Deep Pockets Research Articles

A Deeper Pocket?

This brief paper welcomes the notion of local pockets of resistance while raising two problems about it. One of these concerns teachers' values and leads into wider considerations about what the underlying aims of education should be. This prepares the ground for the 'deeper pocket' of the title. This has to do with challenging the lack of official – i.e.public, not hidden – aims informing English school curricula. In this, England will soon be at odds with the three other UK nations, all of which, as from September 2022, will have aims-based curricula. A many-sided national campaign is recommended to target this weakness in the English system, working closely with more local pockets of resistance.

Dexamethasone-loaded zeolitic imidazolate frameworks nanocomposite hydrogel with antibacterial and anti-inflammatory effects for periodontitis treatment.

Periodontitis is a bacterial-induced, chronic inflammatory disease characterized by progressive destruction of tooth-supporting structures. Pathogenic bacteria residing in deep periodontal pockets after traditional manual debridement can still lead to local inflammatory microenvironment, which remains a challenging problem and an urgent need for better therapeutic strategies. Here, we integrated the advantages of metal-organic frameworks (MOFs) and hydrogels to prepare an injectable nanocomposite hydrogel by incorporating dexamethasone-loaded zeolitic imidazolate frameworks-8 (DZIF) nanoparticles into the photocrosslinking matrix of methacrylic polyphosphoester (PPEMA) and methacrylic gelatin (GelMA). The injectable hydrogel could be easily injected into deep periodontal pockets, achieving high local concentrations without leading to antibiotic resistance. The nanocomposite hydrogel had high antibacterial activity and constructs with stable microenvironments maintain cell viability, proliferation, spreading, as well as osteogenesis, and down-regulated inflammatory genes expression in vitro. When evaluated on an experimental periodontitis rat model, micro-computed tomography and histological analyses showed that the nanocomposite hydrogel effectively reduced periodontal inflammation and attenuated inflammation-induced bone loss in a rat model of periodontitis. These findings suggest that the nanocomposite hydrogel might be a promising therapeutic candidate for treating periodontal disease.

Oral Health Status and Literacy/Knowledge Amongst Pregnant Women in Shanghai

BackgroundThe changes in hormones, diet, and hygiene associated with pregnancy are associated with oral diseases. There is insufficient awareness of the importance of oral health during pregnancy. This study investigated the oral health status and knowledge amongst pregnant women in Shanghai. MethodsThis cross-sectional study enrolled pregnant women at the Shanghai Red House Obstetrics & Gynecology Hospital in December 2020. The Fourth National Oral Health Questionnaire was used to evaluate the oral health status. Decayed/missing/filled teeth (DMFT) were the sum of the number of decayed, missing due to caries, and filled teeth. The chi-square test and Kruskal–Wallis test were used to compare the groups. ResultsA total of 224 pregnant women were enrolled. The rates of dental caries were 69.8%, periodontal health was 1.8%, calculus detection was 95.6%, shallow periodontal pocket was 51.1%, deep periodontal pocket was 4.9%, regular oral examination was 22.8%, correct brushing was 49.6%, and prepregnancy oral examination was 20.1%. DMFT was 2.27, and the caries filling ratio was 45.4%. The number of missing teeth increased with age (P < .001). Only 26.3% used dental floss more than once a day, 47.3% rinsed the mouth more than twice a day, and 46.9% cleaned their tongue coating every week. In addition, 99% of the pregnant women agreed that “oral health was vital to their lives” and 97.7% agreed that “regular oral examination was necessary.” ConclusionsThe oral health status amongst pregnant women in Shanghai was poor, but oral health awareness and attitudes were relatively high.

Comparison of Ozonated Olive Oil and Chlorhexidine Gel as an Adjunct to Nonsurgical Periodontal Therapy for the Treatment of Chronic Periodontitis: A Randomized Controlled Clinical Trial.

