Clinical Attachment Level Gain Research Articles

Efficacy of Guided Tissue Regeneration Using Frozen Radiation-Sterilized Allogenic Bone Graft as Bone Replacement Graft Compared with Deproteinized Bovine Bone Mineral in the Treatment of Periodontal Intra-Bony Defects: Randomized Controlled Trial

(1) Background: The aim of this study was to compare the clinical and radiographic outcomes of guided tissue regeneration (GTR) using two biomaterials as bone replacement grafts in the treatment of periodontal intra-bony defects. (2) Methods: Using a split-mouth design, 30 periodontal intra-bony defects were treated with either frozen radiation-sterilized allogenic bone grafts (FRSABG tests) or deproteinized bovine bone mineral (DBBM, controls) combined with a bioabsorbable collagen membrane in 15 patients. Clinical attachment level gains (CAL-G), probing pocket depth reductions (PPD-R), and radiographic changes in linear defect fill (LDF) were evaluated 12 months postoperatively. (3) Results: The CAL, PPD, and LDF values improved significantly in both groups 12 months after the surgery. However, in the test group, the PPD-R and LDF values were significantly higher compared to the controls (PPD-R 4.66 mm versus 3.57 mm, p = 0.0429; LDF 5.22 mm versus 4.33, p = 0.0478, respectively). Regression analysis showed that baseline CAL was a significant predictor for PPD-R (p = 0.0434), while the baseline radiographic angle was a predictor for CAL-G (p = 0.0026) and LDF (p = 0.064). (4) Conclusions: Both replacement grafts when used for GTR with a bioabsorbable collagen membrane yielded successful clinical benefits in teeth with deep intra-bony defects 12 months postoperatively. The use of FRSABG significantly enhanced PPD reduction and LDF.

Vertical soft tissue augmentation to treat implant esthetic complications: A prospective clinical and volumetric case series.

Challenging implant esthetic complications are often characterized by implant malpositioning and interproximal attachment loss of the adjacent teeth. However, limited evidence is available on the treatment of these conditions. The aim of this study was to evaluate the clinical, volumetric, and patient-reported outcome following treatment of peri-implant soft tissue dehiscences (PSTDs) exhibiting interproximal attachment loss on adjacent teeth, performed through vertical soft tissue augmentation with implant submersion. Ten subjects with isolated PSTD in the anterior maxilla characterized by adjacent dentition exhibiting interproximal attachment loss were consecutively enrolled and treated with horizontal and vertical soft tissue augmentation, involving crown and abutment removal, two connective tissue grafts, and submerge healing. Clinical outcomes of interest included mean PSTD coverage, mean PSTD reduction, clinical attachment level (CAL) gain at the implant and adjacent sites and soft tissue phenotype modifications at 1 year. Optical scanning was used for assessing volumetric changes. Professional assessment of esthetic outcomes was performed using the Implant Dehiscence coverage Esthetic Score (IDES), while patient-reported esthetic assessment involved a 0-10 visual analogue scale. The mean PSTD depth reduction and mean PSTD coverage at 1 year were 2.25 mm, and 85.14%, respectively. A mean keratinized tissue width (KTW) gain of 1.15 mm was observed, while the mean gain in mucosal thickness (MT) was 1.58 mm. A mean CAL gain of 1.45 mm was obtained at the interproximal aspect of the adjacent dentition at 1 year. Greater linear dimensional (LD) changes were observed at the midfacial aspect of the implant compared to the interproximal sites. The mean final IDES was 6.90 points, while patient-reported esthetic evaluation was 8.83 points. The present study demonstrated that vertical soft tissue augmentation with a submerged healing is an effective treatment approach for the treatment of challenging PSTDs with adjacent dentition exhibiting interproximal attachment loss. This technique can be effective in resolution of esthetic complications in most cases, providing a substantial gain in interproximal attachment levels at the adjacent dentition.

Clinical evaluation of periosteal pedicle flap in the treatment of gingival recessions for esthetic root coverage: A randomized controlled clinical trial.

