Root planing strategies: a comparative ex vivo study

BACKGROUND

As oral health has gained a crucial role in low grade inflammation control, new techniques were tested to achieve a better control of periodontal homeostasis. Ultrasound scaling and root planing by means of Gracey curettes were the established techniques, while air-polishing was mostly used on prosthetic surfaces.

METHODS

In the present study, an in-vitro comparison between roughness of enamel and root surfaces after air polishing and curettes was performed. Six extracted teeth were examined for air polishing effects and curettes effects at Scanning Electron Microscope to evaluate the superficial roughness. This aspect was assessed by a dedicated software analyzing roughness indexes such as Ra, Rq, Sa and fractal dimension.

RESULTS

According to our results, air polishing produced a smoother root surface in comparison with the curette's root planing. Although Gracey curette scaling represent the gold-standard so far. Moreover, air polishing did not produce root cementum damage or scratches, as with curette's scaling, and this aspect seems to be related to particles diameter and nature.

CONCLUSIONS

Further studies, both in vitro and in vivo, are needed to better evaluate the real outcome of this kind of management.

Impact of scaling and root planing on association of site- and tooth-specific factors with bleeding on pocket probing

OBJECTIVES

This study was conducted to elucidate the link of site-specific, tooth-related, and patient-associated factors with bleeding on pocket probing (BOPP) and the impact of scaling and root planing over these factors.

METHOD AND MATERIALS

This cross-sectional study comprised of 50 untreated periodontitis patients and 50 periodontitis patients who had received scaling and root planing in the last 6 to 12 months and were on supportive periodontal therapy. Multilevel modeling was applied to data, with BOPP being the dichotomous outcome variable. Variables that revealed a significant association with BOPP in multilevel modeling were analyzed further to find the influence of the treatment group (untreated periodontitis and treated periodontitis) on the association between predictor variables and BOPP.

RESULTS

Odds ratio (OR) for BOPP in untreated periodontitis versus treated periodontitis was 1.493, and in molars versus anterior teeth this was 1.439. Untreated periodontitis had an OR of 3.500 compared to treated periodontitis, in anterior teeth with Plaque Index 0. This was 2.795 and 7.734 in treated periodontitis and 5.106 and 12.762 in untreated periodontitis at Plaque Index 1 and 2, respectively. Bleeding on marginal probing had an OR of 6.984 for BOPP. Bleeding on marginal probing negative sites had higher OR in untreated periodontitis irrespective of the probing pocket depth.

CONCLUSION

Plaque control is more effective in controlling periodontal inflammation after scaling and root planing. The probability of BOPP in the absence of bleeding on marginal probing is higher in untreated patients. The scope of influence of marginal inflammation on periodontal inflammation in shallow pockets is more in untreated periodontitis as compared to treated periodontitis; however, the trend reverses in deep pockets.

Efficacy of nonsurgical periodontal therapy for treatment of periodontitis: practical application of current knowledge

This article summarizes the practical application of current knowledge with respect to nonsurgical treatment of periodontitis. The benefits of nonsurgical therapy with or without adjunctive therapies are discussed. The dental literature was searched for articles that addressed outcomes related to mechanical nonsurgical therapy with or without adjunctive aids to treat periodontitis. The classic periodontal literature was assessed for relevant information, and recent systematic reviews and meta-analyses of adjunctive therapies (published within the last 5 years) were evaluated. Mechanical nonsurgical periodontal therapy can provide a predictable result for the treatment of periodontitis in many situations. Unnecessary cementum removal should be avoided because it can cause root sensitivity and loss of clinical attachment in shallow probing depths. Manual and ultrasonic instruments are both effective for treating periodontitis. Depending on the clinician's preference, either manual or ultrasonic instrumentation can be used because both methods achieve equivalent results when treating most cases of periodontitis. Full- and partial-mouth scaling and root planing (SRP) are both effective therapies. At present, clinical trials have failed to show that lasers--whether used as a monotherapy or an adjunct to SRP--provide a significant clinical benefit compared with nonsurgical therapy. To date, studies have shown that the use of systemic and local drug delivery, photodynamic therapy, and probiotics as adjuncts to SRP yields modest improvements compared with SRP alone.

Randomized Clinical Trial of a Topical Botanical Patch for the Adjunctive Management of Periodontitis

PURPOSE

This randomized, controlled clinical trial aimed to evaluate the clinical, adjunctive effects of an approved botanical barrier device or patch on probing parameters in patients with periodontitis.

MATERIALS AND METHODS

Eighty patients with periodontitis were recruited for this single-blinded trial. Patient demographic data, including gender, age, self-reported smoking status, and history of diabetes or cardiovascular disease, were collected. At baseline, all patients received a full-mouth probing examination followed by scaling and root planing (SRP). Thereafter, patients were randomized to receive either adjunctive botanical patch applications (i.e. at 2-4 treatment sites with baseline pocket depth PD ≥6 mm) or no additional therapy (SRP alone, control). Patients applied botanical patch devices per randomization to treatment sites three times on day 0 and once daily on days 1-6. Study devices were spontaneously shed or removed by the patient at 2-2.5 h after each application. Patients were recalled for probing reexaminations at 1, 2 and 3 months. Statistical analyses focused on intergroup differences in probing parameters and included ANOVA for baseline measures and ANCOVA controlling for baseline measures at 1, 2 and 3 months in the overall population and in subpopulations (e.g. smokers vs nonsmokers).

