Attachment Level Measurements Research Articles

Unvaccinated periodontal patients with a history of COVID-19: clinical findings in a Dental School setting.

This analysis included individuals older than 18 years with no history of systemic disorders other than systemic arterial hypertension. Individuals who had COVID-19 were classified according to the World Health Organization as asymptomatic, with mild, moderate, severe, or critical symptoms. A total of 95 individuals were evaluated, which included 24 with a history of COVID-19. Seventeen percent had been asymptomatic, 21% had mild, 25% moderate, 21% severe, and 17% critical symptoms, including intubation. Individuals with no history of COVID-19 presented significantly lower measurements of probing depth (p=0.003; Mann-Whitney test) and clinical attachment level (p=0.002) compared to individuals with a history of COVID-19. A significant negative association was found between bleeding on probing and the severity of characteristics of COVID-19 (rho= -0.233; p=0.023). Conversely, positive associations between the values of probing depth (rho= 0.292; p=0.004) and mean clinical attachment level (rho= 0.300; p=0.003) and the characteristics of COVID-19 were found. The periodontal data shows that patients who had COVID-19 before vaccination may present a worse periodontal status when compared to patients in the same clinical setting with no history of COVID-19. However, a more extensive study should confirm it with more participants.

Clinical Effects of Subgingivally Delivered Achyranthes Aspera Gel in Chronic Periodontitis: A Clinical and Microbiological Study.

Periodontitis is an inflammatory disease of microbial origin. Local drug delivery agents help reduce subgingival microflora. Achyranthes aspera is a medicinal herb with antimicrobial, antioxidant, anti-inflammatory, and wound-healing properties. A split-mouth study was conducted, in which 60 sites were included. Clinical parameters included measurements of probing depth (PD), gingival index, and clinical attachment level (CAL). Gingival crevicular fluid (GCF) samples were collected, followed by microbiological analysis of Porphyromonas Gingivalis. Clinical and microbiological parameters were recorded at baseline and after 3 months. Statistical analysis was done using the Statistical Package of Social Science (SPSS Version 22; Chicago Inc., USA). At 3 months, Group A resulted in greater mean reductions in clinical parameters: PD (3.77) as compared to Group B (5.23), and also greater mean CAL gain (3.18) in group A as compared to Group B (5.16). Group A also showed a significant reduction in the number of sites harboring periodontopathogens as compared to Group B. A. aspera gel can be used as a nonsurgical local drug delivery agent in patients with chronic periodontitis as an effective adjunct to SRP.

Comparison between Measurements of Clinical Attachment Level and Transgingival Probing with Alveolar Bone Crest Level in Chronic Periodontitis Patients

Background: Periodontitis is an inflammatory disease of the supporting tissues of the teeth that leads to crucial changes in the bony architecture. Early detection is of great practical significance so that treatment may be administered before irreversible destruction could occur. Differences exist between different diagnostic methodology concerning the relationship between the measurements and the level of the lesion. The aim of this study was to assess relationship between clinical attachment level (CAL) and alveolar bone crest level (ABCL), reliability of transgingival bone probing level (TBL) for ABCL measurement, and clinical biologic width (CBW) measurement in chronic periodontitis patients. Methods: An analytical cross-sectional study was conducted on 238 periodontal sites in 25 chronic periodontitis patients, aged 20–60 years who were planned for periodontal flap on residual pocket depth of 5-8mm after four weeks of non-surgical therapy. Stent was used for coronal fixed reference point. The relative attachment level (RAL), relative transgingival bone probing level (RTBL), relative alveolar bone crest level (RABCL), and CBW were measured at six sites per tooth excluding third molars. Descriptive and inferential statistical analysis was done. Probability of significance (p-value) was set at 5%. Results: Overall RAL, RTBL and RABCL (mean ± SD) were 8.08 ± 1.23, 10.82 ± 1.1, and 11.15 ± 1.36 mm respectively. Overall CBW (mean ± SD) was 3.06 ± 0.634 mm. Conclusions: There was a significant positive correlation of CAL and TBL with ABCL. Also, the CBW was greater than that of standard histologic BW.

Comparison of oxidative stress markers in the saliva, gingival crevicular fluid, and serum samples of pregnant women with gestational diabetes and healthy pregnant women.

