A pilot study on the association between soft tissue volumetric changes and non-surgical periodontal treatment in stage III periodontitis patients. A case series study.

OBJECTIVES: This study investigates the correlation between soft tissue volumetric changes and clinical periodontal parameters for patients suffering from Stage III periodontitis after non-surgical periodontal treatment (NSPT) via intraoral scanning. METHODOLOGY: The following study is a case series pilot study involving twenty-eight Stage III Periodontitis patients. All subjects received full-mouth periodontal examination and intra-oral scanning cat baseline and re-evaluation. NSPT with bi-weekly oral hygiene reviews were carried out, and re-evaluation was performed after 10-12 weeks. Baseline scanned data of all subjects would be superimposed with the corresponding scanned data obtained during re-evaluation to ensure the teeth are in the correct alignment. Boolean subtraction would be performed with the 3D scanned data after superimposition and transformation into a 3D solid. The association of baseline clinical parameters and changes after NSPT with soft tissue volumetric changes up to tooth surface level would be evaluated. RESULTS AND CONCLUSION: Mean volumetric reduction after NSPT was 153.45 mm3 ± 185.30 mm3 and 124.06 mm3 ± 124.17 mm3 for the maxillary and mandibular arch, respectively. A statistically significant correlation was detected between soft tissue volumetric reduction to baseline and post-treatment clinical periodontal parameters. Posterior teeth were found to have the highest reduction in soft tissue volume. According to this pilot study, baseline clinical periodontal parameters (PPD, CAL, BOP) correlate with the soft tissue volumetric reduction after NSPT. Further studies on a larger scale and utilization of digital means on tooth sites would be necessary to strengthen the proof of concept. CLINICAL SIGNIFICANCE: Intraoral scanning can be a valid non-invasive method to assess soft tissue volumetric changes after initial periodontal treatment, which are correlated to changes in the baseline clinical periodontal parameters.

Assessment of myocardial strain in hypertensive patients with periodontitis.

BACKGROUND: Left ventricular (LV) relaxation is affected by hypertension. The inflammatory mediators produced in response to systemic inflammation, such as in periodontal disease, may also alter ventricular mechanics and the existing ventricular dysfunction. Thus, the systemic inflammatory burden which occurs in response to chronic periodontitis may alter myocardial activity. OBJECTIVES: The current study aimed to assess the myocardial strain among controlled hypertensive patients with periodontitis by using two-dimensional (2D) echocardiography. MATERIAL AND METHODS: The study involved 150 controlled hypertensive patients, equally divided into group A (without periodontitis) and group B (with periodontitis). The cardiac strain was measured with 2D echocardiography and represented as global longitudinal strain (GLS), while the periodontal inflamed surface area (PISA) score quantified the systemic inflammatory burden experienced by these individuals due to chronic periodontitis. RESULTS: In the multiple linear regression model, the adjusted R2 for group B indicated that 88% of the variation in GLS was due to the independent variable (PISA). Thus, with every one-unit rise in PISA, there was a mild alteration in GLS of 7.54 × 10-5. A scatter plot depicted a positive correlation between PISA and GLS. CONCLUSIONS: Within the limitations of the study, it can be concluded that an increase in the PISA score may cause mild alterations in the GLS score, which could indicate the possible influence of periodontitis on myocardial activity.

Clinical and radiographic evaluation of platelet-rich fibrin and bone graft material (ß-tricalcium phosphate + hydroxyapatite) in the treatment of intrabony defects of periodontitis patients: a randomized controlled trial.

