Long-term effect of surgical and non-surgical periodontal treatment. A 5-year clinical study

Differences in periodontal parameters between SPT patients who regularly and irregularly visited the dental clinic analyzed at tooth level: a 14-year retrospective cohort study

The purpose of this study was to evaluate the periodontal status of patients who routinely did SPT, when compared to patients that did not SPT. This retrospective cohort study was conducted at a general dental office from 2001 to 2019. Patients aged 18 to 81 years who visited the dental office over a 10-year period were assigned into two groups: an SPT group, which included patients who continually visited the dental office for SPT one or more times every year, and an irregular group, consisting of patients who did not visit the dental office at least once a year. A total of 7307 teeth (SPT group) and 4659 teeth (irregular group) were evaluated, and the periodontal conditions were compared between the first and latest visits. Multiple regression analysis was used to analyze the results. The mean follow-up time was 13.74 years. The risk factors for improvements in probing pocket depth included age, sex, smoking, diabetes mellitus, molar tooth, and irregular SPT group (p < 0.001), and that for a positive bleeding on probing site was the irregular group (odds ratio 2.94; 95% confidence interval 2.63-3.29). This study showed that lack of routine in attending the SPT program significantly decreased the periodontal parameters, thus highlighting the importance of continuing with the program to maintain the periodontal health.

Racial and ethnic disparities in periodontal health among adults seeking dental care in rural North Carolina communities: A retrospective study

BACKGROUND

Population studies consistently demonstrate a greater prevalence of chronic diseases, including oral diseases, among underrepresented minorities. This retrospective study aimed to measure and describe the prevalence and extent of periodontitis among adults seeking dental care within an academic practice-based network in rural North Carolina.

METHODS

This study used de-identified electronic health record (EHR) data from 2011 to 2017 of adult dentate patients (aged ≥30 years) seeking dental care who received a comprehensive periodontal examination at one of nine networked clinical centers. Periodontitis prevalence was calculated using CDC/AAP case definitions, along with extent (%) scores for periodontal parameters. Comparisons focused on age, sex, race, ethnicity, tobacco use, diabetes status, payer or insurance status, plaque scores, and the number of teeth.

RESULTS

EHR data for 10,544 adult patients (60.5% female) indicated 79.8% had some form of periodontitis. This patient population was diverse: 22.6% Black, 4.4% American Indian, and 53.8% White, with 4.8% self-identified as Hispanic. Patients 50 years and older showed greater mean extent scores for clinical attachment levels relative to patients 30 to 49 years. Males exhibited greater periodontitis than females (p = 0.001). Blacks showed significantly (p < 0.001) greater periodontitis prevalence relative to Whites. Hispanics also showed a greater prevalence of periodontitis (p < 0.001) relative to non-Hispanics. Significantly greater periodontitis was also noted for tobacco users (p < 0.001) but not for diabetes or payer status. A multiple logistic regression analysis of periodontitis prevalence confirmed significant associations for periodontitis for age, sex, race, ethnicity, tobacco use, high plaque scores, and the number of teeth (p < 0.001), but not diabetes or payer status.

CONCLUSIONS

The data document that racial and ethnic inequalities in periodontal health occur within the population of adults residing in rural communities in North Carolina and seeking dental care.

The efficacy of adjunctive periodontal therapies during supportive periodontal care in patients with residual pockets. A systematic review and meta-analysis