To compare oxidative stress (OS) markers in the saliva, gingival crevicular fluid (GCF), and serum samples of pregnant women with gestational diabetes (GDM) and healthy pregnant women and to investigate the association between periodontal health/diseases and OS and GDM. Eighty women with GDM and 80 healthy pregnant women were included in the study. Medical and clinical anamnesis was obtained from all the pregnant women included in the study, and their plaque index (PI), gingival index (GI), bleeding on probing (BoP), probing pocket depth (PPD), and clinical attachment level (CAL) measurements were performed. GCF, saliva, and serum samples were collected for the measurements of the local and systemic total antioxidant status (TAS) and total oxidant status (TOS). Clinical periodontal parameters were found to be significantly higher in the GDM group compared to the control group. The serum and saliva TAS, TOS, and TAS/TOS values were significantly lower in the GDM group than in the control group. In the analysis of the GCF samples, the mean TAS and TAS/TOS values were significantly lower and the TOS value was significantly higher in the GDM group than in the control group. The multivariate reduced model indicated that gravidity, salivary TAS/TOS, and GCF TAS were significant independent variables in the development of GDM (p < .05). Our results indicated that the OS of serum, saliva, and GCF samples increased in patients with GDM compared to healthy pregnant women. The role of local OS parameters in GDM may be associated with elevated clinical periodontal parameters.

Evaluating the relationship between ankylosing spondylitis and periodontal disease: a case-control study.

This study aimed to determine the possible relationship between periodontal disease and ankylosing spondylitis (AS) by evaluating clinical periodontal measurements and gingival crevicular fluid (GCF) levels of sclerostin, interleukin-1β (IL-1ß), and matrix metalloproteinase-8 (MMP-8) levels. Twenty-eight patients with AS (AS group) and 28 systemically healthy controls (C group) were enrolled in this study. Full-mouth periodontal measurements: plaque index, bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) measurements were obtained from all patients. AS-related parameters were included in the data analyses. An enzyme-linked immunosorbent assay determined GCF IL-1β, MMP-8, and sclerostin levels. There were no significant differences in the clinical periodontal measurements between the two groups (p > 0.05). Interestingly, patients with AS had significantly lower GCF sclerostin levels than the C group (p < 0.05). But there were no statistical differences in the GCF levels of IL-1ß and MMP-8 between the two groups (p > 0.05). Serum C-reactive protein (CRP) levels strongly correlated with both BOP (r = 0.497, p < 0.05) and PPD (r = 0.570, p < 0.05) in the AS group. Bath AS Metrology Index (BASMI) also positively correlated with both BOP (r = 0.530, p < 0.05) and CAL (r = 0.568, p < 0.05). Similarly, Maastrıcht Ankylosing Spondylitis Enthesis Score (MASES) strongly correlated with both BOP (r = 0.487, p < 0.05) and CAL (r = 0.522, p < 0.05). These results suggest that the patient's systemic condition may influence local sclerostin levels in GCF, and the strong correlations between periodontal measurements and AS-related parameters may indicate an interrelationship between inflammatory periodontal disease and AS. The present study provides important information concerning the relationship between periodontal disease and ankylosing spondylitis. Thai Clinical Trials.gov (TCTR20200908001) (08. September 2020).

High-resolution ultrasonography of gingival biomarkers for periodontal diagnosis in healthy and diseased subjects.

To determine the capacity of ultrasonographic image-based measurements of gingival height and alveolar bone level for monitoring periodontal health and disease. Sixteen subjects were recruited from patients scheduled to receive dental care and classified as periodontally healthy (n = 10) or diseased (n = 6) according to clinical guidelines. A 40-MHz ultrasound system was used to measure gingival recession, gingival height, alveolar bone level, and gingival thickness from 66 teeth for comparison to probing measurements of pocket depth and clinical attachment level. Interexaminer variability and comparison between ultrasound measurements and probing measurements was performed via Bland-Altman analysis. Gingival recession and its risk in non-recessed patients could be determined via measurement of the supra- and subgingival cementoenamel junction relative to the gingival margin. Interexaminer bias for ultrasound image analysis was negligible (<0.10 mm) for imaged gingival height (iGH) and 0.45 mm for imaged alveolar bone level (iABL). Diseased subjects had significantly higher imaging measurements (iGH, iABL) and clinical measurements (probing pocket depth, clinical attachment level) than healthy subjects (p < 0.05). Subtraction of the average biologic width from iGH resulted in 83% agreement (≤1 mm difference) between iGH and probing pocket depth measurements. Ultrasonography has an equivalent diagnostic capacity as gold-standard physical probing for periodontal metrics while offering more detailed anatomical information.