OBJECTIVE: The present study aimed to assess the clinical and radiographic effect of a bone graft material (ß-tricalcium phosphate + hydroxyapatite) alone and in combination with platelet-rich fibrin in intrabony defects of periodontitis patients. METHOD AND MATERIALS: This 6-month randomized controlled clinical trial was carried out in 42 intrabony periodontal defects (average age 40 years). Intrabony defects ≥ 3 mm along with associated probing depth of ≥ 5 mm following phase 1 periodontal therapy were treated either with open flap debridement with bone graft (ß-tricalcium phosphate + hydroxyapatite; control group) or open flap debridement with bone graft plus platelet-rich fibrin membrane (test group). Individual customized acrylic stents with grooves were used to ensure reproducible and repeatable measurements of clinical and radiographic parameters, including probing pocket depth (PPD), relative clinical attachment level (RCAL), gingival marginal level (GML), vertical bone defect fill (VHD), and area of intrabony defects (AOD) on intraoral periapical radiographs. Clinical attachment level (CAL) gain was considered as primary outcome and PPD reduction and radiographic bone fill as secondary outcomes. RESULTS: The preoperative Plaque Index, RCAL, GML, PPD, VHD, and AOD in the control group were 1.06 ± 0.08, 11.57 ± 2.29 mm, 5.24 ± 1.89 mm, 6.29 ± 1.52 mm, 14.36 ± 2.65 mm, and 7.79 ± 4.39 mm2, respectively. After 6 months these were 1.08 ± 0.14, 9.34 ± 2.54 mm, 5.81 ± 2.20 mm, 3.52 ± 0.93 mm, 12.64 ± 2.34 mm, and 5.34 ± 3.2 mm2, respectively. The preoperative PI, RCAL, GML, PPD, VHD, and AOD in the experimental group were 1.14 ± 0.05, 12.19 ± 2.86 mm, 4.38 ± 1.63 mm, 7.81 ± 2.6 mm, 13.46 ± 3.42 mm, and 10.31 ± 8.71 mm2, respectively. After 6 months these were 1.09 ± 0.12, 8.62 ± 2.62 mm, 4.90 ± 1.79 mm, 3.71 ± 1.68 mm, 10.10 ± 2.07 mm, and 4.38 ± 2.67 mm2, respectively. After 6 months of evaluation both the groups showed a significant reduction in PPD (P < .001) and a significant gain in CAL (P < .001), as well as significant improvement in radiographic VHD fill and AOD changes. Again, the test group showed significant changes (P < .001) over the control group considering the same outcomes. CONCLUSION: With the study limitations in mind, it can be concluded that for the treatment of intrabony defects with the bone graft material (ß-tricalcium phosphate + hydroxyapatite; Biograft, IFGL Bio Ceramics) or the same bone graft with platelet-rich fibrin membrane results in statistically significant improvement in clinical (CAL and PPD) and radiographic (VHD and AOD) parameters, the latter having highly significant benefits. However, the bone graft material requires improvement.

Clinical and radiographic evaluation of low-speed platelet-rich fibrin (PRF) for the treatment of intra-osseous defects of stage-III periodontitis patients: a randomized controlled clinical trial.

AIM: The current randomized controlled trial assessed for the first time the effect of a low-speed platelet-rich fibrin (PRF) with open flap debridement (OFD) versus OFD alone in the treatment of periodontal intra-osseous defects of stage-III periodontitis patients. METHODS: Twenty-two periodontitis patients with ≥ 6 mm probing depth (PD) and ≥ 3 mm intra-osseous defects were randomized into test (PRF + OFD; n = 11) and control (OFD; n = 11) groups. Clinical attachment level (CAL)-gain (primary outcome), PD-reduction, gingival recession depth (GRD), full-mouth bleeding scores (FMBS), full-mouth plaque scores (FMPS), radiographic linear defect depth (RLDD), and radiographic bone fill (secondary-outcomes) were examined over 9 months post-surgically. RESULTS: Low-speed PRF + OFD and OFD demonstrated significant intra-group CAL-gain and PD- and RLDD-reduction at 3, 6, and 9 months (p < 0.01). Low-speed PRF + OFD exhibited a significant CAL-gain of 3.36 ± 1.12 mm at 6 months (2.36 ± 0.81 mm for the control group; p < 0.05), and a significantly greater PD-reduction of 3.36 ± 1.12 mm at 3 months, of 3.64 ± 1.12 mm at 6 months and of 3.73 ± 1.19 mm at 9 months (2.00 ± 0.89 mm, 2.09 ± 1.04 mm, and 2.18 ± 1.17 mm in the control group respectively; p < 0.05). No significant differences were notable regarding GRD, FMPS, FMBS, RLDD, or bone fill between both groups (p > 0.05). CONCLUSIONS: Within the current clinical trial's limitations, the use of low-speed PRF in conjunction with OFD improved CAL and PD post-surgically, and could provide a cost-effective modality to augment surgical periodontal therapy of intra-osseous defects of stage-III periodontitis patients. CLINICAL RELEVANCE: Low-speed PRF could provide a cost-effective modality to improve clinical attachment gain and periodontal probing depth reduction with open flap debridement approaches.

