Clinical Attachment Loss Research Articles

Assessing Periodontal Health in Tobacco Users: A Salivary Analysis

Background: The risk of periodontal disease is considered to be high among tobacco users compared to those not consuming tobacco in any form. A rise in salivary enzyme levels reflects the destruction of healthy tissues, making it a potential clinical biomarker. Thus, the aim was to assess periodontal health and examine salivary enzyme levels and their correlation with tobacco use. Methods: Unstimulated saliva was collected using a standard protocol from 128 individuals who visited the outpatient department (OPD) of a dental hospital, divided into four groups. Clinical assessment was done using the gingival index (1963) (GI) and the community periodontal index (1982) (CPI). Findings: There was a strong correlation between tobacco use and salivary enzyme levels. Tobacco chewers had the most elevated salivary enzyme levels, followed by smokers and passive smokers. Significant periodontal deterioration presenting as an increase in probing depth and clinical loss of attachment (LOA) was seen among the chewers (3.22±0.87 and 2.16±1.27, respectively) and smokers (3.16±0.80 and 1.63±1.38, respectively), which was more than passive smokers (2.75±0.80 and 0.84±0.30, respectively) and was considered significant between all the groups (P=0.001). Conclusion: Tobacco use in either form affects the severity of periodontal diseases and the levels of salivary enzymes. Thus, salivary enzymes are regarded as reliable biochemical indicators of periodontal tissue damage and can be used as motivators to quit tobacco usage. Additionally, passive smoking was found to have a negative impact on periodontal health and can be considered a risk factor.

Periodontal conditions and salivary microbiota are potential indicators to distinguish silicosis: an exploratory study

BackgroundSilicosis has always been a serious global occupational health problem. Oral microbiota plays important roles in the development of lung disease. However, few studies have investigated the relationship between periodontal conditions, oral bacteria and silicosis disease.MethodA single-center and cross-sectional study was conducted in 2019 in Sichuan Province, China, including a small sample of silicosis patient group and healthy control group. Demographic data and periodontal examinations measured by clinical attachment loss (CAL), bleeding on probing (BOP) and periodontal pocket (PD) were collected from each participant. Phenotypic changes were detected by histopathological staining. Next-generation sequencing targeting 16S ribosomal RNA was targeted to decipher the salivary microbiome of the two groups. Random forest, Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression and multivariable logistic regression analysis were conducted to find potential indicators to distinguish silicosis.ResultsIn general, 29 male healthy controls and 24 male silicosis patients were included. The proportion of CAL ≥ 3 mm in silicosis group was greater than control group, while the proportion of BOP (+) and PD ≥ 4 mm was reduced in silicosis group. The α-smooth muscle actin and fibronectin expression increased in gingiva of patients. The composition of salivary microbiota exhibited significant differences between the two groups, with silicosis patients demonstrating a lower diversity of salivary microbiota. Genus of Aggregatibacter [odds ratio (OR) = 0.000, p = 0.003] and Catonella (OR = 0.000, p = 0.049) were identified as biomarkers to distinguish silicosis.ConclusionsThe silicosis group exhibited worse CAL, improved BOP and PD, which may be related to the gingival fibrosis found in this study. The composition of the oral microbiota underwent significant changes, accompanied by a decrease in diversity, in patients with silicosis. Our study indicates that respirable crystalline silica exposure affects oral health, and alterations of oral microbiota might be implicated in silicosis. We primarily identified Aggregatibacter and Catonella as the potential indicators to distinguish silicosis patients from healthy controls.