RESULTS

Randomized patient groups were balanced with respect to baseline periodontal status (mean and extent PD) but not smoking, with statistically significantly more smokers clustering in the control group (p = 0.002). For the overall population and the non-smoking subpopulation, statistically significantly improved PD and clinical attachment levels (CAL) were observed with adjunctive botanical patch therapy vs control at 1 and 2 months (p < 0.05) but not 3 months (p = 0.08 for PD). For smokers, no statistically significant intergroup differences in PD or CAL were detected with botanical patch treatment.

CONCLUSIONS

The data from this trial indicate short-term improvements in probing parameters with the botanical patch device when used adjunctively with SRP, especially with non-smoking periodontitis patients.

Integrated effects of ultrasonic scaling and subgingival irrigation with 0.12% chlorhexidine by a newly designed ultrasonic scaler tip in chronic periodontitis

OBJECTIVE

To evaluate the integrated efficacy of completely simultaneous ultrasonic scaling and subgingival irrigation with chlorhexidine in chronic periodontitis.

METHOD AND MATERIALS

This was a split-mouth randomized controlled trial including 19 patients with moderate to severe chronic periodontitis. After calculus removal, the test side received simultaneous ultrasonic scaling and subgingival irrigation with 0.12% chlorhexidine, and the control side received simultaneous ultrasonic scaling and subgingival irrigation with distilled water. A newly designed ultrasonic scaler tip with a liquid outlet on the terminal was used. Clinical parameters were assessed, and gingival crevicular fluid was collected before treatment at baseline and 1.5, 3, and 6 months after baseline.

RESULTS

On follow-up, both sides showed significant reductions in clinical parameters and concentration of inflammatory mediators in gingival crevicular fluid. Adjunct application of CHX resulted in an additional periodontal pocket reduction (0.27 to 0.29 mm, P < .05) compared to the control side, in sites with initial probing depth of 4 to 5 mm. Within the initial probing depth ≥ 6 mm, the additional probing depth reduction was 0.44 to 0.60 mm (P < .05), with clinical attachment loss, concentration of interleukin-6, and concentration of matrix metalloproteinase-8 being 0.32 to 0.38 mm, 2.64 to 3.40 µg/L, and 19.78 to 22.39 ng/L, respectively (all P < .05).

CONCLUSION

In this study, treatment outcomes of chronic periodontitis could be improved by treating the root surface with simultaneous ultrasonic scaling and chlorhexidine irrigation. The adjunctive use of 0.12% chlorhexidine with a newly designed ultrasonic scaler tip in the treatment of moderate to severe chronic periodontitis demonstrated significant clinical benefits and decrease in inflammatory mediator when compared with scaling and root planing plus placebo.

Effect of Two Nonsurgical Periodontal Treatment Modalities in Type 2 Diabetes Mellitus Patients with Chronic Periodontitis: A Randomized Clinical Trial

AIM AND OBJECTIVE

The current study aimed to investigate the effect of two nonsurgical periodontal treatment modalities on clinical periodontal parameters and glycemic control.

MATERIALS AND METHODS

A randomized clinical trial was conducted with a sample of 64 type 2 diabetes mellitus (T2DM) patients with chronic periodontitis. Subjects were randomly assigned into two groups. Group I received oral hygiene instructions (OHI) at baseline and each recall visit. Group II received one-stage full-mouth scaling and root planning (SRP) combining OHI. At baseline, third month, and sixth month the plaque index (PlI), gingival index (GI), probing pocket depth (PPD), clinical attachment loss (CAL), and glycated hemoglobin (HbA1c) were recorded and analyzed.

RESULTS

After treatment, two groups showed significant differences for all parameters at both assessed times (p <0.05). The OHI alone only demonstrated a slight reduction in GI in third month, with no significant changes for PlI and PPD indexes. However, Group I recorded the increased HbA1c and CAL values at 6-month follow-up (p <0.05). The combination of OHI and SRP exhibited a significant improvement in all periodontal values (p <0.05). Also, the HbA1C levels of Group II showed a significant reduction after treatment and were lower than those of Group I.

CONCLUSIONS

Oral hygiene instructions only resulted in a better gingival condition of diabetic patients in the initial time. The nonsurgical periodontal therapy by combining SRP and OHI significantly improved both periodontal health and glycemic control.

CLINICAL SIGNIFICANCE

Diabetic patients should be supplied with an effective OHI modality and a professional dental debridement.

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.