While it is well-established that patients that develop signs of relapsing periodontitis in supportive periodontal care (SPC) will need to repeat subgingival instrumentation of the residual pockets, less certainty is available in terms of which protocol should be followed and whether the use of adjunctive therapies or physical agents might provide additional benefits to repeated instrumentation alone. The aim of this systematic review was therefore to assess whether repeating subgingival instrumentation in combination with adjunctive therapies (other than antimicrobials) might provide a significant benefit in terms of pocket closure, probing pocket depth (PPD) reduction or clinical attachment level (CAL) gain in patients during SPC with residual/relapsing pockets. Four databases were searched to identify randomized controlled trials (RCTs) and controlled clinical trials (CCTs) with a minimum follow-up of 3 months that investigated the use of adjunctive therapies (other than antimicrobials) in case of residual/relapsing pockets in patients in SPC since at least 3 months. Data extraction and risk of bias assessment were performed in the studies meeting the inclusion criteria and meta-analysis was performed when ≥3 studies assessing the same adjunctive therapy were identified. 12 studies (2 CCTs and 10 RCTs) were included for qualitative analysis. Meta-analysis was performed only for 3 studies on the adjunctive use of photodynamic therapy (PDT) and it indicated a nonsignificant benefit compared to the placebo in terms of PPD reduction and CAL gain at 3 months (weighted mean difference 0.07 and -0.03, respectively) and at 6 months of follow-up (weighted mean difference -0.09 and -0.18, respectively). While antiseptics did not provide significant benefits, one study on probiotics and one on the use of vitamin D and calcium supplementation showed significant improvements in periodontal parameters. There is currently insufficient/poor evidence to determine the efficacy of adjunctive strategies (other than antimicrobials) to improve the outcomes of SPC in case of residual/relapsing pockets.

Prevalence and determinants of oral health conditions and treatment needs among slum and non-slum urban residents: Evidence from Nigeria

Oral diseases constitute a neglected epidemic in Low and Middle-Income Countries (LMICs). An understanding of its distribution and severity in different settings can aid the planning of preventive and therapeutic services. This study assessed the oral health conditions, risk factors, and treatment needs among adult residents in the slum and compared findings with non-slum urban residents in Ibadan, Nigeria. The Multistage sampling was used to select adult (≥18-years) residents from a slum and a non-slum urban sites. Information sought from participants included dietary habits, oral hygiene practices, and the use of dental services. Oral examinations were performed in line with WHO guidelines. Associations were examined using logistic regression. Mediation analysis was undertaken using generalized structural equation modeling. The sample comprised 678 slum and 679 non-slum residents. Median age in slum vs non-slum was 45 (IQR:32-50) versus 38 (IQR:29-50) years. Male: female ratio was 1:2 in both sites. Prevalence of oral diseases (slum vs non-slum sites): dental caries (27% vs 23%), gingival bleeding (75% vs 53%) and periodontal pocket (23% vs 16%). The odds of having dental caries were 21% higher for the slum dwellers compared to non-slum residents (OR = 1.21, 95% CI:0.94 to 1.56); and 50% higher for periodontal pocket (OR = 1.50, 95%CI: 1.13 to 1.98), after adjusting for age and sex. There was little evidence that tooth cleaning frequency mediated the relationship between place of residence and caries (OR = 0.95, 95%CI: 0.87 to 1.03 [indirect effect], 38% mediated) or periodontal pocket (OR = 0.95, 95%CI: 0.86 to 1.04, 15% mediated). Thirty-five percent and 27% of residents in the slum and non-slum sites respectively required the "prompt and urgent" levels of treatment need. Oral diseases prevalence in both settings are high and the prevalence was generally higher in the slum with correspondingly higher levels of prompt and urgent treatment needs. Participants may benefit from targeted therapeutic and health promotion intervention services.

Effect of diode laser as an adjunct to open flap debridement in treatment of periodontitis – A randomized clinical trial

Background:

The goals of periodontal therapy are to prevent the disease, arrest the disease progression, and regeneration of lost periodontium. Diode laser gained popularity in periodontal practice with a wide range of potential benefits.

Aim:

This study aims to evaluate and compare the clinical effects of laser-assisted open flap debridement (OFD) versus conventional OFD for the periodontitis treatment.

Materials and Methods:

A split-mouth, randomized clinical trial was conducted on fifteen participants with periodontitis having probing pocket depths (PPD) ≥5 mm. A total of 30 sites, two sites in each patient, were randomly divided into two groups. Group A received conventional OFD, and Group B received laser-assisted OFD. The assessment of PPD, relative attachment level (RAL), modified sulcular bleeding index (mSBI) was done at baseline, 3 months, and 6 months. Wound healing index (WHI) was assessed at 3^rd and 7^th day postsurgery, patient response to pain using visual analog scale (VAS) was assessed immediately, 1 day, and 1 week after surgery.

