podem influenciar o bem-estar geral dos indivíduos. Dentre elas podemos destacar a doença periodontal, que interfere na qualidade de vida (QV) das pessoas em diversos aspectos além do físico, como na função mastigatória, na aparência e até nas relações interpessoais. Esta revisão sistemática teve como objetivo avaliar se o tratamento periodontal não cirúrgico comparado a ausência de tratamento melhora a QV de pacientes diabéticos. Para isso, foi realizada uma revisão de estudos clínicos randomizados e estudos clínicos controlados de acordo com os parâmetros internacionais de transparência em Revisões Sistemáticas e Metanálises PRISMA Statement. A revisão foi cadastrada na Base PROSPERO e foi traçada uma estratégia de busca sobre o assunto nas bases de dados: MEDLINE via PubMed, Scopus, Web of Science, Registro Central de Ensaios Controlados da Cochrane e EMBASE. Seis estudos preencheram todos os critérios de elegibilidade e foram selecionados para revisão sistemática (4 estudos clínicos randomizados e 2 estudos controlados). Cinco estudos demonstraram melhora na QV de pacientes adultos diabéticos após tratamento periodontal e apenas 1 não observou mudanças estatisticamente significantes em nenhum dos domínios de QV avaliados pelo questionário utilizado. Os resultados dessa revisão sistemática sugerem que a tratamento periodontal não cirúrgico leva a uma melhora tanto na QV geral quanto na qualidade de vida relacionada à saúde bucal (QVRSB) de pacientes adultos diabéticos acometidos de doença periodontal (AU)

Some common diseases of the oral cavity can influence the general well-being of individuals. Among them, we can highlight periodontal disease, which interferes with people's quality of life (QoL) in several aspects beyond the physical, such as masticatory function, appearance and even interpersonal relationships. This systematic review aimed to assess whether non-surgical periodontal treatment compared to no treatment improves the QoL of diabetic patients. For this, a review of randomized clinical trials and controlled clinical trials was carried out according to international parameters of transparency in Systematic Reviews and Meta-analyses PRISMA Statement. The review was registered in the PROSPERO database and a search strategy was drawn up on the subject in the databases: MEDLINE via PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials and EMBASE. Six studies met all eligibility criteria and were selected for systematic review (4 randomized controlled trials and 2 controlled trials). Five studies showed improvement in the QoL of adult diabetic patients after periodontal treatment and only 1 did not observe statistically significant changes in any of the QoL domains assessed by the questionnaire used. The results of this systematic review suggest that non-surgical periodontal treatment leads to an improvement in both general QoL and QHRSB of adult diabetic patients with periodontal disease. (AU)

Effect of periodontal debridement plus systemic azithromycin in subjects with stage III periodontitis: a randomized controlled clinical trial / Efecto del desbridamiento periodontal más azitromicina sistémica en sujetos con periodontitis estadio III: un ensayo clínico controlado aleatorio

Aim: To evaluate the effect of the systemic administration of azi-thromycin (AZM) as an adjunct to non-surgical periodontal therapy (NSPT) on the clinical and microbiological variables of patients with periodontitis. Material and Methods: Eighteen volunteers received NSPT combined with placebo or AZM (500 mg/day) for 3 days (n=9/group). They were monitored clinically for probing pocket depth (PPD), clinical attachment level (CAL), O'Leary index (OI), bleeding on probing (BoP) at baseline and during the first, third and sixth month and microbiologically, at baseline and at 3 and 6 months after therapy, by conventional polymerase chain reaction tests. Results: Fourteen patients completed the study (n=7/group). Differences statistically significant were observed among both groups. The experimental group presented: A PPD mean (p=0.04) significantly lower and PPD reduction (p=0.02), at 6-months post NSPT. Regarding changes (∆), at the third month post NSPT, there was a significant increase in the number of shallow sites (p<0.001) and a decrease in the intermediate sites (p<0.001). In addition, a significant decrease in the mean number of deep sites (p=0.04) was detected at 6 months post treatment. There was also a significant decrease in periodontal index BoP at 1 (p=0.01), 3 (p<0.001) and 6 (p=0.01) months and OI at 3- and 6-months (p<0.001), post treatment. Regarding the presence of periodontal pathogens, no significant differences were observed, intra and inter groups. Conclusion: AZM as an adjuvant to NSPT provides additional beneficial effects for PPD and BoP compared to NSPT alone.