Efficacy of photodynamic therapy and periodontal treatment in patients with gingivitis and fixed orthodontic appliances: Protocol of randomized, controlled, double-blind study

It is known that the presence of orthodontic brackets predisposes for a change in the biofilm, facilitating the development of gingivits. The sites are difficult to access with a toothbrush and periodontal curette, worsening inflammation, in addition, a gingival hyperplasia is associated with poor hygiene. The objective of this study is to evaluate the impact of photodinamyc therapy (PDT) as an adjuvant treatment, considering clinical immunoregulatory and microbiological parameters. This randomized, controlled, double-blind clinical study will include 34 patients, both genders, having used fixed appliance for more than 12 months, with gingivitis. Participants will be divided into two groups: G1 (n = 17)- Scaling and Root Planing + PDT placebo and G2 (n = 17)- Scaling and Root Planing + PDT. In G2 the following dosimetric parameters will be used: methylene blue 0.005%, λ= 660 nanometers (nm), 9 Joules (J) per site, irradiance= 3.5Watts (W)/ centimeters (cm), radiant exposure= 318J/cm. All participants will receive oral hygiene guidance prior the curetes scaling. The clinical periodontal data to be analyzed are plaque index, gingival index and probing depth. Crevicular fluid, from 4 pre-determined sites and saliva, will be collected and analysed for IL-6, IL-1β, IL-8, TNF-α and IL-10 cytokines using ELISA (Enzyme immunoabsorption assay) method. Total Bacteria count will also be performed, by qPCR and Universal16SrRNA gene. All analysis will be realized using in the baseline (T0), 7 (T1) and 21 (T2) days after treatment. Oral health-related quality of life will be assessed using the OHIP-14 questionnaire at times T0 and T2. If sample distribution is normal, the Student T-test will be applied if it is not normal, the Mann-Whitney test will be used. The data will be presented in terms of ± PD and The significance level will be set at p < 0.05. Our results may improve quality of life and add data to establish a therapeutic alternative for gingivitis during the orthodontic treatment. Registration: clinicaltrials.gov NCT04037709. https://clinicaltrials.gov/ct2/show/NCT04037709 - Registered in July 2019.

Clinical evaluation of ultrasonic subgingival debridement versus ultrasonic subgingival scaling combined with manual root planing in the treatment of periodontitis: study protocol for a randomized controlled trial

BACKGROUND

Periodontal diseases are regarded as the most common diseases of mankind. The prevalence rate of periodontal disease assumes a clear growth tendency, increasing by 57.3% from 1990 to 2010. Thereby, effective periodontal therapy is still a long-term task and a difficult problem. The goals of periodontal therapy are to eliminate the infectious and inflammatory processes of periodontal diseases. Root planing, in order to eliminate the "infected cementum," has been an important step in the treatment of periodontitis since the 1970s. However, along with the understanding of the effects of endotoxin on the root surface, the necessity of manual root planing has been gradually queried. Ultrasonic instruments, which are more recent innovations, would not remove the cementum excessively, and are also more time-saving and labor-saving compared to using hand instruments. Hence, an increasing number of dentists prefer to do scaling with ultrasonic instruments only. However, the necessity of root planing remains emphasized in the international mainstream views of periodontal mechanical treatment. Therefore, this study is devoted to compare the clinical effect of ultrasonic subgingival debridement and ultrasonic subgingival scaling combined with manual root planing, which takes the implementation of root planing as the only variable and is more in line with the current clinical situation, thus hoping to provide some valuable reference to dentists.

METHODS/DESIGN

Forty adult patients who fit the inclusion criteria are being recruited from the Peking University Hospital of Stomatology (Beijing, China). By means of randomization tables, one quadrant of the upper and lower teeth is the test group and the other is the control group. Test group: ultrasonic subgingival scaling combined with manual root planing.

CONTROL GROUP

ultrasonic subgingival debridement. In a 24-week follow-up period, plaque index, probing depth, clinical attachment loss, bleeding index, furcation involvement, mobility, and patient-reported outcome (Visual Analog Scale for pain and sensitivity) will be observed and documented.

DISCUSSION

This study evaluates the effectiveness of ultrasonic subgingival scaling combined with manual root planing and ultrasonic subgingival debridement alone in the nonsurgical treatment of periodontitis with a split-mouth design after 1, 3 and 6 months. The result of the trial should potentially contribute to an advanced treatment strategy for periodontitis with an ideal clinical outcome.

TRIAL REGISTRATION

International Clinical Trials Registry Platform (ICTRP), ID: ChiCTR1800017122. Registered on 12 July 2018.

Effectiveness of Simvastatin 1% oral gel and mouthwash used as an adjunct treatment of scaling and root planning in the treatment of periodontal diseases

Simvastatin is an anti-hyperlipidemic drug which reduces the cholesterol synthesis and also has anti-inflammatory, immunomodulatory and anti-microbial action against the bacteria. This develops the interest of periodontologist to use it in combination with conventional treatment to treat periodontal diseases. The objective of the study was to develop the gel and mouthwash of simvastatin and use it locally to treat gingivitis and periodontitis as an adjunct to scaling and root planning. The patients were randomly allocated into three groups that were standard treatment group, gel treatment group and mouthwash treatment group. Results indicated that simvastatin gel and mouthwash in 1% preparation showed favorable results by significantly reducing periodontal parameters and inflammatory biomarkers (p<0.001) as compared to standard treatment. Thus, we strongly suggest the use of simvastatin by local drug delivery system as an adjunct treatment of scaling and root planning.

The use of enamel matrix derivative for the treatment of the apically involved tooth: A case report

INTRODUCTION

The aim of this report is to present a case of an apically involved tooth with successful regeneration by only applying enamel matrix derivative. The root of the tooth was planed and the defect area was well debrided using various instruments, including curettes and an ultrasonic scaler, and the root surface of the tooth and the defect area were loaded with enamel matrix derivative.

