Gingival Bleeding Research Articles

Screening for Systemic Diseases Associated with Dental Self-Care in Japanese Adolescents

Background: Toothbrushing is important for maintaining oral health and preventing periodontal disease. However, the association between toothbrushing and systemic diseases remains unclear in adolescence. In this study, the association between dental self-care (frequency and duration of toothbrushing) and systemic diseases/disorders in adolescents was examined. Methods: We conducted a retrospective review of mandatory medical questionnaires administered during legally mandated freshman medical checkups between 2017 and 2019 at the University of Tokyo, Japan. Out of 9376 total responses, 9098 cases involving individuals under the age of 20 were included in the analysis. Respondents were classified into three groups based on their daily toothbrushing frequency: “1 time or less”, “twice”, and “3 times or more”. For the duration of each toothbrushing session, they were classified into three groups: “1 min or less”, “2–3 min”, and “4 min or more”. A statistical analysis was performed by Pearson’s χ2 test and multinomial logistic regression analysis. Results: Regarding frequency of daily toothbrushing: The χ2 test showed no significant relationship between frequency of toothbrushing and 17 systemic diseases/disorders. A multivariate analysis found that gingival bleeding and sex were independent factors. The risk of gingival bleeding decreased dramatically with increased frequency of toothbrushing (odds ratio (OR): 0.428; 95% confidence interval (CI), 0.366–0.501; p < 0.001). Regarding the amount of time spent on toothbrushing: The χ2 test showed atopic dermatitis and arrhythmia were significantly associated with the duration of toothbrushing (p = 0.032 and p = 0.016, respectively). In the multivariate analysis, atopic dermatitis, gingival bleeding, and sex were independent factors regarding the duration of toothbrushing; longer brushing time was associated with a lower risk of atopic dermatitis (OR: 0.731, 95% CI: 0.578–0.924, p = 0.009) and a lower risk of gingival bleeding (OR: 0.643, 95% CI: 0.567–0.729, p < 0.001). Conclusions: Dental self-care was most strongly associated with gingival bleeding, while the risk of atopic dermatitis was found to increase with shorter toothbrushing times. The results suggest that dental self-care during adolescence is important not only for oral health but also for general health.

The Impact of Type 2 Diabetes Mellitus on Non-Surgical Periodontal Treatment: A Non-Randomized Clinical Trial.

Background/Objectives: Periodontitis (P), a chronic inflammatory condition that affects the supportive tissues around the teeth, is three to four times more prevalent in individuals with diabetes mellitus (DM), with a direct correlation between its severity and the levels of glycosylated hemoglobin (HbA1c). This study aimed to evaluate the periodontal clinical parameters following non-surgical periodontal treatment (NSPT) in P patients with or without type 2 DM. Methods: Forty patients with P were divided into two groups: Group DM/P and Group P. All the patients were assessed at baseline and at 90 and 180 days after receiving NSPT. The parameters evaluated included the HbA1c level, plaque index (PI), probing pocket depth (PPD), clinical attachment level (CAL), and bleeding on probing (BoP). A statistical analysis was performed with a significance level set at α = 5%. Results: There were significant differences in the HbA1c levels between the DM/P and P groups at baseline, 90, and 180 days, as expected. Importantly, the HbA1c levels did not change after NSPT. Group P showed a significant reduction in both the PI and the BoP values at 90 and 180 days (p < 0.05). In contrast, Group DM/P demonstrated a significant increase in the percentage of sites with a PPD ≥ 5 mm at 180 days (p < 0.05). Additionally, Group P exhibited an increase in sites with a PPD ≤ 4 mm and a decrease in sites with a PPD ≥ 5 mm at both 90 and 180 days (p < 0.05). Conclusions: Our findings suggest that DM may compromise the effectiveness of NSPT, potentially hindering favorable outcomes during the follow-up period.

Diversity and characteristics of the oral microbiome influenced by race and ethnicity.

Recognizing the variations in the oral microbiome among racial/ethnic populations offers insight into the microbial determinants contributing to oral health disparities. In the study presented here, we found a higher level of bleeding on probing (BOP), an indicator of tissue inflammatory response, in the AA group, which is correspondence with a more complex oral microbiome detected in this group. Our observations suggest that the variations of the oral microbiome associated with racial/ethnic backgrounds may directly relate to their virulence potential including their abilities to induce host immune responses and to resist antibiotic treatment. Therefore, these finding can be a stepping stone for developing precision medicine and personalized periodontal prevention/treatment and for reducing oral health disparities.