The role of the oral microbiota in the causal effect of adjunctive antibiotics on clinical outcomes in stage III–IV periodontitis patients

BackgroundPeriodontitis, a prevalent chronic inflammatory disease, offers insights into the broader landscape of chronic inflammatory conditions. The progression and treatment outcomes of periodontitis are closely related to the oral microbiota’s composition. Adjunctive systemic Amoxicillin 500 mg and Metronidazole 400 mg, often prescribed thrice daily for 7 days to enhance periodontal therapy’s efficacy, have lasting effects on the oral microbiome. However, the precise mechanism through which the oral microbiome influences clinical outcomes in periodontitis patients remains debated. This investigation explores the pivotal role of the oral microbiome's composition in mediating the outcomes of adjunctive systemic antibiotic treatment.MethodsSubgingival plaque samples from 10 periodontally healthy and 163 periodontitis patients from a randomized clinical trial on periodontal therapy were analyzed. Patients received either adjunctive amoxicillin/metronidazole or a placebo after mechanical periodontal treatment. Microbial samples were collected at various intervals up to 26 months post-therapy. Using topic models, we identified microbial communities associated with normobiotic and dysbiotic states, validated with 86 external and 40 internal samples. Logistic regression models evaluated the association between these microbial communities and clinical periodontitis parameters. A Directed Acyclic Graph (DAG) determined the mediating role of oral microbiota in the causal path of antibiotic treatment effects on clinical outcomes.ResultsWe identified clear distinctions between dysbiotic and normobiotic microbial communities, differentiating healthy from periodontitis subjects. Dysbiotic states consistently associated with below median %Pocket Probing Depth ≥ 5 mm (OR = 1.26, 95% CI [1.14–1.42]) and %Bleeding on Probing (OR = 1.09, 95% CI [1.00–1.18]). Factors like microbial response to treatment, smoking, and age were predictors of clinical attachment loss progression, whereas sex and antibiotic treatment were not. Further, we showed that the oral microbial treatment response plays a crucial role in the causal effect of antibiotic treatment on clinical treatment outcomes.ConclusionsThe shift towards a normobiotic subgingival microbiome, primarily induced by adjunctive antibiotics, underscores the potential for microbiome-targeted interventions to enhance therapeutic efficacy in chronic inflammatory conditions. This study reaffirms the importance of understanding the oral microbiome's role in periodontal health and paves the way for future research exploring personalized treatment strategies based on individual microbiome profiles.D_npUcg1WaKKucWMF28BqgVideo

Comparison of different flap designs in soft tissues periodontal healing after lower third molars extraction: a descriptive review

The purpose of this descriptive review was to assess post-operative periodontal outcomes of adjacent molar sites after the extraction of lower third molars, comparing different surgical techniques. The electronic search strategy was conducted on different databases (PubMed, Scopus, and Web of Science) fitting the following selection criteria: clinical human studies (RCTs, retrospective and prospective); studies comparing different flap designs (e.g., envelope, triangular, and trapezoidal flaps) for surgical extraction of lower 3rd molars; studies assessing clinical outcomes of periodontal healing at adjacent molar sites. Studies included had to present a minimum follow-up of 1 month and at least variations of probing pocket depth (PPD) at 2nd molar site between baseline and follow-up. The search strategy considered a total of 148 records: based on the predetermined eligibility criteria, 24 articles were read, and 9 were finally identified. Regarding the primary outcome considered (PPD at 2nd molar site), no significant differences in its reduction between baseline and follow-up were found comparing different flaps designs. However, the greatest clinical attachment loss (CAL) was generally reported using a trapezoidal flap. Considering the heterogeneity of studies included, after 1 to 6 months of follow-up, no substantial evidence can be assumed for or against the use of a particular flap design for the extraction of lower third molars.

A Cross-Sectional Study of Serum Levels of Several Vitamins in Healthy and Unhealthy Periodontal Conditions

Vitamins are examples of micronutrients, which are nutrients needed in very minute quantities. They're crucial to metabolism and keeping tissues working properly. The purpose of this study was to determine whether vitamin deficiencies are associated with an increased risk of periodontitis. There was a total of 110 participants: 55 with chronic periodontitis spread throughout the mouth and 55 periodontally healthy individuals. Clinical parameters that were assessed included: Clinical attachment loss (in millimetres) and gingival index (in millimetres). Vitamin B12, vitamin D, folate, as well as vitamin E levels in serum samples were measured. Also measured were Beta-carotene and Beta-cryptoxanthin levels. The acquired data was aggregated and analysed using statistical programmes. All periodontal status clinical measures in the periodontitis group were statistically significantly different from those in the healthy volunteers group (p < 0.0001). Vitamin A precursors Beta-carotene and Beta-cryptoxanthin, folate, D, vitamins B12, and E, and vitamin E were all significantly lower in the periodontitis group compared to the healthy volunteers, but the difference was only statistically significant for vitamins B12 as well as D (p < 0.05). Finally, we conclude that serum micronutrient levels, particularly those of Vitamin A, Vitamin B12, and Vitamin D, may be modifiable risk factors for periodontal disease. In addition to practicing good dental hygiene on a regular basis, eating a diet rich in the right kinds of vitamins may play a significant part in warding off periodontitis.

