American Academy Of Periodontology Research Articles

Navigating Discordance: Assessing Varied Applications of the American Academy of Periodontology In-Service Examination in Postdoctoral Programs

Introduction The American Academy of Periodontology (AAP) In-Service Examination (ISE) is offered annually to residents in postdoctoral periodontal programs across the United States and Canada. The language in AAP published guidance supports both formative and summative uses of the exam, presenting discordance in how to use and interpret the AAPISE. It is important to clarify how programs use data, as formative assessments are low-stakes and aim to provide feedback to learners for improving their learning. On the other hand, summative assessments are used to make high-stakes decisions, such as program admission, graduation, and licensure. These two types of assessments serve different purposes and have distinct outcomes. This study aimed to explore and characterize how stakeholders utilize the AAPISE and its associated score reports. Methods Semi-structured interviews of periodontology program directors, department chairs, and residents were conducted in 2022. Data from these interviews were explored, coded, and thematically analyzed. Results A total of 16 interviews were conducted and analyzed: four chairs, eight program directors, and four residents representing the experience at 20 postdoctoral periodontal programs. Five major themes were identified regarding the use of the AAPISE: formative assessment, board preparation, program development, promoting a culture of achievement, and summative assessment. Conclusion This study's findings suggest varied uses of the AAPISE amongst postdoctoral periodontal program stakeholders, reflecting the variance within the AAP guidance. The discordant uses and guidance jeopardize the AAPISE’s potential to align with the 2018 Consensus Framework for Good Assessment elements. The authors propose recommendations to the AAP and stakeholders for future use.

Association between life's essential 8 and periodontitis: a study based on NHANES 2009-2014.

This research aims to investigate the relationship between Life's Essentials 8 (LE8), the American Heart Association's latest indicator, and periodontitis. The purpose is to provide guidance on preventative measures. Data for our investigation were obtained from the National Health and Nutrition Examination Survey (NHANES) 2009-2014, with a total of 8,784 participants eligible. LE8 scores were compiled from 8 index scores (the score for each component of diet, physical activity, nicotine exposure, sleep duration, body mass index, blood lipids, blood glucose, and blood pressure). Periodontitis was classified by the Centers for Disease Control and Prevention and American Academy of Periodontology (CDC/AAP). The study utilized multivariable logistic analyses to investigate the potential correlation. After controlling for all covariates, LE8 was discovered to have a significant negative correlation with periodontitis prevalence [0.91 (0.88, 0.94)]. This trend continued to hold statistical significance even after converting LE8 into a categorical variable. Furthermore, a noteworthy adverse correlation was discovered across both genders, specifically males [0.35 (0.22, 0.55)] and females [0.39 (0.25, 0.60)], as well as for the majority of categorical classifications, namely ethnicity, age, education level, and marital status. However, only the age subgroups displayed some degree of significant difference from each other. Life's essential 8 was negatively associated with periodontitis, but more prospective trails are needed to confirm our findings.

The Association of Maternal Periodontal Diseases in the Postpartum Period with Preterm Low Birth Weight.

Preterm birth is the most adverse effect of pregnancy, commonly leading to low birth weight. Our study aimed to assess the relationship between maternal periodontal status and adverse pregnancy outcomes by immediate postpartum periodontal examination and diagnosis. 125 mothers were divided into four groups based on gestational day (GD) and newborns' birth weight (BW); the mothers with GD ≥ 259 days and BW ≥ 2500 gm (Control), the mothers with GD <259 days and BW ≥ 2500 gm (PT group), the mothers with GD ≥ 259 days and BW <2500 gm (LBW group), and the mothers with GD <259 days and BW <2500 gm (PT-LBW group). The maternal periodontal assessment was carried out within 3 days after delivery. The bleeding on probing (BOP) of the PT-LBW group was significantly higher than the control (P = 0.027). The correlation test revealed a mild inverse relationship between BOP and BW (R = -0.23, P = 0.044). According to the new 2018 American Academy of Periodontology (AAP) periodontal classification, there was no significant difference between periodontal status within groups. The present study suggests that BOP, an early sign of gingival inflammation, is involved in adverse pregnancy outcomes. This study is the first of its kind to use immediate postpartum periodontal examination and diagnosis by the new 2018 AAP periodontal classification. The findings demonstrate that signs of gingival inflammation may be associated with adverse pregnancy outcomes. How to cite this article: Yanaranci S, Laosrisin N, Sriprasertsuk A, et al. The Association of Maternal Periodontal Diseases in the Postpartum Period with Preterm Low Birth Weight. J Contemp Dent Pract 2024;25(2):99-106.