Antibacterial Activity and Randomised Controlled Trial of Chlorhexidine-Coated Floss on Gingival Bleeding

While Chlorhexidine mouthwash is widely studied for the treatment of periodontal disease, research on chlorhexidine in the form of dental floss is limited. This study aims to evaluate the effect of chlorhexidine wax-coated dental floss on dental plaque accumulation and gingival bleeding. Additionally, antibacterial activity and cellular toxicity were also investigated in vitro. Various concentrations of chlorhexidine wax-coated floss (0%, 0.12%, 1%, and 2%) were prepared. The antibacterial activity against Streptococcus mutans was studied using a disc diffusion assay. Cellular toxicity was assessed in L929 cells and human gingival fibroblasts using an MTT assay. To evaluate the effects on plaque accumulation and gingival bleeding, 27 participants were randomly divided into 3 groups: 1) 0% chlorhexidine wax-coated dental floss (control), 2) 0.12% chlorhexidine wax-coated dental floss, and 3) 1% chlorhexidine wax-coated dental floss. All participants were instructed to use the provided dental floss once daily at bedtime for 14 days. Six sites per tooth were evaluated for the Quigley-Hein plaque index and bleeding index (BI) at day 0 (baseline) and day 15. All fully erupted teeth, except the third molars, were examined. Chlorhexidine-coated floss exhibited antibacterial activity against S. mutans in a dose-dependent manner. In an in-vitro study, a 2% concentration of chlorhexidine in the floss was found to be highly toxic, leading to its exclusion from clinical trials. After 14 days of use, significantly lower levels of BI were observed in the groups using chlorhexidine wax-coated dental floss, compared to the control. Additionally, there was no significant difference in BI between the 0.12% and 1% chlorhexidine wax-coated dental floss groups. However, no significant difference in plaque index was found between the groups using chlorhexidine wax-coated dental floss and the control group. This study demonstrated the antibacterial and anti-gingivitis properties of chlorhexidine wax-coated dental floss. Our results showed that using chlorhexidine wax-coated dental floss at a concentration as low as 0.12% could significantly reduce gingival bleeding. However, no additional benefit of chlorhexidine wax-coated dental floss on dental plaque accumulation was found.

Effectiveness of 0.2% Hyaluronic Acid on Clinical, Biomolecular and Microbiological Parameters in Type 2 Diabetes Mellitus Patients with Periodontitis.

This double-blind randomized clinical trial assessed the effectiveness of 0.2% hyaluronic acid (HA) gel as an adjunct to scaling and root planning (SRP) in patients with periodontitis and type 2 diabetes mellitus (DM), focusing on changes in clinical periodontal parameters, the expression of inflammatory mediators, and oral pathogens. The randomized clinical trial involved 36 participants, 18 DM patients, and 18 healthy patients. The participants in each group were randomly assigned to receive placebo or HA gel after SRP. Gingival crevicular fluid and subgingival plaque samples were taken before treatment and at 4-week follow-up. Clinical parameters, interleukin-1β (IL-1β) and IL-10 levels, and proportions of Porphyromonas gingivalis (Pg) and Fusobacterium nucleatum (Fn) were evaluated at baseline and follow-up. Paired t-test (parametric data) or Wilcoxon signed-rank test (nonparametric data) was used for intragroup comparison between baseline and follow-up, and comparisons between groups one-way analysis of variance test (parametric data) or Kruskal-Wallis test (nonparametric data). At 4 weeks, most of the groups showed statistically significant decreases (p ≤ 0.05) in various clinical and biomolecular parameters. However, there were exceptions: the pocket probing depth (PPD) and clinical attachment loss (CAL) parameter did not significantly decrease for the placebo (p > 0.05) non-DM group, and the IL-10 parameter in the DM HA gel group (p = 0.108). Regarding bacterial proportions, the non-DM and DM placebo group exhibited significant test results for Pg after 4 weeks (p ≤ 0.05). In the case of Fn bacteria proportions, they decreased in all groups, but these results were not statistically significant (p ≥ 0.05). An intergroup analysis revealed no significant differences (p ≤ 0.05) for bleeding on probing (BOP), PPD, and both proinflammatory and anti-inflammatory cytokines. Only clinical attachment loss (CAL) exhibited a statistically significant intergroup difference 0.042. The use of 0.2% HA gel into periodontal pockets alongside SRP, for both diabetic and healthy individuals, showed no statistically significant variances in clinical, biomolecular, and microbiological measures.

Impact of Two Implant-Abutment Connection Types on Crestal Bone Stability: A 3-Year Comparative Split-Mouth Clinical Trial.