The 2018 Classification of Periodontal Diseases: An Observational Study on Inter-examiner Agreement among Undergraduate Students.

The objective of the present observational study was to assess the inter-examiner agreement for the diagnosis of periodontitis using the 2018 CPD among fourth and fifth year undergraduate students. It is hypothesised that there is no difference in the inter-examiner relaibility between fourth- and fifth-year undergraduate students regarding staging and grading periodontal disease using the 2018 Classification of Periodontal Diseases (CPD). All participants received training on the 2018 CPD scheme through a mandatory periodontics course conducted by a periodontist. Documentation for seven deidentified periodontitis patients, comprising medical history, dental history including tooth loss, intra-oral photographs and radiographs, periodontal charts reporting probing depth, plaque and bleeding on probing scores, furcation involvement and clinical attachment loss, was sent via e-mail to undergraduate students. The cases consisted of one sextant, and the participants were instructed to assume the sextant to be a true representation of the entire dentition. Power analysis was done on pilot data, and the level of significance was set at p0.05. The percentage of undergraduate students in the fourth and fifth year that correctly identified the stage of periodontitis according to the 2018 CPD ranged between 28% and 72% and 18.5% and 77.8%, respectively. The percentage of undergraduate students in the fourth and fifth year that correctly identified the grade of periodontitis ranged between 40% and 88% and 51.8% and 92.5%, respectively. The overall staging and grading ranged between 22.8% and 74.1%, and 45.66% and 87.4%, respectively. There was no statistically significant difference between fourth- and fifth-year undergraduate students with regards to assigning the correct diagnoses to case documentation in terms of either stage or grade. Fourth- and fifth-year undergraduate students demonstrated high inter-examiner agreement using the 2018 CPD.

The Impact of Age and Gender on Periodontal Conditions in Iraqi People: A Retrospective Study

Background: Periodontal disease is initially associated with a bacterial infection, such as dental plaque. With aging, the prevalence of periodontal diseases increases, and periodontal destruction in older individuals is due to cumulative damage rather than cumulative rates of devastation. Objective: To assess the effect of gender and age on periodontal health in selected Iraqi populations. Methods: The cross-sectional retrospective study analyzed the periodontal records of patients from October 2021 to June 2023. The study was conducted at the Dentistry Department, Al-Rafidain University College, Baghdad, Iraq. The sample was taken from patients who visited the periodontal department. A total of 508 subjects, with an age range of 10-69 years (35.23±10.25), participated in this study, including 287 males and 221 females. The sample was classified based on age and sex into 5 groups. The clinical evaluation includes plaque index (PLI), gingival index (GI), probing pocket depth (PPD), and clinical attachment loss (CAL). Results: The overall percentage of chronic gingivitis was 53.94%, while the percentage of chronic periodontitis was 46.06%. The 60–69-year-old group reported the highest rate of patients with chronic periodontitis. Additionally, the 10–19-year group showed the highest percentage of patients with chronic gingivitis. Conclusions: The prevalence of chronic periodontitis increases with age, and it is higher among females than males. Clinical periodontal parameters such as plaque index, probing pocket depth, and clinical attachment level are higher in older age groups than in younger age groups.