ACCURACY OF CLINICAL AND RADIOGRAPHIC MEASUREMENTS OF PERIODONTAL INFRABONY DEFECTS OF DIAGNOSTIC TEST ACCURACY (DTA) STUDIES: A SYSTEMATIC REVIEW AND META-ANALYSIS.

The aim of this study was to determine the accuracy of clinical and radiographic measurements of infrabony periodontal defects. The MEDLINE-Pubmed and Cochrane-CENTRAL electronic databases were searched from initiation to May 2020. The inclusion criteria were clinical trials, human subjects with at least one infrabony defect, measurements of clinical attachment level (CAL), radiographic bone level (rBL), and intraoperative bone level (iBL) used as the reference standard. In total, 11 studies including 17 comparisons were included in this meta-analysis. All 17 comparisons showed that the values of the CAL and rBL measurements underestimated the iBL values. For CAL, the analysis showed a significant difference of means of -1.22 (P < .00001; 95%CI: [-1.49; -0.95]) and for rBL -1.10 (P < .00001; 95%CI: [-1.34; -0.85]). No significant DiffM were observed between the CAL and rBL measurements (DiffM -0.05; P = .76; 95%CI: [-0.39; 0.28]). The results of this systematic review and meta-analysis show that both clinical and radiographic measurements substantially underestimate the bone level when compared to intraoperative level measurements. However, there was no significant difference in the results between the clinical attachment level measurements and the radiographic observation.

Efficacy of the Er,Cr:YSGG Laser Application Versus the Conventional Method in Periodontal Flap Surgery: A Split-Mouth Randomized Control Trial.

Introduction: the Er,Cr:YSGG laser has a suitable wavelength for the ablation of both hard and soft tissues of the periodontium and can be considered as a potential tool in periodontal surgeries. The current study aimed at evaluating the application of this laser versus conventional instruments in periodontal pocket reduction flap surgery. Methods: Eight patients (16 dental arches) requiring periodontal surgery were included (Trial registration number: IRCT201711129014N199). Using a split-mouth study design, two posterior sextants of a dental arch were randomly allocated into either a test group, open flap debridement periodontal surgery using the Er,Cr:YSGG laser or a control group using the conventional method. Laser parameter settings of a 2780 nm wavelength, H mode (60 µs pulse duration), 25-50 Hz, 2-3.5 W output powers and Air-20%, Water-60-80% were applied and adjusted individually for each step of the flap surgery procedure. Baseline, 1 and 3-month measurements of plaque index (PI), Gingival Index (GI), gingival recession (GR), probing depth (PD) and clinical attachment level (CAL) were recorded for comparisons. Data were analyzed by a linear model for correlated data using the generalized estimating equations (GEE) method and the least significant difference (LSD). Results: In both treatment groups, reductions in PI and GI were observed in the 3-month follow-up period. These indices were significantly lower in the laser-treated sides compared to the conventional group (P<0.05). The Mean PD and CAL were lower at 1 month and 3 months compared to the baseline in both groups (P<0.05). However, these parameters were not statistically different in the treatment groups during these follow-up timelines. An increase in GR was observed from the baseline to 1 month and 3 months with less recession in the laser-treated sides (P=0.016). Conclusion: Based on the results of the present study, the Er,Cr:YSGG laser assisted periodontal flap surgery resulted in similar treatment outcomes to the conventional method and may be considered as a safe and effective treatment modality.

Prospective evaluation of vitamin D levels in dental treated patients: A screening study.