This prospective, preliminary controlled clinical trial investigates the comparative effectiveness of platform-switching (PS) versus traditional butt-joint or platform-matching (PM) implant-abutment connections on peri-implant crestal bone stability. Utilizing a split mouth design, 10 systemically healthy patients (n= 20 implants) had adjacent non-restorable maxillary anterior teeth replaced with two different implants (butt-joint connections and platform-switching interfaces). Patients underwent alveolar ridge preservation, followed by implant placement: platform-matching implants were inserted at crestal bone level, and platform-switching implants were placed 1mm subcrestally. Customized Zirconia crowns were then fabricated for both systems. Outcome measures included bleeding on probing (BOP), probing pocket depth (PPD), and marginal bone loss (MBL), which were evaluated through standardized periapical radiographs over 3-year timeframe. Results showed significantly higher initial MBL in the PM group (0.86 ± 0.13 mm) compared to the PS group (0.34±0.29 mm) [p value: p<0.01]. Moreover, at the three-year follow-up, the crestal bone levels remained above the implant shoulder until the third year of the study for the PS subcrestal group (PS: -0.15±0.39 mm) and slightly below the implant platform in the PM crestal group (PM: 0.55±0.19). After 3 years, the PS group also exhibited lower mean BOP percentages (12%) than the butt-joint group (17%). This study suggests that subcrestal placement with PS and internal connections can provide better long-term peri- implant bone preservation, thereby potentially improving implant success and aesthetic outcomes in the anterior maxillary region.

Dietary Inflammatory Index is associated with periodontitis risk in pregnant women with gestational diabetes mellitus

Recent studies suggest a link between periodontitis and the Dietary Inflammatory Index (DII). We hypothesize that a more pro-inflammatory diet is associated with periodontitis risk in pregnant women with gestational diabetes mellitus (GDM). This study aimed to explore the association between DII scores and periodontitis risk in GDM women. In this cross-sectional study, 302 eligible GDM women from a Maternal and Child Health Hospital were enrolled between February and July 2023. DII scores were calculated based on dietary intake data collected using a validated semi-quantitative food frequency questionnaire (SQ-FFQ). Periodontal health was assessed through periodontal parameters including bleeding on probing (BOP), probing depth (PD), and clinical attachment loss (CAL). Logistic regression models were employed to evaluate the odds ratios (ORs) for periodontitis risk across DII tertiles. Our study found that the prevalence of periodontitis across the DII tertiles 1, 2, and 3 was 34.7%, 56.4%, and 54.0%, respectively. Comparing the highest DII tertile (tertile 3) with the lowest (tertile 1), a significant association was found between higher DII scores and periodontitis risk (univariate OR: 2.21; 95% CI: 1.25, 3.90; P = 0.006), which remained significant in the fully adjusted model (adjusted OR: 2.30; 95% CI: 1.21, 4.37; P = 0.011). In conclusion, elevated DII scores are associated with an increased risk of periodontitis, underscoring the crucial role of a pro-inflammatory diet in periodontitis progression. Future well-designed experimental studies are needed to verify if tailored dietary strategies can effectively reduce periodontitis risk among pregnant women with GDM.

Retrospective study on the clinical and radiographic outcomes of 2.8 mm diameter implants supporting fixed prostheses up to 11 years.

This study aimed to report the clinical and radiographic results of 2.8 mm two-piece narrow diameter implant (NDI) supporting fixed restorations. Clinical and radiographic data of 54 NDIs in 32 patients were retrospectively assessed after 2 to 11 (mean 8.17) years of follow-up. Clinical and radiographic measurements were taken. Survival rate, implant and prosthesis failure, pink aesthetic scores (PES), white aesthetic scores (WES), bleeding on probing (BOP), probing depth (PD), marginal bone loss (MBL), and mechanical and biological complications were evaluated. An implant failed during the follow-up period, resulting in a cumulative survival rate of 98.15% at the implant level and 96.88% in the patient. The total mean values of PES and WES for 2.8 mm NDIs were 7.09 ± 1.15 (range: 3.33-9.00) and 7.42 ± 1.03 (range: 3.67-9.33). The prevalence of sites with positive BOP was 38.14 ± 29.77%. The mean PD value was 2.46 ± 0.62 mm. The average MBL was 1.15 ± 0.74 mm (range: 0.25-4.03 mm). No implant or abutment fracture was detected. A veneer chipping was present in one patient, and a loose crown appeared in another patient. Two implants (3.7%) and two patients (6.3%) were diagnosed with peri-implantitis. Within the limitation of the study, the results indicate that the use of two-piece 2.8 mm NDI for the fixed prosthetic rehabilitation of edentulous regions with reduced interdental and/or buccal-lingual width is viable.