Objetivo: Evaluar el efecto de la administración sistémica de azitromicina (AZM) como coadyuvante de la terapia periodontal no quirúrgica (TPNQ) en las variables clínicas y microbiológicas de pacientes con periodontitis. Material y Métodos: Dieciocho voluntarios recibieron TPNQ combinado con placebo o AZM (500 mg/día) durante 3 días (n=9/grupo). Fueron monitoreados clínicamente para determinar Profundidad de Sondaje del Saco (PSS), Nivel de Inserción Clínica (NIC), Índice de O'Leary (IO), Sangrado al sondaje (SS) al inicio y durante el primer, tercer y sexto mes y microbiológicamente, al inicio y a los 3 y 6 meses después de la terapia, mediante la reacción en cadena de la polimerasa convencional. Resultados: Catorce pacientes completaron el estudio (n=7/grupo). Se observaron diferencias estadísticamente significativas entre ambos grupos. El grupo experimental presentó una media de PSS significativamente menor (p=0,04) y una reducción de PSS (p=0,02), a los 6 meses post TPNQ. En cuanto al delta (∆) pre y post tratamiento, al tercer mes post TPNQ, hubo un aumento significativo en el número de sitios poco profundos (p<0.001) y una disminución en los sitios intermedios (p<0.001). Además, se detectó una disminución significativa en la media de los sitios profundos (p=0.04) a los 6 meses post tratamiento. También hubo una disminución significativa en el índice SS al primer (p=0.01), tercer (p<0. 0 01) y sexto mes (p=0.01) post TPNQ y del IO al tercer y sexto mes (p<0.001), post tratamiento. En cuanto a la presencia de patógenos periodontales, no se observaron diferencias significativas tanto intra como ínter grupos. Conclusión: AZM como adyuvante a TPNQ proporciona efectos benéficos adicionales en la PSS y SS en comparación a TPNQ solo.

The effect of the national scaling program on tooth loss: a claim-based matched large cohort study in Korea.

OBJECTIVE: Tooth loss affects quality of life. Scaling is a measure to prevent periodontal disease and tooth loss. This study aimed to determine the effect of scaling on tooth loss. BASIC RESEARCH DESIGN: Secondary analysis of the Korean National Health Insurance Services database, comprising 514,866 Koreans as an initial cohort, followed for 14 years up to 2015. The study population comprised people who had received an oral check-up in 2002-2003. Using propensity score matching, we matched the intervention group (receipt of scaling) and controls (no scaling) 1:1. The outcome, tooth loss was defined as including all teeth except for third molars until 2015. The final sample included 94,738 people. Analysis used a Cox proportional hazard regression model. RESULTS: Scaling showed conflicting results in univariate and multivariable analyses. In univariate analysis, people who received scaling were more likely to lose teeth (HR, 1.04; 95% CI, 1.02-1.05). After adjusting for confounders in the multivariable analysis, those who didn't receive scaling were more likely to lose teeth (HR, 0.97; 95% CI, 0.95, 0.99). The effects of scaling were identified in people without diabetes (HR, 0.97; 95% CI, 0.95, 0.99) but not in people with diabetes (HR, 0.97; 95% CI, 0.89-1.06). CONCLUSIONS: Scaling was associated with less tooth loss. Regular scaling might be encouraged for vulnerable groups, such as males, older adults, lower income, handicapped, chronic diseases, and smokers.

Open flap debridement compared to repeated applications of photodynamic therapy in the treatment of residual pockets: A randomized clinical trial.

BACKGROUND: The aim of the present study was to compare repeated applications of antimicrobial photodynamic therapy (aPDT) to open flap debridement (OFD) in the treatment of residual periodontal pockets in non-furcation sites. METHODS: Forty-six subjects with a diagnosis of Stage III or IV Grade C periodontitis, that had been previously treated, participated in the study.  Residual pockets were divided between two groups: (1) aPDT group: received ultrasonic periodontal debridement followed by immediate application of aPDT, and repeated on1st, 2nd, 7th, and 14th days; and (2) OFD group: treated by modified papilla preservation technique, where granulation tissue and visible calculus were removed with hand curettes and an ultrasonic device. Clinical, immunological, and microbiological parameters were evaluated before and after treatment. RESULTS: Both treatments were effective reducing clinical parameters of disease. OFD resulted in a greater mean probing pocket depths (PPD) reduction in deep pockets (p = 0.001). However, aPDT resulted in a lower occurrence of gingival recession (GR), dentin hypersensitivity (DH) and analgesic intake. Reduction in Porphyromonas gingivalis was observed in both groups. Only the OFD group had a significant reduction in Aggregatibacter actinomycetemcomitans. aPDT group had greater increase in interleukin 10 (IL-10) levels and a greater reduction of interleukin 1 beta (IL-1ß) at 14 days when compared to the OFD group (p < 0.05). CONCLUSION: OFD was superior in reducing PPD in deep pockets compared to the aPDT. However, OFD resulted in greater GR.  Both treatments lowered P. gingivalis levels but only OFD reduced levels of A. actinomycemtemcomitans.

