Pocket Depth Research Articles

Changes in Serum Inflammatory Markers and in Clinical Periodontal Condition After Non-Surgical Periodontal Treatment in Hypertensive Patients

Background: Chronic inflammatory disorders, such as periodontitis, may contribute to pro-hypertensive inflammation. Objectives: This study aimed to analyze changes in parameters for periodontitis, such as periodontal inflamed surface area (PISA) and serum inflammatory markers, following non-surgical periodontal treatment in hypertensive patients. Methods: A quasi-experimental pre-and-post study was conducted, involving 42 controlled hypertensive patients with periodontitis. The patients underwent periodontal assessment and tests, including complete blood count, glucose, triglycerides, HDL-C, LDL-C, and serum levels of inflammatory biomarkers. All patients received scaling and root planning treatment in a single session and were reevaluated one month after the treatment. Results: Post-treatment evaluations showed significant improvements in periodontal inflammation parameters, such as pocket depth, attachment level, bleeding on probing, and biofilm percentage, with statistically significant differences (p < 0.001). There were decreases in serum VEGF levels (p < 0.001) and reductions in PISA associated with declines in cytokine levels such as IL-10, IL-6, IL-12p70, IL-17A, and VEGF. PISA for IL-6 and IL-10 had a positive correlation before periodontal treatment and with IL-1β and IL-10 after treatment. Conclusions: Hypertensive patients with periodontitis who underwent non-surgical periodontal treatment showed improvements in their periodontal condition, a decrease in cytokine levels such as VEGF, and reductions in PISA associated with declines in cytokines such as IL-10, IL-6, IL-12p70, IL-17A, and VEGF. These findings confirm the role of inflammation in hypertensive patients with periodontitis.

Efficacy of Oral Melatonin Supplementation as an Adjunct in Periodontal Treatment: A Systematic Review and Meta-analysis of Randomized Control Clinical Trails

Aim: To study the effectiveness of melatonin supplements used orally as an adjunct to NSPT in the treatment of periodontitis. Materials and methods: Using Booleans like “AND,” “OR,” the MesH terms “melatonin” AND “periodontitis,” “melatonin” OR “periodontitis” were searched for in the databases of “Web of Science,” “PubMed,” and “Scopus” from 2010 till July 2023. Randomized controlled clinical trials that prescribed the oral supplementation of melatonin as an adjunct to NSPT were included. For continuous outcomes, mean differences and 95% confidence interval (CI) were used to summarize the results of each study. The meta‑analysis was conducted using fixed‑ or random‑effects methods. Fixed‑effects meta‑analysis was used when the heterogeneity was small ( I 2 < 60%, p < .05). When the heterogeneity was large ( I 2 > 60%, p > .05), a random‑effects model analysis was undertaken. All statistical analyses were conducted using RevMan 5.4. The present systematic review and meta-analysis were registered on the PROSPERO (CRD42023455908) on September 8, 2023. Results: A total of 109 publications were found (40 PubMed, 35 Scopus, and 34 Web of Science). We eliminated 70 articles that were identical. Only seven of the 39 articles that were examined met the requirements for acceptance and were chosen for the qualitative review. In every study, periodontal metrics such as pocket depth, clinical attachment loss, and plaque index gingival index improved. Outcome data were taken from every research. Conclusions: Key periodontal indicators, including pocket depth and clinical attachment loss, have improved in individuals with periodontitis when melatonin is administered systemically. However, the presented data should be interpreted cautiously due to the substantial potential for bias. To provide stronger clinical results and indications, more carefully planned RCTs must be carried out in addition to standardizing the dosage titration, frequency, and formulation. Clinical implications: Melatonin is one possible substance that modulates the host when used as an adjunctive to non-surgical periodontal therapy.

Effect of non-surgical periodontal therapy on the salivary levels of IL-18 and IL-35 in patients with periodontitis.