Sugar-sweetened beverage consumption and periodontitis among adults: A population-based cross-sectional study.

Investigating the association between sugar-sweetened beverages (SSBs) and periodontitis and whether the awareness of diabetes modifies this relationship. Cross-sectional analysis was conducted using the National Health and Nutrition Examination Survey (NHANES III) data involving US adults aged 30-50. Periodontitis was classified according to the Centers for Disease Control and Prevention and American Academy of Periodontology (CDC-AAP), and SSB consumption as dichotomous (<5 or ≥5, <7 or ≥7 and <14 or ≥14 times/week), ordinal and continuous variables. Confounders included family income poverty ratio, education, race/ethnicity, sex, age, food energy intake, smoking and alcohol. Odds ratios (ORs) were obtained by logistic regressions using inverse probability weighting. Effect modification analysis was performed considering self-reported diabetes. Among 4473 cases analysed, 198 self-reported diabetes. SSBs were associated with periodontitis when individuals consumed ≥5 (OR 1.64; 95% confidence interval [CI] = 1.30-2.06), ≥7 (OR 1.92; 95% CI = 1.50-2.46) and ≥14 (OR 2.19; 95% CI = 1.50-3.18) times/week. The combined effect of consuming SSBs (≥5 and ≥14 times/week) and self-reported diabetes had less impact than the cumulative effect. SSB consumption was associated with higher odds of periodontitis, and the estimates were reduced among those with awareness of diabetes.

Predictors of standardized in-service examination performance and residency outcomes in a graduate periodontics program.

The objectives of this study were to assess the influence of learner- and education-related factors on standardized in-service examination performance and determine whether in-service examination scores predict residency outcomes. American Academy of Periodontology (AAP) In-service Examination (AIE) scores from 10 periodontics residency classes at a single center were recorded and compared against a panel of learner- and education-related variables using multiple linear regression models. Defined residency outcome measures were analyzed against AIE scores using binomial logistic regression. No evaluated learner- or education-related variable was a statistically significant predictor of AIE score in this study sample. Likewise, AIE score was not a statistically significant predictor of any assessed residency outcome. The AAP has performed a tremendous service to periodontics residents and programs by marshaling the leadership and expertise necessary to offer a professionally constructed assessment instrument. However, in the current study, no relationship could be identified between AIE score and any outcome, including first-attempt board certification. The AAP In-service Committee appears well situated to provide additional leadership focusing on exam implementation, which may enhance AIE value in competency decision making.

Artificial intelligence in dental education: ChatGPT's performance on the periodontic in-service examination.