Root coverage using subepithelial connective tissue graft (SCTG) is gold standard with few drawbacks such as requirement of second surgical site, reduced donor tissue availability, and increased surgical complications and pain. Periosteal pedicle graft (PPG) due to its rich source of pluripotent stem cells and nonrequirement of second surgical site could be a successful alternative for invasive SCTG. Therefore, current research aims to compare the amount of root coverage obtained with PPG to SCTG. Fifty-two single gingival recessions were included in the sample, with 26 patients allocated to the SCTG (control) and PPG (test) groups at random. At baseline, 3, and 6 months after surgery, clinical measurements of probing depth, clinical attachment level (CAL), recession depth (RD), recession width (RW), and width of keratinized tissue were taken. Both procedures, i.e., SCTG and PPG, resulted in root coverage to a variable extent and a significant decrease in RD (1.69, 1.38 mm in SCTG and PPG groups, respectively) and RW, CAL gain is found in both the groups without any intergroup statistical variance. Complete root coverage (CRC) was obtained in 14 out of 26, i.e., 53.8% defects in both SCTG and PPG groups. A better comfort level is found in the group treated with PPG. Gingival recessions can be successfully treated with PPG, which has predictability comparable to SCTG and does not require a second surgical site.

Radiographic angle width as predictor of clinical outcomes following regenerative periodontal therapy with enamel matrix derivative. A retrospective cohort study with a mean follow-up of at least 10 years.

To assess the association between the baseline radiographic defect angle and the long-term clinical outcomes following periodontal regenerative therapy with enamel matrix derivative (EMD). Baseline periapical radiographs obtained from a cohort of patients treated with periodontal regenerative therapy were digitized and the radiographic angle width between the root surface and the bony wall of the adjacent intraosseous defect was calculated and reported (in degrees). Changes in pocket probing depth (PD) and clinical attachment level (CAL) were assessed and reported (in mm). Clinical outcomes were evaluated at baseline (T0), 6 months following therapy (T1), and at the latest follow-up (T2). Thirty-eight defects in 26 patients enrolled in supportive periodontal care for a mean period of 10.4 years (range 8.0 to 15.5 years) were available for analysis. The mean PD change between T0 and T2 was 2.33 ± 1.66 mm at teeth with a defect angle width < 20 degrees and 0.86 ± 1.66 mm at teeth with a defect angle width > 30 degrees (P = .021). When the baseline radiographic angle width was < 20 degrees the probability of obtaining a CAL gain > 3 mm was 1.5-times higher (95% CI 0.19 to 13.8) at T1 and 2.5-times higher (95% CI 0.40 to 15.6) at T2 compared with defects with a radiographic angle width > 30 degrees. Within their limitations, these results indicate that pretherapeutic measurement of the radiographic defect angle width might provide relevant information on the short-/long-term clinical outcomes following regenerative periodontal therapy with EMD.

Clinical efficacy of hyaluronic acid in the treatment of periodontal intrabony defect: a systematic review and meta-analysis.

This systematic review aimed to evaluate the effects of hyaluronic acid (HA) alone or in combination with any bone substitute for the treatment of intrabony defects (IBDs). Six databases were searched up to April 2022 to find randomized clinical trials comparing the clinical effects of open flap debridement (OFD) + HA versus OFD alone (first group) or OFD + HA + bone substitutes versus OFD + bone substitutes (second group) in the treatment of IBDs with a follow-up of at least 3months. Random effects models of mean differences were used to determine the clinical attachment level (CAL) gain, probing depth (PD) reduction, and radiographic bone fill (RBF). Of the 276 studies identified, 6 were included in the qualitative synthesis, and 5 in the meta-analyses. The meta-analyses in the first group showed a statistically significant differences for CAL gain (mean difference [MD]:1.00; 95% confidence interval [CI]:0.65 - 1.35; n = 2) and PD reduction (MD: 0.76; 95%CI: 0.34 - 1.17; n = 2) favoring HA + OFD at 6months. However, in the second group, the meta-analyses did no show additional effect of HA in association with bone substitute was demonstrated for either CAL gain (MD: 0.57; 95%CI: - 0.30 - 1.43; n = 2) or PD reduction (MD: 1.05; 95%CI: - 0.38 - 2.47; n = 2) but did show significant differences for RBF (MD: 0.57; 95%CI: 0.15 - 0.99; n = 2) at 12months. Compared with OFD alone, local application of HA in the treatment of IBDs provided a significant CAL gain and PD reduction at 6months. However, its combination with bone substitutes showed no statistically significant differences at 12months. The use of OFD + HA improves the CAL and PD in the treatment of IBDs compared to OFD only after 6months of follow-up. These results are not maintained after 12months.

Intramarrow penetration synergized with advanced platelet-rich fibrin in periodontal regeneration: A randomized controlled trial.