Men with HIV have increased alveolar bone loss

BackgroundPeriodontal health in men with HIV remains understudied, despite suggestions of associations between HIV infection and gingival pocketing, periodontal attachment loss, and gingival inflammation. As antiretroviral therapy (ART) has improved the quality of life for people living with HIV (PLWH), aging-related risk factors and comorbidities, including periodontitis, have emerged. This study aims to assess alveolar bone height, gingival crevicular fluid (GCF) cytokines, and periodontal disease activity in men with and without HIV.MethodsNinety-three men (50 HIV+, 43 HIV-) aged 35–70 years were recruited from Columbia University Irving Medical Center clinics. Periodontal examination, GCF collection, and intraoral radiographs were collected. Statistical analysis was conducted with t-tests for continuous variables and chi-squared tests for categorical variables.ResultsWhile no significant differences were observed in bleeding on probing, clinical attachment loss and pocket depths, men with HIV exhibited significantly greater alveolar crestal height on radiographs compared to men without HIV (HIV + 3.41+/-1.35 mm, HIV- 2.64+/-1.01 mm; p = 0.004), reflecting greater alveolar bone loss.ConclusionsMen living with HIV demonstrate increased alveolar bone loss compared to those without HIV, possibly mediated by elevated IL6 levels. These results underscore the importance of comprehensive oral health management in PLWH and highlight the need for further research understanding the mechanisms linking HIV infection, cytokine dysregulation, and periodontal health.

Periodontitis and pre-eclampsia among pregnant women in Rwanda: A case-control study.

Several studies have indicated that the presence of periodontitis during pregnancy could increase the risk of developing pre-eclampsia, thereby negatively influencing pregnancy outcomes for both the mother and child. Notably, despite the high prevalence of both periodontitis and adverse pregnancy outcomes in Rwanda, there exists a crucial evidence gap concerning the precise relationship between periodontitis and pre-eclampsia. The aim of this study was to assess the association between periodontitis and pre-eclampsia amongst pregnant women in Rwanda. Employing an unmatched 1:2 case-control design, we studied 52 pre-eclamptic and 104 non-pre-eclamptic pregnant women aged ≥18 years at two referral hospitals in Rwanda. Pre-eclampsia was defined as a systolic blood pressure ≥ 140 and diastolic blood pressure ≥ 90 mm Hg, diagnosed after 20 weeks of gestation and proteinuria of ≥300mL in 24 hours of urine collection. Periodontitis was defined as the presence of two or more teeth with one or more sites with a pocket depth ≥ 4mm and clinical attachment loss >3 mm at the same site, assessed through clinical attachment loss measurement. Bivariate analysis and logistic regression were used to estimate Odds ratio (ORs) and 95% confidence interval. The prevalence of periodontitis was significantly higher among women with pre-eclampsia, compared to pregnant women without pre-eclampsia, at 90.4% and 55.8%, respectively (p< 0.001). Pregnant Women with periodontitis were 3.85 times more likely to develop pre-eclampsia after controlling for relevant confounders (adjusted Odds Ratio [aOR] = 3.85, 95%CI = 1.14-12.97, p<0.05). This study results indicates that periodontitis is significantly associated with pre-eclampsia among pregnant women in Rwanda. These findings suggest that future research should explore whether enhancing periodontal health during pregnancy could contribute to reducing pre-eclampsia in this specific population.

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 proinflammatory 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 semiquantitative food frequency questionnaire. Periodontal health was assessed through periodontal parameters including bleeding on probing, probing depth, and clinical attachment loss. 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 = .006), which remained significant in the fully adjusted model (adjusted OR: 2.30; 95% CI: 1.21, 4.37; P = .011). In conclusion, elevated DII scores are associated with an increased risk of periodontitis, underscoring the crucial role of a proinflammatory 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.

Effect Modification by Obesity on Nonsurgical Periodontal Treatment.