Treatment for Chronic Periodontitis with Class II Furcation Involvement: A Case Report with Four-year Follow-up.

This report describes a case of generalized chronic periodontitis requiring periodontal treatment including surgery. The patient was a 64-year-old man who visited the Tokyo Dental College Suidobashi Hospital with the chief complaint of pain in tooth #27. An initial examination revealed a probing depth (PD) of ≥4 mm at 38.2% of sites and bleeding on probing at 26.5% of sites. Radiographic examination revealed vertical bone resorption in # 27, 34, and 47, and horizontal resorption in other areas. Based on a clinical diagnosis of severe chronic periodontitis, initial periodontal therapy consisting of plaque control, scaling and root planing was performed. Both #27 and #47 were extracted due to bone resorption extending as far as the root apex. After initial periodontal therapy, sites with a PD of ≥4 mm were observed at 16.7% of sites. Furcation involvement was observed in #16, 17, 36, and 37. The need and options for periodontal surgery based on these findings were explained to the patient. Open flap debridement was implemented for #16, 17, 31, 34, 36, and 37 to reduce periodontal pockets. After reevaluation, the patient was placed on supportive periodontal therapy. The results of the periodontal examination at first visit revealed a periodontal pocket depth of 6 mm and 7 mm in #16 and 17, respectively, and class II furcation involvement in both. Periodontal therapy with open flap debridement resulted in an improvement in horizontal bone resorption where there was class II furcation involvement. This improvement has been adequately maintained over a 4-year period.

Clinical and radiographic effects of ascorbic acid-augmented platelet-rich fibrin versus platelet-rich fibrin alone in intra-osseous defects of stage-III periodontitis patients: a randomized controlled clinical trial.

AIM: To assess platelet-rich fibrin (PRF) with ascorbic acid (AA) versus PRF in intra-osseous defects of stage-III periodontitis patients. METHODOLOGY: Twenty stage-III/grade C periodontitis patients, with ≥ 3 mm intra-osseous defects, were randomized into test (open flap debridement (OFD)+AA/PRF; n = 10) and control (OFD+PRF; n = 10). Clinical attachment level (CAL; primary outcome), probing pocket depth (PPD), gingival recession depth (RD), full-mouth bleeding scores (FMBS), full-mouth plaque scores (FMPS), radiographic linear defect depth (RLDD) and radiographic defect bone density (RDBD) (secondary-outcomes) were examined at baseline, 3 and 6 months post-surgically. RESULTS: OFD+AA/PRF and OFD+PRF demonstrated significant intragroup CAL gain and PPD reduction at 3 and 6 months (p < 0.001). OFD+AA/PRF and OFD+PRF showed no differences regarding FMBS or FMPS (p > 0.05). OFD+AA/PRF demonstrated significant RD reduction of 0.90 ± 0.50 mm and 0.80 ± 0.71 mm at 3 and 6 months, while OFD+PRF showed RD reduction of 0.10 ± 0.77 mm at 3 months, with an RD-increase of 0.20 ± 0.82 mm at 6 months (p < 0.05). OFD+AA/PRF and OFD+PRF demonstrated significant RLDD reduction (2.29 ± 0.61 mm and 1.63 ± 0.46 mm; p < 0.05) and RDBD-increase (14.61 ± 5.39% and 12.58 ± 5.03%; p > 0.05). Stepwise linear regression analysis showed that baseline RLDD and FMBS at 6 months were significant predictors of CAL reduction (p < 0.001). CONCLUSIONS: OFD+PRF with/without AA significantly improved periodontal parameters 6 months post-surgically. Augmenting PRF with AA additionally enhanced gingival tissue gain and radiographic defect fill. CLINICAL RELEVANCE: PRF, with or without AA, could significantly improve periodontal parameters. Supplementing PRF with AA could additionally augment radiographic linear defect fill and reduce gingival recession depth.