Intramarrow penetration (IMP) is one of the recent treatment protocol where decortication is performed to stimulate osteogenic cells. IMP improves the blood supply and the inherent osteogenic properties of the vital bone and has the advantages of minimal surgical invasion, time, and cost. Incorporation of IMP in the regeneration of periodontal defects is very scarce. Hence, the present study aimed to evaluate the involvement of IMP and advanced platelet-rich fibrin (A-PRF) in the regenerative outcomes in the treatment of intrabony defects. In the present randomized controlled trial, 20 periodontitis patients with 20 defects were randomly allotted into two groups: group I open flap debridement (OFD) and A-PRF, group II OFD, intramarrow debridement, and A-PRF. Clinical parameters recorded were plaque index (PI), gingival index (GI), and clinical attachment level (CAL) probing depth. Radiographic parameters were defect depth, defect resolution, and change in alveolar crest height. Values were tabulated and subjected to statistical analysis. Paired and unpaired t-tests were performed for intra and intergroup comparisons. P <0.05 was set as statistically significant. Intragroup comparisons showed a significant reduction (P < 0.05) in probing pocket depth, GI, PI, gain in CAL, and greater bone fill in both the groups from baseline to 6 months postoperative. Intergroup comparisons were not statistically significant (P > 0.05). Within limitations, both treatment modalities stand good, but utilization of IMP along with A-PRF results in effective regenerative outcome in intrabony defects because of its stimulation of osteogenic properties.

Efficacy of Acellular Dermal Matrix Versus Connective Tissue Graft for Root Coverage in Patients with Gingival Recession: A Meta-Analysis.

This study aimed to compare the efficacy of acellular dermal matrix (ADM) versus connective tissue graft (CTG) for root coverage in patients with gingival recession. Randomized controlled trials (RCTs) on the comparison of ADM with CTG in adult patients with gingival recession were searched in multiple databases updated on 15th May 2020. The quality of studies was evaluated using the upgraded Jadad scale. Included studies were assessed for percent root coverage (PRC), clinical attachment level (CAL), keratinized tissue (KT), probing depth (PD), recession width (RW) and recession depth (RD). Weighted mean difference (WMD) was used as the statistics for measurement data and the effect sizes were expressed as 95% confidence intervals (CI). Totally 24 RCTs were eligible for the final analysis. The patients accepting ADM had a higher gain in CAL (WMD: 0.250, 95%CI: 0.030-0.470, P=0.026) but a smaller gain in KT width (WMD: -0.440, 95%CI: -0.629--0.252, P<0.001) than those receiving CTG. No significant differences were found between the patients accepting ADM and those undergoing CTG in PRC (WMD: -1.608, 95%CI: -3.491-0.275, P=0.094), PD (WMD: 0.066, 95%CI: -0.005-0.137, P=0.067), RW (WMD: 0.065, 95%CI: -0.098-0.228, P=0.437) and RD (WMD: 0.109, 95%CI: -0.095-0.314, P=0.294). Overall, the ADM treatment for patients with gingival recession may be superior to CTG in gaining CAL, but CTG has a significant advantage over ADM in gaining KT width.

Clinical Effects of Scaling and Root Planing in Treatment of Patients with Amlodipine Induced Gingival Overgrowth

Introduction: A multifactorial condition characterised by an increase in size is called gingival enlargement. Most common form is drug induced gingival enlargement. Different treatment options to manage gingival overgrowth are categorised as non-surgical approach and surgical approach. Non-surgical mechanical periodontal treatment is gold standard of periodontal therapy and first recommended approach to control of periodontal infections. Objective: To determine clinical effect of scaling and root planing (SRP) in treatment of patient with amlodipine induced gingival overgrowth. Methods: A pretest post-test study was conducted from January 2021 to December 2021 among 19 subjects recruited by conveniencesampling who exhibited amlodipine induced gingival overgrowth of grade 1-2 (Miller’s and Damm index). The probing depth (PD) ≤7mm and clinical attachment level (CAL) ≤4 mm were evaluated on upper and lower anterior teeth on labial aspect, before and after SRP at one month, three months, and six months. Plaque index (PI), Gingival index (GI) were also evaluated before and after SRP at one month, three months, and six months. Results: Statistically significant reduction was found in terms of GOS, PD, gain in CAL, PI, GI after treatment with SRP at one month, three months, and six months. However, results were not statistically significant in intragroup comparison post-treatment at one month, three months, and six months in terms of CAL, GI, and PI. Conclusions: Scaling and root planing, has showed significant improvement in reduction of gingival overgrowth, probing depth, clinical attachment level, plaque index and gingival index as compared to pretreatment.