PATIENT CONCERNS

A 32-year-old man visited the clinic due to a referral for the evaluation of his mandibular left first molar.

DIAGNOSIS

The clinical and radiographic assessment displayed the loss of the periodontium around the tested tooth with apical involvement of the mesial root. Bleeding upon probing was noted at the mandibular first molar, with the deepest periodontal probing depth of 15 mm.

INTERVENTIONS

A nonsurgical approach was firstly performed on the tooth, and the deepest probing depth was reduced to 12 mm. After re-evaluation, elevation of a full-thickness flap was done, the root of the tooth was planed, and the defect area was well debrided using various instruments, including curettes and an ultrasonic scaler. The defect area on the mandibular left first molar was grafted with enamel matrix derivative.

OUTCOMES

The 7-month postoperative clinical and radiographic evaluation showed healthy gingiva and an increase in radiopacity. The final 1-year and 9-month postoperative evaluation showed that regeneration of bony defect was well maintained up to the final evaluation with reduction of probing depth.

CONCLUSION

In conclusion, a case of apically involved tooth can be treated only with enamel matrix derivative after meticulous debridement with curettes and an ultrasonic scaler.

Surface changes and bacterial adhesion on implant abutment materials after various clinical cleaning procedures

BACKGROUND

Supportive treatments are essential to long-term dental implant success; however, professional cleaning procedures may alter the surfaces of implant abutments and lead to adverse biological responses. This study aimed to evaluate four clinically used cleaning procedures by examining surface changes and subsequent bacterial adhesion on abutment materials.

METHODS

Discs of titanium and zirconia were polished and divided into five groups: titanium curette treatment, carbon fiber reinforced plastic curette treatment, ultrasonic scaling with carbon fiber tip treatment, air polishing with glycine powder, and control group without any treatment. After instrumentation, the arithmetical mean roughness (Ra), hydrophilicity, and surface free energy were recorded. The bacterial adhesion was evaluated after 1 h of Streptococcus mitis incubation by optical microscope and quantified by turbidity test.

RESULTS

Among the titanium samples, titanium curette treatment group showed significant surface morphology changes, increased Ra, hydrophilicity, surface free energy, and higher optical density of adhered bacteria. As for the zirconia samples, the differences in surface morphology, Ra, and bacterial adhesion between groups were nonsignificant.

CONCLUSION

Comparing to titanium, zirconia was less susceptible to surface changes after tested cleaning procedures. Titanium curette should be used with care on titanium abutments.

Comparison of root surface roughness produced by air polishing combined with hand instrumentation or ultrasonic instrumentation: an in vitro study

The aim of this study was to examine the surface roughness produced by root debridement during periodontal maintenance therapy. The root surface roughness produced by hand scaling and subsequent glycine powder air polishing (GPAP) was compared with that produced by ultrasonic scaling and subsequent GPAP. Fifty extracted incisor and premolar teeth were collected and randomly allocated to the following 5 groups (n = 10 per group): 1, hand scaling followed by GPAP; 2, ultrasonic scaling followed by GPAP; 3, hand scaling alone; 4, ultrasonic scaling alone; and 5, no treatment. After the initial scaling procedure, specimens in groups 1 and 2 were incubated at 37°C for 3 days. The specimens then underwent GPAP for 5 seconds. All specimens were examined under a profilometer, and the root surface roughness was measured in micrometers. The specimens in groups 1 (hand scaling with GPAP) and 2 (ultrasonic scaling with GPAP) were studied in detail under a scanning electron microscope. The different protocols produced the following mean root surface roughness values: group 1, 2.31 µm; group 2, 4.33 µm; group 3, 5.84 µm; group 4, 6.32 µm; and group 5, 9.20 µm. The difference between groups 1 and 2 was statistically significant (P < 0.05). In this in vitro study, hand scaling with curettes produced smoother root surfaces than ultrasonic scaling. Adjunctive use of GPAP for 5 seconds along with hand scaling or ultrasonic scaling resulted in improved root surface smoothness during periodontal maintenance therapy.

Impact of Er:YAG laser on wound healing following nonsurgical therapy: A pilot study