Comparative Analysis of the Temporomandibular Joints in Patients with Chronic Periodontitis Using Cone-Beam Computed Tomography (CBCT).

INTRODUCTION: Chronic periodontitis is a common disorder in adults causing periodontal destruction and loss of teeth. These clinical presentations may lead to temporomandibular joint disorders (TMDs). This study aimed to examine the anatomic structures of the temporomandibular joints (TMJs) using cone-beam computed tomography (CBCT) in patients with chronic periodontitis. METHODS: Fifty patients with chronic periodontitis were enrolled in the study. Based on the severity of chronic periodontitis, these patients were divided into the mild, moderate, and severe groups. CBCT images of TMJs were acquired and reconstructed. Several indices on the reconstructed CBCT images were collected and analyzed, such as the oblique joint space parallel to the long axis of the condyle, the long axis diameter of the condyle, the vertical angle of the condyle, the inclination of the articular eminence vertical to the long axis of condyle at the oblique and sagittal positions, the depth of the fossa, and the horizontal angle of the cross-sections. The measurements between right and left sides of each patient were compared. Statistical analysis (paired samples t test) was performed. RESULTS: The differences of the joint space vertical to the bilateral condyles were statistically significant (P < 0.05). Additionally, in the severe periodontitis group, the distances between the inner and outer poles of the condyles were statistically different (P < 0.05). CONCLUSION: In patients with chronic periodontitis, TMJ space vertical to the condyles and the distances between the outer and inner poles of the condyle may change over time. These two indices can potentially be used as indicators for diagnosis and further comparative analyses.

Reduction of inflammation in a chronic periodontitis model in rats by TNF-α gene silencing with a topically applied siRNA-loaded calcium phosphate paste.

We developed a calcium phosphate-based paste containing siRNA against TNF-α and investigated its anti-inflammatory and bone-healing effects in vitro and in vivo in a rat periodontitis model. The bioactive spherical CaP/PEI/siRNA/SiO2 nanoparticles had a core diameter of 40-90 nm and a positive charge (+23 mV) that facilitated cellular uptake. The TNF- α gene silencing efficiency of the nanoparticles in J774.2 monocytes, gingival-derived cells, and bone marrow-derived cells was 12 ± 2%, 36 ± 8%, and 35 ± 22%, respectively. CaP/PEI/siRNA/SiO2 nanoparticles cancelled the suppression of alkaline phosphatase (ALP) activity in LPS-stimulated bone marrow-derived cells. In vivo, ALP mRNA was up-regulated, TNF-α mRNA was down-regulated, and the amount of released TNF-α was significantly reduced after topical application of the calcium phosphate-based paste containing siRNA-loaded nanoparticles. The number of TNF-α-positive cells in response to CaP/PEI/siRNA/SiO2 nanoparticle application was lower than that observed in the absence of siRNA. Elevated ALP activity and numerous TRAP-positive cells (osteoclasts) were observed in response to the application of all calcium phosphate pastes. These results demonstrate that local application of a paste consisting of siRNA-loaded calcium phosphate nanoparticles successfully induces TNF-α silencing in vitro and in vivo and removes the suppression of ALP activity stimulated by inflammation. STATEMENT OF SIGNIFICANCE: We developed a calcium phosphate-based paste containing nanoparticles loaded with siRNA against TNF-α. The nanoparticles had a core diameter of 40-90 nm and positive charge (+23 mV). The anti-inflammatory and osteoinductive effects of the paste were investigated in vitro and in vivo in a rat periodontitis model. In vitro, the TNF-α gene silencing efficiency of the nanoparticles in J774.2 monocytes, gingival-derived cells, and bone marrow-derived cells was 12 ± 2%, 36 ± 8%, and 35 ± 22%, respectively. The ALP activity of bone marrow-derived cells was recovered. In vivo, TNF-α mRNA was down-regulated and the amount of released TNF-α was significantly reduced, whereas the ALP mRNA was up-regulated. Elevated ALP activity and TRAP-positive cells were observed by immunohistochemistry.