Results:

The results revealed a significant reduction in PPD, mSBI, and gain in RAL within the groups from baseline to 3 months and 6 months. Intergroup comparison showed a significant difference in PPD, RAL, mSBI, WHI and VAS scores.

Conclusions:

The use of 980 nm diode laser provided additional benefits over conventional flap therapy.

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.

Tooth loss in complying and non-complying periodontitis patients with different periodontal risk levels during supportive periodontal care

OBJECTIVES

To evaluate yearly tooth loss rate (TLR) in periodontitis patients with different periodontal risk levels who had complied or not complied with supportive periodontal care (SPC).

MATERIALS AND METHODS

Data from 168 periodontitis patients enrolled in a SPC program based on a 3-month suggested recall interval for at least 3.5 years were analyzed. For patients with a mean recall interval within 2-4 months ("compliers") or > 4 months ("non-compliers") with different PerioRisk levels (Trombelli et al. 2009), TLR (irrespective of the cause for tooth loss) was calculated. TLR values were considered in relation to meaningful TLR benchmarks from the literature for periodontitis patients either under SPC (0.15 teeth/year; positive benchmark) or irregularly complying with SPC (0.36 teeth/year; negative benchmark).

RESULTS

In both compliers and non-compliers, TLR was significantly below or similar to the positive benchmark in PerioRisk level 3 (0.08 and 0.03 teeth/year, respectively) and PerioRisk level 4 (0.12 and 0.18 teeth/year, respectively). Although marked and clinically relevant in non-compliers, the difference between TLR of compliers (0.32 teeth/year) and non-compliers (0.52 teeth/year) with PerioRisk level 5 and the negative benchmark was not significant.

CONCLUSION

A SPC protocol based on a 3- to 6-month recall interval may effectively limit long-term tooth loss in periodontitis patients with PerioRisk levels 3 and 4. A fully complied 3-month SPC protocol seems ineffective when applied to PerioRisk level 5 patients.

CLINICAL RELEVANCE

PerioRisk seems to represent a valid tool to inform the SPC recall interval as well as the intensity of active treatment prior to SPC enrollment.

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.

Short-Term Impact of Non-Surgical and Surgical Periodontal Therapy on Oral Health-Related Quality of Life in a Greek Population-A Prospective Cohort Study

While periodontitis deteriorates patients’ quality of life, non-surgical periodontal treatment seems to offer an improvement. The purpose of the present study was to evaluate the impact of non-surgical and surgical periodontal treatment on the oral health-related quality of life (OHRQoL) utilizing patient-centered assessments and surrogate clinical measurements in Greek adults. Eighty-three individuals with chronic periodontitis were enrolled in the study. Assessment of OHRQoL with the use of the Oral Health Impact Profile (OHIP-14) questionnaire in conjunction with clinical measurements of pocket probing depth (PPD), plaque index (PI) and bleeding on probing (BOP) were performed at baseline (t0), after non-surgical therapy (t1) and after periodontal surgery (t2). A statistically significant reduction of OHIP-14 score was recorded at t1 and t2 examination compared to baseline (p < 0.001) and a statistically significant improvement in all clinical parameter at all time points was recorded (p < 0.05). No correlation between the clinical parameters and the total score of OHIP-14 was recorded at any time point. Non-surgical periodontal treatment seemed to improve OHRQoL in terms of OHIP-14 scores, whilst supplementary surgical periodontal therapy did not offer any additional benefit. No correlation was found between patients’ perception of quality of life expressed by OHIP-14 score and the surrogate clinical parameters.

Clinical and microbiological evaluation of the synergistic effects of diode laser with nonsurgical periodontal therapy: A randomized clinical trial

Context:

Nonsurgical and surgical therapies along with local and systemic antibiotic regimens have been advocated in the treatment of periodontitis. Due to increasing risk of developing antibiotic resistance and inability of nonsurgical periodontal therapy to completely eradicate the pathogenic microorganisms, lasers have been used as an adjunct to conventional therapy.

Aim:

The aim of the present study is to evaluate the effectiveness of the use of diode lasers as adjunct to scaling and root planing (SRP) compared to SRP alone on various clinical and microbiologic parameters in chronic periodontitis patients.