The purpose is to examine early wound healing through histological analysis by characterizing connective tissue distribution and organization in the treated periodontium following nonsurgical therapy. Periodontal disease is a multifactorial pathological process that leads to the loss of the surrounding periodontium. Traditional periodontal therapies have proven beneficial in halting the progression of disease. The aim of this study is to investigate early wound healing in periodontal patients following hand/ultrasonic instrumentation alone, erbium-doped yttrium aluminum garnet laser instrumentation alone, or a combination of hand/ultrasonic instrumentation and Er:YAG laser instrumentation for the nonsurgical treatment of periodontitis by histologic evaluation. Twenty-one patients were randomized to receive nonsurgical therapy for the treatment of chronic periodontitis with three modalities prior to surgical therapy. Baseline clinical measurements were obtained prior to treatment. Wound healing was assessed by obtaining an otherwise discarded tissue sample following nonsurgical therapy of the selected study site. Samples were obtained at 2 or 6 weeks following initial therapy with a step-back incision and fixated for histological and immunohistochemical analysis. There were minimal between-group differences in the amount of collagen distribution when analyzing the Mallory-Heidenhain Azan trichrome, Picrosirus Red stain, and proliferating cell nuclear antigen at both time points. Descriptive analysis of baseline measurements showed no differences in probing depth change, bleeding on probing, and clinical attachment level following initial therapy between the three treatment groups at 2 or 6 weeks. Each treatment modality was effective in treating moderate to severe chronic periodontitis; however, the results of this study are inconclusive regarding superiority of any one treatment approach from a histologic and immunohistochemical perspective. Based on this assessment, there was increased fibroblast proliferation and collagen maturation between the 2- and 6-week time point after treatment in all treatment groups, with few apparent differences between treatment groups. This pilot study qualitatively evaluated early wound healing in periodontal patients following non surgical therapy with various treatment modalities. When comparing descriptive outcomes of Er:YAG laser therapy and hand/ultrasonic instrumentation there were minimal differences in collagen distribution and density between groups. The evaluated modalities were each effective treating periodontal patients with non surgical therapy.

Effect of Subgingival Mechanical Debridement and Local Delivery of Chlorhexidine Gluconate Chip or Minocycline Hydrochloride Microspheres in Patients Enrolled in Supportive Periodontal Therapy: a Retrospective Analysis

PURPOSE

To retrospectively evaluate the clinical outcomes of subgingival debridement (e.g. scaling and root planing, SRP) and application of either a chlorhexidine chip (PerioChip, PC) or Arestin (AR) minocycline microspheres in patients with chronic periodontitis during supportive periodontal treatment (SPT).

MATERIALS AND METHODS

Patients diagnosed with moderate to severe chronic periodontitis who were treated with SRP and a slow-release device during SPT were evaluated (total n = 53; n = 37 received PC, n = 16 received AR). Clinical measurements at baseline, 3, 6 and 12 months included changes in probing pocket depth (PD), bleeding on probing (BOP) and clinical attachment level (CAL).

RESULTS

Both treatments led to a reduction in PD and gain of CAL. AR showed higher improvements in pockets of ≥7 mm compared with PC. In contrast, PC was more effective in 5-6 mm PD. At one year following treatment, both treatments reduced the need-for-surgery index (95% to 100%) of the sites at baseline to 30% for AR and 42% for PC, with no differences between PC and AR.

CONCLUSIONS

In patients enrolled in SPT, the use of both PC and AR in conjunction with subgingival mechanical debridement represents an effective treatment modality for improving the clinical outcomes and reducing the need for surgery.

Systemic effects of periodontitis treatment in patients with type 2 diabetes: a 12 month, single-centre, investigator-masked, randomised trial

BACKGROUND

Chronic inflammation is believed to be a major mechanism underlying the pathophysiology of type 2 diabetes. Periodontitis is a cause of systemic inflammation. We aimed to assess the effects of periodontal treatment on glycaemic control in people with type 2 diabetes.

METHODS

In this 12 month, single-centre, parallel-group, investigator-masked, randomised trial, we recruited patients with type 2 diabetes, moderate-to-severe periodontitis, and at least 15 teeth from four local hospitals and 15 medical or dental practices in the UK. We randomly assigned patients (1:1) using a computer-generated table to receive intensive periodontal treatment (IPT; whole mouth subgingival scaling, surgical periodontal therapy [if the participants showed good oral hygiene practice; otherwise dental cleaning again], and supportive periodontal therapy every 3 months until completion of the study) or control periodontal treatment (CPT; supra-gingival scaling and polishing at the same timepoints as in the IPT group). Treatment allocation included a process of minimisation in terms of diabetes onset, smoking status, sex, and periodontitis severity. Allocation to treatment was concealed in an opaque envelope and revealed to the clinician on the day of first treatment. With the exception of dental staff who performed the treatment and clinical examinations, all study investigators were masked to group allocation. The primary outcome was between-group difference in HbA_1c at 12 months in the intention-to-treat population. This study is registered with the ISRCTN registry, number ISRCTN83229304.

FINDINGS

Between Oct 1, 2008, and Oct 31, 2012, we randomly assigned 264 patients to IPT (n=133) or CPT (n=131), all of whom were included in the intention-to-treat population. At baseline, mean HbA_1c was 8·1% (SD 1·7) in both groups. After 12 months, unadjusted mean HbA_1c was 8·3% (SE 0·2) in the CPT group and 7·8% (0·2) in the IPT group; with adjustment for baseline HbA_1c, age, sex, ethnicity, smoking status, duration of diabetes, and BMI, HbA_1c was 0·6% (95% CI 0·3-0·9; p<0·0001) lower in the IPT group than in the CPT group. At least one adverse event was reported in 30 (23%) of 133 patients in the IPT group and 23 (18%) of 131 patients in the CPT group. Serious adverse events were reported in 11 (8%) patients in the IPT group, including one (1%) death, and 11 (8%) patients in the CPT group, including three (2%) deaths.

INTERPRETATION

Compared with CPT, IPT reduced HbA_1c in patients with type 2 diabetes and moderate-to-severe periodontitis after 12 months. These results suggest that routine oral health assessment and treatment of periodontitis could be important for effective management of type 2 diabetes.