Clinical and radiographic evaluation of amnion chorion membrane and demineralized bone matrix putty allograft for management of periodontal intrabony defects: a randomized clinical trial.

The aim of this trial was to compare the clinical and radiographic outcomes of amnion chorion membrane (ACM) with demineralized bone matrix (DBM) in a putty form in management of periodontal intrabony defects. Twenty-two participants with severe chronic periodontitis and intrabony defects, were randomly assigned in two equal parallel groups. Each group was treated with open flap debridement (OFD) and ACM or OFD and DBM putty. Plaque index, gingival index, pocket depth (PD), clinical attachment level (CAL) and radiographic measurement of bone defect area (BDA) were recorded at baseline, 3 and 6 months postoperatively. Both ACM and DBM putty demonstrated significant improvement in all clinical and radiographic outcomes at 6 months compared to baseline values. However, no significant difference was observed between the two treatment modalities when compared at different time intervals. Six months postoperatively, ACM showed 3.18 ± 0.85 mm, PD reduction and 2.25 ± 0.75 mm CAL gain, while DBM putty revealed 3.45 ± 1.08 mm PD reduction and 2.73 ± 0.85 mm CAL gain. Radiographic assessment showed that mean baseline BDA for ACM group was 10.39 ± 3.86 mm2, which significantly reduced to 5.21 ± 2.38 after 6 months. Mean BDA mm2 in DBM putty group also significantly improved after 6 months, 5.35 ± 3.63 mm2 when compared to baseline values 9.80 ± 5.77 mm2. Both ACM barrier and DBM putty allograft provided significant improvement in clinical and radiographic outcomes after 6 months, yet no significant differences were noticed between them. This trial implied that both biomaterials have a potential regenerative capacity in treating periodontal intrabony defects.

[Comparison of clinical values in decision making between cone beam CT and conventional approach in furcation involvement of maxillary molar].

Objective: To compare the use of cone beam computed tomography (CBCT) and conventional approach (clinical probing and periapical radiograph) in assessing furcation involvement (FI) of maxillary molars and making treatment decisions. Methods: Thirty-two subjects were selected from the pool of patients at the Department of Periodontology, Tianjin Stomatology Hospital & Hospital of Stomatology, NanKai University from January 2015 to December 2016. All the patients have a diagnosis of generalized chronic periodontitis. Ninety-five maxillary molar with FI from the radiography database were analysed. Two doctors used conventional approach and CBCT images to assess FI and make treatment decision respectively. If the clinical and radiographic findings did not clearly indicate a distinct periodontal therapy, two treatment options were considered. Results: There was statistical difference of the FI diagnosis between traditional group and CBCT group assessment of the 95 molars (P=0.000). Thirty-five maxillary molars (36.8%, 17 patients) got two treatment recommendations by conventional approach but 7 (7.4%, 5 patients) by CBCT-based approach. When with the less invasive treatment recommendation, there was statistical difference between conventional approach and CBCT-based approach (P=0.001). An agreement was observed in 63.2% (60/95) of the teeth, while in another 29.5% (28/95) the CBCT-based treatment decision was more invasive than the conventional approach. When with the more invasive treatment recommendation, there was also statistical difference between two approaches (P=0.045). An agreement was observed in 86.3% (82/95) of the teeth, while in another 3.2% (3/95) the CBCT-based treatment decision was more invasive than the conventional approach. Conclusions: CBCT images of maxillary molars may provide detailed information of FI and a reliable basis for treatment decision.

Comparative evaluation of subgingivally-delivered 1% metformin and Aloe vera gel in the treatment of intrabony defects in chronic periodontitis patients: A randomized, controlled clinical trial.