Settings and Design:

Patients were taken from the department of periodontology and implantology, who were having chronic periodontitis.

Materials and Methods:

A total of forty patients participated in the study and they were divided into Group I – the test group (SRP + diode laser) and Group II – the control group (SRP alone). The following clinical parameters were assessed: oral hygiene index simplified; clinical attachment level (CAL); probing pocket depth (PPD); bleeding on probing (BOP) at baseline, 4 weeks, and 12 weeks after the treatment; and colony-forming units (CFUs) 1 week postoperatively.

Statistical Analysis Used:

The statistical analysis was performed using paired t-test, unpaired t-test, Wilcoxon signed-rank test, and Mann–Whitney test.

Results:

There was reduction in BOP, PPD, and gain in CAL from baseline to 3 months and also a reduction in CFU 1 week postoperatively.

Conclusion:

There was a significant improvement in clinical parameters in test group (SRP + laser) as compared to the control group (SRP alone).

Local Drug Delivery Based Treatment Approaches for Effective Management of Periodontitis

Background:

Periodontal disease is an immuno-inflammatory condition of tissues that surround and hold the teeth. It is the disease which succeeds in all races, groups and both genders. Almost 10 to15% of the global population gets suffered from severe periodontitis as per WHO reports. Periodontal disease may likely cause other systemic diseases such as cardiovascular disease and pre-term low birth weight infants. Mechanical removal of plaques and calculus deposits from supra and subgingival environment is the backbone of periodontal treatment till date whereas complete elimination of these deleterious agents is quite unrealistic as the pocket depth increases.

Recent Approaches:

Recently controlled local drug delivery application is more encouraging in comparison to systemic approach as it mainly targets to enhance the therapeutic efficacy by maintaining site-specificity, avoiding first pass metabolism, reduction in gastrointestinal (GI) side effects and decreasing the dose. Several drugs such as antiseptics and antibiotics alongwith various carriers are being formulated as local drug delivery systems for effective management of the disease. Various local delivery systems reported are fibers, films, strips, compacts, injectables, microparticles, vesicular carriers, gels and nanoparticles. These local carriers provide effective prolonged treatment at the site of infection at reduced doses. This review enlightens detailed pathophysiology and various phases of periodontitis, challenges in treatment of disease and various antimicrobial agents (along with their marketed formulations) used. The main emphasis of the review is to cover all carrier systems developed so far for local delivery application in the effective management of periodontitis, as a patient compliant drug therapy.

Long-term assessment of periodontal disease progression after surgical or non-surgical treatment: a systematic review

The primary aim of this systematic review was to assess the evidence on periodontal disease progression after treatment in patients receiving supportive periodontal therapy (SPT) and to identify predictors of clinical attachment level (CAL) loss. A protocol was developed to answer the following focused question: In adult patients treated for periodontitis, what is the disease progression in terms of CAL loss after surgical or non-surgical treatment? Randomized controlled clinical trials, prospective cohort studies, and longitudinal observational human studies with a minimum of 5 years of follow-up after surgical or non-surgical treatment that reported CAL and probing depth changes were selected. Seventeen publications reporting data from 14 investigations were included. Data from 964 patients with a follow-up range of 5-15 years was evaluated. When the CAL at the latest follow-up was compared to the CAL after active periodontal therapy, 10 of the included studies reported an overall mean CAL loss of ≤0.5 mm, 3 studies reported a mean CAL loss of 0.5-1 mm, and 4 studies reported a mean CAL loss of >1 mm. Based on 7 publications, the percentage of sites showing a CAL loss of ≥2 mm varied from 3% to 20%, and a high percentage of sites with CAL loss was associated with poor oral hygiene, smoking, and poor compliance with SPT. The outcomes after periodontal therapy remained stable over time. Disease progression occurred in a reduced number of sites and patients, mostly associated with poor oral hygiene, poor compliance with SPT, and smoking.