Periodontal disease is the most prevalent chronic inflammatory condition that can cause the destruction of supporting periodontal tissues. It has been hypothesized that while the synthesis of proinflammatory cytokines causes tissue destruction and disease progression, anti-inflammatory cytokine production can result in protective immunity. The balance of inflammatory cytokines is central to the immunoregulation of the disease. The aim of the study was to assess and compare the salivary levels of interleukin (IL)-18 and IL‑35 in subjects diagnosed with gingivitis, periodontitis, and healthy individuals. Additionally, the study sought to evaluate the difference in the concentration of IL‑18 and IL‑35 after non-surgical periodontal therapy (NSPT) in subjects diagnosed with periodontal disease. A total of 69 individuals were divided into 3 groups: healthy (group 1; n = 23); gingivitis (group 2; n = 23); and stage II periodontitis (group 3A; n = 23). Saliva samples were obtained from each participant at baseline and, in the periodontitis group, at baseline and 12 weeks after NSPT (group 3B; n = 23). Probing pocket depth (PD), bleeding on probing (BoP), gingival index (GI), and clinical attachment level (CAL) were recorded and IL‑18 and IL‑35 levels were analyzed using an enzyme-linked immunosorbent assay (ELISA). The mean salivary level of IL‑18 was significantly higher in the gingivitis group compared to the other groups (p < 0.05), whereas the mean IL‑35 level was significantly higher in the healthy group compared to the other groups (p < 0.05). Twelve weeks after NSPT, the periodontitis group demonstrated a statistically significant difference in cytokine levels, characterized by a decline in the IL‑18 concentration (229.63 ±49.35 pg/mL) and an increase in the concentration of IL‑35 (29.47 ±17.88 pg/mL). In the present study, a significant difference in the salivary levels of IL‑18 and IL‑35 before and after NSPT was observed. Therefore, these cytokines could serve as potential inflammatory biomarkers.

Systematic Review Regarding the Clinical Implications of Allograft and Alloplastic Bone Substituents Used for Periodontal Regenerative Therapy

Background/Objectives: Regenerative periodontal therapy is a treatment method that focuses on restoring the periodontium affected by chronic inflammatory disease or injury. It involves using different biomaterials and techniques to completely restore the periodontal structures. The main objective was to identify and critically evaluate relevant studies comparing the clinical efficacy of allograft and alloplastic materials in regenerative periodontal therapy. Methods: For evaluation, a systematic review based on PRISMA guidelines was conducted. Data were extracted using only specific types of study designs, which included randomized controlled trials, cohort studies, and case-control studies. Target patients with periodontal disease or periodontal lesions undergoing periodontal therapy using allograft or alloplastic materials were selected. Periodontal parameters such as clinical attachment level, probing pocket depth, radiographic bone fill, or patient-reported outcomes were analyzed. Results: The results showed that allograft and alloplastic materials offered reduced pocket depth, a gain in clinical attachment, and bone repairment. The variation observed indicated that allografts showed a slightly more significant clinical attachment gain and a superior bone fill than alloplastic ones, suggesting that allografts enhance osteogenesis and provide a greater capacity for repair in periodontal defects. Conclusions: The results of the present study suggest that allograft and alloplastic materials offered reduced pocket depth, a gain in clinical attachment, and bone repairment, with both methods having similar clinical efficacy.

Angulated titanium bases screw channel abutments for single implant restorations: A systematic review and meta-analysis.

Screw-retained implant crowns are a common solution to rehabilitate single or multiple edentulous sites. Angulated screw channel (ASC) abutments have been developed as a new system of connection to correct the angulation of the implant and avoid a possible undesired emergence of the access hole. The purpose of this systematic review was to examine available literature related to the effects of ASC abutments in rehabilitating single implant crowns. A protocol was registered in the PROSPERO database (ID=CRD42022295521). An electronic search of the Cochrane Central Register of Controlled Trials and Trial Protocols, MEDLINE, SCOPUS, and Web of Science was performed up to January 16, 2024. Additionally, a manual search was carried out. The meta-analysis used a fixed or a random effects model, based on the heterogeneity between the studies, focusing on binary and continuous data. A risk of bias assessment was performed (NOS or MOGA etal.) The outcomes assessed were peri-implant marginal bone level, probing pocket depth (PPD), the prevalence of technical and mechanical complications, implant and prosthesis survival rates, and esthetics. Statistical significance was set at p<0.05. The searches resulted in a total of 10 studies included in the meta-analysis. The mean implant and prosthesis survival rates were respectively 99% (absolute quantity=243) and 100% (absolute quantity=239) with non-statistically significant differences observed in single crowns supported by ASC abutments compared to cemented restorations, in terms of marginal bone loss (MBL) (p=0.22), PPD (p=0.08), risk of complications (p=0.53), and esthetics (p=0.47). Follow-up intervals ranged from 14 days to more than 3 years. Data based on this systematic review suggest that the clinical and radiographic outcomes of single implants restored using ASC are promising if compared to the outcomes relating to screw-retained single crowns.

A BiO-Optimizing Site Targeted (BOOST) Approach to Periodontal Regeneration Through Local Doxycycline Prior to Surgery: A Randomized Clinical Trial.