Objectives:Complete elimination of the pathogenic microorganisms from the gingival sulcus area is the ultimate goal of any periodontal therapy. Certain factors such as anatomical variation of teeth, deep periodontal pocket, and tissue-invading ability of some bacteria decrease the effectiveness of conventional nonsurgical periodontal therapy, i.e., scaling and root planing (SRP). Hence, antimicrobial agents could be used as an adjunct to SRP, in order to increase the efficacy of it. Although Chlorhexidine (CHX) is the gold standard as an antiplaque agent, it has several drawbacks. Recently, ozone therapy is being tried for the treatment of several diseases in the field of dentistry. Therefore, the purpose of this study was to evaluate and compare the efficacy of local application of CHX and ozonated olive oil as adjunctive to SRP for the treatment of chronic periodontitis.Materials and Methods:Thirty individuals who fulfilled the eligibility criteria were selected for this split-mouth randomized controlled trial. The treatment sites from each individual were randomly allocated into two groups. Along with SRP, the local application of CHX and ozonated olive oil was done for the control and test sites, respectively. Pocket probing depth, relative attachment loss, and sulcus bleeding index were measured before and 3 months after the treatment. Intragroup and intergroup differences in the clinical parameters were analyzed by Wilcoxon signed-rank test and Mann–Whitney U test, respectively.Results:Three months' posttreatment, all the parameters showed significant improvement in both the groups. However, the intergroup comparison failed to be significant statistically.Conclusion:Ozonated olive oil could enhance the outcomes of SRP for the treatment of periodontal diseases.

Platelet-rich Fibrin – A Wonder Material for Periodontal Regeneration – A Clinical Case Series

The discovery of platelet-rich fibrin has enhanced the possibility of treating periodontal defects with significantly positive results in terms of bone defect fill, probing pocket depth, and clinical attachment level, apart from aiding in healing of wounds in other surgical procedures. This case series describes the use of platelet-rich fibrin (PRF) as a membrane along with allografts, in the treatment of intrabony periodontal defects, and the success of this treatment in eliminating factors such as deep periodontal pockets. The use of PRF in periodontal surgical procedures has been amply supported by various authors in the literature. Hence, it can be concluded from this case series that PRF can be used as an autologous alternative to the artificial materials for specifically treat intrabony periodontal defects with equal or better clinical outcomes.

Structural characterization and fatty acid epoxidation of CYP184A1 from Streptomyces avermitilis

The genome of Streptomyces avermitilis contains 33 cytochrome P450 genes. Among the P450 gene products of S. avermitilis, we characterized the biochemical function and structural aspects of CYP184A1. Ultra-performance liquid chromatography–tandem mass spectrometry analysis showed that CYP184A1 induced an epoxidation reaction to produce 9,10-epoxystearic acid. Steady-state kinetic analysis yielded a kcat value of 0.0067 min−1 and a Km value 10 μM. The analysis of its crystal structures illustrated that the overall CYP184A1 structure adopts the canonical scaffold of cytochrome P450 and possesses a narrow and deep substrate pocket architecture that is required for binding to linear chain fatty acids. In the structure of the CYP184A1 oleic acid complex (CYP184A1-OA), C9–C10 of oleic acid was bound to heme for the productive epoxidation reaction. This study elucidates the roles of P450 enzymes in the oxidative metabolism of fatty acids in Streptomyces species.

Analysis of inequality trends in dental caries, deep periodontal pockets, and severe tooth loss according to income level of adults using data from the Korea National Health and Nutrition Examination Survey

Analysis of inequality trends in dental caries, deep periodontal pockets, and severe tooth loss according to income level of adults using data from the Korea National Health and Nutrition Examination Survey

A Systematic Review and Meta-Analysis of the Association Between Periodontal Disease and Severe Mental Illness.

