Crestal bone resorption after the application of two periodontal surgical techniques. A randomized, controlled clinical trial

Clinical evaluation of impact of periodontal phenotype on the outcome of open flap debridement in patients with chronic periodontitis: A comparative interventional study

BACKGROUND

Several studies have implicated the role of periodontal phenotype (PP) in the outcome of various periodontal interventions. However investigations have not been performed to estimate such impact on the outcome of open flap debridement (OFD) for the management of chronic periodontitis.

METHODS

A total of 73 individuals with chronic periodontitis underwent scaling and root planing (SRP). Eight weeks following SRP, modified Widman flap (MWF) surgery was performed in 40 patients (20 of either PP) presenting with probing depth (PD) ≥4 mm and gingival index (GI) ≥1 at ≥4 sites distributed over ≥2 anterior teeth with radiographic evidence of horizontal bone loss. PD, clinical attachment level (CAL), gingival recession, plaque index, GI, and bleeding on probing (BOP) were recorded at baseline, 3 and 6 months. PP was assessed using transparency of periodontal probe through the gingival margin at midfacial level.

RESULTS

A total of 34 patients were re-evaluated after intervention. All periodontal parameters improved in both groups after periodontal surgery. PD & PP were found to have positive correlation with CAL gain in ≥7 mm probing sites. Attachment gain of >2 mm was observed in more percentage of sites in thick PP than in thin PP.

CONCLUSION

PP can be an important factor influencing CAL gain in OFD.

The efficacy of pocket elimination/reduction compared to access flap surgery: A systematic review and meta-analysis

AIM

To assess the efficacy and adverse effects of resective surgery compared to access flap in patients with periodontitis.

METHODS

Randomized controlled trials with a follow-up ≥6 months were identified in ten databases. Screening, data extraction, and quality assessment were conducted by two reviewers. The primary outcome was probing pocket depth, and the main secondary outcome was clinical attachment level. Data on adverse events were collected. Meta-analysis was used to synthesize the findings of trials.

RESULTS

A total of 880 publications were identified. Fourteen publications from nine clinical trials met the inclusion criteria and were included for analysis. Meta-analysis was carried out using all available results. The results indicated superior pocket depth reduction following resective surgery compared to access flap after 6-12 months of follow-up (weighted mean difference 0.47 mm; confidence interval 0.7-0.24; p = .010). After 36-60 months of follow-up, no differences were found between the two treatments in pocket depth and attachment level. The prevalence of adverse effects was not different between the groups. Post-operative recession tended to be more severe for the resective approaches.

CONCLUSION

Resective surgical approach was superior to access flap in reducing pocket depth 6-12 months post-surgery, while no differences between the two modalities were found at 36-60 months of follow-up.

Effects of topical application of 1% sodium alendronate gel in the surgical treatment of periodontal intrabony defects: A 6-month randomized controlled clinical trial

BACKGROUND

Sodium alendronate (ALN) is an aminobisphosphonate and potent inhibitor of bone resorption. It has been suggested that ALN might be a promising carrier of biomolecules for periodontal bone repair. The aim of this randomized split-mouth clinical trial was to evaluate the effects of the topical application of 1% ALN gel in intrabony defects during the surgical treatment of patients with periodontitis.

METHODS

Sixty-four intrabony defects from 32 patients with periodontitis were randomly treated with either 1% ALN gel or placebo gel during periodontal surgeries. Full-mouth periodontal examination was performed at baseline and at 3 and 6 months after surgical treatment. Clinical attachment level (CAL), probing depth (PD), and bleeding on probing (BOP) were recorded as the clinical outcomes. Bone defects were evaluated by digital subtraction radiography (DSR) at baseline and 6 months post-treatment. Analyses were performed through Fisher, Kruskal-Wallis, and ANOVA tests and a generalized estimation equations method.

RESULTS

Both ALN and placebo groups showed significant improvements in BOP, PD, and CAL after periodontal surgical procedures (P < 0.001). Intergroup analysis showed significantly better outcomes in the ALN group with higher PD reduction and clinical attachment gain. DSR showed positive effects on periodontal bone repair strongly associated in the ALN group (P < 0.001).

CONCLUSION

Topical application of 1% ALN may be a promising and beneficial adjuvant for the treatment of intrabony defects during surgical periodontal therapy.

Pilot study on the clinical and microbiological effect of subgingival glycine powder air polishing using a cannula-like jet

OBJECTIVES

To assess the efficacy of subgingival glycine powder air polishing (GPAP) during supportive periodontal therapy (SPT).

METHODS

Each quadrant of 25 subjects was randomly assigned to the following treatments: subgingival scaling with hand instruments (SRP), GPAP, subgingival ultrasonic debridement (UD) and no subgingival treatment (NT). Clinical recordings included the following: probing pocket depth (PPD), gingival recession (RE), clinical attachment level (CAL), Gingival and Plaque Index. Subgingival plaque samples were taken from two sites >4 mm per quadrant. Therapy, recordings and microbial sampling were performed at baseline, 3 and 6 months, while at 1 month only clinical recordings and sampling were performed. Subgingival samples were analysed using 'checkerboard' DNA-DNA hybridization for Porphyromonas gingivalis, Tannerrella forsythia and Treponema denticola.

RESULTS

All groups were homogeneous at baseline for the clinical parameters assessed. The GPAP group displayed statistically significant higher PPD compared to SRP and UD at 1, 3 and 6 months and no statistical differences with the 'no treatment' group at all time points. At 1 month, the GPAP group displayed statistically significantly higher levels of CAL compared to SRP, while at 3 and 6 months statistically significant differences were observed with groups assigned to SRP and UD. No differences were observed among groups for RE, PI, GI and numbers of the investigated bacteria at any time point.

CONCLUSIONS

On the basis of clinical and microbiological data, this study does not support the superiority of GPAP as sole treatment over SRP or subgingival ultrasonic scaling.