EFFECTIVENESS OF PLATELET- RICH FIBRIN WITH BETA TRI-CALCIUM PHOSPHATE PLUS CALCIUM SULFATE ON PERIODONTAL INTRABONY DEFECT MANAGEMENT (RANDOMIZED CONTROLLED CLINICAL STUDY)

The purpose of this study is to evaluate the effectiveness of beta tri-calcium phosphate plus calcium sulfate mix, with or without platelet rich fibrin in reducing probing periodontal pockets clinically and defect depths radiographically, while increasing clinical attachment levels to reconstruct intrabony defects in human clinical trials. Materials and Methods: Sixteen participants with periodontal intrabony defects ≥ 5 mm were divided into two equal groups. The first eight intrabony defects in study group received platelet rich fibrin mixed with EthOss ®; while the eight remaining intrabony defects in control group were reconstructed only with EthOss® synthetic bone substitute. Freidman ANOVA and Mann-Whitney tests were chosen for intra-group and inter-group comparisons, respectively. Results: Final outcomes revealed statistically significant decrease in periodontal pocket depth and defect depth values (P ˂ 0.05) with a statistically significant clinical attachment level gain in study and control groups. Precisely, mean values of all measured categories were greater in study rather than control group participants, as confirmed clinically by William’s probe and radiographically by cone-beam computed tomography at 6 months after surgery. Conclusion: Adding PRF to β-TCP plus CS is highly effective in inducing new periodontal soft and hard tissue synthesis resulting in better clinical and radiographic outcomes when surgically incorporated in periodontal intrabony defect(s).

Comparative Evaluation of Injectable Platelet Rich Fibrin (I-PRF) with DFDBA and Titatium Prepared Platelet Rich Fibrin (T-PRF) with DFDBA In The Treatment of Infrabony Defects In Chronic Periodontitis Patients - A Clinico-Radiographical Study

Objectives: The main objective of this study was to evaluate the efficacy of Titanium prepared platelet-rich Fibrin (T-PRF) and Injectable Platelet Rich Fibrin (I-PRF) with demineralized freeze-dried bone allograft (DFDBA) in order to improve the clinical and radiographic results obtained in treatment of periodontal infrabony defects.&#x0D; Materials and Methods: This split-mouth randomized controlled clinical trial was conducted on 30 subjects with two comparable bilateral infrabony defects. Plaque Index(PI), Gingival Index(GI) Clinical attachment level (CAL), Periodontal Pocket depth (PD), as well as radiographic parameters IOPA including the radiographic defect size, were measured at six months post-operatively.&#x0D; Results: The mean reductions in PD and CAL were 4.0±0.77 mm and 2.5±0.68 mm in sites treated with I-PRF+DFDBA, respectively (P&lt;0.05); these reductions were 4.2±0.86 mm and 3.1±0.62 mm, respectively in T-PRF+DFDBA group (P&lt;0.05). Radiographic evaluation revealed reduction in the radiographic defect size in the I-PRF+DFDBA and T-PRF+DFDBA sites. Statistically, there were no significant differences between the two treatment modalities.?&#x0D; Conclusion: This study showed that both treatments resulted in significant improvement in the probing depth reduction, clinical attachment level gain and radiographic size of the infrabony defect at six months after surgery. I-PRF with DFDBA membrane in treatment of infrabony osseous defect showed more defect fill followed by T- PRF along with DFDBA membrane.

Comparative evaluation of demineralized freeze-dried bone allograft with and without concentrated growth factor membrane in the treatment of periodontal intrabony defects: a randomized controlled clinical trial.