Periodontal disease represents a global public health concern, with a disproportionate burden being borne by vulnerable populations. One such group is people with severe mental illness (SMI), and this study examined whether periodontal health is poorer in people with SMI than the general population. We conducted a systematic search for studies published before March 2021 on the periodontal health of people with SMI using the following databases: PubMed, PsycINFO, EMBASE, China National Knowledge Infrastructure, and Chongqing VIP. Outcomes were periodontitis, periodontal disease, and shallow and deep periodontal pockets. Results were compared with the general population. Seventeen studies had sufficient data for a random-effects meta-analysis, consisting of 4404 psychiatric patients and 95,411 controls. SMI was associated with an increased prevalence of periodontitis (odds ratio = 1.97, 95% confidence interval [CI] = 1.15-3.35) compared with the general population. People with SMI had 4.28 the odds of having periodontal disease compared with controls (95% CI = 2.54-7.21). They also had 3.65 the odds of shallow pockets (95% CI = 1.80-7.42) and 2.76 the odds of deep pockets (95% CI = 1.10-6.93). Our findings highlight the increased prevalence and severity of periodontal disease in people with SMI. Oral health is often considered the gateway to overall health and should be a public health priority for this population.

Engineering the Active Site Pocket to Enhance the Catalytic Efficiency of a Novel Feruloyl Esterase Derived From Human Intestinal Bacteria Dorea formicigenerans

The human gut microbiota play essential roles in metabolism and human health, especially by enzymatically utilizing dietary fiber that the host cannot directly digest and releasing functional components including short-chain fatty acids (SCFAs) and hydroxycinnamic acids (e.g., ferulic acid). In our previous study, seven potential feruloyl esterase (FAE) genes were identified from the gut microbiota. In the current work, one of the genes encoding a novel FAE (DfFAE) from Dorea formicigenerans of Firmicutes was bacterially expressed, purified and characterized. The 30.5 kDa type-A DfFAE has an optimum pH and temperature of 8.4 and 40 °C, respectively, exhibiting a higher substrate specificity toward short-chain acyl-ester substrate (pNPA). The AlphaFold2 based ab initio structural modeling revealed a five α-helices cap domain that shaped an unusually narrow and deep active site pocket containing a specific substrate access tunnel in DfFAE. Furthermore, rational design strategy was subjected to the active site pocket in an aim of improving its enzymatic activities. The mutants V252A, N156A, W255A, P149A, and P186A showed 1.8 to 5.7-fold increase in catalytic efficiency toward pNPA, while W255A also exhibited altered substrate preference toward long-chain substrate pNPO (45.5-fold). This study highlighted an unusual active site architecture in DfFAE that influenced its substrate selectivity and illustrated the applicability of rational design for enhanced enzymatic properties.

Designed Ankyrin Repeat Proteins as a tool box for analyzing p63

The function of the p53 transcription factor family is dependent on several folded domains. In addition to a DNA-binding domain, members of this family contain an oligomerization domain. p63 and p73 also contain a C-terminal Sterile α-motif domain. Inhibition of most transcription factors is difficult as most of them lack deep pockets that can be targeted by small organic molecules. Genetic knock-out procedures are powerful in identifying the overall function of a protein, but they do not easily allow one to investigate roles of individual domains. Here we describe the characterization of Designed Ankyrin Repeat Proteins (DARPins) that were selected as tight binders against all folded domains of p63. We determine binding affinities as well as specificities within the p53 protein family and show that DARPins can be used as intracellular inhibitors for the modulation of transcriptional activity. By selectively inhibiting DNA binding of the ΔNp63α isoform that competes with p53 for the same promoter sites, we show that p53 can be reactivated. We further show that inhibiting the DNA binding activity stabilizes p63, thus providing evidence for a transcriptionally regulated negative feedback loop. Furthermore, the ability of DARPins to bind to the DNA-binding domain and the Sterile α-motif domain within the dimeric-only and DNA-binding incompetent conformation of TAp63α suggests a high structural plasticity within this special conformation. In addition, the developed DARPins can also be used to specifically detect p63 in cell culture and in primary tissue and thus constitute a very versatile research tool for studying the function of p63.

Comparative Evaluation of Azadirachta indica (Neem) Chip and Soft Tissue Diode Lasers as a Supplement to Phase I Periodontal Therapy in Localized Chronic Moderate Periodontitis: A Randomized Controlled Clinical Trial.