The efficacy of the adjunct use of subgingival air-polishing therapy with erythritol powder compared to conventional debridement alone during initial non-surgical periodontal therapy.

AIM: To assess the efficacy of the adjunct use of a subgingival erythritol powder air-polishing device (EPAP) in comparison to conventional subgingival instrumentation alone during initial non-surgical periodontal therapy. MATERIALS AND METHODS: Twenty-one patients with generalized Stages 2 and 3 grade B periodontitis were included in this single centre, single blinded, split-mouth, randomized clinical trial. Teeth on the control side were treated with conventional hand and ultrasonic instrumentation, while those on the contralateral test side was treated using EPAP as adjunct to conventional subgingival instrumentation with hand and ultrasonic instruments. Three months after initial instrumentation, persisting pockets of ≥4 mm were re-treated, in both control and test sides, again with the respective treatment approach-subgingival instrumentation alone on control, and subgingival instrumentation + EPAP on test side. Clinical parameters such as probing pocket depth (PPD), bleeding on probing, and relative attachment level were recorded at baseline and 3 and 6 months following the initial instrumentation. Subgingival plaque samples were collected at baseline, immediately post surgery, as well as at 1 week, 1 month, 3 months, and 6 months after initial instrumentation. RESULTS: In the test group after 6 months, a significantly larger number of initially deep pockets (PPD ≥ 5.5 mm) were reduced to shallow (PPD ≤ 3.4 mm), and a larger attachment gain was observed. No statistically significant microbiological differences could be found between test and control group. CONCLUSIONS: The results of the present study indicate that the adjunct use of subgingival airflow therapy with EPAP during initial non-surgical periodontal therapy might be beneficial in initially deep pockets (PPD ≥ 5.5 mm).

Non-surgical periodontal debridement affects subgingival bacterial diversity in patients with HIV-1 and periodontitis.

BACKGROUND: Following human immunodeficiency virus-1 (HIV-1) infection and antiretroviral therapy, the development of periodontal disease was shown to be favored. However, the influence of HIV-1 infection on the periodontal microbiota after non-surgical periodontal debridement (NSPD) needs a broad comprehension. This work aimed to compare the subgingival microbiological content of patients infected with HIV-1 and controls (non-infected) with periodontitis undergoing NSPD. METHODS: The bacterial profile of subgingival biofilm samples of patients with HIV-1 (n = 18) and controls (n = 14) with periodontitis was assessed using 16S rRNA gene sequencing. The samples were collected at baseline, 30, and 90 days after NSPD. The taxonomic analysis of gingival microbiota was performed using a ribosomal RNA database. The microbiota content was evaluated in the light of CD4 cell count and viral load. RESULTS: Both HIV and control groups showed similar stages and grades of periodontitis. At baseline, the HIV group showed higher alpha diversity for both healthy and periodontal sites. Streptococcus, Fusobacterium, Veillonella and Prevotella were the predominant bacterial genera. A low abundance of periodontopathogenic bacteria was observed, and the NSPD induced shifts in the subgingival biofilm of patients with HIV-1, leading to a microbiota similar to that of controls. CONCLUSIONS: Different subgingival microbiota profiles were identified-a less diverse microbiota was found in patients infected with HIV-1, in contrast to a more diverse microbiota in controls. NSPD caused changes in the microbiota of both groups, with a greater impact on the HIV group, leading to a decrease in alpha diversity, and produced a positive impact on the serological immune markers in patients infected with HIV-1. Control of periodontitis should be included as part of an oral primary care, providing the oral health benefits and better control of HIV-1 infection.

Clinical comparison of instrumentation systems for periodontal debridement: A randomized clinical trial.

