Impact of Deep Margin Elevation Procedures Upon Periodontal Parameters: A Systematic Review.

INTRODUCTION: Deep margin elevation (DME) is an emerging technique attempting to minimize the need for surgical procedures (i.e., crown lengthening [CL]), deliver indirect restorations in one clinical session and reduce overall treatment time. The present study evaluated the impact of DME upon periodontal measurements based exclusively on human studies. METHODS: A literature search was performed by two independent reviewers in several databases including PubMed, EMBASE, and Cochrane Central up to March 2022. This review searched for randomized human trials, cohort (prospective/ retrospective) and/or case series studies using DME, reporting periodontal (i.e. marginal bone levels [MBL], probing depths [PD], bleeding on probing [BoP], recession [REC], clinical attachment level [CAL]), and the type of approach (non-surgical or surgical) with at least ⟩3 months of post-operative outcomes. RESULTS: None of the included studies reported MBL, REC or CAL, and thus, results were limited to PD and BoP. BoP was increased when the distance between restorative margin and alveolar bone was approximately ⟨2mm. Non-surgical and surgical DME approaches led to different outcomes in PD (0.26±0.77mm vs -0.39±0.85mm) and BoP (31.50% vs -22.33%). CONCLUSIONS: Limited findings of the present systematic review can be drawn and thus, the impact of DME upon the periodontium remains inconclusive.

Effect of periodontal dressing on non-surgical periodontal treatment outcomes: a systematic review.

BACKGROUND: Periodontal dressing has been advocated and showed some positive outcomes for placing over the surgical site after periodontal surgery. However, little is known about its effect on non-surgical therapy. PURPOSE: The aim of this review was to assess the clinical effect of periodontal dressing when used after non-surgical therapy. MATERIAL AND METHODS: Two examiners performed an electronic search in several databases for relevant articles published in English up to November 2013. Selected studies were randomized human clinical trials (prospective or retrospective trials) with the clear aim of investigating the effect of periodontal dressing placement upon periodontal non-surgical mechanical therapy. Data were extracted from the included articles for analysis. RESULTS: Three randomized clinical trials fulfilled the inclusion criteria and thus were included in the data analysis. Statistical analysis could not be carried out due to the lack of clear data of the included studies. However, descriptive analysis showed its effectiveness in improving clinical parameters such as gain of clinical attachment level and reduction of probing pocket depth. CONCLUSION: Placement of periodontal dressing right after non-surgical mechanical therapy can be beneficial in improving overall short-term clinical outcomes, although more controlled studies are still needed to validate this finding.

Epigenetic Modifications of Histones in Periodontal Disease.

Periodontitis is a chronic infectious disease driven by dysbiosis, an imbalance between commensal bacteria and the host organism. Periodontitis is a leading cause of tooth loss in adults and occurs in about 50% of the US population. In addition to the clinical challenges associated with treating periodontitis, the progression and chronic nature of this disease seriously affect human health. Emerging evidence suggests that periodontitis is associated with mechanisms beyond bacteria-induced protein and tissue degradation. Here, we hypothesize that bacteria are able to induce epigenetic modifications in oral epithelial cells mediated by histone modifications. In this study, we found that dysbiosis in vivo led to epigenetic modifications, including acetylation of histones and downregulation of DNA methyltransferase 1. In addition, in vitro exposure of oral epithelial cells to lipopolysaccharides resulted in histone modifications, activation of transcriptional coactivators, such as p300/CBP, and accumulation of nuclear factor-κB (NF-κB). Given that oral epithelial cells are the first line of defense for the periodontium against bacteria, we also evaluated whether activation of pathogen recognition receptors induced histone modifications. We found that activation of the Toll-like receptors 1, 2, and 4 and the nucleotide-binding oligomerization domain protein 1 induced histone acetylation in oral epithelial cells. Our findings corroborate the emerging concept that epigenetic modifications play a role in the development of periodontitis.