Introduction The current trial aimed to assess and compare the efficacy of neem chip and diode laser as a local drug delivery (LDD) agent as a supplement to phase I periodontal therapy in treatment of localized chronic moderate periodontitis. Materials and Methodology. Fourteen systemically healthy participants with 4–6 mm deep periodontal pockets at least in three quadrants (with no alveolar bony defect amenable to respective or regenerative osseous surgery, as seen in orthopantomograph) were selected for the trial. One week after phase I therapy, 10% absorbable chip of neem (commercially prepared by staff of a pharmacy college, Sheriguda, India) was placed in the periodontal pocket on one site, and soft tissue diode laser pocket sterilization was performed on the other site of the arch. Remaining one site was considered as a control. Parameters recorded clinically were plaque index (PI), papillary bleeding index (PBI), probing pocket depth (PPD), and relative attachment level (RAL) measured at baseline, 21st day, and one month postoperatively. Results Statistically significant improvements were observed in all clinical parameters at one month as compared to baseline for both treatment groups. Conclusion Neem chip supplemented with phase I therapy showed best improvement in clinical parameters followed by laser supplemented with phase I therapy in comparison to phase I therapy alone at one month follow-up. Clinical Significance. Neem chips are nature's products, affordable without side effects, with a potential to be used as a local drug delivery agent in treating moderate chronic periodontitis.

A Study on Application of Linear Programming on Product Mix for Profit Maximization and Cost Optimization

Objectives: This research aims to sneak into the retailer\'s perception about that customer segment and plan a product mix accordingly. The focus is on small players in small towns not having deep pockets to synergize the product mix decisions effectively. Methods: The data used in this research paper is from Hatchers, a medium-sized enterprise with zero budget for software for product mix decisions. The data was collected through face-to-face interviews with ten representatives and five supervisors in compliance with the existing documents and existing datasheet obtained from the production department, which was slightly updated to make the final output. The data was for one season, i.e., April to March. The data was analyzed to study pre-Linear Programming and post-Linear Programing profits. Findings: This examination distinguishes the current asset usage level and the benefit of every period of one of the apparel producing organizations, utilizing a linear programming procedure. Actual consumption of resources (product wise) was calculated to evaluate profit post applying Linear Programing to see the wastage and cost. There was a 54% increase post LP compared to the product-wise resource utilization. Similarly, the profit using Linear programming was more than double as wastage and costing were minimum, and revenue was high. Novelty: The article focused on the simple basic principle of linear programming for identifying product mix using Excel(Solver). LINGO. The software solutions become costlier for small firms, whereas Excel is more accessible and cost-efficient. There is a gap in existing literature as previous research has not focused on this aspect for small business houses where adapting software solutions is challenging. Keywords: Linear Programming, Profit maximization, Product Mix, Production, cost optimization

Association between periodontitis and mild cognitive impairment: a clinical pilot study