To test a BiO-Optimizing Site Targeted (BOOST) approach to periodontal regeneration by the adjunctive use of locally delivered doxycycline (DOX) 2 weeks prior to minimally invasive surgery in terms of clinical and radiographic outcomes at 1 year. For this randomized clinical trial, stage III/IV periodontitis patients presenting sites with intrabony defects and bleeding on probing (BoP+) after steps 1-2 of periodontal treatment were included. Sites were treated via subgingival instrumentation with or without a BOOST approach by local DOX. After 2 weeks, defects were accessed by minimally invasive surgical technique with xenograft and amelogenins. Primary (clinical attachment level [CAL] gain) and secondary (probing pocket depth [PPD] reduction, composite outcomes, radiographic bone defect fill) outcomes were assessed at 12 months. Sixty patients completed the study (30 on each group). BOOST led to lower preoperative BoP (p < 0.001) and better wound healing after surgery (p = 0.027). Both groups showed clinical and radiographic improvements at 1 year, with significant differences in mean CAL gain (4.1 ± 1.9 vs. 3.2 ± 2.0 mm; p = 0.019) and PPD reduction (4.4 ± 1.8 vs. 3.6 ± 1.9 mm; p = 0.040) favoring the test group. BOOST group also achieved higher composite outcome measure (PPD ≤ 4 mm and CAL gain ≥ 3; 83.3% vs. 46.7%; p = 0.006), pocket closure (PPD ≤ 3 mm or 4 mm BoP-; 83.3% vs. 60.0%; p = 0.045), and defect fill (3.5 ± 1.2 vs. 2.7 ± 1.3 mm; p < 0.001) compared to the control group. A BOOST approach by local doxycycline 2 weeks before surgery enhanced the local inflammatory control prior to periodontal regeneration and post-operative early wound healing, yielding to improved clinical and radiographic outcomes at 1year. ClinicalTrials.gov identifier: NCT05878353.

Effect of Nonsurgical Mechanical Debridement With or Without Chlorhexidine Formulations in the Treatment of Peri-Implant Mucositis. A Randomized Placebo-Controlled Clinical Trial.

To evaluate the treatment of peri-implant mucositis (PM) using a nonsurgical submarginal peri-implant instrumentation (NSPI) with or without chlorhexidine (CHX) solutions. Fifty-six patients (28 per group) were randomly assigned to the test (NSPI + 0.12% mouthwash and subgingival CHX irrigation plus tongue brushing with 1% CHX gel) or the control group (NSPI + placebo mouthwash and subgingival placebo irrigation plus tongue brushing with placebo gel). At baseline, 1, 3, 6 months, bleeding on probing (BOP), probing pocket depth (PPD), modified gingival index (mGI), modified plaque index (mPlI), full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), and the proportions of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola were recorded. The BOP reduction was set as a primary outcome. Data were analyzed to assess BOP reduction at a 6-month follow-up and to identify significant predictors of implant-site BOP through mixed generalized linear regression. After 6 months in both groups, a significant reduction of BOP, PD, mPlI, mGI, FMBS, and FMPS was noted (p < 0.05). However, at 6 months, the test group was more effective than the controls in reducing median BOP (∆values control/test: 39.3% [95% CI 37.4-42.3] vs. 48.7 [95% CI 46.5-51.2], p = 0.044), as well as mPlI (p = 0.041) and the proportion of Treponema denticola (p = 0.039). Moreover, the implant-sites BOP reduction was significantly influenced by test treatment (p < 0.001), history of periodontitis (p = 0.003), and a high number of cigarettes/day (p = 0.002), the proportion of Porphyromonas gingivalis (p = 0.021) and Tannerella forsythia (p = 0.032). NSPI + CHX showed better results compared to placebo in implant-sites BOP reduction. The high number of cigarettes/day and the proportion of Porphyromonas gingivalis and T. forsythia negatively influenced the BOP reduction in PM-treated patients.

Role of Injectable Platelet-Rich Fibrin in the Management of Soft and Hard Tissue Periodontal Regeneration in Dentistry: Protocol for a Systematic Review.

Injectable platelet-rich fibrin (i-PRF) has the capacity to release great amounts of several growth factors, as well as to stimulate increased fibroblast migration and the expression of collagen, transforming growth factor β, and platelet-derived growth factor. Consequently, i-PRF can be used as a bioactive agent to promote periodontal tissue regeneration. We aim to compare and evaluate the effectiveness of i-PRF in periodontal tissue regeneration. We will conduct an electronic search in the following databases: PubMed, Cochrane Library, Google Scholar, Semantic Scholar, Scopus, and Web of Science. Papers will be restricted to those in English and to those that are randomized controlled trials comparing PRF or any other biomaterial with i-PRF for periodontal regeneration during dental treatment. The included papers in this review and the reference lists of pertinent reviews will be manually searched. The selection of studies, data extraction, and assessment will be carried out separately by 2 reviewers using the Risk of Bias 2 tool for the included research. The success of i-PRF will be evaluated by comparing the mean difference in periodontal regeneration of soft and hard tissues in terms of gingival recession, probing pocket depth, clinical attachment level, bone gain, and gingival width. The combined effect size measurements and the associated 95% CIs will be estimated using a random-effects model. The synthesis or work for this systematic review started in October 2023 and will last until December 2025. i-PRF may play a role in dentistry and could enhance soft and hard tissue regeneration. PROSPERO CRD42023464250; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=464250. PRR1-10.2196/65137.