Gingival Health Status among Patients Wearing Fixed Orthodontic Appliance in Erbil City

Objectives and background: People have increasing demand for orthodontic treatment and it became a common treatment plan nowadays that may affect the gingival health. However, the correlation between orthodontics and periodontal health is not clear, which troubles the clinical orthodontist during planning of the treatment. So many studies showed previously a relationship between orthodontic appliance and the dental diseases that it may cause. This study aimed to evaluate the relationship between gingival health status and the duration of wearing fixed orthodontic appliance. Method: The study included 40 patients wearing fixed orthodontic appliance. Patients’ folders were analyzed according to the duration of wearing the appliance and route of breathing then comparing these two factors and their effects on plaque index, gingival index and gingival sulcus depth. Results: As the duration of wearing the appliance increased, there was an increase in the plaque accumulation and gingival bleeding on probing, except for the forth group of duration (more than 12 months with the appliance). As for breathing factor, the findings were as the following (In order from less plaque accumulation to the most, respectfully): nasal, both (nasal and mouth) and finally mouth, while with the gingival index, the data showed the opposite. Conclusion: Prolonged orthodontic treatment was associated with an increased plaque retention and increased bleeding on probing; however, the magnitude of the difference in gingival sulcus depth in both duration of wearing the appliance and different breathing routes was of no clinical significance. Breathing orally had negative effect on the oral hygiene.

Subcrestal versus Bone-Level One-Stage Implants: Early Bone and Soft Tissues Modification: One-Year Randomized Clinical Trial

Reducing marginal bone resorption is a challenge in implant dentistry. Sub-gingival implant placement has been suggested as a suitable strategy to avoid long-term esthetic and biological complications. A total of 38 healthy patients received bone-level (BLG-Control) or 2 mm sub-crestal (SCG-Test) conical connection, platform-switched implants. The test group received an immediate tissue-level abutment, following the one-time abutment (OTA) concept. Marginal bone modification (MBM) was calculated on standardized radiographs at surgery (T0), loading (T1), and 6 (T2) and 12 (T3) months after loading and classified as bone loss (BL) if it occurred below the implant neck and bone remodeling (BR) if above. Pocket-probing depth (PPD), Bleeding on probing (BoP), and Plaque Index (PI) were collected. At 12 months, the mean MBM was 0.61 mm in the test group and 0.52 mm in the control group. In all the cases of the test group (SCG), MBM occurred only above the implant neck, therefore being classified as BR, and no BL was observed. In the control group (BLG), MBM occurred below the implant neck, thus corresponding entirely to BL. The test group had an average PPD of 2.38 mm compared to 3.04 mm in the control group, with BoP at 50% and 43%, and PI at 33% and 19.44%, respectively. At one year after loading, sub-crestal conical connection, platform-switched implants show comparable MBM to bone level implants; however, no bone loss was observed.

Soluble urokinase plasminogen activator receptor (suPAR) is a potential biomarker of stage III-IV, grade C periodontitis through the impact of post-radiotherapy on head and neck cancer patients

BackgroundThe urokinase-type plasminogen activator receptor (uPAR) plays an essential function in leukocytes and endothelial homeostasis and, therefore, in the development of chronic periodontitis.MethodsThe study enrolled 150 participants, 50 chronic periodontitis with head and neck cancer post radiotherapy (CP + HNC post-RT) patients, 50 chronic periodontitis (CP) without HNC patients, and 50 healthy controls. Clinical Attachment Loss (CAL), Probing Pocket Depth (PPD), Plaque Index (PI), and Gingival Bleeding Index (GBI) were recorded. An enzyme-linked immunosorbent assay (ELISA) was constructed to quantify serum (suPAR) levels.ResultsStage and grade of periodontitis were stage III-IV, grade C in patients (CP + HNC post-RT), stage I-III, grade A/B in patients (CP without HNC), and absent in (healthy). Chronic periodontitis with HNC post-RT patients presented a significantly higher proportion of suPAR levels (506.7 pg/ml) compared to chronic periodontitis without HNC and healthy controls (423.08 pg/ml and 255.9 pg/ml), respectively. A significant positive correlation was found between serum suPAR levels and CAL, PPD, PI, and GBI in the periodontal disease groups. ROC results of suPAR (AUC = 0.976 for CP + HNC post-RT, AUC = 0.872 for CP without HNC). Hyposalivation appeared in patients (CP + HNC post-RT; 0.15 [0.11–0.23] ml/min, P = 0.001) and (CP without HNC; 0.30 [0.25–0.41] ml/min, P = 0.001), compared to healthy controls; 0.35 [0.28–0.54] ml/min, P = 0.001).ConclusionThe study showed a significant elevation in serum suPAR levels in CP + HNC post-RT patients compared to the CP without HNC and control groups.Clinical trial registrationThe study was registered retrospectively; clinicaltrials.gov identifier: NCT06529588. Date of registration: July 31, 2024 https://clinicaltrials.gov/study/NCT06529588.