ChatGPT's (Chat Generative Pre-Trained Transformer) remarkable capacity to generate human-like output makes it an appealing learning tool for healthcare students worldwide. Nevertheless, the chatbot's responses may be subject to inaccuracies, putting forth an intense risk of misinformation. ChatGPT's capabilities should be examined in every corner of healthcare education, including dentistry and its specialties, to understand the potential of misinformation associated with the chatbot's use as a learning tool. Our investigation aims to explore ChatGPT's foundation of knowledge in the field of periodontology by evaluating the chatbot's performance on questions obtained from an in-service examination administered by the American Academy of Periodontology (AAP). ChatGPT3.5 and ChatGPT4 were evaluated on 311 multiple-choice questions obtained from the 2023 in-service examination administered by the AAP. The dataset of in-service examination questions was accessed through Nova Southeastern University's Department of Periodontology. Our study excluded questions containing an image as ChatGPT does not accept image inputs. ChatGPT3.5 and ChatGPT4 answered 57.9% and 73.6% of in-service questions correctly on the 2023 Periodontics In-Service Written Examination, respectively. A two-tailed t test was incorporated to compare independent sample means, and sample proportions were compared using a two-tailed χ2 test. A p value below the threshold of 0.05 was deemed statistically significant. While ChatGPT4 showed a higher proficiency compared to ChatGPT3.5, both chatbot models leave considerable room for misinformation with their responses relating to periodontology. The findings of the study encourage residents to scrutinize the periodontic information generated by ChatGPT to account for the chatbot's current limitations.

Validity of individual self-report oral health measures in assessing periodontitis for causal research applications.

Self-reported measures of periodontitis developed for use in population surveillance are increasingly used in causal research. Numerous studies evaluate the validity of these measures against clinical parameters of periodontitis, yet few include validation parameters outside of multivariable models. Individual item validity is necessary to adequately inform use of these measures in causal research. We used data from the National Health and Nutrition Examination Survey 2011-2014 in which dentate participants completed full-mouth periodontal examinations (N=6966). We evaluated six self-report questionnaire items related to periodontal disease status against periodontitis case definitions developed by the Centers for Disease Control and Prevention and American Academy of Periodontology (CDC-AAP). We estimated the sensitivity and specificity of individual items using severe and moderate-to-severe periodontitis classifications. We additionally combined items to evaluate the validity of joint measures. Sensitivity was highest when measures were evaluated against severe periodontitis. Self-rated oral health of fair/poor demonstrated the highest sensitivity for severe (0.60) and moderate-to-severe periodontitis (0.48). Specificity was highest when evaluated against moderate-to-severe periodontitis, with self-reported history of tooth mobility as the most specific measure (0.87 for severe disease; 0.92 for moderate-to-severe) followed by a history of bone loss (0.88 for severe; 0.91 for moderate-to-severe). Combining questions generally improved specificity at the expense of sensitivity. Our findings related to item-specific validity and the associated clinical profiles facilitate needed considerations for the use of self-reported measures of periodontitis in causal research. Additionally, item-specific validity can be used to inform assessments of misclassification bias within such investigations.

Prevalence of Periodontitis Based on the American Academy of Periodontology and European Federation of Periodontology 2017 Classification Scheme in Patients Visiting a Tertiary Care Center in New Delhi – An Epidemiological Study

Introduction: Periodontitis is one of the major reasons for tooth loss in adults. Therefore, it is important to know the true prevalence of the disease. Aim: This study was designed to find out the prevalence of periodontitis in Delhi state based on the American Academy of Periodontology (AAP) and European Federation of Periodontology (EFP) 2017 classification scheme. Materials and Methods: It was a descriptive cross-sectional study involving 2200 patients. Periodontal data were collected using the Community Periodontal Index of Treatment Needs-Epidemiological probe. Periodontal disease was diagnosed with the 2017 AAP and EFP definitions and classifications. Results: Of the study population, 93.2% had no detectable clinical attachment loss (CAL), 34.8% (n = 52) were classified with Stage I, 34.8% (n = 52) with Stage II, 16.8% (n = 25) with Stage III, and none with Stage IV periodontitis. Grade A was the predominant grade, being diagnosed in 50% of the periodontitis cases. The majority of cases (62%) demonstrated generalized periodontitis. Conclusion: The new periodontal disease classification system introduced in 2017 has provided a comprehensive description of periodontal disease which can classify the periodontal disease on the basis of various factors. Based on this, our study reported a maximum number of Stage I and II periodontitis patients.

Prevalence and social determinants of periodontal disease in Colombian pregnant women.