Obesity is associated with increased periodontal disease prevalence and incidence. This retrospective cohort study examined whether body mass index (BMI) is an effect modifier of periodontal treatment outcomes in patients attending an urban dental school clinic. Data were extracted from electronic health records of 344 patients at a large urban dental school clinic who had at least 1 tooth with a probing pocket depth (PD) ≥5 mm at baseline and who subsequently received nonsurgical periodontal treatment. BMI was computed from self-reported weight and height and categorized as obese (≥30 kg/m2), overweight (25-29.9 kg/m2), or healthy (18-24.9 kg/m2). The primary treatment outcome of interest was defined as having no teeth with PD ≥5 mm in a quadrant on follow-up after nonsurgical periodontal therapy. That outcome was considered to represent treatment success in this study. Secondary outcomes included changes in mean PD and clinical attachment loss (CAL). Analyses included 879 treated quadrants among 344 patients (185 males, 159 females; mean age 49 ± 12 y at baseline; mean posttreatment follow-up of 6 ± 2 mo). Clinical outcomes in patients who were overweight or obese were compared to healthy-weight patients using generalized linear models for binary or continuous outcomes, accounting for clustering within patients. Covariates were age, gender, tobacco use, history of diabetes, insurance type, and number of baseline sites ≥5 mm. Obesity was associated with a significantly lower likelihood of successful nonsurgical treatment (odds ratio = 0.47; 95% confidence interval, 0.25-0.88) than healthy weight. Being overweight was not associated with treatment success. Posttreatment reductions in the percentage of sites with pockets ≥5 mm and CAL ≥5 mm were greater in patients with healthy weight as compared to those either overweight or obese. However, posttreatment changes in mean PD and CAL did not differ among the BMI groups. Obesity adversely modifies the effectiveness of nonsurgical periodontal treatment among dental school clinic patients. The results of this study may be used by dental providers to better understand and manage periodontal therapy in patients with obesity. Furthermore, patients will be better informed about their therapeutic options and outcome success.

Root Coverage in Miller's Class 3 Gingival Recession using a Laterally Positioned Flap with Advanced PRF: A Two-year Follow-up Case Report

Introduction: Gingival recession, marked by the apical migration of gingival tissue, presents aesthetic and functional challenges. The laterally positioned flap (LPF) technique, often used for localized root coverage, remains effective, particularly when combined with advanced platelet-rich fibrin (A-PRF). Case Report: A 23-year-old male presented with Miller Class III gingival recession on tooth 41, with clinical attachment loss of 4.5 mm and high frenum attachment. A treatment plan involved the revised LPF technique, A-PRF membrane application, and frenectomy. Surgical Procedure: Following patient consent and scaling, a sulcular incision was made, and flaps were elevated. A-PRF was prepared and placed over the exposed root, with the flap secured by sutures. Post-operative Care: The patient received antibiotics and analgesics, with follow-up at 2 years showing a 4 mm gain in clinical attachment level and complete root coverage. Results: The combination of the LPF technique and A-PRF effectively managed Miller Class III gingival recession, restoring both function and aesthetics. Conclusion: This case underscores the efficacy of using A-PRF with the LPF technique for treating gingival recession, offering a reliable approach for restoring the keratinized gingival zone.

Differences Between Vietnamese Living in Germany and German Periodontitis Patients in Periodontal Conditions and Subgingival Microbiota

Introduction and aimsA number of studies have reported ethnic differences in the prevalence and severity of periodontitis. Such discrepancies could be attributed to disparities in periodontal risk factors, as well as variations in the composition of the subgingival microbiota. Given the substantial Vietnamese population residing in the former German Democratic Republic, the present study aimed to compare the clinical and microbial characteristics of periodontitis patients of Vietnamese Asian origin living in Germany with those of German Caucasian periodontitis patients. MethodsA total of 60 patients with a minimum stage II periodontitis diagnosis were included in the study. Of these, 30 were of Vietnamese origin, with an average age of 55 years and a male prevalence of 33.3%. The remaining 30 patients were of German origin, with an average age of 54.5 years and a male prevalence of 40%. The periodontal diagnosis was made in accordance with the recently revised classification of periodontal disease. The pooled subgingival plaque samples were subjected to next-generation sequencing on the MiSeq platform (Illumina). ResultsThe German patients were significantly more likely to be smokers (56.7% vs 13.3%), had significantly higher body mass index (26 vs 22.6 kg/m²), probing depth (4.1 vs 3.6 mm), and clinical attachment loss (5 vs 4.1 mm). In terms of microbiota, the Vietnamese patients exhibited significantly lower beta diversity compared to the German patients, and smokers demonstrated a significantly higher beta diversity compared to nonsmokers. The microbiota of both groups differed most significantly in the relative abundance of Porphyromonas gingivalis (Vietnamese) and Fusobacteriia (German). ConclusionsGerman patients with periodontitis showed more severe periodontal symptoms and more pronounced periodontal risk factors compared to Vietnamese patients. Both patient groups also showed significant differences in the subgingival microbiota. Clinical relevanceCompared to Vietnamese living in Germany, German patients have a higher need for periodontal treatment and at the same time the risk factors of smoking and obesity should be reduced. More research is needed before the differences in oral microbiota between the two groups can lead to individualised therapeutic approaches.