Changes and Roles of IL-6, hsCRP, and proCT in Patients with Chronic Periodontitis in Head and Neck Cancer Pre/Post Radiotherapy

Background: Head and neck cancer (HNC) patients frequently undergo radiotherapy as a standalone treatment or in combination with chemotherapy. Radiotherapy is associated with adverse effects, including detrimental impacts on periodontal health, which increase the risk of periodontitis. Objective: To investigate the clinical significance of interleukin-6 (IL-6), high-sensitive C-reactive protein (hsCRP), and procalcitonin (proCT) as prognostic indicators. Methods: 150 participants were divided into three groups: (n=50, HNC post-RT) patients with head and neck cancer who had radiation treatment six months ago (n=50, HNC pre-RT), and individuals with periodontal health as the control group (n=50). Probing pocket depth (PPD), clinical attachment loss (CAL), gingival bleeding index (GBI), plaque index (PI), and hyposalivation were meticulously recorded. To quantify serum concentrations of IL-6, hs-CRP, and proCT, an electrochemiluminescence immunoassay (eCLIA) was used. Results: Serum levels of IL-6, hsCRP, and proCT were significantly elevated in two groups of patients with chronic periodontitis with head and neck cancer post-radiotherapy (CP+HNC post-RT) and patients with chronic periodontitis with HNC pre-radiotherapy (CP+HNC pre-RT) compared to a control group. ROC analysis demonstrated the diagnostic accuracy of IL-6, hsCRP, and proCT for both clinical cases. Furthermore, all clinical periodontal index scores (CAL, PPD, PI, and GBI) were significantly elevated compared to a control group. Conclusions: HNC post-RT patients presented significantly higher serum IL-6, hs-CRP, proCT, and periodontal score levels than HNC pre-RT.

Poly-Ether-Ether-Ketone versus dead-soft coaxial bonded retainers: a randomized clinical trial. Part 2: periodontal health and microbial biofilm assessment.

Retainers have the potential to detrimentally impact periodontal health and contribute to tooth decay. To investigate periodontal health and bacterial biofilm related to Poly-Ether-Ether-Ketone (PEEK) fixed retainers as compared to Dead-soft coaxial fixed retainer (DSC). A two-arm parallel groups single-centre randomized clinical trial. The trial included patients whose orthodontic treatment was completed and required retainers. Participants were randomly assigned into two retainer groups: PEEK retainers, prepared by computer-aided design and manufacturing into 0.8mm wire form, and DSC retainers. The objectives included assessing periodontal health through plaque accumulation index (PI), bleeding on probing (BOP), periodontal pocket depth (PPD), gingival index (GI), calculus index (CI), and alveolar bone height (ABH) assessment. Biofilm assessment involved bacteriological screening of aerobic, facultative anaerobic, mutans streptococci, and lactobacilli. The periodontal indices and microbiological screening as well as were assessed at the debonding stage (T0), 1-month (T1), 3-month (T3), and 6-month (T6) after the commencement of the trial, except for the ABH, which was recorded using periapical radiograph at T0 and T6. Single blinding of participants in addition to the bacteriological specialist. Initially, the trial enrolled 46 participants, aged between 12 and 28 years, and were randomly assigned to two groups, with 23 participants in each group. Subsequently, one participant withdrew from the trial, resulting in a total of 45 participants whose data were analysed. Assessment of the periodontal indices, excluding the CI (P = .480), revealed statistically but not clinically significant differences between groups after 6-month of retention (P = .016 of PI, P = .020 of BOP, P = .05 of PPD, and P = .01 of GI). There was slight plaque accumulation, normal PPD (approximately 1mm), healthy to mild gingivitis with a GI of less than 1 and BOP was around 10%. Concerning the ABH, there was a noticeable reduction in its score after 6 months, particularly in the PEEK group, although the difference was not statistically significant (P = .102). Furthermore, the bacteriological viable count did not show any significant difference between the groups during the recall visits. There have been no reported negative consequences. Blinding the assessor of periodontal indices was not feasible due to the nature of the intervention. The trial follow-up duration was limited. Both the PEEK and DSC retainers have comparable impacts on periodontal health and bacterial accumulation and composition during the retention period. NCT05557136.