The objective of the study was to identify the prevalence of periodontal disease in pregnant women in the Colombian population and its association with social determinants and medical history based on data from the Fourth National Oral Health Survey (ENSAB IV). A total of 1012 pregnant women from different areas of Colombia were evaluated. A periodontal evaluation was performed using a North Carolina periodontal probe. The following data were recorded: number of teeth, probing depth (PD), the position of the gingival margin (GM) and clinical attachment level (CAL). An ordinal logistic regression analysis was performed for the association between social determinants and the Centers for Disease Control and Prevention and the American Academy of Periodontology (CDC/AAP) classification and logistic regression between social determinants and the European Federation of Periodontology (EFP) classification. The prevalence of periodontitis was 37.1% using the CDC/AAP criteria and 41.2% according to the criteria of EFP distributed in sensitive (40.2%) and specific cases (0.9%). Age, belonging to a subsidized regime, living in a rural area, having an intermittent water supply and bleeding in medical records were found to be positively associated with periodontitis (mild, moderate, severe). The findings of this national study of pregnant women show a high prevalence of periodontitis-using the CDC/AAP and EFP criteria-associated with age, living in rural areas, subsidized regime, intermittent water supply and bleeding in medical records.

Diagnostic accuracy of severe periodontitis for Ramfjord teeth based on different classifications.

To evaluate the accuracy of Ramfjord teeth (RT) protocol for the diagnosis of severe periodontitis based on different classifications and explore the misclassification bias such as teeth loss. Patients (n = 435) receiving full-mouth periodontal examination (FMPE) were included. Patients were classified as severe (stage III/IV) periodontitis and no/mild/moderate (no/stage I/II) periodontitis according to the case definition proposed by the Centers for Disease Control and Prevention (CDC) and the American Academy of Periodontology (AAP)-(CDC/AAP), a new classification introduced by AAP and the European Federation of Periodontology (EFP)-(AAP/EFP), and consensus of Chinese experts (CCE). Sensitivity, specificity, positive predictive value, negative predictive value, Youden's index, and area under the receiver operating characteristic curve (AUROC) compared with FMPE were evaluated. The specificity of RT was 86.8%, 92.2%, and 77.1% when compared with FMPE protocol based on CDC/AAP, AAP/EFP, and CCE classifications, while the AUROC value was 0.934, 0.961, and 0.886 specifically. The loss of the first molar leads to the greatest reduction in the detection rate of severe periodontitis. RT showed the highest specificity based on the new AAP/EFP classification. The loss of the first molar leads to the greatest reduction in the detection rate of severe periodontitis.

J-shaped association between systemic immune-inflammation index and periodontitis: Results from NHANES 2009-2014.

To examine the relationship between the systemic immune-inflammation index (SII) and periodontitis and to investigate possible effect modifiers. Data used in the present cross-sectional study are from the National Health and Nutrition Examination Survey (NHANES) 2009-2014 (N=10,301). The SII was calculated using the following formula: (neutrophils count × platelet count)/lymphocytes count. The category of periodontitis was defined by the Centers for Disease Control and Prevention and American Academy of Periodontology (CDC/AAP) classification. We employed natural cubic spline and multivariable logistic regression analyses to evaluate the associations of the SII with periodontitis. The associations between SII and periodontal health followed a J-shape (p<0.001). The risk of periodontitis tended to reduce with the increment of log2(SII) in participants with log2(SII)≤8.66 (odds radio [OR]=0.83; 95% CI: 0.69-0.999), especially among non-Hispanic Whites (OR=0.70; 95% CI: 0.52-0.95), and increased with the increment of log2(SII) in participants with log2(SII)>8.66 (OR=1.19; 95% CI: 1.02-1.38). A similar trend was also observed between the SII and the number of sites with probing pocket depth (PPD)≥4mm and clinical attachment loss (CAL)≥3 or 5mm. Furthermore, we found a significantly stronger correlation between lymphocytes and either neutrophils or platelets in individuals with log2(SII)>8.66, as opposed to those with log2(SII)≤8.66. There is a J-shaped association between SII and periodontitis in US adults, with an inflection point of log2(SII) at 8.66, which may provide potential adjunctive treatment strategies for periodontitis with different immune response states. Further prospective trials are still required to confirm our findings.