The available epidemiological data indicates the existence of numerous tooth deficiencies and periodontopathies in the Polish population. Successful surgical treatment is dependent upon multiple factors, including bone quality, which is affected by vitamin D - one of the regulators of calcium (Ca) and phosphorus (P) metabolism. The aim of this study was to conduct a prospective evaluation of the levels of vitamin D among patients receiving dental treatment for various reasons (conservative, surgical or prosthodontic treatment). The study involved 60 patients, who, for various reasons, were admitted for dental treatment for over a 1-week period in the summer season. A thorough interview together with a periodontological examination consisting of probing depth (PD) and clinical attachment level (CAL) measurements, were conducted. A total of 2 mL of blood was collected from each patient to determine the concentrations of vitamin D, parathyroid hormone (PTH), Ca, magnesium (Mg), and P in the blood with the use of mass spectrometry. Among the 60 patients enrolled in the study, 53 (88.3%) showed vitamin D deficiency and 18 (30%) showed a concentration below 17.8 ng/mL, which is an independent general mortality factor. The difference in the level of vitamin D between group A (without periodontitis) and group B (with periodontitis) was not statistically significant (p = 0.076), but a tendency for lower vitamin D levels in people with periodontitis was observed. We also observed a tendency for periodontal disease to occur more often with extreme vitamin D deficiency (<15 ng/mL) (p = 0.730). Low levels of vitamin D are present in a large proportion of dental patients, and an increase in the incidence of periodontal disease is likely associated with a decrease in the level of vitamin D.

Clinical Periodontal Assessment Following the Adjunctive Use of Clinical Periodontal Assessment Following the Adjunctive Use of Lycopene and Vitamin C in Non Surgical Therapy of Chronic Lycopene and Vitamin C in Non Surgical Therapy of Chronic Periodontitis: A Randomized Clinical Tria

Objective: To evaluate the clinical outcome of chronic periodontitis patients by clinical measurement of pocket depth (PD) and clinical attachment level (CAL) following non-surgical periodontal treatment with adjunctive use of lycopene and vitamin C. Subjects and Methods: 42 eligible systemically healthy patients with chronic periodontitis assigned to each group after assessment of clinical parameters plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment loss (CAL), were recorded. Cases were allocated into 3 groups by computerized randomization, 14 patients each group (n = 14). Group I (Lycopene): Patients were supplemented with 10 mg lycopene soft gels once daily for 2 months following SRP treatment. Group II (Vitamin C): Patients were supplemented with Vitamin C 500mg once daily for two months following SRP treatment. Group III (Control): Patients were supplemented with placebo once daily for two months following SRP treatment. All the clinical parameters were assessed at baseline &amp; two months post-treatment. Results: Overall results of our study, in all groups there were a statistically significant decrease in mean PD, CAL measurements post-treatment (P-value) Conclusion: Lycopene could be considered as a promising adjunct to SRP treatment in improving periodontal inflammation and clinical outcomes

Evaluation of the effect of periodontitis on quality of life using Oral-Dental Health-Related Quality of Life-United Kingdom scale.

The aim of this study was to investigate the impact of periodontitis on oral health-related quality of life (OHQoL) using Oral-Dental Health-Related Quality of Life-United Kingdom (OHRQoL-UK) scale and evaluate the contributing factors. 50 patients with untreated periodontitis and 50 individuals without periodontitis were enrolled in the study. All subjects received detailed periodontal examination. Plaque index (PI), gingival index (GI), probing depth (PD) and clinical attachment level (CAL) measurements were examined. OHRQoL was assessed by the Oral Health Quality of Life-United Kingdom (OHRQoL-UK) scale. Symptoms of periodontitis were monitored by visual analogue scale (VAS). Socio-demographic characteristics, medical history, smoking status, hygiene habits of the participants were recorded. This study is registered at ClinicalTrials.gov as NCT04240014. Total OHRQoL-UK scores were 38.24±6.47 in periodontitis patients and 55.88±9.38 in non-periodontitis individuals (p<0.001). The scores of all 4 parameters were significantly lower in patients with periodontitis compared to healthy individuals (p <0.001). Higher PI, GI, PD and CAL values were associated with extensive negative impacts of periodontitis on OHRQoL (p<0.001). According to the results of linear regression analysis, only periodontitis was found to associate with OHRQoL. Periodontal disease reduces the total quality of life score by 15.087 (ß= -15.087; 95% CI = [(-18.934)-(-11.240)]. Individuals with periodontitis has diminished OHRQoL compared to healthy individuals.

Relationship between periodontal status and disease activity in patients with ankylosing spondylitis.