The current study's aim was to evaluate and compare demineralized freeze-dried bone allograft (DFDBA) with and without concentrated growth factor (CGF) membrane in the treatment of periodontal intrabony defects on both a clinical and radiographic level. 30 stage III grade B periodontitis patients with bilateral intrabony defects were involved in the split mouth randomized controlled trial, and they received either DFDBA alone (control group) or DFDBA plus CGF membrane treatment (test group). At baseline and 6 and 12months, the gingival index (GI), plaque index (PI), probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession (GR) were assessed, whereas cone beam computed tomography was used to assess the bone defect height (BDH), vertical bone loss (VBL), bone defect depth (BDD), mesio-distal bone defect width (MDBDW), bucco-lingual bone defect width (BLBDW), and bone defect volume (CBCT) at baseline and 12months. The radiographic measures BDH, BDD, MDBDW, BLBDW, and BDV in the test group likewise showed a higher reduction in PPD and gain in CAL than the control group. The results of the intergroup comparison showed that the test group had statistically significant differences in BDH, BDD, and MDBDW. The data show that the test group achieved better results, with greater reductions in PPD, gains in CAL, and decreases in BDH, BDD, MDBDW, BLBDW, and BDV. The use of concentrated growth factor in conjunction with demineralized freeze-dried bone allograft may be suggested for the treatment of periodontal intrabony defects.

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.

Five-year results following regenerative periodontal surgery with an enamel matrix derivative in patients with different smoking status.

To evaluate the five-year results following regenerative periodontal surgery of intrabony defects using an enamel matrix derivative (EMD) in patients with different smoking status. The dental records of patients treated with regenerative periodontal surgery with EMD between 2001 and 2011 were screened. The clinical parameters at baseline (T0) and 6 months (T1) and 5 years (T2) after surgery were collected and analyzed in relation to patient's smoking status (smokers, former smokers, and nonsmokers). A total of 71 sites were initially assessed in 38 patients. In total, 56 sites could be evaluated at T1, and 34 after 5 years (T2). At 6 months after surgery, a statistically significant mean probing pocket depth (PPD) reduction of 2.91 ± 1.60 mm and a mean clinical attachment level (CAL) gain of 1.89 ± 1.90 mm were measured. Nonsmokers revealed a greater, statistically not significant CAL gain compared to smokers (2.38 ± 2.12 mm vs 1.50 ± 1.71 mm). Although at 5 years the site-specific PPD values remained stable in nonsmokers, smokers showed an increase of 1.60 ± 2.41 mm. The present study provides evidence that regenerative periodontal surgery with EMD may lead to clinically relevant improvements even in smoking patients. However, the positive effect of EMD seems to be limited in time and can only partially compensate for the negative influence of smoking.

Evaluation of Propolis Gel in Two Different Polymeric Systems as an Adjunctive Aid to Non-Surgical Therapy in the Management of Stage III Grade B Periodontitis: A Randomized Clinical Trial

Background: The goal of this study was to clinically evaluate the effect of propolis gel in different polymeric systems as an adjunct to non-surgical therapy in the management of periodontitis patients. Methods: A total of 30 patients with stage III grade B periodontitis were divided into the following three groups: group I patients, who received propolis in a chitosan polymer gel with non-surgical therapy, group II patients, who received propolis in a polyox polymer gel with non-surgical therapy, and group III patients who served as a control treated with non-surgical therapy only. Clinical parameters were assessed at baseline, one month, and three months. Results: At three months, the mean gingival index (GI) of groups I and II was the same (0.6 ±0.52), and there was no change in the mean GI in group III. There was a reduction in the mean probing depth (PD) in group I (4.80 ±0.63) and group II (4.90 ±0.74) at the end of the study. The greatest percent gain in clinical attachment level (CAL) was noted in group II (17.26 ±6.71) followed by group I (5.93 ±9.87), whereas the least percent decrease was noted in group III (3.67 ±7.77). Conclusion: The adjunctive use of propolis in a polyox polymer with non-surgical therapy demonstrated superior clinical results over the use of propolis in a chitosan polymer in periodontitis patients.

Evaluation of a Novel Local Drug Delivery System Containing Tetracycline Hydrochloride Microparticles as an Adjunct to Mechanotherapy in the Management of Chronic Periodontitis

Background: Tetracycline hydrochloride is a primarily used antimicrobial for periodontitis. Due to its limitations when used systemically, local application in the subgingival zone is encouraged. The local concentration of the drug can be maximized further by optimizing its delivery vehicle. Aim and Objectives: The aim was to compare and assess the efficacy of novel drug formulation containing tetracycline microparticles with commercially available tetracycline fibers as local drug delivery agents in patients with chronic periodontitis. Materials and Methods: A total of 10 patients in the age group of 23–53 years with chronic periodontitis were selected. Patients having isolated periodontal pockets with probing pocket depth (PPD) &gt;5 mm were selected. They were randomized into Group A (scaling and root planning [SRP] + tetracycline microparticles) and Group B (SRP + tetracycline fibers). Clinical parameters such as plaque index, gingival index, probing pocket depth (PPD), and clinical attachment level (CAL) were recorded at 0 and 90 days. The data obtained were consolidated and subjected to statistical analysis. Results: Both the groups confirmed statistically significant improvement in all the clinical parameters. Results of the study showed enhanced CAL gain in Group A compared to Group B. Conclusion: The novel drug formulation is equally efficacious to the commercially available formulation, with decreased manufacturing cost and greater drug availability. Nevertheless, more clinical trials are necessary to study the long-term results.