EFEK ANTIBAKTERIAL CUKA SARI APEL DALAM BERBAGAI KONSENTRASI TERHADAP PORPHYROMONAS GINGIVALIS

Background: periodontal disease is a disease that can affect the supporting tissues of the teeth. The American Academy of Periodontology (AAP) classifies it into two, namely chronic periodontitis and aggressive periodontitis. Periodontitis is usually caused by bacteria, one of which is Porphyromonas gingivalis. One of the ingredients that can be used as mouthwash and has an antibacterial effect is chlorhexidine, but the use of this mouthwash has side effects so people turn to herbal medicines, namely apple cider vinegar which contains phenols, flavonoids, saponins, and alkaloids as antibacterial. This study aims to determine whether or not there is an antibacterial effect of apple cider vinegar on Porphyromonas gingivalis bacteria. Methods: the material in the form of fermented apple cider vinegar has a pH value of 3.13 and the remaining sugar content is 1.5% Brix. The research sample was Porphyromonas gingivalis ATCC 33277, obtained from the Aretha Medika Utama Biomolecular and Biomedical Research Center (BBRC) Laboratory in Bandung. The research method is the disc diffusion method (Kirby-Bauer), which is the method on disc paper with various concentrations of apple cider vinegar. Results: based on laboratory experimental research on the antibacterial effect of apple cider vinegar with a concentration of 1.56% and 3.12%, the criteria are weak because they have a value of 0, at concentrations of 6.25% and 50%, have moderate criteria because they have a value of 6.18 mm and 8.33 mm, and at a concentration of 100% has strong criteria because it has a value of 13.93 mm. Conclusion: apple cider vinegar has an antibacterial effect that can inhibit the growth of Porphyromonas gingivalis bacteria, the largest inhibition zone is at a concentration of 100% and decreases as the concentration of apple cider vinegar decreases.

Isolated periodontal pockets: a clinical review

An isolated periodontal pocket is a perplexing clinical entity that usually poses a diagnostic challenge to the oral health professional. Although periodontal pockets are easy to detect, they can be easily missed during a routine clinical examination. The broad range of aetiological factors that can result in an isolated periodontal pocket makes identifying the cause difficult. The aetiology can be as simple as an overhanging restoration or food impaction due to open interproximal contacts, to more complex and uncommonly occurring presentations, such a palato-radicular groove or cemental tears. Although previous classifications proposed by the American Academy of Periodontology and European Federation of Periodontology have discussed this topic under different headings, an explicit classification on isolated periodontal pockets based on aetiology is currently missing. Isolated periodontal pockets are easily undiagnosed, with associated cases presenting with substantial destruction necessitating complex multidisciplinary treatment. This article highlights the various causes of an isolated periodontal pocket, and provides a systematic and easy clinical aetiology-based classification. The proposed classification categorizes isolated periodontal pockets into those occurring due to: (1) developmental anomalies of the teeth; (2) iatrogenic causes; and (3) pathological conditions. Further studies are essential to validate this classification. CPD/Clinical Relevance: Early detection of easily missed isolated periodontal pockets is of clinical value during initial screening to avoid delayed diagnosis and treatment.

Subgingival Microbiota and Periodontal Clinical Status in Patients with Plaque Psoriasis: A Cross-Sectional Study.