FUNDING

Diabetes UK and UK National Institute for Health Research.

Comparison of the Efficacy of Calculus Detection Between Ultrasonic Inserts and an Explorer

Purpose: The purpose of this study was to evaluate the efficacy of calculus detection between a thin and curved ultrasonic inserts (UI) as compared to the Old Dominion University (ODU) 11/12 explorer.Methods: Three clinical dental hygiene faculty members were recruited to participate as calibrated raters for the presence of calculus in a group of 60 patient volunteers. Inclusion criteria were: adults aged >18 in good health, and no history of a professional prophylaxis within the past six months. Raters used an ODU 11/12 explorer, thin and curved UIs to evaluate 4 surfaces on Ramfjord index teeth for the presence of subgingival calculus. Data were analyzed for intra- and intrerrater reliability, sensitivity, and specificity.Results: Interrater reliability for calculus detection with an ODU 11/12 explorer and a thin UI was demonstrated with an Intraclass Coefficient (ICC) of .782, confidence interval (CI) 95%. An ICC of .714, CI 95% was demonstrated with the ODU 11/12 explorer and curved UIs. Intra-rater reliability was shown with mean Kappa averages in the full agreement range (Kappa=.726, n=2,160, p<0.01) for use of the ODU 11/12 explorer versus the thin UI as well as versus curved UIs (Kappa=.680, n=2160, p<0.01). Sensitivity was 75%, specificity 97%, PPV 81%, and NPV 94% when the thin UI was used and sensitivity measured 65%, specificity 98%, PPV 81%, and NPV 95% when curved UIs were used.Conclusion: Calculus detection was comparable when using the ODU 11/12 explorer, a thin UI and curved UIs on patients with limited amounts of calculus among the three clinicians. Efforts may be focused on developing tactile sensitivity for calculus detection in addition to calculus removal when using thin and curved ultrasonic instruments. Future studies should investigate calculus evaluation utilizing a variety of ultrasonic insert designs, varying amounts of calculus, and levels of clinical experience.

Application of enamel matrix derivative and deproteinized bovine bone for the treatment of peri-implantitis after decontamination with an ultrasonic scaler: A case report

RATIONALE

The purpose of this report is to present a case of peri-implantitis with successful regeneration. The surface of the affected dental implant was decontaminated with an ultrasonic scaler and treated with bovine-derived hydroxyapatite and enamel matrix derivative.

PATIENT CONCERNS

A 52-year-old male was referred for evaluation of a dental implant placed in the mandibular right second premolar area.

DIAGNOSIS

The radiographic evaluation showed the loss of supporting bone around the dental implant. Bleeding upon probing and suppuration were observed, with the deepest probing depth at 6 mm.

INTERVENTIONS

The area was firstly treated with a nonsurgical approach. After re-evaluation, a full-thickness flap was elevated. The area was well debrided using various instruments, including curettes and an ultrasonic scaler. The defect area was grafted with bovine-derived hydroxyapatite and enamel matrix derivative.

OUTCOMES

Histopathologic evaluation revealed chronic inflammation with fibrosis and calcification. The evaluation at 2 years and 3 months after surgery showed that the prosthesis was functioning well. Bleeding upon probing and suppuration was not noted, and reduction of probing depth was seen, with the deepest depth at 4 mm. The area showed maintenance of graft material with increased radiopacity around the dental implant.

LESSONS

In conclusion, a case of peri-implantitis can be successfully treated with bovine-derived hydroxyapatite and enamel matrix derivative after surface decontamination with an ultrasonic scaler.

Comparison of the clinical and microbiological effects of antibiotic therapy in periodontal pockets following laser treatment: An in vivo study

BACKGROUND

Laser technology in periodontal therapy could help in reducing total bacterial count.

OBJECTIVES

The aim of this study was to evaluate the effects of pocket debridement using an erbium-doped yttrium aluminium garnet laser (Er:YAG laser - ERL), scaling and root planing (SRP) with photodynamic therapy (PDT), or SRP alone. Teeth vitality and soft tissue carbonization were also assessed.

MATERIAL AND METHODS

This study included 1,169 single-rooted teeth from 84 patients divided into 3 groups (n = 28). The G1 group had ERL with 40 mJ of energy, a frequency of 40 Hz and a fluence of 63.66 J/cm2. The G2 group had SRP + PDT (635 nm diode laser, 12 J of energy and irradiation time of 30 s) and a Toluidine Blue photosensitizer (PS) (application time of 60 s). The G3 group was administered SRP alone. In the 42 subjects (G1: n = 11, G2: n = 14 and G3: n = 17) with high amounts of Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Treponema denticola (Td) and Tannerella forsythia (Tf), additional 1-week antibiotic treatments with clindamycin or amoxicillin + clavulanic acid - in doses of 600 mg/day or 1000 mg/day, respectively - were prescribed 3 months after the therapy. Microbiological and clinical analyses of the probing depth (PD), recession (RC), plaque index (PI), bleeding on probing (BOP), and attachment loss (AT) were performed at baseline and at the follow-up of 3 months, 3 months and 1 week, and 6 months.