Efficacy of Proanthocyanidins in Nonsurgical Periodontal Therapy

BackgroundThe aim of this work was to evaluate the efficacy of proanthocyanidins (PACNs) as an adjunctive periodontal therapy in patients with periodontitis. MethodsPatients with periodontitis (stage III–IV) were included in this randomised clinical study. Patients with periodontitis received 2 different treatment modalities: minimally invasive nonsurgical therapy only (MINST group) or minimally invasive nonsurgical therapy and subgingival application of collagen hydrogels with PACNs (MINST + PACNs group). Clinical periodontal parameters, that is, pocket probing depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP), plaque index (PI), were evaluated before treatment and after 8 weeks. Concentrations of immunologic markers, matrix metalloproteinase-3 (MMP-3), and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) in saliva were assessed at baseline and at 8-week follow-up. ResultsForty-six patients diagnosed with periodontitis were randomised into 2 groups: 23 patients in the MINST group and 23 patients in the MINST + PACNs group received the intended treatment. PACNs combined with MINST resulted in additional statistically significant PPD reduction and CAL gain in moderate periodontal pockets by 0.5 mm (P < .05) on average compared to MINST alone. Additional use of PACNs did not result in additional statistically significant improvement of BOP or PI values. Application of PACNs showed significant reduction of MMP-3 levels in saliva after 8 weeks (P < .05). ConclusionsAdjunctive use of PACNs in MINST resulted in better clinical outcomes for moderate pockets. Additional use of PACNs improved MMP-3 concentration in saliva more than MINST alone. Biochemical analysis revealed that MMP-3 concentration in saliva reflected the periodontal health state.

Combined Regenerative and Mucogingival Treatment of Intraosseous Defects with Buccal Gingival Recession: A Case Series

&lt;p&gt;Abstract: Regenerative surgery is an effective treatment of intraosseous defects, however, subject with thin gingival tissue phenotype and bone dehiscence defect tends to have more post-surgery gingival recession. The gingival recession is considered as soft tissue loss, which may affect the result of periodontal regeneration. Therefore, this case series aimed to describe a periodontal regenerative surgery combined with subepithelial connective tissue graft (SCTG) in intraosseous defects associated with buccal gingival recession would make periodontal regeneration more predictable. Materials and Methods: The case series describes a surgical approach to improve regenerative parameters in deep intraosseous defects associated with buccal gingival recession. Teeth with buccal bone dehiscence or furcation involvement were included. The surgical technique consisted of an SCTG placed on the buccal dehiscence defect or furcation area to thicken the soft tissue wall, then treated with enamel matrix derivative and biomaterials as regenerative scaffolds inside the intraosseous component of the defect. Results: In all cases, there were buccal gingival margin thickness increased, significant clinical attachment level gain, bone level gain, reduced probing pocket depth, and partial root coverage at least one year after the surgery. The radiographs demonstrated increased bone density of the deep intraosseous defects associated with buccal gingival recession in both single root and furcation-involved teeth. Conclusion: The combination of regenerative treatment and SCTG in intraosseous defects associated with buccal gingival recession in a single root or furcation-involved molar supports the stability of the gingival profile and improves root coverage outcome as well as periodontal regeneration.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Smoking negatively impacts the clinical, microbiological, and immunological treatment response of young adults with Grade C periodontitis.