Molar Incisor Hypomineralization and Periodontitis in Adolescents: A Population-Based Study.

To investigate the association between molar incisor hypomineralization (MIH) and periodontitis in adolescents. A population-based study was undertaken of Brazilian adolescents aged 18 and 19 years (n = 2515). MIH was assessed according to Ghanim's criteria. The outcomes were Periodontitis Indicators, a continuous latent variable estimated on the basis of the common variance shared by the indicators bleeding on probing (BoP), probing pocket depth (PPD ≥ 4 mm) and clinical attachment level (CAL ≥ 3 mm), as well as periodontitis cases defined according to CDC-AAP. Structural equation modelling was used, and the models were adjusted for lower socioeconomic status, sex, smoking, triglycerides/high-density lipoprotein (TG/HDL) (mg/dL) and visible plaque index. Two other approaches were used for sensitivity analysis: (i) logistic regression, considering the effect of MIH on periodontitis (CDC/AAP) at the individual level, and (ii) multilevel regression to evaluate the association of MIH with CAL and PPD, considering the tooth as the unit of analysis, adjusted for other tooth-level and individual-level variables. The prevalence of MIH was 16.86% (n = 423). Individuals with MIH had higher values of the Periodontitis Indicators through a direct pathway (standardized coefficient [SC] = 0.193, p < 0.001) and indirectly mediated by biofilm (SC = 0.263, p < 0.001). MIH was also associated with periodontitis according to CDC-AAP (SC = 0.071, p < 0.001) and indirectly mediated by biofilm (SC = 0.344, p < 0.001). Consistently, lower socioeconomic status, sex, TG/HDL and biofilm were associated with both periodontal outcomes. Tooth-level sensitivity regression analysis confirmed the association observed in individual-level analyses. Our findings suggest that adolescents with MIH are susceptible to periodontitis, and it is therefore important to monitor their periodontal health.

Prevalence of Peri-Implant Diseases in a Private Practice and Potential Risk Indicators.

The purpose of this study was to evaluate the occurrence of peri-implant diseases and their potential risk indicators in a private practice setting. This cross-sectional study evaluated data from 390 subjects (mean age 55.8 ± 11.6 years) with implant-supported prosthetic reconstructions, who were enrolled in a maintenance program for 6.25 ± 3.36 years. Clinical evaluation included peri-implant probing pocket depth (PPD), bleeding on probing (BOP) and full-mouth plaque scores (FMPS). Radiographic evaluation was performed using retro-alveolar radiographs for each implant. Further, smoking habits, history of periodontitis, or tooth loss due to periodontal disease, presence/absence of keratinized mucosa ≥ 2 mm and the quality of the prosthetic restoration were also assessed. The prevalence of the peri-implant disease (at the subject/implant level) was determined and various potential risk indicators were evaluated by multi-level logistic regression analysis. The prevalence of peri-implant diseases was 37.7% and 23.3% at the subject and implant level, respectively. 14.3% of the subjects were diagnosed with peri-implant mucositis and 8.9% were diagnosed with advanced peri-implantitis (PI). PI was statistically significantly associated with poor (FMPS > 0.45, p 0.001) or moderate oral hygiene (FMPS: 0.3-0.45, p 0.001), a history of periodontitis (p 0.001), lack of keratinized tissue ≥2 mm (p 0.001) or implant function time > 5 years (p 0.001). In a private practice setting, a prevalence of peri-implant diseases of 37.7%/ 23.3% (subject/implant level) was found. Poor oral hygiene, history of periodontitis, a keratinized mucosa 2 mm and a time in function ≥ 5 years have been associated with the occurrence of peri-implant diseases.