OBJECTIVE: To compare clinical efficacy, chairside time and post-treatment hypersensitivity of four instruments used for subgingival periodontal debridement. MATERIALS & METHODS: Seventeen patients with stage II and III periodontitis were enrolled in this randomized clinical trial using a split-mouth design. Quadrants were randomly divided into four treatment groups: Group A: Gracey curettes-Hu-Friedy® ; Group B: piezoelectric ultrasonic (Satelec® ) with No.1S insert; Group C: diamond burs 40 µm (Intensiv Perioset® ); and Group D: piezosurgery ultrasonic (Mectron® ) with PP1 insert. Clinical outcomes, chairside time and hypersensitivity were assessed at 1, 2, 4 and 8 weeks after treatment. The primary outcome variable was improvement in clinical attachment level. RESULTS: At 8 weeks post-treatment, Gracey curettes, piezoelectric ultrasonic (Satelec® ) and piezosurgery ultrasonic (Mectron® ) were statistically more effective than diamond burs in increasing attachment level and reducing probing pocket depth. Comparison of piezoelectric ultrasonic (Satelec® ) and piezosurgery ultrasonic (Mectron® ) with the other instruments showed a statistical difference (p < 0.001) in chairside time. Regarding post-treatment hypersensitivity, no statistical differences were observed in any of the groups. CONCLUSIONS: Gracey curettes, piezoelectric ultrasonic (Satelec® ) and piezosurgery ultrasonic (Mectron® ) were clinically more effective than diamond burs 40 µm. The ultrasonic instruments showed a significant reduction in chairside time.

The effectiveness of using the perioscope as an adjunct to non-surgical periodontal therapy: Clinical and radiographic results.

BACKGROUND: It is well known that following root surface debridement (RSD) residual deposits remain. Periodontal endoscopy has provided a method of directly visualizing root surfaces during periodontal debridement in an intact pocket without the need for surgical incision. The aim of this study was to determine if periodontal debridement using endoscopic visualization was more effective in improving clinical and radiographic parameters as compared to RSD. METHODS: Thirty-eight subjects were randomized into RSD with perioscope (n = 19) or RSD only (n = 19) groups. A full-mouth evaluation included probing pocket depths (PPDs), clinical attachment levels (CAL), bleeding on probing (BOP) and plaque scores (PI) recorded at baseline, 3 and 12 months and compared among groups. Radiographs were taken at sites with deepest pockets at baseline and 12-month and the change in radiographic bone levels (RBL) compared. An independent samples T-test was used to assess statistical significance. RESULTS: Both groups had significant improvements in clinical outcomes. The test (T) group had a significantly lower percentage of PPDs 7 to 9 mm at three (0.72 ± 1.2%) and 12 months (0.5 ± 1.0%) as compared with the control (C) group (2.25 ± 2.9%; 1.84 ± 2.3%). At 12 months, the test group recorded a significantly lower mean PPD (T: 2.70 + 0.2 mm; C: 2.98 ± 0.4 mm), BOP% (T: 4.3 ± 3.2%; C: 11.95 ± 7.1%), PI% (T: 25.61 ± 3.9%; C: 30.11 ± 6.3%) and less change in gingival recession (T: -0.13 ± 0.2 mm; C: -0.50 ± 0.6 mm) (P < 0.05). More radiographic bone gain was observed in the test group (0.69 ± 0.3 mm) as compared with the control group (0.49 ± 0.2 mm). This was also observed around multi-rooted teeth (T: 0.83 ± 0.45 mm; C: 0.46 ± 0.36 mm). CONCLUSION: The adjunctive use of the perioscope provided a slight benefit to the outcomes of non-surgical therapy particularly at deeper probing depths.

Adjunctive probiotics after periodontal debridement versus placebo: a systematic review and meta-analysis.

OBJECTIVE: To comprehensively investigate the efficacy of adjunctive probiotics compared to placebo, using conventional and novel treatment outcomes. MATERIALS AND METHODS: Three databases (MEDLINE, EMBASE, and CENTRAL) were searched. Outcomes included percent change in the total number of deep sites before and after therapy, change in mean probing pocket depth (mm), percentage patients requiring additional therapy, risk for disease progression, and microbiological and immunological results. Meta-analysis was conducted to evaluate treatment effects wherever appropriate. RESULTS: Ten studies were selected from 818 records. Meta-analysis showed that adjunctive probiotics had no additional benefit for percentage change of the total number of deeper sites (≥5 mm, ≥6 mm, ≥7 mm) before and after therapy. No significant difference was observed for mean probing pocket depth reduction at 3 and 6 months. Statistically significant beneficial odds ratios for need for additional therapy (OR = 0.19, 95% CI [0.07-0.56]) and risk of disease progression (OR = 0.32, 95% CI [0.14-0.73]) were observed with probiotic administration. Immunological rather than microbiological outcomes correlated more consistently with clinical findings. No adverse events were reported. CONCLUSIONS: Adjunctive probiotics are safe in systemically healthy individuals and could offer additional patient-level benefits compared to placebo, hence its use can sometimes be justified.