Objective: To evaluate the association between periodontitis and mild cognitive impairment (MCI), and explore the potential local oral risk factors for MCI. Methods: The study included 70 middle-aged and elderly subjects (44 females and 26 males) with periodontal disease who were first diagnosed by the Department of Periodontology or referred by the Department of Geriatrics in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January 2021 to January 2022. In this study, the control group consisted of periodontal disease patients without cognitive impairment, and the case group (MCI group) consisted of those diagnosed with MCI referred by the geriatrics specialists. Full-mouth periodontal examinations of all subjects were performed and periodontal indicators were recorded by periodontists, while digital panoramic radiographs were taken. The severity of periodontitis was defined according to the 1999 classification, and the staging and grading of periodontitis were defined according to the 2018 American Academy of Periodontology and European Federation of Periodontology classification. The mini-mental state examination scale was chosen by geriatricians to evaluate the cognitive function of the included subjects. The cubital venous blood was drawn to detect the expression levels of inflammatory factors such as hypersensitive C-reactive protein (hs-CRP), interleukin (IL)-1β, IL-6 and tumor necrosis factor-α(TNF-α) in serum. Independent-samples t test and chi-square test were used to analyze the differences in population factors, periodontal-related indexes and serum inflammatory factors between the two groups (α=0.05). Odds ratios (OR) for MCI according to the severity of periodontitis and main periodontal clinical indexes were calculated by binary Logistic analysis. Results: Thirty-nine subjects were included in the control group and thirty-one in the MCI group. The age of the study population was (58.3±6.2) years (range: 45-70 years). The comparison between two groups showed that the control group was with higher educational background (χ²=9.45, P=0.024) and 2.6 years younger than the MCI group [(57.1±6.0) years vs. (59.7±6.3) years, t=-1.24, P=0.082]. The number and proportion of moderate to severe periodontitis in control group were significantly lower compared to those in MCI group (17 cases with 43.6% vs. 23 cases with 74.2%, χ²=6.61, P=0.010), and the OR of moderate to severe periodontitis adjusted by age and educational background was 3.00 (95%CI: 1.01-8.86, P=0.048). Compared with the grading (χ²=5.56, P=0.062) of periodontitis, staging had a greater impact on MCI (χ²=7.69, P=0.041), moreover the proportion of MCI in stage Ⅰ grade A periodontitis was significantly lower than any other type of periodontitis (χ²=13.86, P=0.036). In addition, less presence of deep periodontal pockets [probing depth (PD)≥6 mm] (17.9% vs. 41.9%, χ²=4.87, P=0.027), fewer number of PD≥4 mm (6.48±6.70 vs. 11.03±8.91, t=-2.44, P=0.017), lower plaque index (1.42±0.56 vs. 1.68±0.57, t=-1.91, P=0.059) and gingival index (1.68±0.29 vs. 1.96±0.30, t=-3.93, P<0.001) were in the control group than in the MCI group. However, there were no significant differences between the two groups in the levels of serum inflammatory factors, such as hs-CRP, IL-1β, IL-6 and TNF-α (P>0.05). Conclusions: It appears a strong correlation between moderate to severe periodontitis and the incidence of MCI in middle-aged and elderly people. Moreover, deep and increased number of periodontal pockets, poor oral hygiene, and severe gingival inflammation can be potentially associated risk factors for MCI.

Production of human embryonic kidney 293T cells stably expressing C-X-C chemokine receptor type 4 (CXCR4) as a screening tool for anticancer lead compound targeting CXCR4

AimThe C-X-C chemokine-receptor type 4 (CXCR4) is an emerging target for cancer drug discovery due to its high expression in cancer cells. The present study aimed to produce CXCR4 overexpressing HEK293T cells for a non-radioactive binding assay as a platform to identify drug candidates targeting CXCR4. Main methodsHEK293T cells stably expressing human CXCR4 were constructed by transfection of CXCR4 plasmids from the human CXCR4 gene. The CXCR4 overexpressing HEK293T cells were obtained by fluorescence-activated sorting and verified by conducting the competition binding assay of a known CXCR4 inhibitor, AMD3100 (plerixafor), to determine the IC50 value against monoclonal anti-human CD184 (hCD184) antibody tagged with fluorescence probe, phycoerythrin (PE). The non-radioactive binding assay using CXCR4 overexpressing HEK293T cells and PE-anti hCD184 was applied as a platform for identifying the target of natural compounds that exhibited cytotoxicity against cancer cell lines. Key findingsThe CXCR4 overexpressing HEK293T cells were produced with high expression (99.8%). The IC50 value of plerixafor determined by fluorescence tagged antibody-based competition assay using our developed cells agree with previously reported values using a radioligand binding assay. We observed no significant displacement of bound PE-anti-hCD184 by the test natural compounds which could be due to non-specific binding to other functional targets or organelles, low potency of the natural compounds, or binding to CXCR4 at deeper pockets. SignificanceThe verified non-radioactive binding assay can serve as an alternative screening tool for anticancer lead compounds targeting CXCR4 and an essential tool for proof of mechanism study in the drug discovery.

Effects of Locally Delivered Minocycline Microspheres in Postmenopausal Female Patients with Periodontitis: A Clinical and Microbiological Study.