High Mobility Group Box-1 (HMGB1)/microRNA-155 Axis in the Pathogenesis of Type 2 Diabetes Mellitus Associated Periodontitis: A Case Control Study

Aim: To evaluate the role of the high mobility group box-1 (HMGB1)/miR-155 axis in the pathogenesis of stage III/IV periodontitis with and without type 2 diabetes mellitus (T2DM). Materials and Methods: A total of 48 patients were assigned into four groups (12 per group): group 1: systemically and periodontally healthy (PH), group 2: systemically healthy with stage III/IV periodontitis (PD), group 3: PH with T2DM (PH + T2DM), group 4: stage III/IV periodontitis with T2DM, HbA1c ≤ 7 (PD + T2DM). Site-specific plaque index (SS-PI), gingival index (SS-GI), mean probing pocket depth (M-PPD) and clinical attachment loss (M-CAL) were recorded. Gingival tissue samples were analysed for HMGB1 and miR-155 gene expression by real-time polymerase chain reaction. Results: The miR-155 fold change (FC) increased by 10.29, 8.1 and 5.6 times in groups 4, 3 and 2, respectively. Intergroup comparison of miR-155 FC showed a significant difference between the groups ( p &lt; .05). HMGB1 FC increased by 6.5, 5.9 and 5.23 times in groups 4, 2 and 3, respectively, with no significant difference ( p &gt; .05). miR-155 FC is positively and significantly correlated with M-PPD (group 1, 2 and total sample), site-specific plaque score (SS-PS) (group 4) and SS-GI (total sample). miR-155 could discriminate periodontal health from T2DM + PD based on area under the curve 0.82 ( p &lt; .05) with 83.3% sensitivity, 75% specificity, 76.9% positive and 81.8% negative predictive value and 79.2% diagnostic accuracy. Conclusion: miR-155 is significantly upregulated in the diseased periodontium both in the presence and absence of T2DM. Further, miR-155 could be a potential diagnostic biomarker for diabetes-associated PD. However, the significance of HMGB1 and the HMGB1-miR155 axis in the aetiology of diabetes-associated PD is still unclear and warrants additional investigation.

Effectiveness of nonsurgical re-instrumentation of residual pockets as step 3 of periodontal therapy: A field study.

The study aims to analyze the effectiveness of nonsurgical re-instrumentation of residual pockets as step 3 of periodontal therapy and the stability of treatment outcomes at 18 months. The study sample consisted of 489 patients diagnosed and treated nonsurgically for periodontitis. After a 6-month evaluation, residual pockets (≥5mm) were re-instrumented. A final examination was performed at 18 months. Participants were categorized by treatment outcome at 6 months: (A) No residual pockets ≥5mm, (B) Residual pockets 5-6mm, or (C) Residual pockets ≥7mm. The primary outcome was pocket closure (≤4mm). Logistic regression models were built to evaluate the effectiveness of re-instrumentation and stability of initial outcomes at 18 months. Re-instrumentation of pockets 5 to 6mm resulted in pocket closure of around 39% in groups B and C. The corresponding result at sites with deeper residual pocketing (probing pocket depth [PPD] ≥7mm) was 28%. Combining hand and ultrasonic instrumentation was more effective than each alone. Healed sites (6 months) were more likely to remain closed in group A (80%) than in groups B (50%) and C (40%). The logistic regression revealed that the stability of outcomes of step 1 and step 2 therapy was influenced by PPD at baseline, tobacco smoking, age, and type of tooth. At step 3, nonsurgical re-instrumentation can effectively improve periodontal health conditions. Treatment decisions after nonsurgical therapy should be based on residual probing depth, overall healing response, and patient behavior. The stability of clinical results was influenced by disease severity and the effectiveness of step 2 therapy. This study examined the effectiveness of nonsurgical re-treatment of residual pockets (periodontal pockets not healed) after initial therapy and the stability of treatment outcomes to 18 months. The study involved 489 patients with periodontitis (loss of tooth-supporting structures) treated in general dental practice. Residual pockets were re-treated after examination at 6 months. A final examination was performed at 18 months. Treatment of residual gingival pockets was more successful in moderately diseased pockets compared with the most severely diseased pockets. Clinical results achieved in patients with a mild form of periodontitis were better in terms of stability compared with patients suffering from moderate and severe periodontitis. The success of nonsurgical periodontal treatment was influenced by the severity of periodontitis at the study start, the type of tooth affected, the age of the patient, and whether the patient was a smoker or not.

Periodontal Indices as Predictors of Cognitive Decline: Insights from the PerioMind Colombia Cohort.