RESULTS

Plaque index decreased in G1 after 3 months, 3 months and 1 week, and 6 months (p < 0.05) and was lower in G1 vs G2 after 3 months (p < 0.05). The reduction in BOP in G1 after 3 months and 1 week was higher in comparison with G2 or G3 (p < 0.02). Probing depth decreased in all groups (p < 0.05). We found a reduction in the percentage of sites with some bacteria after 3 months - Prevotella intermedia (Pi) (G1 and G2), Capnocytophaga gingivalis (Cg) and Eubacterium nucleatum (En) (G3), and after 3 months and 1 week with En, Td, Tf (G1, G2 and G3), Pi (G1 and G2), Aa, Peptostreptococcus micros (Pm), and Cg (G3), and with Pi (G1 and G2), Tf (G2), Pg, En (G2 and G3), and Pm (G3) after 6 months (p < 0.05). We observed no signs of carbonization or teeth injury.

CONCLUSIONS

Scaling and root planing + PDT and ERL may be an alternative therapy for chronic periodontitis.

Two-Year Randomized Clinical Trial of Adjunctive Minocycline Microspheres in Periodontal Maintenance

Purpose: The purpose of this study was to evaluate the effects of repeated scaling and root planing (SRP), with or without locally-delivered minocycline microspheres (MM) on residual pockets in patients undergoing periodontal maintenance (PMT).Methods: Patients on PMT were randomized into two groups for treatment of one posterior interproximal inflamed pocket (≥5 mm) with a history of bleeding on probing every 6 months: SRP plus MM (n=30) or exclusively SRP (n=30). Baseline and 24-month measurements included radiographic interproximal alveolar bone height, probing depths (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival crevicular fluid (GCF), and salivary interleukin (IL) - 1β, (24 month only). Results were analyzed for baseline data or change in measurements after 24 months of treatment between different treatment groups, as well as whether significant changes occurred after 24 months of treatment for each treatment group individually.Results: Alveolar bone height and GCF IL-1β remained stable over the 24 months. The SRP + MM and SRP groups each demonstrated reduced PD (0.8 ± 0.9 mm and 1.1 ±0.6 mm, respectively, p < 0.001 each), CAL (0.8 ± 0.9 mm and 1.0 ± 0.6 mm, respectively, p < 0.001 each) and BOP (55% and 48%, respectively, p = 0.001 each). However, there were no differences between groups over the 24-month study period.Conclusion: Scaling and root planning alone, of moderately inflamed periodontal pockets at 6-month intervals, produced stable interproximal alveolar bone height as well as sustained improvements in probing depths, clinical attachment level, bleeding on probing over 24 months; minocycline microspheres were not shown to enhance these results.

Effects of nonsurgical periodontal treatment on glycated haemoglobin on type 2 diabetes patients (PARODIA 1 study): a randomized controlled trial in a sub-Saharan Africa population

BACKGROUND

There is a burglar association between diabetes and periodontitis. Many studies has shown that periodontitis treatment can help improving glycemic control in diabetes patients but little evidence of non-surgical treatment benefit is available in sub Saharan african diabetes patients. We aimed to assess the effects of non-surgical periodontal treatment (NSPT) of chronic periodontitis on glycaemic control in poorly controlled type 2 diabetes patients (T2D) in a sub-Saharan Africa urban setting.

METHODS

A total of 34 poorly controlled T2D patients with chronic periodontitis aged 51.4 ± 8.8 years (mean ± SD), with known duration of diabetes of 55.5 ± 42.6 months, and HbA1c of 9.3 ± 1.3% were randomly assigned to two groups. The treatment group (Group 1, n = 17) received immediate ultrasonic scaling, scaling and root planning along with subgingival 10% povidone iodine irrigation, whereas the control group (Group 2, n = 17) was assigned to receive delayed periodontal treatment 3 months later. Pharmacological treatment was unchanged and all participants received the same standardized education session on diabetes management and dental hygiene. The primary outcome was the 3-month change in HbA1c from baseline. Plaque index (PI), gingival bleeding index (GBI), pocket depth (PD), clinical attachment loss (CAL) were also assessed prior to, at 6 and 12 weeks after enrolment.

RESULTS

Two subjects in each group were excluded from the study. Data were analyzed on thirty patients (15 per group). Non-surgical periodontal treatment with education for better dental hygiene (group 1) significantly improved all periodontal parameters whereas education only (group 2) improved only the plaque index among all periodontal parameters. Immediate non-surgical periodontal treatment induced a reduction of HbA1c levels by 3.0 ± 2.4 points from 9.7 ± 1.6% at baseline to 6.7 ± 2.0% 3 months after NSPT, (p ˂ 0.001) but the change was not significant in group 2, from mean 8.9 ± 0.9% at baseline vs 8.1 ± 2.6% after 3 months (p = 0.24).

CONCLUSION

Non-surgical periodontal treatment markedly improved glycaemic control with an attributable reduction of 2.2 points of HbA1c in poorly controlled T2D patients in a sub Saharan setting.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02745015 Date of registration: July 17, 2016 'Retrospectively registered'.