AIM: The aim of the current study was to explore the effectiveness of locally-delivered 1% metformin (MtF) and Aloe vera (AV) gel as an adjunct to scaling and root planning (SRP) in the treatment of intrabony defects in chronic periodontitis patients. METHODS: A total of 90 volunteers were randomly assigned to three treatment groups: (a) SRP + placebo gel; (b) SRP + 1% MtF gel; and (c) SRP + AV gel. Clinical parameters, including gingival index (GI), bleeding on probing (BoP), pocket probing depth (PPD), and clinical attachment level (CAL), were recorded at baseline, and 6 and 12 months. The radiological assessment of bone defect fill was done at 6 and 12 months. RESULTS: GI, BoP, PPD, and CAL improved in all the groups; however, the mean PPD reduction, CAL gain, and percentage of bone fill was found to be greater in the MtF and AV groups than the placebo group at all visits. CONCLUSION: Local delivery of 1% MtF and AV gel stimulates a significant PPD reduction, CAL gain, and improved bone fill and regeneration when compared with placebo gel. Results were significantly better with the use of 1% MtF gel than AV gel.

Assessing periapical dental radiographs as a screening parameter for early indications of osteoporosis in postmenopausal periodontal patients and root surface evaluation using spectrochemical analysis.

OBJECTIVES: To assess the usefulness of periapical dental radiograph as a screening tool aimed at early signs of osteoporosis in postmenopausal periodontal patients  and root surface evaluation using spectrochemical analysis. Methods: This study was conducted at the Department of Periodontics, Riyadh Elm University, Riyadh, Saudi Arabia, for 12 months between December 2016 and November 2017. Two groups consisted healthy postmenopausal women having chronic periodontitis and postmenopausal women having chronic periodontitis with osteoporosis. Osteoporosis were evaluated for plaque index (PI); gingival index (GI); clinical attachment level (CAL); probing pocket depth (PPD), and bone mineral density (BMD). A standardized digital dental periapical radiographs were taken for every patient. The spectrochemical analysis was carried out using the self-assembled Laser-Induced Breakdown Spectroscopy (LIBS) system used for qualitative and quantitative analysis of Calcium (Ca), Potassium (K), Phosphorus (P), Fluoride (F), and Magnesium (Mg). Results: There was no statistically significant difference between both groups for GI and PI. Similarly PPD and CAL were showing the difference but statistically, significant difference was only for CAL. Value of distance starting from cement enamel junction to the alveolar crest (CEJ-AC) and BMD were having a statistically significant variance between both groups. The differences between osteoporotic and control group were statistically significant regarding Ca with the mean higher in the control group. Furthermore, the variances between the groups in both K and Mg were statistically significant with higher mean in the osteoporotic group (p less than 0.05).  Conclusion: The clinical, radiographic, and experimental findings of this study indicated that osteoporosis has a direct effect on the progression rate of periodontal tissue destruction and dental radiographic can be suggested as a screening tool for an early sign of osteoporosis.

Correlation of radiovisuographic analysis of interdental and interradicular bone loss in furcation involvement of mandibular first molars: A retrospective study.

BACKGROUND AND OBJECTIVES: The presence of furcation involvement represents a formidable problem in the treatment of periodontal disease. Advances in radiographic analysis such as radiovisuographic (RVG) aid in the early diagnosis and treatment planning, which is critical for long-term success. The present investigation aims to correlate the interdental and interradicular bone loss in chronic periodontitis patients so as to explore the potential of interdental bone loss as a rough approximate screening tool for early furcation diagnosis in mandibular first molar. MATERIALS AND METHODS: RVG radiographs with furcation radiolucency in mandibular first molars were selected. The morphometric measurements of mesial, distal interdental bone loss, and interradicular bone loss in mandibular first molars were recorded using RVG. The correlation between mesial and distal interdental bone loss and interradicular bone loss was analyzed. RESULTS: In this retrospective investigation, it was observed that distal interdental bone loss was not significantly different when compared with mesial interdental bone loss. The interradicular bone loss was significantly different when compared with mesial interdental bone loss, whereas on analysis between distal interdental bone loss and interradicular bone loss was also found to be statistically significant. INTERPRETATION AND CONCLUSION: Interdental bone loss was found to be associated with progressive bone destruction in furcation area which suggests that early detection of interdental bone loss can be helpful in predicting future interradicular bone loss.