Background: Poor oral health and periodontitis have been epidemiologically linked to cognitive decline and mild cognitive impairment (MCI) in older adults. However, specific metrics directly linking these clinical signs are exceedingly limited. Methods: To address this gap and develop novel tools to help clinicians identify individuals at risk of cognitive decline, we established the PerioMind Colombia Cohort, comprising elderly Colombian subjects who underwent comprehensive neurocognitive and periodontal evaluations. Results: The results revealed that subjects diagnosed with MCI exhibited significantly higher scores in specific periodontal indices, including gingival erythema and pocket depth parameters. The predictive model identified positive associations with MCI, with gingival erythema showing the strongest correlation, followed by the presence of periodontitis and variations in pocket depth measurements. Additionally, lower educational attainment was associated with a higher likelihood of being classified in the periodontitis-MCI group. Conclusions: Here, we show that specific altered periodontal metrics are associated with MCI diagnosis, and the generated results provide defined metric ranges for identifying individuals at risk. Upon validation in larger cohorts, the findings reported here could offer dental practitioners and clinicians innovative tools to identify individuals at risk of MCI and age-related dementias through routine oral health assessments, thereby enabling more accessible and highly sought-after early intervention strategies in both developing and developed countries.

Application of a 3D Fusion Model to Evaluate the Efficacy of Clear Aligner Therapy in Malocclusion Patients: Prospective Observational Study.

Investigating the safe range of orthodontic tooth movement is essential for maintaining oral and maxillofacial stability posttreatment. Although clear aligners rely on pretreatment digital models, their effect on periodontal hard tissues remains uncertain. By integrating cone beam computed tomography-derived cervical and root data with crown data from digital intraoral scans, a 3D fusion model may enhance precision and safety. This study aims to construct a 3D fusion model based on artificial intelligence software that matches cone beam computed tomography and intraoral scanning data using the Andrews' Six Element standard. The model will be used to assess the 3D effects of clear aligners on tooth movement, to provide a reference for the design of pretreatment target positions. Between May 2022 and May 2024, a total of 320 patients who completed clear aligner therapy at our institution were screened; 136 patients (aged 13-35 years, fully erupted permanent dentition and periodontal pocket depth <3 mm) met the criteria. Baseline ("simulation") and posttreatment ("fusion") models were compared. Outcomes included upper core discrepancy (UCD), upper incisors anteroposterior discrepancy (UAP), lower Spee curve deep discrepancy (LSD), upper anterior teeth width discrepancy (UAW), upper canine width discrepancy (UCW), upper molar width discrepancy (UMW), and total scores. Subanalyses examined sex, age stage (adolescent vs adult), and treatment method (extraction vs nonextraction). The study was funded in May 2022, with data collection beginning the same month and continuing until May 2024. Of 320 initial participants, 136 met the inclusion criteria. Data analysis is ongoing, and final results are expected by late 2024. Among the 136 participants, 90 (66%) were female, 46 (34%) were male, 64 (47%) were adolescents, 72 (53%) were adults, 38 (28%) underwent extraction, and 98 (72%) did not. Total scores did not differ significantly by sex (mean difference 0.01, 95% CI -0.13 to 0.15; P=.85), age stage (mean difference 0.03, 95% CI -0.10 to 0.17; P=.60), or treatment method (mean difference 0.07, 95% CI -0.22 to 0.07; P=.32). No significant differences were found in UCD (mean difference 0.001, 95% CI -0.02 to 0.01; P=.90) or UAP (mean difference 0.01, 95% CI -0.03 to 0.00; P=.06) by treatment method. However, adolescents exhibited smaller differences in UCD, UAW, UCW, and UMW yet larger differences in UAP and LSD (df=134; P<.001). Extraction cases showed smaller LSD, UAW, and UCW but larger UMW differences compared with nonextraction (df=134; P<.001). The 3D fusion model provides a reliable clinical reference for target position design and treatment outcome evaluation in clear aligner systems. The construction and application of a 3D fusion model in clear aligner orthodontics represent a significant leap forward, offering substantial clinical benefits while establishing a new standard for precision, personalization, and evidence-based treatment planning in the field. Chinese Clinical Trial Registry ChiCTR2400094304, https://www.chictr.org.cn/hvshowproject.html?id=266090&v=1.0.

Probiotic Therapy as an Adjuvant in the Treatment of Periodontal Disease: An Innovative Approach.