ObjectivesAnkylosing spondylitis (AS) is a chronic inflammatory disease mainly affecting the spine and sacroiliac joints, characterized by enthesitis. Recent studies have investigated the relationship between AS and periodontitis. The aim of this study was to evaluate the periodontal status of patients with AS and to determine the factors affecting this.Material and methodsThe study included 200 AS patients, of which 129 were taking anti-tumour necrosis factor (TNF) drugs and 71 were taking non-steroid anti-inflammatory drugs (NSAID). Patients did not change their medication during the study. Disease activity was evaluated with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), mobility with the Bath Ankylosing Spondylitis Metrology Index (BASMI), functional status with the Bath Ankylosing Spondylitis Functional Index (BASFI), enthesitis with the integrated Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), and quality of life with the Ankylosing Spondylitis Quality of Life (ASQoL) scale. Data related to erythrocyte sedimentation rate, and C-reactive protein were recorded from the hospital information system. The plaque index (PI), gingival index (GI), pocket depth (PD), attachment level (CAL) measurements, and bleeding index (BOP) were measured.ResultsThe results showed that 35.5% of the AS patients had periodontitis, at a lower rate in the anti-TNF group than in the NSAID group, but the difference was not statistically significant. Periodontitis-related factors were found to be age, BASFI and BASMI. A significant relationship was found between MASES and BOP and GI.ConclusionsThis suggests that periodontitis may be an enthesis in AS. Nevertheless, further studies are needed to explain the mechanism of periodontitis in AS patients.

Frequency and Factors Associated with Periodontitis in Congolese Patients: A Cross-Sectional Study

Background: Periodontitis is a multifactorial disease which is highly prevalent worldwide. The control of periodontal risk factor network is of paramount importance for the management of the disease. Aim: The aim of this study was to assess the frequency and identify the factors associated with periodontitis in Congolese patients. Material and Methods: This cross-sectional study was carried out in four medical centers in the city of Kinshasa between April 2017 and April 2018. The study included patients aged at least 12 years old who consulted the dental services of these centers and who met the inclusion criteria. The participants underwent a structured interview and a clinical periodontal examination. The latter involved the entire dentition, and periodontal pocket and attachment level measurements were taken at six sites per tooth. The plaque and bleeding index were recorded. Logistic regression was used to identify associated factors. The significance level was set at p 0.05. Results: The study included 827 patients and 42% of them had periodontitis. The most represented age group was between 20 and 29 years old. In multivariate analysis, age greater than or equal to 35 years, OR = 2.45 CI 95% (1.77 - 3.45), and the amount of plaque expressed as plaque index ≥ 1, OR = 2 CI 95% (1.31 - 3.07) were factors associated with periodontitis. Conclusion: Factors associated with periodontitis found in this study are age ≥35 years and the amount of plaque expressed as plaque index ≥ 1. The latter reveals the importance of good oral hygiene.

Does parkinsonism affect periodontal health? A cross-sectional study in a tertiary hospital.

Background:Muscular rigidity, tremors, and bradykinesia with diminished motor skills are the characteristic features of Parkinson's disease (PD).Aim:The study investigated the influence of reduced motor proficiency on the periodontal health of PD patients and compared it with controls.Setting and Design:A cross-sectional study was conducted on PD patients selected from outpatient section of a tertiary healthcare center and compared with age- and gender-matched controls.Materials and Methods:Oral health status of the subjects was graded based on decayed, missing, and filled teeth index, oral hygiene index (OHI), modified gingival index, probing pocket depth (PPD), clinical attachment level (CAL), tooth mobility, interproximal PPD, and interproximal CAL measurements. PD patients were categorized based on Hoehn and Yahr scale and duration to assess the influence of PD severity and progression.Statistical Analysis:Difference in the mean values of quantitative variables was analyzed by parametric t-test and Chi-square test for categorical variables.Results:In PD patients, 84.4% of subjects had moderate–severe gingivitis, while it was 2.4% in the control group. Mean number of interproximal sites with CAL >5 mm in PD patients and control subjects was 8.41 ± 6.37 and 1.12 ± 2.28, respectively (P < 0.05). The mean OHI was 2.90 ± 0.81 in patients with mild PD and increased to 3.77 ± 0.52 as PD severity exalted.Conclusion:PD patients had impaired oral condition with higher OHI and increased gingival inflammation with a likelihood of male predisposition. Substantial interproximal tissue destruction, debilitated periodontal health as PD progresses, suggests early attention toward their oral health.