One percent alendronate and aloe vera gel local host modulating agents in chronic periodontitis patients with class II furcation defects: A randomized, controlled clinical trial.

AIM: Alendronate (ALN) has antiresorptive and osteostimulative properties. The major component of aloe vera (AV) gel is acemannan, which has been found to have osteogenic properties. The aim of the present study is to explore the effectiveness of 1% ALN and AV gel as an adjunct to scaling and root planing (SRP) in chronic periodontitis patients with class II furcation defects. METHODS: Ninety volunteers were randomly assigned to three treatment groups: (a) SRP plus placebo gel; (b) SRP plus 1% ALN gel; and (c) SRP plus AV gel. Clinical and radiographic parameters were recorded at baseline and at 6 and 12 months. RESULTS: The mean probing depth reduction and relative horizontal clinical attachment level (CAL) and relative vertical CAL gains were greater in the ALN group than in the AV and placebo groups at 6 and 12 months. Furthermore, a significantly greater mean percentage of defect depth reduction (DDR) was found in the ALN group (38.09 ± 9.53, 44.86 ± 6.29) than the AV groups (11.94 ± 15.10, 14.59 ± 25.49) at 6 and 12 months, respectively. CONCLUSION: ALN showed significant improvement in all clinical parameters, along with greater DDR, compared to AV in the treatment of class II furcation defects as an adjunct to SRP.

Clinical and CBCT Evaluation of Combined Periodontal Regenerative Therapies Using Enamel Matrix Derivative and Deproteinized Bovine Bone Mineral With or Without Collagen Membrane.

Use of collagen membrane (CM) with deproteinized bovine bone mineral (DBBM) and enamel matrix derivative (EMD) in periodontal regenerative therapy was evaluated. A total of 40 intrabony defects in periodontitis patients were treated. Clinical parameters and filled bone volume (FBV) and rate (FBR) were assessed. Probing pocket depth (PPD) was reduced significantly at 12 months with CM treatment, while clinical attachment level (CAL), FBV, and FBR showed similar improvements. In stratified analyses, CM-treated thick-biotype patients showed significant improvement in PPD and CAL. Regenerative therapy with the use of EMD and DBBM showed similar improvements in periodontal tissue regeneration with or without CM. The combination with CM appeared to influence the healing of soft tissue and was effective in decreasing pocket depth.

Radiographic morphology of intrabony defects in the first molars of patients with localized aggressive periodontitis: Comparison with health and chronic periodontitis.

BACKGROUND AND OBJECTIVE: The aim of this study was to describe the radiographic features of the first molars of patients with localized aggressive periodontitis (LAgP) and of their associated intrabony defects and to compare them with a control sample of chronic periodontitis cases and healthy subjects. METHODS: Data from a total of 93 patients were included in this analysis. First, dental panoramic tomograms of 34 patients with LAgP (131 first molars) and 30 periodontally healthy patients (110 first molars) were compared. Then, periapical radiographs of the first molars of the same patients with LAgP and of 29 patients with chronic periodontitis affected by intrabony defects were analysed. RESULTS: Shorter root trunks were associated with the presence of intrabony defects in patients with LAgP (P = .002 at multilevel logistic regression), also when LAgP molars were compared with healthy subjects (P = .036). Although no difference in defect depth and angle was noted between LAgP and chronic periodontitis intrabony defects, LAgP intrabony defects appeared to be more frequently symmetrical and arch-shaped than in chronic periodontitis (P = .008), with positive predictive value and negative predictive value of for 'wide arch' defect of 87.3% (95% CI = 77.2%-93.3%) and 32.3% (95% CI = 27.7%-37.2%) respectively. CONCLUSION: First molars of patients with LAgP affected by intrabony defects may have some distinct radiographic anatomical characteristics to those of healthy subjects. The shape of intrabony defects seems to differ between LAgP and chronic periodontitis cases. Further studies need to confirm these features and investigate if they are related to the initiation and progression of periodontitis.

Treatment of severe generalized chronic periodontitis in a patient with Behçet's disease: A case report.