Plaque Psoriasis (PP) and periodontitis are inflammatory disorders with a bidirectional association. They both have a qualitatively similar immune-modulatory cascade, cytokine profile, and a recently described dysbiosis. Different oral bacterial species compositions in the periodontal pocket might play a role in the development of PP. To describe the subgingival microbiota of the Mexican population with PP and the periodontal conditions. Subjects were divided into two groups: periodontal health (PH) (PH-non-PP, PH-PP) and periodontitis (PD) (P-non-PP, PD-PP). Following clinical examination, the patients were classified into three groups according to the degree of psoriasis as measured by the Psoriasis Area Severity Index (PASI) and the periodontal status according to the parameters of the American Academy of Periodontology (AAP). Subgingival microbiota samples of each patient were used to determine 40 species of periodontal bacteria by checkerboard DNA-DNA hybridization. IL-2 and IL-6 were measured by ELISA. Of the forty-eight patients with PP, 21 patients had PH and 27 patients had PD. PD-PP group has a significant increase in the percentage of plaque, gingival redness, pocket probing depth, and clinical attachment loss (P<0.001) compared to PH-PP group. Microbiologically PD-PP exhibited significantly higher mean counts for A. georgiae, A. israelii, A. naeslundii from blue complex (P<0.001) than PD-non-PP. Moreover, the counts of these Actinomyces in PD-PP increased according to the severity of index PASI. The concentration of IL-2 and IL-6 were increased in saliva from PH-PP and PD-PP patients compared to PH non-PP. PP individuals harbored a particular sub-gingival microbiota profile different from non-PP. The severity of psoriasis was related to dysbiosis of microbiota -PASI > 5 related to periodontitis with the predominance of Actinomyces periodontal, irrespective of their periodontal condition. Finally, the severity of psoriasis could be unbalanced in subgingival microbiota and increase the risk to develop periodontitis.

Validity of a Simple Periodontal Disease Screening Tool in Thai Patients

Objectives: To develop and evaluate the validity of a self-reporting questionnaire for periodontitis in the Thai population. Methods: A cross-sectional analytical study was performed in a group of 300 Thais aged 19-85 years old at the Faculty of Dentistry, Chiang Mai University. Each participant took a questionnaire and received a periodontal status evaluation. Participants were classified into three severity groups using the Centers for Disease Control and Prevention, in partnership with the American Academy of Periodontology (CDC-AAP) criteria. Multivariable ordinal logistic regression analysis was used to achieve the final model. The scoring system was also developed. Results: One hundred patients of each severity group were recruited. Significant predictors in the final model included age, gender, bleeding gums, tooth mobility, dental flossing, dental check-up frequency, diagnosis by a dentist, and individual assessment of periodontitis. The total derived scores identified the severity group of patients into no/mild, moderate, and severe periodontitis. Our model predicted severity groups correctly in 65.7% of patients, while giving an underestimation of 19.3% and an overestimation of 15%. The area under the receiver operating characteristic curves (AuROCs) equal to 0.92 and 0.80 discriminated moderate and severe from no/mild periodontitis, and severe from no/mild and moderate periodontitis, respectively. Conclusions: Our periodontal disease screening tool demonstrates adequate accuracy. Its validity should be evaluated in other populations.

The influence of periodontitis case definition on the association between periodontal disease and glycaemic status.

The association between periodontitis and glycaemic control is complex, and often described as 'bidirectional'. Although epidemiological studies have examined this relationship extensively, a disagreement on periodontitis case definition still exists. This study aimed to assess the influence of case definition on the association between periodontal disease and glycaemic status. The study is a secondary analysis of data from the United States National Health and Nutrition Examination Survey (NHANES), 2009-2014 cycles. The association between periodontitis and glycated haemoglobin (HbA1c) was assessed using different periodontitis case definitions: the definition by the Centers for Disease Control and Prevention and the American Academy of Periodontology (CDC/AAP), Community Periodontal Index (CPI), ≥1 site with ≥3 mm clinical attachment loss (CAL) and ≥4 mm probing depth (PD), ≥1 site with ≥4 mm CAL and ≥4 mm PD, the 5th European Workshop definitions, Machtei et al. 'established periodontitis', the 2017 World Workshop classification, and self-reported periodontitis. The associations between periodontitis and HbA1c were compared across the case definitions. There was substantial variability in prevalence estimates of periodontitis, and in the strength of association between periodontitis and HbA1c when different case definitions were applied. The CDC/AAP and stage III/IV periodontitis were consistently significantly associated with elevated HbA1c. For stage III/IV, the adjusted odds ratios of prediabetes and diabetes HbA1c were 1.19 and 1.76, respectively. Comprehensive periodontitis case definitions that account for CAL and PD, such as the CDC/AAP and the 2017 classification, seem to better detect the association between periodontal disease and HbA1c.