Community biofilm-formation, stratification and productivity in serially-transferred microcosms.

The establishment of O2 gradients in liquid columns by bacterial metabolic activity produces a spatially-structured environment. This produces a high-O2 region at the top that represents an un-occupied niche which could be colonised by biofilm-competent strains. We have used this to develop an experimental model system using soil-wash inocula and a serial-transfer approach to investigate changes in community-based biofilm-formation and productivity. This involved 10 transfers of mixed-community or biofilm-only samples over a total of 10-60 days incubation. In all final-transfer communities the ability to form biofilms was retained, though in longer incubations the build-up of toxic metabolites limited productivity. Measurements of microcosm productivity, biofilm-strength and attachment levels were used to assess community-aggregated traits which showed changes at both the community and individual-strain levels. Final-transfer communities were stratified with strains demonstrating a plastic phenotype when migrating between the high and low-O2 regions. The majority of community productivity came from the O2-depleted region rather than the top of the liquid column. This model system illustrates the complexity we expect to see in natural biofilm-forming communities. The connection between biofilms and the liquid column seen here has important implications for how these structures form and respond to selective pressure.

Periodontal inflamed surface area in patients on haemodialysis and peritoneal dialysis: a Croatian cross-sectional study

BackgroundThe decision to initiate dialysis treatment via haemodialysis (HD) or peritoneal dialysis (PD) often involves the consideration of complex factors and remains a matter of debate. The purpose of this study was to quantify the inflammatory burden that periodontitis causes in dialysis patients and to examine whether patients on PD and HD differ in terms of the periodontal inflamed surface area (PISA), which can be helpful for selecting the most appropriate dialysis modality.MethodsA cross-sectional study was performed on 58 consecutive patients on HD and 31 consecutive patients on PD. PISA was calculated using measurements of the clinical attachment level, recession and bleeding on probing. We performed the primary analysis using multivariable robust regression.ResultsPatients on PD had a 746 mm2 (93%) lower mean PISA than patients on HD after adjustment for 20 possible confounders, including the duration of dialysis. The type of dialysis was independently correlated with the PISA (semipartial correlation: − 0.50; p = 0.017; false discovery rate < 5%). After adjusting for confounding factors, the correlation between the duration and type of dialysis was not significant (F (2,44) = 0.01; p = 0.994; η2 = 0.00). Differences in the PISA between patients who had undergone dialysis for less than a year, 2–3 years or ≥ 3 years were not significantly different in either of the two dialysis groups.ConclusionsPISA levels in Croatian patients on dialysis indicate a high need for periodontal treatment. PD is associated with a smaller PISA independent of many sociodemographic, lifestyle, laboratory and clinical factors. The duration of dialysis does not influence PISA levels.Trial registrationISRCTN17887630.A clinical study to investigate gum infection in patients undergoing kidney dialysis.

Post-surgical flap placement following osseous surgery: A short-term clinical evaluation.

The purpose of this study is to examine the relationship between immediate post-surgical flap position and subsequent probing depth measurements following osseous surgery. Twenty-four patients treatment planned for osseous surgery after completion of initial therapy and re-evaluation were enrolled. Pressure molded stents were fabricated to serve as a reference for probing depth and relative attachment level measurements prior to surgery. After osseous recontouring was completed, flaps were sutured and compressed, and bone sounding measurements were made as designated by the stent. Patients returned at 3- and 6 months for repeat measurements of probing depth and attachment level. Twenty-four patients completed surgical treatment and follow-up measurements with a total of 402 treated sites. A statistically significant moderate correlation between immediate post-surgical bone sounding measurements and subsequent probing depth was found at 6 months (R=0.56, P<0.001). There was no significant difference between this correlation at 3 and 6 months. The probability of having 6 month probing depth ≤3mm was 93.5% when the surgical flap was placed within 3mm of the alveolar crest (286/306 sites) as opposed to 50% when the surgical flap was >3mm away from the alveolar crest (48/96 sites). Interproximal sites were significantly more likely (P <0.01) to have probing depths>3mm at 3 and 6 months. Results suggest a statistically significant relationship between immediate post-surgical flap placement and subsequent probing depths. Positioning the surgical flap more closely to the alveolar crest when performing osseous surgery resulted in shallower probing depths at 3 and 6 months.