Clinical Efficacy of Subgingivally Delivered 1.2 mg Simvastatin in the Treatment of Patients with Aggressive Periodontitis: A Randomized Controlled Clinical Trial

Simvastatin (SMV) is a specific competitive inhibitor of 3-hydroxy-2-methylglutaryl coenzyme A reductase that promotes bone formation. The present clinical trial was designed to investigate the effectiveness of 1.2 mg SMV as a local drug delivery system and as an adjunct to scaling and root planing (SRP) in the treatment of aggressive periodontitis (AgP). A total of 68 intrabony defects from 24 patients with AgP were treated either with 1.2 mg SMV gel or placebo gel. The subjects were randomly assigned to SRP + placebo (group 1; n = 12) or SRP + SMV (group 2; n = 12). Clinical parameters were recorded at baseline and at 3 and 6 months and included bleeding index, Plaque Index, probing depth (PD), and clinical attachment level (CAL). At baseline and after 6 months, radiologic assessment of bone defect fill was done. The mean decrease in PD at 6 months was 1.14 ± 0.04 mm and 3.78 ± 0.62 mm in groups 1 and 2, respectively. Significant gain in mean CAL was found between the groups (P < .05). Furthermore, significantly greater mean percentage of bone fill was found in group 2 (34.01%) compared to group 1 (2.62%). Locally delivered SMV provides a comfortable method to improve clinical parameters and promotes bone formation.

A new management strategy for the treatment of streptococcal gingivitis: A pilot study

OBJECTIVE

To demonstrate a supportive treatment option based on microorganism's growth characteristics.

METHODS

This study was conducted at Ordu University, Faculty of Dentistry, Turkey, between January and April, 2017, comprising patients whose periodontal parameters and saliva pH scores were measured before and after the treatments. The patients were divided into two equal groups. Group I underwent routine periodontal treatment methods for streptococcal gingivitis, while a supportive treatment that involved an antacid chewing tablet two times a day for a week based on the microorganism's growth characteristics was used on patients in Group II. SPSS 11.5 was used for data analysis.

RESULTS

There were 16 patients in the study with an average age of 27.90±5.54 years. The periodontal index values progressively decreased for all patients post-treatment. However, the decrease of gingival index values in Group I was significantly higher than Group II (p<0.05). The decrease in the oral pH was statistically significant after the periodontal treatment procedures with supportive method (p<0.001).

CONCLUSIONS

The use of antacids in addition to conventional periodontal treatment may be effective in the treatment of oral streptococcal infections..

Microbial colonization of the periodontal pocket and its significance for periodontal therapy

The aim of this paper was to evaluate strategies for periodontal therapy from the perspective of periodontal disease being a consequence of microbial colonization of the periodontal pocket environment. In classic bacterial infections the diversity of the microbiota decreases as the disease develops. In most cases of periodontitis, however, the diversity of the flora increases. Most incriminating bacteria are thought to harm tissues significantly only if present in high numbers over prolonged periods of time. Clinical trials have repeatedly demonstrated that scaling and root planing, a procedure that aims to remove subgingival bacterial deposits by scraping on the tooth surface within the periodontal pocket, is effective. At present, for the therapy of any form of periodontal disease, there exists no protocol with proven superiority, in terms of efficiency or effectiveness, over scaling and root planing plus systemic amoxicillin and metronidazole. Some exponents advocate rationing these drugs for patients with a specific microbial profile. However, the evidence for any benefit of bacteriology-assisted clinical protocols is unsatisfactory. Treated sites are subject to recolonization with a microbiota similar to that present before therapy. The degree and speed of recolonization depends on the treatment protocol, the distribution patterns of periodontal microorganisms elsewhere in the oral cavity and the quality of the patient's oral hygiene. To limit the use of antibiotics and to avoid accumulation of harmful effects by repeated therapy, further efforts must be made to optimize procedures addressing the microbial colonization and recolonization of the periodontal pocket.

The Effect of Nonsurgical Periodontal Therapy on the Level of Human Neutrophil Peptides 1-3 in Patients with Aggressive Periodontitis

PURPOSE

To assess the presence of HNP1-3 in the gingival crevicular fluid (GCF) of patients suffering from aggressive periodontitis before and after nonsurgical periodontal therapy.

MATERIALS AND METHODS

Twenty patients, each with generalised aggressive periodontitis (GAP) were included in the study. After periodontal examination, one site with a probing depth (PD) ≥ 4 mm was selected. Patients received nonsurgical treatment (scaling and root planing [SRP]) with additional administration of systemic antibiotic therapy (amoxicillin 375 mg three times daily + metronidazole 250 mg three times daily for 7 days). Prior to therapy and 3 and 6 months after, the following parameters were evaluated from the same site: PD, gingival recession (GR), clinical attachment level (CAL), plaque index (PI), bleeding on probing (BOP), sulcus fluid flow rate (SFFR). The level of HNP1-3 in GCF was determined by means of a commercially available ELISA kit.

RESULTS

Compared to baseline, the level of HNP 1-3 did not show statistically significant differences at 3 and 6 months. The evaluated clinical parameters and SFFR showed statistically significant decreases compared to baseline. At 6 months, PD (median) decreased from 7 to 3.5 and CAL (median) decreased from 7 to 4.

CONCLUSION

In patients with GAP, nonsurgical periodontal therapy in conjunction with systemic administration of amoxicillin and metronidazole had no effect on the level of HNP1-3 in GCF.