Background and Objectives: Periodontal inflammation, often linked to oral microbiota dysbiosis dominated by pathogenic bacteria, remains a significant challenge in periodontitis management. Traditional periodontal therapies primarily reduce the bacterial load but fail to restore the microbiota balance. Probiotics offer a promising therapeutic adjunct with their ability to enhance beneficial bacteria. This study investigates the effects of probiotics on the oral microbiota, inflammatory markers (IL-1β, TNF-α), and clinical parameters (gingival index, bleeding index, and periodontal pocket depth). Materials and Methods: In this pilot study, 80 patients with moderate-to-severe periodontitis were assigned to two groups. Group A received standard periodontal therapy (non-surgical periodontal therapy (NSPT)) with probiotic supplementation (Lactobacillus reuteri, 2 × 10⁹ CFU daily for 8 weeks), and Group B received standard treatment with a placebo. Microbiological changes were assessed via quantitative PCR, while inflammatory markers (IL-1β, TNF-α) were analyzed using ELISA. Clinical parameters, including the gingival index (GI), bleeding index (BI), and periodontal pocket depth (PPD), were measured at baseline (T0), 4 weeks (T1), and 8 weeks (T2) using standardized methods. Results: Probiotic therapy (Group A) significantly reduced the pathogenic bacteria and increased the beneficial bacteria levels compared to the placebo (p < 0.01). Inflammatory markers decreased by 37% (IL-1β) and 42% (TNF-α), while clinical parameters improved, with reductions in the gingival and bleeding indices (-1.5, -1.3) and a 2 mm decrease in the periodontal pocket depth (p < 0.01). Conclusions: Probiotics, as an adjunct to periodontal therapy, effectively restore the microbiota balance, reduce inflammation, and improve clinical outcomes in periodontitis.

Use of a periodontal resective procedure (proximal wedge technique) for treating gingival and periodontal pockets of mandibular canine teeth in dogs.

This study aims to evaluate the ability of a periodontal resective procedure (the Proximal Wedge Technique) to improve the long-term health of the mandibular canines by reducing probing depths immediately post-surgery via targeted tissue recontouring and precise debridement. The technique aims to enhance periodontal health and stabilize the supporting structures of strategically important adjacent canine teeth, including alveolar bone, rather than relying solely on mandibular incisor extractions with simple closure. A retrospective records review compiled data from patients with suprabony pockets of 6 mm or greater at the mesial aspect of the mandibular canines treated with the proximal wedge technique (PWT). The PWT utilizes non-displaced gingival flaps combining concepts from the modified Widman flap and distal wedge procedures with selective osteoplasty. Twenty-one mandibular canine sites from 12 patients of various breeds with pocket depths ranging from 6 to 10 mm were treated with the PWTresulting in post-operative mean pocket depths of 1.7 ± 0.1 mm. Approximately 1 year later, the improved depths were unchanged in six of the patients comprising 12 of the 21 sites. By employing this method, veterinarians can enhance periodontal health and stabilize the supporting structures of strategically important adjacent canine teeth, including alveolar bone, rather than relying solely on mandibular incisor extractions with simple closure. The Proximal Wedge Technique resulted in reliable periodontal success and improved patient outcomes for one year and potentially longer, allowing retention of the mandibular canines and maintaining the integrity of the rostral mandible.

Antioxidant, antibacterial, and systemic efficacy of sesame oil-pulling in periodontitis and diabetes management.

To evaluate the efficacy of sesame oil-pulling in periodontitis with/without Type2 Diabetes Mellitus (T2DM), compared to Chlorhexidine, for its oral and systemic health benefits. Total of 120 periodontitis patients, without (Group A; 60)/with (Group B; 60) T2DM, underwent control (chlorhexidine 0.12%; Group A1 & B1) and test (sesame oil-pulling; Group A2 & B2) interventions. Plaque index, pocket depth, salivary total antioxidant capacity (T-AOC) enzyme-linked-immunosorbent-assay (ELISA), subgingival plaque BANA test, and serum CRP were evaluated at baseline and 30 days post-intervention using analysis of variance (ANOVA) with a significant p-value set at 0.05. Group B serum samples also analyzed for Fructosamine and lipid profile. Both treatment regimens were equivalent in reduction of plaque, pocket depth, red complex periodontopathogens in Group A & B. Significant increase in salivary T-AOC post-intervention observed in Group B with both interventions (p<0.01). Sesame oil-pulling significantly decreased systemic CRP and triglyceride levels, with no difference observed with Chlorhexidine in Group B. Sesame oil-pulling is equivalent to Chlorhexidine for anti-plaque, antibacterial, and antioxidant effects in periodontitis patients with/without T2DM. Systemic anti-inflammatory, cardio-protective benefits (reduction of CRP and triglycerides) make it better adjunct to Chlorhexidine in periodontitis with T2DM.

Determination of IL-17, BCL-3 and IκBζ expression levels in the gingival crevicular fluid of psoriasis patients.