Neurogenic inflammation in periimplant and periodontal disease: A case-control split-mouth study.

Although the regulatory effects of substance-P (SP), neurokinin-A (NKA), calcitonin gene-linked peptide (CGRP) and neuropeptide-Y (NPY) on periodontal inflammatory responses have been described, the effects of these neuropeptides on healthy and diseased periimplant tissues are not clearly defined. Thirty-nine implants loaded at least for 12months with their symmetrically matching teeth were evaluated and compared by a split-mouth study design. Six study groups were created in this regard as follows: group 1 (healthy periodontal tissues), group 2 (healthy periimplant tissues), group 3 (gingivitis), group 4 (periimplant mucositis), group 5 (periodontitis) and group 6 (periimplantitis). Clinical examinations included Silness-Löe plaque index, Löe-Silness gingival index, bleeding on probing, probing pocket depth and clinical attachment level measurements. Gingival crevicular fluid and periimplant sulcular fluid samples were collected, and the concentrations of neuropeptides were determined by enzyme-linked immunosorbent assay. Their levels and correlations were investigated together with the clinical parameters. Neuropeptide levels were different in the teeth and implant groups according to the periodontal status (p<0.001). SP and NKA levels were increased, whereas CGRP and NPY levels were decreased in the diseased states. There were no differences between the neuropeptide levels of matching teeth and implants (groups 1-2, groups 3-4 and groups 5-6; p>0.05). Our study demonstrated the presence of local neuropeptides in healthy and diseased periimplant tissues. The neurogenic inflammatory responses were also found to be similar in both periimplant and periodontal tissues.

Clinical and radiographic evaluation of amnion chorion membrane and demineralized bone matrix putty allograft for management of periodontal intrabony defects: a randomized clinical trial.

The aim of this trial was to compare the clinical and radiographic outcomes of amnion chorion membrane (ACM) with demineralized bone matrix (DBM) in a putty form in management of periodontal intrabony defects. Twenty-two participants with severe chronic periodontitis and intrabony defects, were randomly assigned in two equal parallel groups. Each group was treated with open flap debridement (OFD) and ACM or OFD and DBM putty. Plaque index, gingival index, pocket depth (PD), clinical attachment level (CAL) and radiographic measurement of bone defect area (BDA) were recorded at baseline, 3 and 6months postoperatively. Both ACM and DBM putty demonstrated significant improvement in all clinical and radiographic outcomes at 6months compared to baseline values. However, no significant difference was observed between the two treatment modalities when compared at different time intervals. Six months postoperatively, ACM showed 3.18 ± 0.85mm, PD reduction and 2.25 ± 0.75mm CAL gain, while DBM putty revealed 3.45 ± 1.08mm PD reduction and 2.73 ± 0.85mm CAL gain. Radiographic assessment showed that mean baseline BDA for ACM group was 10.39 ± 3.86mm2, which significantly reduced to 5.21 ± 2.38 after 6months. Mean BDA mm2 in DBM putty group also significantly improved after 6months, 5.35 ± 3.63mm2 when compared to baseline values 9.80 ± 5.77mm2. Both ACM barrier and DBM putty allograft provided significant improvement in clinical and radiographic outcomes after 6months, yet no significant differences were noticed between them. This trial implied that both biomaterials have a potential regenerative capacity in treating periodontal intrabony defects.

Stent as an accessory tool in periodontal measurements: An insight.

A better reflection of periodontal destruction can be obtained by the measurement of the clinical attachment level (CAL), i.e., the distance from the probe tip to the level of the cementoenamel junction (CEJ). However, there were several problems in CEJ identification. Due to the time consumption and inherent problems in CEJ identification, CAL measurements without using a stent in surveys or other clinical trials are highly questionable. The use of stent is recommended during clinical trials which will minimize the errors in terms of over and underestimation of CALs. Hence, the stent used for vertical probing (vertical/occlusal stent), horizontal probing (furcation stent), and interdental papilla (IDP) stent for IDP-deficiency measurement is discussed to comprehend its clinical applications.