Behçet's disease is a systemic disorder of unknown etiology. It involves multiple organ systems and is characterized by recurring episodes of oral ulcers as well as ocular, genital, and skin lesions. Oral ulcers can affect tooth brushing and impair proper oral hygiene. As a result, a dental biofilm accumulates, and the condition of the teeth and periodontal tissue deteriorates. The aim of this case report is to highlight the efficacy of periodontal treatment for patients with Behçet's disease. A 51-year-old man with Behçet's disease presented with generalized severe periodontitis. After basic treatment of the periodontal tissues, periodontal surgery was performed at several sites with bony defects. However, the patient developed severe stomatitis in the oral mucosa and gingiva after periodontal surgery. Administration of the antimicrobial agent cefdinir had little effect on recovery; however, subsequent administration of sitafloxacin resulted in significant improvement of the stomatitis. This case demonstrates that periodontal therapy is very useful for alleviating the oral signs and symptoms of Behçet's disease. Systemic antibiotic treatment with sitafloxacin (but not cefdinir) and mechanical debridement were effective in preventing the recurrence of aphthous ulcer outbreaks after periodontal surgery.

Non-surgical periodontal therapy reduces salivary adipocytokines in chronic periodontitis patients with and without obesity.

AIM: The aim of the present study was to assess the effect of scaling and root planing (SRP) on periodontal parameters and whole salivary resistin and interleukin (IL)-6 levels in chronic periodontitis (CP) patients with and without obesity. METHODS: Participants were divided into two groups; group 1 included obese and non-obese individuals with CP; and group 2 included obese and non-obese individuals without CP. In both groups, bleeding on probing (BOP) and probing depth (PD) ≥4 mm and whole salivary resistin and IL-6 levels were measured using enzyme-linked immunosorbent assay at baseline and 6 months after SRP. The number of missing teeth was counted, and marginal bone loss was measured on digital panoramic radiographs at baseline and 6 months' postoperatively. RESULTS: BOP was significantly higher among obese patients in group 1 than obese (P < .001) and non-obese (P < .001) individuals in group 2. At 6 months' follow up, BOP (P < .001) and PD ≥4 mm (P < .001) were significantly lower among obese and non-obese patients in group 1 than their respective baseline values. At 6 months' follow up, BOP (P < .001) and PD ≥4 mm (P < .001) were significantly higher among obese and non-obese individuals in group 1 compared with individuals in group 2. CONCLUSION: SRP is effective in reducing periodontal inflammation in CP patients with and without obesity. CP seems to be the primary factor that influences periodontal status and the expression of resistin and IL-6 levels in obese and non-obese patients.

Clinical efficacy of subgingivally-delivered 0.75% boric acid gel as an adjunct to mechanotherapy in chronic periodontitis: A randomized, controlled clinical trial.

AIM: Borinic acid quinoline esters are a recently-identified class of new antibacterial and anti-inflammatory compounds known to inhibit osteoclastic bone resorption. They have proposed to have osteostimulative properties by causing osteoblast differentiation in vivo and in vitro. The purpose of this double-masked, randomized, controlled clinical trial was to evaluate the effects of the subgingival delivery of boric acid gel as an adjunct to scaling and root planing (SRP) on clinical and radiographic parameters, and compare this method with SRP plus placebo gel alone in chronic periodontitis (CP) patients. METHODS: Thirty-nine systemically-healthy patients with CP were included in the present study. They were divided into two groups: (a) SRP + 0.75% boric acid gel (BA group); and (b) SRP + placebo gel (placebo group). At baseline, 3 and 6 months after treatment, clinical measurements, including plaque index, modified sulcus bleeding index, probing depth (PD), clinical attachment level (CAL), intrabony defect depth, and percentage change in radiographic defect depth reduction (DDR%) as radiographic parameters were assessed. RESULTS: The mean PD reduction and mean CAL gain were greater in the BA group than the placebo group at 3 and 6 months. A significantly greater mean percentage of radiographic DDR% was found in the BA group (36.97±3.47%) compared to the placebo group (2.88±0.89%) after 6 months. CONCLUSION: BA as an adjunct to SRP can provide a new insight into therapeutic strategies for the management of CP, but further clinical evaluations are needed.