The postmenopausal period, due to low hormonal concentrations, can exert a negative influence on both periodontitis and osteoporosis evolution. The present study aimed to identify potential clinical and microbiological benefic effects of locally delivered minocycline microspheres (Arestin®) in post-menopausal female patients with moderate and severe periodontitis. Probing depth, clinical attachment levels and bleeding on probing index, along with BANA tests for Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola, were performed before and at 3 months after a combined treatment of scaling, root planing (SRP), and Arestin® placed in deep periodontal pockets. The association between SRP and Arestin® exerted significant improvements in terms of clinical periodontal parameters, as well as significant reductions in the red complex bacteria detection.

Are firms with 'deep pockets' more responsive to tort liability? Evidence from nursing homes.

We provide time series evidence of tort reform's impact on inputs and quality in the nursing home industry. Between 2000 and 2010, 11 state reforms capped noneconomic damages for health care services. Small chain and unaffiliated nursing homes enjoyed "judgment proof standing" and were less apt to be sued, prior to reform. We find that the managers of such homes were relatively unresponsive to the implementation of state caps on noneconomic damages. Large "deep-pocketed" chain-affiliated homes lacked judgment proof standing and implemented greater reductions in their nursing inputs in the aftermath of tort relief. However, we find little evidence of service quality erosion across four measured dimensions of care outcomes. Our findings are consistent with a "defensive care" model in which large chain homes employ unproductive inputs in an effort to meet a negligence standard of care.

Sculpting a Uniquely Reactive Cysteine Residue for Site-Specific Antibody Conjugation.

Catalytic antibody 38C2 and its humanized version h38C2 harbor a uniquely reactive lysine at the bottom of a 11 Å deep pocket that permits site-specific conjugation of β-diketone-, β-lactam-, and heteroaryl methylsulfonyl-functionalized small and large molecules. Various dual variable domain formats pair a tumor-targeting antibody with h38C2 to enable precise, fast, and stable assembly of antibody-drug conjugates (ADCs). Here, we expand the scope of this ADC assembly strategy by mutating h38C2's reactive lysine to a cysteine. X-ray crystallography of this point mutant, h38C2_K99C, confirmed a deeply buried unpaired cysteine. Probing h38C2_K99C with maleimide, monobromomaleimide, and dibromomaleimide derivatives of a fluorophore revealed highly disparate conjugation efficiencies and stabilities. Dibromomaleimide emerged as a suitable electrophile for the precise, fast, efficient, and stable assembly of ADCs with the h38C2_K99C module. Mass spectrometry indicated the presence of a thio-monobromomaleimide linkage which was further supported by in silico docking studies. Using a dibromomaleimide derivative of the highly potent tubulin polymerization inhibitor monomethyl auristatin F, h38C2_K99C-based ADCs were found to be as potent as h38C2-based ADCs and afford a new assembly route for ADCs with single and dual payloads.

The influence of diabetes mellitus on the peri-implant microflora: A cross-sectional study

BackgroundType 2 diabetes mellitus (T2DM) is an important systemic disease, predisposing patients to inflammatory conditions including periodontitis and peri-implantitis and negatively affects dental implant success through various mechanisms. This study aimed to compare clinical and microbiological findings of individuals with dental implants with or without T2DM. MethodsA total of 82 dental implants which were in function >3 years, were involved. The participants were divided into 2 groups; T2DM (n: 45 implants) and systemically healthy controls (n:37 implants). Periodontal indexes (Bleeding on probing (BOP), plaque index (PI), pocket depth (PD), and radiographic bone loss were recorded around implants in function >3 years. Subgingival microbiological samples were also collected from the peri-implant sites. Pathogens include Fusobacterium nucleatum, Camphylobacter rectus, Porphyromonas gingivalis, Tannerella forsythia, Actinobacillus actinomycetemcomitans, Treponema denticola, Prevotella intermedia, Peptostreptococcus micros, Eikinella corrodens, Prevotella nigrescens were evaluated. ResultsPeri-implant heatlh was determined in systemically healthy (54.1%) and type 2 diabetes patients (24.4%). Peri-implantitis was also evident in systemically healthy (8.1%) and T2DM (35.6%) groups. No differences was found in shallow peri-implant pockets in both groups in terms of the prevelance of all evaluated bacteria (p > 0.05). However, C. rectus, P. gingivalis, A. actinomycetemcomitans and T. forsythia were isolated more frequently in deep peri-implant pockets in systemically healthy patients compared to T2DM patients (p < 0.05). ConclusionsEvaluted periodontal pathogens may not be affected by the presence of T2DM in implants. T2DM may not significantly alter the levels of specific periodontal pathogens in shallow and deep peri-implant pockets. C. rectus, P. gingivalis, A. actinomycetemcomitans and T. forsythia may be affected by T2DM in implants in deep pockets.