Oral hygiene phase revisited: How different study designs have affected results in intervention studies

Every periodontal researcher have been taught, and every textbook in periodontics have advocated, that a phase in which the patient is meticulously motivated and instructed in proper oral hygiene-the oral hygiene phase-must be included in any periodontal intervention. However, how is this oral hygiene phase actually portrayed in periodontal intervention studies, and how much space have this important phase received in the planning and carry-through of intervention studies? The purpose of this letter to the editor was to review current literature in the period 1975/01/01-2017/12/31 on periodontal, mechanical intervention studies in order to see what focus the oral hygiene phase had received in these articles. The result showed that the oral hygiene phase is variable in length and content, variable in claimed result, insufficiently described, and invariably amalgamated with the scaling and root planing which is the intervention or part of an intervention. The consequences of these findings are discussed and suggestions proposed for more harmonized and calibrated oral hygiene phase introduced to avoid biased and inflated results of interventions.

Nonsurgical therapy for teeth and implants-When and why?

As periodontal and peri-implant diseases represent opportunistic infections, antiinfective therapy is the method of choice. Correctly performed, the treatment outcomes will include resolution of the inflammation concomitant with shrinkage of the tissues, reflected in reduced probing depths. Depending on the patient data obtained after initial antiinfective therapy, further - mostly surgical - treatment may be rendered to reach the goals of a healthy periodontium and peri-implant tissues. Patient compliance is as important as operator skills for optimal treatment outcomes. Regenerative therapy may be applied in compliant patients and for appropriate defects. This article depicts the historical development of periodontal therapy during the 20th century and addresses the various outcome parameters to be used in daily decision making. Obviously, nonsurgical therapy has gained clinical relevance, resulting in highly satisfactory treatment outcomes in many cases. The critical probing depth above which positive attachment gain is registered varies from one treatment modality to another. It is a concept that helps facilitate decision making for additional therapeutic measures after initial therapy. Treatment of peri-implant mucositis prevents development of peri-implantitis. Hence, nonsurgical treatment of mucositis is frequently performed during the continuous monitoring of oral implants. This chapter of Periodontology 2000 presents evidence for the prevention and therapy of peri-implant diseases.

Traditional or regenerative periodontal surgery?-a comparison of the publications between two periodontal journals over time

OBJECTIVES

The objective is to compare the amount and content of publications regarding traditional or regenerative periodontal surgery in the years 1982/1983 and 2012/2013 in two leading periodontal journals of North America and Europe.

MATERIAL AND METHODS

The search was carried out in the Journal of Periodontology and Journal of Clinical Periodontology. Four reviewers screened the articles and allocated the topics with respect to periodontal surgery. The distribution of articles with respect to traditional or regenerative periodontal surgery was then compared between the journals and the respective time periods.

RESULTS

Out of 1084 screened articles, 145 articles were included. Articles with periodontal surgery content amounted to 18% for the first time period and to 11% for the second time period. In the years 1982/1983, 7% of articles in the Journal of Periodontology and 8% in the Journal of Clinical Periodontology referred to traditional periodontal surgery, while 8% (Journal of Periodontology) and 5% (Journal of Clinical Periodontology) examined regenerative periodontal surgery. The distribution changed 30 years later, with 1% (Journal of Periodontology) and 3% (Journal of Clinical Periodontology) traditional periodontal surgery and 7% and 6% regenerative periodontal surgery content.

CONCLUSION

While the clinical need for traditional periodontal surgery remained, research in this important field decreased. Publications rather tended to focus on adjunctive regenerative measures.

CLINICAL RELEVANCE

Periodontal surgery with adjunctive regenerative measures is an established and well-documented clinical procedure. However, with respect to the dominance of horizontal bone loss in periodontally diseased patients, there is a need for ongoing research with focus on traditional periodontal surgery.

Periodontal diseases

Periodontal diseases comprise a wide range of inflammatory conditions that affect the supporting structures of the teeth (the gingiva, bone and periodontal ligament), which could lead to tooth loss and contribute to systemic inflammation. Chronic periodontitis predominantly affects adults, but aggressive periodontitis may occasionally occur in children. Periodontal disease initiation and propagation is through a dysbiosis of the commensal oral microbiota (dental plaque), which then interacts with the immune defences of the host, leading to inflammation and disease. This pathophysiological situation persists through bouts of activity and quiescence, until the affected tooth is extracted or the microbial biofilm is therapeutically removed and the inflammation subsides. The severity of the periodontal disease depends on environmental and host risk factors, both modifiable (for example, smoking) and non-modifiable (for example, genetic susceptibility). Prevention is achieved with daily self-performed oral hygiene and professional removal of the microbial biofilm on a quarterly or bi-annual basis. New treatment modalities that are actively explored include antimicrobial therapy, host modulation therapy, laser therapy and tissue engineering for tissue repair and regeneration.