The effect of non-surgical and surgical mechanical root debridement on infrabony defects: a retrospective study.

The aim of this retrospective study was to assess the outcomes of non-surgical and surgical mechanical root debridement for the treatment of infrabony defects and explore potential prognostic factors. Treated infrabony defects followed for at least 1 year were selected. All data pertaining to the clinical outcomes were recorded. Multi-level regression analysis and Cox Proportional-Hazards Models were used to assess the immediate (3-6 months) clinical outcomes, survival of the treated teeth, and factors influencing these results. 132 patients were included in the analysis. The analysis showed 1.42 ± 1.71 and 2.23 ± 1.64 mm in pocket depth (PD) reduction, 0.13 ± 1.83 and 0.08 ± 1.76 mm in clinical attachment level (CAL) gain, and 1.29 ± 1.56 and 2.15 ± 1.33 mm increase in gingival recession (REC) for the non-surgical and surgical groups, respectively. The 5-year survival rates were 93% for the non-surgically and 90% for the surgically treated teeth. Several factors affected clinical outcomes and tooth survival. Within its limitations, the treatment of infrabony defects with non-surgical and surgical mechanical root debridement was found to result in moderate but significant PD reduction, nevertheless, this may also be attributable to the resultant REC.

Immunohistochemical Evaluation of Periodontal Regeneration Using a Porous Collagen Scaffold.

(1) Aim: To immunohistochemically evaluate the effect of a volume-stable collagen scaffold (VCMX) on periodontal regeneration. (2) Methods: In eight beagle dogs, acute two-wall intrabony defects were treated with open flap debridement either with VCMX (test) or without (control). After 12 weeks, eight defects out of four animals were processed for paraffin histology and immunohistochemistry. (3) Results: All defects (four test + four control) revealed periodontal regeneration with cementum and bone formation. VCMX remnants were integrated in bone, periodontal ligament (PDL), and cementum. No differences in immunohistochemical labeling patterns were observed between test and control sites. New bone and cementum were labeled for bone sialoprotein, while the regenerated PDL was labeled for periostin and collagen type 1. Cytokeratin-positive epithelial cell rests of Malassez were detected in 50% of the defects. The regenerated PDL demonstrated a larger blood vessel area at the test (14.48% ± 3.52%) than at control sites (8.04% ± 1.85%, p = 0.0007). The number of blood vessels was higher in the regenerated PDL (test + control) compared to the pristine one (p = 0.012). The cell proliferative index was not statistically significantly different in pristine and regenerated PDL. (4) Conclusions: The data suggest a positive effect of VCMX on angiogenesis and an equally high cell turnover in the regenerated and pristine PDL. This VCMX supported periodontal regeneration in intrabony defects.

Infection Control in Adult Periodontal Patients Using Ultrasonic Debridement and Erythritol Powder: A Randomized, Controlled, Split-Mouth Clinical Study.

Ten patients with a diagnosis of generalized chronic periodontitis underwent nonsurgical periodontal therapy performed with the exclusive use of ultrasonic instrumentation and air polishing with erythritol powder. For each patient, four pockets with probing depths (PDs) of 4 to 10 mm were selected as experimental sites, and air polishing was performed either before (Group A) or after (Group B) ultrasonic scaling. PDs and clinical attachment levels significantly improved over a 12-month observation period. No significant difference was observed between the use of air polishing before or after ultrasonic instrumentation. The present clinical protocols could represent a suitable treatment for cause-related periodontal therapy.

Prognostic factors affecting the short-term efficacy of non-surgical treatment of chronic periodontitis: a multilevel modeling analysis.