Oral Yeasts Carriage in Prediabetic Smokers and Nonsmokers

Habitual smoking and prediabetes are independent risk factors for increased oral yeasts carriage (OYC); however, no studies have compared OYC amongst cigarette smokers and nonsmokers with and without prediabetes. The aim was to fill this research gap. Ninety-two participants were included and categorised into 4 groups: group 1, prediabetic (haemoglobin A1c [HbA1c] levels, 5.7%-6.4%) cigarette smokers; group 2, cigarette smokers without prediabetes; group 3, prediabetic nonsmokers; and group 4, nonsmokers without prediabetes. Patient demographics and HbA1c levels were recorded. Data on duration of smoking habit (pack-years) and family history of smoking were collected. Information on daily toothbrushing and flossing and most recent visit to a dentist/dental hygienist was gathered. Clinical and radiographic periodontal examination was performed and unstimulated whole salivary flow rate (UWSFR) was determined. OYC was assessed using the oral rinse sampling method. Power analysis was done, and group comparisons were performed. Logistic regression analysis was performed and P values <5% reflected statistical significance. Respectively, 23, 24, 22, and 23 individuals with comparable mean ages were included in groups 1, 2, 3, and 4. In groups 1 and 2, participants had a smoking history of (mean ± SD) 24.7 ± 3.2 and 10.6 ± 2.5 pack-years. Plaque index, clinical attachment loss, and probing depth were higher in groups 1 (P < .05), 2 (P < .05), and 3 (P < .05) than in group 4. Number of missing teeth was significantly higher in group 1 compared with groups 2 (P < .05), 3 (P < .05), and 4 (P < .05). There was no difference in UWSFR amongst the groups. OYC was greater in group 1 than in groups 2 (P < .05), 3 (P < .05), and 4 (P < .05). OYC was greater in groups 2 (P < .05) and 3 (P < .05) than in group 4. In prediabetic cigarette smokers, OYC appears to be influenced by hyperglycaemia, whilst in nondiabetic smokers, the severity of periodontal inflammation appears to be the determining factor in OYC.

Horizontal bone augmentation with simultaneous implant placement using ridge splitting with sticky bone

Abstract Introduction A variety of bone grafting techniques had been used to augment horizontally deficient alveolar bone ridges to provide a sufficient bone volume to achieve a correct prosthetic three-dimensional placement of dental implants. Objectives To evaluate clinically and radiographically by cone beam computed tomography the amount of horizontal bone gain by ridge splitting with sticky bone technique for horizontal ridge deficiency with simultaneous implant placement; using piezo-assisted ridge splitting technique with sticky bone graft in patients who had bilateral posterior edentulous sites in the maxillary ridge. Patients and methods Seven patients with seven sites for ridge splitting modality. Each patient had posterior maxillary edentulous areas with horizontal ridge deficiency ranging from 3 to 5 mm. Piezo-assisted ridge splitting technique with simultaneous implant placement was used for augmentation. Patients were evaluated for clinical parameters, including ridge width using a bone caliper, radiographic assessment of marginal bone width and alveolar bone density using cone beam computed tomography, clinical attachment loss, plaque index, bleeding on probing, and pocket depth. Results were obtained at surgery time, 6 months postsurgery, and 18 months postsurgery. Results The was a statistically significant increase in bone width in the studied group. Also, bone density was slightly increased at implant and grafting sites at 6- and 18-months follow-ups. Furthermore, the group showed a statistically significant increase in bone width measured by bone caliper at baseline and at 6 months postsurgically. No significant changes were observed in plaque index, bleeding on probing, or clinical attachment level. Conclusion Ridge splitting with sticky bone surgical technique provides promising clinical and radiographic outcomes.