Diagnosis and Management of Chronic and Aggressive Periodontitis Part 2: Periodontal Management

The first paper of this three-part series discussed periodontal disease pathogenesis and highlighted elements in the clinical assessment which will help the clinician to establish the diagnosis of chronic and aggressive periodontitis. This second paper will focus on the management of chronic and aggressive periodontitis. Finally, the diagnosis and management of chronic and aggressive periodontitis will be reviewed in the third part of the series using two clinical examples. Clinical relevance: This paper aims to provide the general dental practitioner with an understanding of the aim of periodontal treatment, the management of chronic and aggressive periodontitis and the prognosis of periodontally involved teeth.

Surgical and Non-Surgical Procedures Associated with Recurrence of Periodontitis in Periodontal Maintenance Therapy: 5-Year Prospective Study

BACKGROUND AND OBJECTIVE

Prospective studies that investigated the influence of surgical and nonsurgical procedures in the recurrence of periodontitis and tooth loss in periodontal maintenance therapy (PMT) programs have not been previously reported. The objective of this study was to evaluate longitudinally the recurrence of periodontitis in regular compliers (RC) and irregular compliers (IC) individuals undergoing surgical and non-surgical procedures over 5 years in a program of PMT.

MATERIALS AND METHODS

A total of 212 individuals participated in this study. Full-mouth periodontal examination including bleeding on probing, probing depth, and clinical attachment level were determined at all PMT visits over 5 years. The recurrence of periodontitis was evaluated in RC and IC individuals undergoing surgical and non-surgical procedures in PMT. The influences of risk variables of interest were tested through univariate analysis and multivariate logistic regression.

RESULTS

Recurrence of periodontitis was significantly lower among RC when compared to IC. Individuals with recurrence of periodontitis and undergoing surgical procedures showed higher probing depth and clinical attachment loss than those who received non-surgical procedures. Recurrence of periodontitis was higher in individual undergoing surgical procedures and irregular compliance during PMT.

CONCLUSIONS

Irregular compliance and surgical procedures in individuals undergoing PMT presented higher rates of recurrence of periodontitis when compared to regular compliant patients undergoing non-surgical procedures.

Surgical periodontal therapy with and without initial scaling and root planing in the management of chronic periodontitis: a randomized clinical trial

AIM

To compare the outcomes of surgical periodontal therapy with and without initial scaling and root planing.

METHODS

Twenty-four patients with severe chronic periodontitis were enrolled in this pilot, randomized controlled clinical trial. Patients were equally allocated into two treatment groups: Control group was treated with scaling and root planing, re-evaluation, followed by Modified Widman Flap surgery and test group received similar surgery without scaling and root planing. Clinical attachment level, probing depth and bleeding on probing were recorded. Standardized radiographs were analysed for linear bone change from baseline to 6 months. Wound fluid inflammatory biomarkers were also assessed.

RESULTS

Both groups exhibited statistically significant improvement in clinical attachment level and probing depth at 3 and 6 months compared to baseline. A statistically significant difference in probing depth reduction was found between the two groups at 3 and 6 months in favour of the control group. No statistically significant differences in biomarkers were detected between the groups.

CONCLUSIONS

Combined scaling and root planing and surgery yielded greater probing depth reduction as compared to periodontal surgery without initial scaling and root planing.

Evaluation of postsurgical clinical outcomes with/without removal of pocket epithelium: A split mouth randomized trial

Background:

Periodontitis is bacteria-related chronic inflammatory condition characterized by pocket formation, loss of clinical attachment, gingival recession, mobility, and eventual loss of teeth. The purpose of this study was to clinically evaluate the need for elimination of the pocket epithelium during mucoperiosteal flap surgery aimed at reattachment or re-adaptation.