Supracrestal tissue attachment: an update

Supracrestal tissue attachment (STA) is a relatively new term that was introduced in 2017 following the World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions, co-sponsored by the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP), which included expert participants from all over the world. It has replaced the term biological width, and refers to the junctional epithelium and supracrestal connective tissue. This article provides an updated review of the anatomy of STA, highlights the negative effects of violation and discusses its clinical relevance in restorative dentistry, including the use of crown lengthening. The impact of implants on STA is highlighted, and a summary of the relevance of STA in implant dentistry is also discussed. CPD/Clinical Relevance: To allow dental practitioners to have more confidence providing adequate function, comfort, and aesthetics in the dentition, while maintaining periodontal health.

Comparison of Non Surgical Periodontal Treatment Outcome and Clinician's Comfort Levels using LM ErgoMax over Hu-Friedy Hand Instruments-A Randomised Clinical Trial

Introduction: Non surgical periodontal therapy by scaling is done by using different sets of hand and motor driven instruments. The best instrument for non surgical periodontal therapy has to be identified, so that, it will benefit the clinicians in point of ergonomics and for patients in terms of less discomfort caused during scaling. Aim: To compare the effectiveness of Linear Monolithic (LM) instruments to Hu-Friedy instruments in non surgical periodontal treatment. Materials and Methods: The split-mouth randomised clinical trial study comprised 50 patients, who were selected from those attending the Department of Periodontics and Implantology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India, and who were classified with gingivitis or moderate to severe periodontitis according to American Academy of Periodontology (AAP) standards from 1999 and had not undergone any periodontal therapy in the previous six months to one year. The study was conducted from September 2021 to February 2022. Periodontal treatment outcomes were evaluated by plaque index, bleeding index, probing pocket depths, gingival index, and clinical attachment level. Clinicians comfort levels and handling characteristics of two sets of hand instruments (Test: LM instruments to control: Hu-Friedy instruments) were assessed by questionnaire consisting of 10 closed ended questions immediately after the non surgical therapy. The unpaired t-test was used for intergroup analysis and one-way ANOVA was used for intragroup analysis. Results: The mean gingival index scores for test and control sites at baseline were (1.65 and 1.72), at one week were (0.89 and 0.64) and at one month were (0.46 and 0.31). The mean periodontal pocket depth for test and control sites at baseline were (3.93 and 3.79), at one week were (3.40 and 3.25) and at one month were (3.18 and 2.42). A statistically significant difference seen in gingival index (p=0.001), sulcus bleeding index (p&lt;0.001), periodontal probing depths (p&lt;0.001) and clinical attachment level (p&lt;0.001) at one-month interval. Conclusion: The findings demonstrate that LM instruments have higher handling features and cutting efficiency than HuFriedy instruments, althou gh there is no significant difference in plaque index, gingival index, probing depth reduction, sulcus bleeding index, or clinical attachment level.