The Papilla Base CTG: A Novel Approach for Interdental Soft Tissue Reconstruction.

Impairment or loss of interdental papilla is a common issue in patients with periodontal disease, leading to phonetic, functional, and aesthetic concerns. Numerous techniques have been explored to reconstruct and regenerate interdental papillae, but consistent success remains challenging. This article presents a novel surgical approach that applies the principles of the Connective Tissue Graft (CTG) wall technique to enhance papilla volume when interdental clinical attachment loss is present in the aesthetic zone. The case of a 35-year-old woman with an RT3 recession defect associated with loss of interdental hard and soft tissues is discussed. The patient underwent a procedure involving palatal incisions, application of amelogenins, and a trapezoidal shape CTG fixed at the base of the papilla under a coronally advanced flap. This approach aimed to stabilize the blood clot and prevent soft tissue collapse into the defect area, enhancing the position and volume of the interdental papilla. Results at 6- and 12-months follow-up indicated significant improvement in papilla appearance and complete root coverage. This case suggests that the modified CTG wall technique can effectively treat buccal and interdental gingival recessions associated with horizontal or infrabony defects. Further clinical trials are necessary to confirm these findings and establish the most effective approach for interdental papilla reconstruction.

Partial-Full-Thickness Tunnel Technique and Supra-Crestal Sling Suture for Treatment of RT2 and RT3 Gingival Recessions: Technical Report with Two Cases.

The purpose of this technical report is to describe a modified tunnel surgical approach and connective tissue graft (CTG) stabilization technique for the treatment of gingival recessions with interproximal clinical attachment loss (ICAL). The partial-full-thickness (PFT) tunnel technique utilizes multiple vestibular incisions to facilitate creation of a split-mucoperiosteal tunnel that enhances tissue passivity and allows for coronal advancement of soft tissue with minimal tension. The supra-crestal sling (SCS) suture engages only the CTG, independent of the overlying tissue and stabilizes the CTG around the buccal and proximal root surfaces. The treatment approach of PFT tunnel preparation and CTG stabilization with the SCS suture was designed to optimize blood supply and maximize wound stability, resulting in complete root coverage with satisfactory clinical outcomes in RT2 and RT3 gingival recession. It is suggested that the PFT tunnel preparation with graft stabilization via the SCS suture has the potential to treat recessions with anatomical limitations associated with ICAL.

Evaluation of periodontal health among old Indian patients with glaucoma and chronic tonsillitis

Periodontitis, marked by the deterioration of the tissues bordering the surfaces of the teeth, is one of the most prevalent diseases. The presence of pathogenic bacteria, also known as "periopathogens", in the gingival sulcus region is the main cause of periodontitis. Analyzing the relationship between ocular disorders, chronic tonsillitis and periodontitis has been the subject of few investigations. The aim of this study was to evaluate the association between periodontitis, glaucoma and chronic tonsillitis. This study evaluated periodontal health in glaucoma and chronic tonsillitis patients among ageing adults and the elderly population. It was a case-control study in which there was an evaluation of the correlation between periodontitis glaucoma and chronic tonsillitis. 120 clinically diagnosed cases of glaucoma and 120 clinically healthy individuals were taken as controls. 123 cases of clinically diagnosed cases of chronic tonsillitis were taken as controls. In every clinically diagnosed case, there was a thorough periodontal examination by measuring the following parameters. PI: periodontal index. CAL: Clinical attachment loss. BI: Bleeding index. There was a collection of biofilm specimens from the buccal surface of the maxillary first molar, second molar and mandibular anterior for evaluation of colonies of Streptococcus mutans. The specimens were cultured in agar plates. The CFU/ml was calculated. Logistic regression analysis revealed that there was statistically significant difference in values of PI (p&lt;0.001) indicating poor periodontal health in glaucoma patients and chronic tonsillitis patients. There was statistically significant difference in values of BI (p&lt;0.001), indicating increased bleeding from gums in glaucoma patients and chronic tonsillitis patients. In our study there was statistically significant difference in values of CAL indicating increased attachment loss in glaucoma patients and chronic tonsillitis patients. There was statistically significant difference in values of CFUs of Streptococcus mutans in plaque samples indicating increased CFUs of Streptococcus mutans in chronic tonsillitis and glaucoma patients. This study demonstrated the link between periodontitis glaucoma and chronic tonsillitis and offered a potential explanation. To solve this study's shortcomings, more research would be required. Examining individuals with chronic tonsillitis and glaucoma requires determining the oral cavity's state and computing dental indices, of which the periodontal index is crucial. Recommending extensive therapy for patients suffering from periodontitis, glaucoma, and chronic tonsillitis is imperative by ophthalmologists, ENT professionals and periodontists.