BACKGROUND: This study is aimed to analyze the prognostic factors affecting the short-term efficacy of non-surgical treatment of patients in periodontitis from stage II to stage IV by the multilevel modeling analysis. MATERIALS AND METHODS: A total of 58 patients with chronic periodontitis were included in this study. Patients were clinically explored before and 3 months after the treatment and the difference in probing depth was determined [Reduction of probing depth (Δ PD) = baseline PD - finial probing depth (FPD)] which is considered as the therapeutic evaluation. Three different levels were analyzed: patients, teeth and sites to construct a multi-layer linear model. RESULTS: Probing depth (PD) improved significantly compared with that before treatment (p < 0.05), in which FPD was (3.90 ± 1.39) mm, and the ΔPD was (1.79 ± 0.97) mm. Compared with the mesial sites and distal sites of the multi-rooted teeth, the number of PD ≥ 5 mm or PD < 5 mm after the treatment was significantly different (P < 0.05), and the proportion of PD < 5 mm was higher in mesial sites. The null model showed that Δ PD varied greatly between groups at various levels (P < 0.001), with prediction variable of site level, tooth level, and patient level accounted for 66%, 18%, and 16% of the overall difference, respectively. The complete model showed that the Δ PD of smokers was significantly lower than that of non-smokers (P < 0.001). The Δ PD of the mesial and distal sites was larger than that of the buccolingual central site (P < 0.001). The Δ PD of single-rooted teeth was larger than that of multi-rooted teeth (P < 0.001). The baseline PD, tooth mobility (TM), bleeding index (BI), clinical attachment loss (CAL) were significantly negatively correlated with Δ PD (P < 0.001). CONCLUSIONS: Patients with periodontitis from stage II to stage IV, who were non-smoking, have good compliance, good awareness of oral health, and low percentage sites with PD ≥ 5 mm at baseline, single-rooted teeth with hypomobility, less clinical attachment loss and lower bleeding index and sites of mesial or distal can obtain an ideal short-term efficacy of non-surgical treatment.

Clinical outcomes of using erythritol powder by means of air polishing with ultrasonic debridement in the treatment of initial periodontal pockets in hand of dental students: A split-mouth, randomized, comparative, controlled study. Part I.

OBJECTIVE: The purpose of this trial was to evaluate the clinical efficacy and patient acceptance of using the erythritol powder air polishing with mechanical debridement in non-surgical periodontal therapy. METHODS: The trial was conducted as a split-mouth design study of 6 weeks' duration including 13 patients with gingivitis and stage I periodontitis with grade A. Each patient received ultrasonic debridement and polishing (UD+P) on one side, whereas the contralateral side was treated by erythritol powder air polishing and ultrasonic instrumentation (EPAP+UI) when required. Clinical variables were as follows: papillary bleeding index (PBI), bleeding on probing (BOP), full mouth plaque index (FMPI), calculus index (CI), modified gingival index (MGI), probing pocket depth (PPD), the time needed and rate the pain for each group. RESULTS: The FMPI, MGI, CI, PBL and BOP parameters improved significantly for both treatment procedures; however, there were no statistically significant differences between the two groups at any of the examinations intervals, except for MGI and CI which showed a significant reduction at 2 weeks compared with baseline. PPD was significantly decreased in EPAP+UI group. Perceived pain intensity was lower for EPAP+UI group than UD+P group without any significant difference during follow-up periods between the two groups. Seven patients favoured air polishing. The treatment's time was (24.92 ± 9.260 and 34.08 ± 9.106) minutes for the test and control side, respectively. CONCLUSION: This study generally revealed no significant differences in clinical outcomes between two groups for gingivitis and stage I periodontitis treatment. However, EPAP+UI had higher patient's preference and less time-consuming compared with UD+P.

Comparação entre as técnicas de raspagem e alisamento radicular e desbridamento ultrassônico no protocolo de desinfecção de boca toda: relato de caso / Comparison between scaling and root planing and ultrasonic debridement techniques in the full mouth disinfection protocol: case report

O tratamento periodontal consiste na remoção do biofilme patogênico, através da raspagem e alisamento radicular. O desbridamento ultrassônico de boca toda promove uma instrumentação mais conservadora, porém eficiente da superfície radicular, em sessão única. Evitando a translocação bacteriana de uma região tratada para outra que já foi. O objetivo do presente trabalho foi realizar uma comparação entre a eficácia da raspagem manual e a ultrassônica dentro do protocolo da FMD, através de um relato de caso clínico. Houve uma melhora nos parâmetros clínicos periodontais em todos os quadrantes, porém resultados superiores foram observados com o desbridamento com ultrassom e irrigação com clorexidina. A instrumentação com ultrassom associada a clorexidina no tratamento da periodontite estágio III grau C generalizada, reduz com eficácia o tempo de tratamento, otimizando o tempo do paciente e profissional(AU)