Using precision periodontal health care chart (PPHCC) to improve periodontal health.

Developing a Precision Periodontal Health Care Chart (PPHCC) in the electronic dental record (EDR) system and evaluating its clinical usability and effects on clinical outcomes. A survey with ten questions based on the System Usability Scale (SUS) and six questions about assessing clinical impact was used to evaluate the satisfaction of periodontitis patients and care providers with PPHCC before and after non-surgical periodontal therapy (NSPT). The clinical outcomes, including probing depth (PD), interdental clinical attachment loss (CAL), and bleeding on probing (BOP), in patients who used PPHCC (PC) were compared to those in patients without using PPHCC (control). The associations between risk assessments included in PPHCC and clinical outcomes of NSPT were also analyzed. The mean scores of SUS questions at the initial periodontal examination were 74.26 ± 18.89 (n = 37) for patients and 88.31 ± 14.14 (n = 37) for care providers. The mean scores of SUS questions at re-evaluation were 74.84 ± 17.78 (n = 16) for patients and 89.63 ± 13.48 (n = 20) for care providers. The changes in the percentages of teeth with interdental CAL 1-2mm (p = 0.019) and CAL 3-4mm (p = 0.026) at the re-evaluation visit were significantly different between the PC and control groups, but the other parameters were not. Both patients and care providers were satisfied with using PPHCC in the clinic. However, the short-term clinical outcomes in the PC group were similar to those in the control group. PPHCC, as a tool for delivering clinical and educational information, can motivate patients to control periodontitis and assist clinicians in making a personalized treatment plan.

Association of crown-root ratio and tooth survival in Chinese patients with advanced periodontitis: An 11-year retrospective cohort study

IntroductionPeriodontitis is a chronic multifactorial inflammatory disease which eventually lead to tooth loss (TL). Therefore, a retrospective study was conducted to evaluate the status of tooth survival within 11 years after non-surgical periodontal treatment (NSPT) and to analyze the risk factors especially crown-root ratio (CRR) that affected TL in Chinese with advanced periodontitis. Methods3481 teeth of 131 subjects who underwent NSPT were examined retrospectively within a mean follow-up period of 11.6 years. The association of risk factors including clinical and radiographic parameters with TL was assessed using univariate and multivariate Cox regression analyses. Smooth curve fitting and segmented regression model were conducted to show the nonlinear relationship and the threshold effect between CRR and the risk of TL. Results347 teeth were lost in 97 patients in this study. Male, diabetes mellitus, heavy-smoker, molar, probing depth (PD), attachment loss (AL), bleeding on probing (BOP), tooth mobility, and radiographic bone loss were significantly associated with tooth loss (P < 0.05). A nonlinear relationship between CRR and the risk of TL was found, with different turning point values between molars and non-molars (1.9 vs. 2.76). ConclusionsThe findings based on practice-based clinical and radiographic data do suggest a nonlinear relationship between CRR and the survival of teeth, and provide evidence to help clinicians to determine the prognosis of teeth for patients with advanced periodontitis. Clinical SignificanceBased on clinical and radiographic data, this study provides an individualized basis for clinicians to judge the dental prognosis of patients with advanced periodontitis according to the different tooth sites.

Impact of body mass index and polycystic ovary syndrome (PCOS) subtypes on periodontal health in Chinese women with PCOS and periodontitis

Background This study aimed to investigate the impact of body mass index (BMI) and Polycystic Ovary Syndrome (PCOS) subtypes on periodontal parameters in Chinese women with PCOS and periodontitis. Method We conducted a retrospective case-control study analyzing data from 88 women with PCOS and 82 healthy controls. Participants were categorized by BMI (<24.0 kg/m2and ≥24.0 kg/m2) and PCOS subtypes. We compared periodontal parameters [including probing depth (PD), gingival bleeding index (GBI)] and reproductive hormone-related parameters. Results Women with PCOS and periodontitis had a significantly higher GBI (2.71 ± 0.53) compared to controls (2.25 ± 0.41, p < 0.0001). Among patients with BMI <24.0 kg/m2, those with PCOS had a younger age [25.00(5.00) vs. 26.00(6.00) years, p < 0.05], lower PD [3.24(0.55) mm vs. 3.43 (0.48) mm, p < 0.01], and higher GBI [2.63(0.76) vs. 2.23(0.55), p < 0.0001]. For BMI ≥24.0 kg/m2, PCOS patients had a higher GBI [2.91(0.36) vs. 2.38(0.59), p < 0.01] but a lower percentage of severe periodontal disease (p < 0.05). Conclusion PCOS could potentially worsen gingival inflammation among women already suffering from periodontitis, and a higher BMI might further intensify this correlation.