Validity of Simple Self-Reported Periodontal Status Questions

The aim of this research was to evaluate the validity of the questions developed by Thai periodontists on self-reported periodontal status and symptoms in identifying severe periodontitis amongst adults in Thailand. Registered Electricity Generating Authority of Thailand (EGAT) employees completed medical examinations and full-mouth periodontal examinations. They also were interviewed using a self-reported questionnaire that was developed by Thai periodontists. The questions pertained to their periodontal status and symptoms comprising swollen gums, bad breath, loose teeth, bleeding on brushing, painful gums, and pus or abscesses. The participants were categorised as having nonsevere and severe periodontitis according to the Centers for Disease Control and Prevention in partnership with the American Academy of Periodontology (CDC/AAP) case definitions. Self-reported periodontal status and symptom results were compared with actual periodontal status. The area under the receiver operating characteristic curve (AUROCC), sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. A total of 1393 EGAT employees participated in this study. The questions on self-reported periodontal status and all symptoms poorly identified patients with severe periodontitis, with an AUROCC of 0.52 to 0.60. The sensitivity was 5.0% to 40.2%; however, the specificity was good, at 73.2% to 99.1%. The validity of the self-reported questions was comparable amongst the sex, education, and income subgroups. This study demonstrated that self-reported periodontal status and symptoms were inadequate in identifying patients with severe periodontal disease.

Efficacy of biologics for the treatment of periodontal infrabony defects: An American Academy of Periodontology best evidence systematic review and network meta-analysis.

A large variety of biomaterials, biologics and membranes have been utilized in the past 40 years for the regenerative treatment of periodontal infrabony defects. Biologic agents have progressively gained popularity among clinicians and are routinely used for periodontal regeneration. In alignment with the goals of the American Academy of Periodontology (AAP) Best Evidence Consensus (BEC) on the use of biologic mediators in contemporary clinical practice, the aim of this sytematic review was to evaluate the effect of biologic agents, specifically autogenous blood-dervied products (ABPs), enamel matrix derivative (EMD) and recombinant human platelet-derived growth factor-BB (rhPDGF-BB), on the regenerative outcomes of infrabony defects. A detailed systematic search was conducted to identify eligible randomized control trials (RCTs) reporting the outcomes of periodontal regenerative therapy using biologics for the treatment of infrabony defects. A frequentist mixed-modeling approach to network meta-analysis (NMA), characterized by the assessment of three individual components for the treatment of an infrabony defect (the bone graft material [BG], the biologic agent, the application of a barrier membrane) was performed to evaluate and compare the relative efficacy of the different components, on the outcomes of different therapeutic modalities of periodontal regeneration. A total of 153 eligible RCTs were included, with 150 studies contributing to the NMA. The quantitative analysis showed that the addition of biologic agents to bone graft significantly improves the clinical and radiographic outcomes, as compared to BG and flap procedures alone. Barrier membranes enhanced the regenerative outcomes of BG but did not provide further benefits in combination with biologics. The type of BG (autogenous, allogeneic, xenogeneic or alloplastic) and the biologic agent (EMD, platelet-rich fibrin [PRF], platelet-rich plasma [PRP] or rhPDGF-BB) played a significant role on the final outcomes of infrabony defects. Allogeneic and xenogeneic BGs exhibited statistically significantly superior clinical gain than synthetic and autogenous BGs (p<0.05 in all the comparisons), while rhPDGF-BB and PRF demonstrated significantly higher stability of the gingival margin (p<0.01) and radiographic bone fill/gain (p<0.05), together with greater, although not statistically significant, clinical attachment level gain and pocket depth reduction, than EMD and PRP. Overall, rhPDGF-BB exhibited the largest effect size for most parameters, including clinical attachment level gain, pocket depth reduction, less gingival recession and radiographic linear bone gain. Considering the relatively high number of trials presenting an unclear or high risk of bias, the strength of recommendation supporting the use of PRP was judged weak, while the recommendation for EMD, PRF and rhPDGF-BB was deemed in favor. Biologics enhance the outcomes of periodontal regenerative therapy. Combination therapies involving BGs + biologics or BGs + barrier membrane demonstrated to be superior to monotherapies. The choice of the type of BG and biologic agent seems to have significant impact on the clinical and radiographic outcomes of infrabony defects.