Periodontal treatment consists of removing the pathogenic biofilm, by scaling and root planing. Ultrasonic debridement of the entire mouth promotes more conservative, yet efficient instrumentation of the root surface, in a single session. Avoiding bacterial translocation from one treated region to another that has already been. The objective of the present study was to make a comparison between the effectiveness of manual and ultrasonic scraping within the FMD protocol, through a clinical case report. There was an improvement in periodontal clinical parameters in all quadrants, but superior results were observed with debridement with ultrasound and irrigation with chlorhexidine. Instrumentation with ultrasound associated with chlorhexidine in the treatment of generalized stage III grade C periodontitis, effectively reduces treatment time, optimizing patient and professional time(AU)

Exploratory Efficacy of Calcium-Vitamin D Milk Fortification and Periodontal Therapy on Maternal Oral Health and Metabolic and Inflammatory Profile.

In this 2 × 2 factorial, outcome-assessor blinded, feasibility randomised trial we explored the effect of a non-pharmaceutical multi-component intervention on periodontal health and metabolic and inflammatory profiles among pregnant women with periodontitis receiving prenatal care in a Brazilian public health centre. 69 pregnant women (gestational age ≤20 weeks, T0) were randomly allocated into four groups: (1) fortified sachet (vitamin D and calcium) and powdered milk plus periodontal therapy during pregnancy (early PT) (n = 17); (2) placebo sachet and powdered milk plus early PT (n = 15); (3) fortified sachet and powdered milk plus late PT (after delivery) (n = 19); (4) placebo sachet and powdered milk plus late PT (n = 18). Third trimester (T1) and 6-8 weeks postpartum (T2) exploratory outcomes included periodontal health (% sites with bleeding on probing (BOP)), glucose, insulin, C-Reactive Protein, serum calcium and vitamin D. The mean BOP was significantly reduced in the early PT groups, while BOP worsened in the late PT groups. No significant effect of fortification on BOP was observed. Changes in glucose levels and variation on birthweight did not differ among groups This feasibility trial provides preliminary evidence for estimating the minimum clinically important differences for selected maternal outcomes. A large-scale trial to evaluate the interventions' clinical benefits and cost-effectiveness is warranted.

Surgical and non-surgical debridement for the treatment of peri-implantitis: a two-center 12-month randomized trial.

OBJECTIVES: To compare surgical (ST) and non-surgical (NST) debridement for the treatment of peri-implantitis in a two-center randomized trial. MATERIALS AND METHODS: Forty-five individuals with 63 implants with probing depth (PPD) ≥5mm, bleeding on probing (BOP), and radiographic bone loss ≥2mm were included. In the NST (30 implants), submucosal debridement was performed. In the ST (33 implants), a mucoperiosteal flap was raised and surfaces were decontaminated only by debridement as performed in NST. Clinical parameters and radiographs were compared at baseline and after 12 months. Means and standard errors were reported. RESULTS: PPD considering all implant sites reduced significantly in NST from 4.14±0.25 to 3.25±0.18mm. In ST, PPD also significantly changed (3.74±0.22 to 3.00±0.29mm). No significant differences were observed between the two groups. For deep sites (≥7mm), PPD was 7.82±0.20mm at baseline and reduced to 5.10±0.30mm in NST, while in ST group, it was 7.11±0.11mm and changed to 5.22±0.91mm (between-groups p value=0.51). BOP significantly reduced from ~60 to 35% of all sites in both groups, without significant differences between them. When sites with radiographic bone level ≥3mm at baseline were analyzed, there was a significant difference between groups in bone gain after 12 months in favor of ST (ST=0.78±0.30mm compared to NST=0.25mm±0.13; p=0.03). CONCLUSIONS: Surgical and non-surgical debridement for the treatment of peri-implantitis present similar clinical outcomes. Bone levels were better improved in ST than NST for sites with higher initial bone loss. CLINICAL RELEVANCE: The treatment of peri-implantitis is still a challenge in clinical practice, since less than half of affected implants achieve health after surgical or non-surgical debridement. Considering the lack of clinically relevant differences between these two treatments, non-surgical debridement should be considered the first therapeutic choice for peri-implantitis, mainly mild to moderate cases.