Reconstructive surgical therapy of peri-implant defects with ribose cross-linked collagen matrix and crosslinked hyaluronic acid – a prospective case series

ObjectiveTo investigate the efficacy of ribose-crosslinked collagen (RCLC) matrices functionalized by crosslinked hyaluronic acid (xHya) for reconstructive treatment of class I and III (b-c) peri-implantitis lesions in a transmucosal healing mode.Materials and methodsThirteen patients presenting with 15 implants were included in this prospective case series. Upon flap reflection, the implants were thoroughly decontaminated employing glycine powder air polishing and adjunctive sodium hypochlorite. For defect augmentation, xHyA was administered to the bony defect walls, exposed implant surfaces, and the RCLC matrix before defect grafting. The full-thickness flap was readapted and sutured around the implant neck for transmucosal healing. Baseline and respective values at the 12 months post-op evaluation were recorded for the clinical parameters peri-implant probing depth (PPD), buccal soft tissue dehiscence (BSTD) and bleeding on probing (BoP). Furthermore, two independent investigators analyzed radiographic changes in the defect area. The mean changes for all variables were analyzed with a paired t-test.ResultsThe initial mean PPD was 7.2 ± 1.9 mm, and BoP was present in 63% of sites. After 12 months, PPD at the latest visit was 3.2 ± 0.66 mm, which amounted to a respective 3.9 ± 1.85 mm reduction, while the BoP frequency dropped to 10% at all sites. Radiographic bone fill was accomplished for 62.8% of the former defect area, accompanied by a mean MBL gain of 1.02 mm around the treated implants (all p < 0.001).ConclusionsWithin the limits of this case series, we conclude that the proposed treatment sequence substantially improved peri-implant defects and offered a simplified but predictive technique.Clinical relevanceReconstructive treatment approaches for peri-implantitis are effective but remain non-superior to open flap debridement. Further research on novel biomaterial combinations that may improve reconstructive treatment outcomes are warranted. Ribose-crosslinked collagen matrices biofunctionalized by hyaluronic acid used in this study yield improved clinical and radiographic peri-implant conditions after 12 months.Graphical

Behçet's disease modifies the gingival inflammatory response.

Behçet's disease (BD) pathogenesis involves severe outcomes such as blindness, central nervous system manifestations, and deep venous thrombosis that impacts systemic and local inflammatory changes. We tested the hypothesis that BD negatively affects gingival health and increases the severity of gingivitis. The study included 37 BD patients with gingivitis without any sign of periodontitis. Systemically healthy 19 patients with gingivitis (G) and 20 periodontally and systemically healthy individuals (C) were recruited as controls. BD patients were further grouped as stable and unstable based on their responses to BD treatment. Clinical periodontal parameters were measured to determine the impact of BD on gingival health. Serum and saliva levels of ELA-2 (neutrophil elastase-2), SLPI (secretory leukocyte protease inhibitor), α1-AT (alpha1-anti-trypsin), VEGF (vascular endothelial growth factor), IL-6 (interleukin-6), IL-8 (interleukin-8), and TNF-α (tumor necrosis factor alpha) were analyzed using multiplex immunoassay to measure the systemic and local inflammatory impact of BD. Plaque index (PI), probing pocket depth (PPD), and bleeding on probing (BOP) were significantly higher in the BD group than in the controls (p<0.05). IL-6 was higher in both serum and saliva in the BD group than in the G group (p<0.05). ELA-2 levels in saliva were higher in the stable BD group than in the controls, while TNF-α and SLPI were statistically significantly higher in BD than in the control (p<0.05). Salivary α1-AT level was statistically lower in the BD group compared to the control group. Our study suggested that the gingival inflammatory profile was impaired in patients with BD.

Similar short-term outcomes for bone-level implants with or without intermediate abutments.