Materials and Methods:

A split mouth design was done to compare modified Widman flap (MWF) with removal of the pocket epithelium and crevicular mucoperiosteal flap (CMF) without removing the pocket epithelium. The following measurements were taken after 1 month of completion of nonsurgical phase gingival index (Loe and Silness), plaque index (Silness and Loe), mobility, furcation involvement, level of attachment, pocket depth, gingival recession, gingival contour index, and dentinal hypersensitivity (ice stick test). In addition to these measurements, which were taken immediately prior to the surgery (baseline), 1- and 3-month and 6 months postsurgical measurements were also recorded.

Results:

The results of this study showed a greater reduction of mean probing depth in the test group (MWF). The control group (CMF) showed greater mean gingival recession compared to the test group throughout the study period. The test group showed more gain in the clinical attachment levels compared with the control group. The difference between the two groups was statistically significant (P < 0.001).

Conclusions:

The results of this study demonstrate that MWF surgery was more effective in reducing mean probing depth, showed greater gain in clinical attachment, and demonstrated less gingival recession.

Anti-infective therapy with an Er:YAG laser: influence on peri-implant healing

In addition to conventional treatment modalities (mechanical and chemical), the use of lasers has been increasingly proposed for the treatment of periodontal and peri-implant infections (i.e., cleaning and detoxification of implant surfaces). Preliminary results from basic studies have pointed to the high potential of the Erbium-doped: Yttrium, Aluminum and Garnet (Er:YAG) laser. Furthermore, preliminary clinical data indicate that treatment with this kind of laser may positively influence peri-implant healing. The aim of this research update is to evaluate, based on the currently available evidence, the use of an Er:YAG laser for the treatment of peri-implant infections and to indicate its potential as a new treatment modality.

Resolution of Localized Chronic Periodontitis Associated with Longstanding Calculus Deposits

This report, which is based on nonstandardized serial radiographs obtained over a period of 15 years, documents a case of localized chronic periodontitis associated with progressive deposition of calculus on the distal aspect of a mandibular second molar. The site was treated by scaling and root planing, followed by a course of adjunctive systemic azithromycin. Treatment yielded favorable reductions in probing depth and clinical inflammation, leaving only few isolated sites with pockets no deeper than 4 mm. Two years after completion of active treatment, there was radiographic evidence of increased bone density distal to the second molar.

Microbiological basis for periodontal therapy

The search for the etiologic agents of periodontal diseases started in the Golden Era of medical bacteriology, when the etiologic agents of many bacterial infections were isolated and characterized. After the initial enthusiasm in establishing the infectious nature and the true agents of periodontal diseases, this concept was virtually ignored for the next four decades. Until the early 1970s treatment regimens based on the non-specific plaque hypothesis were directed towards a non-specific reduction in plaque amount. Later, the specific plaque hypothesis established the role of some microorganisms such as A. actinomycetemcomitans, P. gingivalis, T. forsythensis, T. denticola, P. intermedia and F. nucleatum in different forms of periodontal diseases. It was recently suggested that these suspected periodontal pathogens seem to not act alone and interactions between species, especially the balance between pathogenic and beneficial species affect both progression of disease and response of tissues to periodontal therapy. Nowadays it is well established that one of the goals of therapy is to control such periodontal pathogens. Among the most commonly used therapies to treat periodontal infections are scaling and root planing (SRP), supragingival plaque control and periodontal surgeries. Many studies confirmed the reduction of "red complex" species by SRP, and apically repositioned flap can lead to an additional beneficial effect in the subgingival microbiota by decreasing levels of "red" and "orange complexes" species. Furthermore, the level of plaque control maintained by the patients has been considered a crucial step in preventing recurrence of destructive periodontitis.

Teriparatide and osseous regeneration in the oral cavity

BACKGROUND

Intermittent administration of teriparatide, a drug composed of the first 34 amino acids of parathyroid hormone, has anabolic effects on bone. Although teriparatide has been evaluated for the treatment of osteoporosis and for the healing of fractures, clinical trials evaluating it for the treatment of osseous conditions of the oral cavity in humans are lacking.

