Recent advances in periodontal diagnosis and treatment: exploring new treatment alternatives

The effect of adjuvant oral irrigation on self-administered oral care in the management of peri-implant mucositis: A randomized controlled clinical trial

OBJECTIVES

This single-blinded randomized clinical trial evaluated the effect of adjuvant oral irrigation in addition to self-administered oral care on prevalence and severity of peri-implant mucositis.

MATERIAL & METHODS

After randomization, patients suffering from peri-implant mucositis were assigned to the following: Group 1 (control) received oral hygiene instruction following a standardized protocol, including a sub- and supramucosal mechanical debridement. Group 2 and 3 additionally were instructed to use an oral irrigator with either water or 0.06% CHX solution. One implant per patient was considered for examination. Clinical examinations included Probing Depth, Bleeding on Probing (BOP-positive sites), and Modified Plaque and Gingival Index. A surrogate variable (mucositis severity score) was applied measuring severity of disease. Statistical analysis included linear regression models and sensitivity analysis.

RESULTS

Sixty periodontally healthy patients were examined for presence and severity of peri-implant mucositis. 70% of all patients reached complete resolution of disease after 12 weeks. The prevalence of peri-implant mucositis after 12 weeks was 50% in group 1, 35% in group 2, and 5% in group 3. Average BOP-positive sites were reduced in all groups after 12 weeks (mean change from baseline: group 1: -1.5; group 2: -1.8; group 3: -2.3).

CONCLUSION

Within the limits of the study, adjuvant use of an oral irrigator with 0.06% CHX in addition to mechanical biofilm removal and oral hygiene instruction can reduce the presence and severity of peri-implant mucositis after 12 weeks.

The effect of keratinized mucosa on the severity of peri-implant mucositis differs between periodontally healthy subjects and the general population: a cross-sectional study

Objective

The study aims to investigate the effect of reduced keratinized mucosa (KM) and other risk indicators on the severity of peri-implant mucositis in (i) the general population, (ii) in periodontally healthy patients, and (iii) in periodontally healthy patients without a history of periodontitis.

Materials and methods

Anamnesis and the following clinical parameters were taken: mucosal-index, bleeding on probing, local plaque index, oral hygiene-index, and width of KM. Mucositis severity score was determined for each implant. Multi-level and subgroup analysis was performed on the patient and implant level.

Results

Six hundred twelve implants in 130 patients were analyzed. Subgroup analysis showed significant associations between KM < 2 mm and the severity score in (ii) periodontally healthy patients (p = 0.014) and in (iii) patients without history of periodontitis (p = 0.017). Secondary outcome showed higher severity scores for patients with insufficient oral hygiene or without residual teeth (p ≤ 0.001), in maxillary implants (p = 0.04), and for the number of implants per patient (p ≤ 0.001).

Conclusion

Within the limits of the study, one may conclude that a reduced width of KM is a risk indicator for the severity of peri-implant mucositis in periodontally healthy patients and patients without a history of periodontitis.

Clinical relevance

The results indicate a band of ≥ 2 mm KM to reduce the severity of peri-implant mucositis in periodontally healthy patients.

Increasing the width of periodontal attached gingiva using an Nd:YAG laser and GTM: results of a clinical study

OBJECTIVE

Demonstrate a new technique to increase the width of keratinized gingiva using a biological membrane material in place of donor tissue.

SUMMARY BACKGROUND DATA

Most current surgical techniques require donor tissue as a graft to increase keratinized gingiva, which results in a second trauma site for the patient.

METHODS

Using an Nd:YAG laser with contact tip. Laser energy at settings of 3.0-6.0 W continuous mode. Local anesthetic, lidocaine 2% and epinephrine 1:100,000, was administered. A mucogingival flap was made to the periosteum and reflected, followed by placement of a biological membrane, and sutured into place, over the surgical site.

RESULTS

A total of 20 sites were treated on 20 different patients of 15 mandible and 5 maxillary sites. The average increase for all sites was 3.8 mm of keratinized gingiva per site. No adverse events (e.g., bleeding, allergic reactions, abscesses, or pain) after any of the treatments were noted during the entire observation. The treatment procedure led to significant improvements in width of gingiva. The 20 patients were pleased with this new technique using the Nd:YAG laser with contact tip.

CONCLUSION

It may be concluded that the new procedure provides significant increase of keratinized gingiva with the advantage of minimal morbidity and pleasing cosmetic results. Further clinical studies are needed to compare traditional procedures with the laser augmentation technique.

A use of freeze-dried bone in endodontics

A 40-yr-old man was referred for the treatment of a large bony lesion of the mandible proximal to the root apices of the lower left first molar. Treatment had been done 7 to 8 yr previous to the examination, and the fill appeared to be adequate. Treatment was curettement of the lesion, apical curettage, and filling of the lesion with sterile freeze-dried bone. The patient was seen 6 months later and reported that he had been asymptomatic and was very pleased with the treatment. A postoperative radiograph was taken at that time and it showed that there had been an ingrowth of healthy bone into the bony lesion and that only a small radiolucency at the mesial root remained. In only 6 months, a very large lesion of the mandible had almost completely resolved after using freeze-dried bone to act as a matrix for the ingrowth of new bone tissue. At 7 months postoperatively, another radiograph was taken which showed continued healing.