Efficacy of different protocols of non-surgical periodontal therapy in patients with type 2 diabetes: A systematic review and meta-analysis.

The aim of the present systematic review of the literature and meta-analysis was to evaluate the efficacy of different protocols of NSPT without any adjunctive therapy in subjects with type 2 diabetes, by considering clinical and patient-centered outcomes. For the purposes of the study randomized controlled clinical trials with more than 3-month follow-up were searched in MEDLINE, EMBASE, and Cochrane Central. Then the articles were screened for inclusion and considered based on the protocols adopted, the outcome measure, follow-up, and the level of glycemic control. A total of 23 articles about 22 studies were included. NSPT was more effective than just oral hygiene measures/no treatment in reducing periodontal probing depth (PPD) and clinical attachment loss (CAL) at 3 months (0.47 mm [0.29-0.65 mm] and 0.50 mm [0.24-0.76 mm], respectively) and 6 months (0.56 mm [0.28-0.84 mm] and 0.45 mm [0.13-0.77 mm], respectively for PPD and CAL) follow-up (very low and low level of evidence). The meta-analysis found no evidence of a difference between full-mouth disinfection versus quadrant protocol clinical outcomes (very low level of evidence). One study found no evidence of a difference in periodontal clinical response between good versus poor glycemic control. Based on the results of the present research NSPT protocols could be considered more efficacious than others in terms of clinical outcomes in subjects with type 2 diabetes. Moreover, NSPT resulted in efficacious improvement of periodontal parameters and HbA1c levels compared to no treatment or oral hygiene instructions alone.

Impact of Tocopherol Supplementation on Clinical Parameters of Periodontal Disease: A Systematic Review and Meta-Analysis.

Background and Objectives: The significance of periodontal disease as a public health issue prompts the exploration of effective treatments, including the potential use of tocopherol (Vitamin E) due to its anti-inflammatory and antioxidant properties. Materials and Methods: The PICO statement (Population, Intervention, Comparator, Outcome) was as follows: In patients with periodontal disease, does tocopherol (Vitamin E) supplementation compared to no supplementation or insufficient Vitamin E intake improve clinical outcomes such as gingival inflammation, pocket depth, and clinical attachment levels? This study searched through PubMed, Scopus, and Web of Science up to June 2024 focused on studies involving human subjects with various forms of periodontal disease, analyzing the impact of tocopherol through dietary or supplementary intake. Primary outcomes evaluated included improvements in gingival inflammation, pocket depth, and clinical attachment levels, with data synthesis conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Quality assessment and risk of bias were meticulously performed for the included observational studies and randomized controlled trials. Results: The meta-analysis incorporated 8 studies that were used for data extraction, totaling 12,832 patients, revealing a heterogeneous response to tocopherol supplementation, with a pooled odds ratio for efficacy in reducing periodontal disease severity at about 0.97 (95% CI: 0.96-0.98). Noteworthy findings indicated a statistically significant increase in clinical attachment loss and pocket depth with odds ratios ranging from 1.15 to 9.33 when Vitamin E was insufficient. However, the considerable heterogeneity (I2 = 88.35%) underscores variations in tocopherol's effectiveness across different populations and study designs. Conclusions: While tocopherol supplementation shows a modest benefit in managing periodontal disease, particularly in reducing clinical attachment levels and pocket depth, the variability in outcomes emphasizes the necessity for more research to establish standardized treatment protocols and dosages.