METHODS

A total of 40 patients with severe, chronic periodontitis underwent periodontal surgery and received daily injections of teriparatide (20 μg) or placebo, along with oral calcium (1000 mg) and vitamin D (800 IU) supplementation, for 6 weeks. The patients were followed for 1 year. The primary outcome was a radiographic linear measurement of alveolar bone level. Secondary outcomes included clinical variables, bone turnover markers in serum and oral fluid, systemic bone mineral density, and quality of life.

RESULTS

Radiographic linear resolution of osseous defects was significantly greater after teriparatide therapy than after placebo beginning at 6 months, with a mean linear gain in bone at 1 year of 29% as compared with 3% (P<0.001). Clinical improvement was greater in patients taking teriparatide than in those taking placebo, with a reduction in periodontal probing depth of 33% versus 20% (2.42 mm vs. 1.32 mm) and a gain in clinical attachment level of 22% versus 7% (1.58 mm vs. 0.42 mm) in target lesions at 1 year (P = 0.02 for both comparisons). No serious adverse events were reported; however, the number of patients in the study was small. No significant differences were noted with respect to the other variables that were assessed.

CONCLUSIONS

Teriparatide, as compared with placebo, was associated with improved clinical outcomes, greater resolution of alveolar bone defects, and accelerated osseous wound healing in the oral cavity. Teriparatide may offer therapeutic potential for localized bone defects in the jaw. (Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT00277706 .).

The effect of laser therapy as an adjunct to non-surgical periodontal treatment in subjects with chronic periodontitis: a systematic review

BACKGROUND

The objective of this study was to systematically review the evidence on the effectiveness of laser therapy as an adjunct to non-surgical periodontal treatment in adults with chronic periodontitis.

METHODS

A search was conducted for randomized controlled trials comparing the outcome of periodontitis with laser as an adjunct to scaling and root planing in the treatment of chronic periodontal disease. The electronic databases, PubMed and Cochrane Central Register of Controlled Trials, were used as data sources. Screening, data abstraction, and quality assessment were conducted independently by three reviewers (MK, HJ, and CDL). The primary outcome measures evaluated were changes in clinical attachment level, probing depth, and bleeding on probing.

RESULTS

The search resulted in 25 abstracts; four randomized controlled clinical trials were included. Four different laser methods were used; consequently, it was impossible to conduct a quantitative data synthesis leading to a meta-analysis. All studies included a limited number of subjects.

CONCLUSIONS

No consistent evidence supports the efficacy of laser treatment as an adjunct to non-surgical periodontal treatment in adults with chronic periodontitis. More randomized controlled clinical trials are needed.

Clinical evaluation of periodontal surgical treatment with an Er:YAG laser: 5-year results

BACKGROUND

The aim of the present study was to evaluate and compare the long-term clinical outcomes of erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser-assisted periodontal flap surgery versus conventional treatment with the modified Widman flap procedure.

METHODS

A total of 146 single-rooted periodontally involved teeth from 25 patients were included in this study. In each patient, left or right maxillary single-rooted teeth were assigned randomly to one of two groups: group A (Er:YAG laser) and group B (modified Widman flap surgery). Er:YAG laser was used to debride the bone pockets, scale the root surface, and trim the periodontal flap. Recession, probing depth (PD), clinical attachment level (CAL), plaque index (PI), gingival index (GI), and bleeding on probing (BOP) scores were recorded at baseline and at 3, 6, 12, 24, 36, 48, and 60 months.

RESULTS

Both treatments resulted in decreases in PD, PI, GI, and BOP, increases in gingival recession, and gains in CAL. PD reduction in group A versus group B was statistically significant at 6, 12, 24, and 36 months (P < 0.05). Gains in CAL were significantly greater in group A versus group B at 6, 12, 24, and 36 months. BOP scores were significantly lower in group A versus group B at 3 and 6 months (P < 0.05). All other differences between treatment groups were not statistically significant.

CONCLUSIONS

Surgical treatment of single-rooted teeth with chronic periodontitis using the Er:YAG laser yields greater PD reduction and gains in CAL for up to 3 years compared to conventional Widman flap surgery. The short-term results obtained with both treatments can be maintained over 5 years.