A single-center (university-setting), prospective, longitudinal, split-mouth, single-blind, randomized controlled clinical trial investigated peri-implant parameters of bone-level implants restored with either screw-retained prostheses connected directly to the implants or with intermediate abutments over a 3-year period. The study adhered to the ethical principles of the Helsinki Declaration and the CONSORT guidelines. Ethical approval was granted, and the trial was registered at Clinicaltrials.gov . Participants included were over 18 years of age, had a plaque index below 25%, and were missing at least two adjacent teeth, allowing for rehabilitation with screw-retained fixed partial prostheses over two implants and 2-4 prosthetic units. Exclusion criteria included long-term use of medications affecting bone metabolism, smoking more than 10 cigarettes per day, history of local radiotherapy, untreated periodontitis, and the need for rehabilitation in the anterior sextant of the maxilla. The primary clinical outcome was marginal bone loss (MBL), while secondary outcomes included probing pocket depth (PPD), plaque index (PI), bleeding on probing (BOP), and patient-reported outcomes (PROs). The study schedule included a screening (visit 1), implant surgery (visit 2), stage-two 8 weeks post-surgery (visit 3), impressions taken 4 weeks post stage-two (visit 4), baseline standardized radiograph (visit 5), followed by 6-month (visit 6), 12-month (visit 7), and 36-month (visit 8) follow-up visits. Descriptive statistics and quantitative measures included means, standard deviations (SDs), minimum and maximum values, and 95% confidence intervals (CIs). Clinical parameters (six sites per implant) measured were MBL, PPD, PI, and BOP. Paired t tests were utilized for intragroup comparisons across different time points and intergroup comparisons at each time point. PROs at 36 months were compared using Student's t test. The alpha significance level was set at 0.05. The study included 36 patients (72 implants), with two not completing the follow-up due to death and relocation. No implants showed signs of inflammation or mobility. Mean interproximal bone level (IBL) at baseline was 0.13 mm ± 0.15 mm for the control group and 0.10 ± 0.13 mm for the test group. At the 36-month follow-up, mean IBL was 0.13 ± 0.18 mm for the control group and 0.20 ± 0.24 mm for the test group, with no significant differences (F(1, 32) = 1.06; p > 0.05). Clinical parameters (PPD, BOP, PI) at 36 months showed no significant differences between groups. Minor complications occurred in 6.7% of the control group and 5.3% of the test group. PROs indicated no significant differences in general satisfaction, esthetics, comfort, phonetics, and masticatory function between the groups. After a 36-month follow-up, bone-level implants restored with CAD/CAM prostheses directly connected to the implants displayed similar clinical outcomes, PROs, and marginal bone level changes as those restored with intermediate standardized abutments.

Guided biofilm therapy versus conventional protocol—clinical outcomes in non-surgical periodontal therapy

BackgroundThe aim of the randomized controlled clinical trial study was to evaluate the effectiveness in reducing pathologically increased pocket probing depths (PPD > 3 mm) using the Guided Biofilm Therapy (GBT) protocol (adapted to the clinical conditions in non-surgical periodontal therapy (NSPT): staining, air-polishing, ultrasonic scaler, air-polishing) compared to conventional instrumentation (staining, hand curettes/sonic scaler, polishing with rotary instruments) both by less experienced practitioners (dental students).MethodsAll patients were treated according to a split-mouth design under supervision as diseased teeth of quadrants I/III and II/IV randomly assigned to GBT or conventional treatment. In addition to the treatment time, periodontal parameters such as PPD and bleeding on probing (BOP) before NSPT (T0) and after NSPT (T1: 5 ± 2 months after T0) were documented by two calibrated and blinded examiners (Ethics vote/ Trial-register: Kiel-D509-18/ DRKS00026041).ResultsData of 60 patients were analyzed (stage III/IV: n = 36/ n = 24; grade A/ B/ C: n = 1/ n = 31/ n = 28). At T1, a PPD reduction of all diseased tooth surfaces was observed in 57.0% of the GBT group and 58.7% of the control group (p = 0.067). The target endpoint (PPD ≤ 4 mm without BOP) was achieved in 11.5% for GBT (conventional treatment: 11.2%; p = 0.714). With the exception for number of sites with BOP, which was at T1 15.9% in the GBT group and 14.3% in the control group (p < 0.05) no significant differences between the outcomes of the study were found. At 30.3(28.3) min, the treatment time was significantly shorter in GBT than in the control group at 34.6(24.5) min (p < 0.001).ConclusionsWith both protocols (GBT/ conventional instrumentation) comparably good clinical treatment results can be achieve in NSPT in stage III-IV periodontitis patients.Trial registrationThe study was registered before the start of the study and can be found under the number DRKS00026041 in the German Clinical Trials Register. The registration date was 19/08/2021.