This study aimed to investigate the influence of smoking on clinical, microbiological and immunological parameters in young adult with stage III-IV Grade C periodontitis after full-mouth ultrasonic debridement (FMUD) associated with Amoxicillin and Metronidazole (AMX + MTZ), comparing smokers (PerioC-Y-Smk) with non-smokers (PerioC-Y-NSmk). Fifteen PerioC-Y-NSmk and 14 PerioC-Y-Smk patients underwent FMUD associated with AMX + MTZ for 10 days. All parameters were collected at baseline and 3 and 6months after treatment. Plaque index (PI), bleeding on probing (BoP), probing depth (PD), clinical attachment level (CAL)- the primary variable-, and gingival recession (GR) were clinically assessed. The impact of PI on CAL change at 6-month was verified by a regression analysis. Samples of the subgingival biofilm was collected for detection of levels of Aggregatibacter actinomycetemcomitans (A.actinomycetemcomitans), Porphyromonas gingivalis (P.gingivalis), Tannerella forsythia (T.forsythia), and Fusobacterium nucleatum ssp (F.nucleatum), and were analyzed by real-time qPCR; gingival crevicular fluid was collected for detection of levels of interleukin (IL)-1β, IL-4, IL-6, IL-10, tumor necrosis factor (TNF)-α, and interferon (IFN)-γ, which were analyzed using an enzyme immunoassay. PerioC-Y-Smk had significantly higher PI, BOP, and GR at baseline compared to non-smokers (p< .05). PerioC-Y-Smk presented higher PD, CAL, and GR at 3 and 6months (p<.05) compared with PerioC-Y-NSmk in the same periods; PI negatively affected CAL gain in PerioC-Y-NSmk at 6-month follow-up (p=.052) and did not impact on clinical response in PerioC-Y-Smk (p=.882). Lower levels of IFN-γ, IL1-β, and IL-4 were observed at 3months in the PerioC-Y-NSmk (p<.05) compared with PerioC-Y-Smk. Lower proportions of P.gingivalis were observed in PerioC-Y-NSmk at baseline and at 3months (p<.05) and lower proportions of F.nucleatum were observed at 6months, in the PerioC-Y-NSmk (p<.05). PerioC-Y-Smk presents an unfavorable clinical, microbiological, and immunological response after 3 and 6months after FMUD associated with AMX + MTZ. Smoking worsens periodontal condition of young treated adults presenting stage III/IV Grade C periodontitis.

Local Drug Delivery of Aloe Vera Gel in Chronic Periodontitis Patient.

BACKGROUND- Since historical times, for both medical and dental therapy many herbal agents, like Aloe vera (AV), have been used. Aloe vera (AV) belonging to the Liliaceae Family, presents with anti-inflammatory, antioxidant, antibacterial, antiviral, antifungal and immune boosting properties. It also promotes wound healing by accelerating epithelial cell migration and collagen maturation, facilitating tissue restoration. This study aims at investigating the clinical effectiveness of locally delivered AV gel used as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis (CP).MATERIAL AND METHODS: Sixty patients with probing depth (PD) ≥5mm and clinical attachment (CA) level ≥3mm were randomly divided into two groups. All patients underwent SRP. Aloe Vera gel was locally delivered in Group 1 patients and Placebo in Group 2 patients. Clinical recording of full mouth plaque index (PI), bleeding index (BI), probing depth (PD) and clinical attachment (CA) level was done first at baseline and then at intervals of 3 months and 6 months.RESULT: Patients in AV group showed significantly greater mean reductions in PI, BI and PD and mean gain in CA level compared to those in placebo group from baseline to 3 months. Gain in CA level was significantly greater in AV group at all time intervals than the placebo group.CONCLUSION: Adjunctive use of AV gel LDD, in comparison to placebo gel LDD, is associated with greater reduction in PI, BI and PD as well as more gain in CA level in patients with CP.

Complications and treatment errors in periodontal and implant therapy.

The assortment of periodontal and implant-related treatments has been continuously improved over the last 50 years. Once the decision-making process has been established and the treatment procedure applied, the partial or complete resolution of the problem (eg, periodontal probing depth reduction, clinical attachment level gain, gingival recession reduction, dental hypersensitivity decrease) and a diagnosis change with no or minimal occurrence of adverse events (ie, complications, harms, technical errors, or adverse/side effects) can be expected. The clear identification of the potential types of adverse effects, complications, or even errors is important for contemporary decision-making processes, as they may be related to different local, systemic, and technical aspects. This chapter focused on four core components: (a) providing periodontal definitions for errors, complications, harms, and side effects; (b) defining the types of risk and the clinical impact of adverse effects, errors, and complications in periodontal and peri-implant therapies; (c) evaluating the influence of accidental errors versus the lack of a proper treatment planning; and (d) reporting on the importance of establishing the "net benefit ratio" between the clinical improvements promoted by the therapy and the occurrence of potential adverse events.