The purpose of this study was to determine the levels of IL-17, Bcl-3 and IκBζ gene expression in the gingival crevicular fluid (GCF) of psoriatic and healthy individuals and to compare the clinical periodontal parameters in the patient and control groups. A total of 10 psoriasis patients and 2 healthy patients in the control group were included in the analysis for IL-17, Bcl-3, and IκBζ gene expression in the GCF. Periodontal health, gingival index, plaque index, and mobility (using a periotest device) levels were compared between the groups. While considering the down-expressed patients, the expression level of the Bcl-3 gene showed the most variability among the genes studied in psoriasis disease. IL-17 gene expression levels were significantly higher and up-regulated in all patients compared to the control group. In addition, when comparing IL-17 with Bcl-3, IL-17 gene expression was notably high in all patients except patients 4, 9 and 10. The highest expression levels of the IκBζ gene were observed in the patient sample, except for patients 7 and 8. While plaque index, gingival index, and pocket depth parameters were higher in the psoriasis group, there was no significant difference between the two groups (p = 0.257, p = 0.390, p = 0.240, respectively). In the periotest (mobility) parameter, while the mean value was higher in the psoriasis group significantly (p = 0.030), clinically mean values of two groups were in the same grade according to Miller mobility index. The IκBζ gene showed notable high expression levels in psoriasis patients. It was concluded that psoriasis may be associated with periodontitis. CLINICAL TRIAL REGISTRATION NUMBER: NCT06408454-05/06/2024. NAME OF THE TRIAL REGISTER: Interleukin- 17 (IL-17), Bcl-3, and NF-kappa-B Inhibitor Zeta (IκBζ) Expression Levels in the Psoriasis Patients.

Is ADDM graft practical? A comparative study to evaluate ADDM graft in third molar surgery.

It has been outlined that LTM (Lower third molar) extracted from patients in which grinding, cleaning, sterilization & demineralization prove to be highly effective as graft material for filling the alveolar socket of the very same patient. These investigations aim to assess the efficiency of ADDM (Autogenous Demineralized Dentin Matrix) graft in third molar extraction sockets. To check the effectiveness of ADDM as graft material in extraction socket by evaluating pain, swelling, trismus, PD (Probing Depth) and bone density. A prospective, randomized control trial was conducted at our institute. The patients were haphazardly, non-blindly alienated into two groups. Group A (45 patients) on the test side after LTM impaction surgery will receive ADDM graft material with bio-collagen membrane and Group B (45 patients) on the control side underwent LTM removal, with the alveolus left to heal conventionally by forming a blood clot. Swelling showed significant difference between CG (Control Group) and TG (Test Group), the intergroup comparison of change in the swelling scores at seventh post-operative day (from pre-op level) was significantly higher in the TG (117.35) as compared to the CGs (115.92) (p = 0.001). A statistically significant difference in probing depth was also noted between the two groups, CG 4.46 ± 1.252 & TG 2.52 ± 0.641 in the post-operative examination at three months. In our study radiographical evaluation revealed progressive increase in bone density in TG (135.81 ± 8.73) when compared to CG (121.59 ± 13.83) over a period of three months. Pain and trismus evaluation did not reveal any significant difference between TG & CG. The clinical results of the ADDM graft procedure demonstrate satisfactory outcomes in extraction sockets. The findings of this study highlight the importance of preservation methods in maintaining the periodontal pocket depth distal to the second molar and the remaining alveolar ridge following extraction.

Detection of Salivary Biomarkers Osteocalcin and Osteonectin of Bone Turnover among smokers Periodontitis Patients in Erbil City-Iraq

This study aims to compare the periodontal health conditions between study and control groups, regarding clinical periodontal parameters (attachment loss, probing pocket depth, bleeding on probing, and plaque index), and also compare salivary biomarkers (Osteocalcin and Osteonectin) and their relationship. Eighty nine subjects participated in this study; they were distributed into three groups, sixty of them selected from patients seeking periodontal treatment, and their ages ranged between (20 and 50). The healthy group included (29) subjects of analogous ages to the study groups, with a clinically healthy periodontium state. The study groups consisted of (60) patients distributed equally to two groups (30) nonsmokers and (30) smokers with clinical signs of periodontitis. Our outcomes revealed a significant p. value ≤ 0.001 increase in parameters of periodontal in periodontitis group compared to the heathy group. There were no significant differences for all parameters between periodontitis groups, except bleeding on probing. While results of Osteonectin showed highly significant difference P. value ≤ 0.001 between the control and the smokers groups and similar results between the study groups. There was no significant difference between the control and nonsmoker groups. Statistical analysis indicated no significant association between periodontal parameters and salivary biomarkers. However, in the Osteocalcin group; the control group had a significantly different plaque index. Similarly in the osteonectin, the control group showed significant differences in bleeding on probing. The study concluded that smoking is a contributing factor that initiates bone recession. Osteocalcin and Osteonectin are potential biomarkers for the early diagnosis and prognosis of periodontal disease.