The predictive performance of surgical treatment in upper molars with combined bony defect and furcation involvement: a retrospective cohort study.

BackgroundTo evaluate the impact of combined defects, bony destruction and furcation involvement, on disease resolution after surgery in terms of pocket elimination, absence of inflammation, furcation improvement and predictive performance.MethodsCombined bony (intrabony (+) or (−)) and furcation defects (FI degree 1 or 2) at maxillary molars in patients diagnosed as periodontitis stage III to IV, being through periodontal surgery and at least 6 months follow-up were retrospectively screened. Cumulative predictability (CR, %), failure of treatment and the change of clinical parameters from baseline at pre-operative visit to the latest maintenance care, including pocket depth (PD), horizontal and vertical furcation involvement (FI) were analyzed. Failure of treatment with low predictability was defined as residual PD > 4 mm with bleeding on probing during maintenance period.ResultsThirty-three patients with fifty-one combined defects were included. Statistical analysis showed significant overall PD reduction and FI improvement (p < 0.001). Combined FI degree 2 with intrabony (+) defects revealed more horizontal furcation improvement compared with FI degree 2 with suprabony defect (p = 0.007). However, type of combined defects was not relevant to CR (p = 0.702) and PD reduction (p = 0.707). Among all parameters, baseline PD with proximal FI degree 2 was indicated to failure of treatment.ConclusionsDifferent types of combined defects, deep baseline pocket and proximal FI degree 2 would compromise the predictability of treatment outcomes in upper molars. Nevertheless, the combination of surgical treatment and strict maintenance care could still yield high predictability and survival rate.Trial registration: retrospectively registered.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12903-022-02196-0.

The effectiveness of scaling and root planing with combined application of air polishing and Nd:YAG laser in periodontal pockets of stage III grade C periodontitis patients: a single-blinded randomized clinical trial.

Evaluating the efficiency of combined air polishing and Nd:YAG laser application in addition to scaling and root planning (SRP) in treatment of periodontal pockets of stage III grade C periodontitis patients was the aim of this clinical trial. Twenty-four systemically healthy, stage III grade C periodontitis patients were recruited for this clinical trial. In this split-mouth study, the quadrants were randomly allocated to either SRP with combined air polishing (erythritol/chlorhexidine powder) and Nd:YAG laser (2W, 200mJ/pulse, 10Hz) therapy (test group) or SRP alone (control group). A masked examiner recorded clinical parameters such as plaque index (PI), gingival index (GI), bleeding on probing (%) (BOP %), probing depth (PD), and clinical attachment level (CAL) on periodontal charts at baseline, 1month and 3months after treatment. The clinical parameters had significantly reduced 1 and 3months after treatment compared to baseline for both study groups (p < 0.05). Considering PI, GI, and BOP (%) parameters, there were no significant differences between the study groups at any time points (p > 0.05). While PD and CAL reductions were similar in study groups for moderately deep pockets (5 to 6mm) (p > 0.05), PD and CAL reductions were significantly greater in test group compared to control group for deep pockets (PD ≥ 7mm) (p < 0.05). The present clinical trial demonstrated that SRP with combined application of air polishing and Nd:YAG laser may be advantageous in sites where mechanical debridement alone cannot access, such as deep pockets in the short term. Long-term, well-designed future studies including clinical, biochemical, and microbiological analyses are needed to determine the effectiveness of this procedure. SRP with combined application of air polishing and Nd:YAG laser provided more reductions in probing depth and clinical attachment level parameters in deep pockets compared to SRP alone.