Field Of Periodontology Research Articles

Biologics Agents in Periodontal Regeneration:A Review

The field of periodontology and dental implantology has witnessed significant advancements in the use of molecular mediators and biologic agents over the past decade. Periodontal regeneration, which involves the complete restoration of cementum, bone, and connective tissue following removal of epithelial tissues, is considered superior to tissue repair. Recent research has focused on utilizing biologic materials as complementary therapies to enhance regeneration by accelerating wound healing. These biologic agents were investigated using the following search terms: tissue engineering, intercellular signaling molecules, and biological factors. Enamel matrix derivative (EMD), platelet-derived growth factor (PDGF), platelet-rich plasma, bone morphogenetic proteins (BMPs), fibroblast growth factor (FGF), and parathyroid hormone (PTH) have demonstrated the capacity to stimulate both hard and soft tissue regeneration. However, no single biologic agent is universally effective, necessitating a case-by-case evaluation for optimal treatment selection. Currently, EMD and PDGF are the only biologic therapies approved by the FDA for periodontal regeneration, while BMP-2 is indicated for bone augmentation. Due to a lack of FDA approval for periodontal applications, the clinical use of FGF and PTH in this context is not recommended.

Pain Perception Following Periodontal Decontamination Treatment with Laser Therapies: Comparison between Oxygen High-Level Laser Therapy (OHLLT) and Laser-Assisted New Attachment Procedure (LANAP)

Introduction: Within the field of periodontology, there has been a proposal for the utilization of noninvasive laser therapy as a potential treatment for persistent periodontitis. The Laser-Assisted New Attachment Procedure (LANAP) employs an Nd:YAG laser as a specific technique. Through its interaction with endogenous chromophores, the Nd: YAG laser exhibits a selective effect on the evaporation of granulation tissue, therefore establishing a correlation with reduced bleeding. The study also examined Oxygen High-Level Laser Therapy (OHLLT). The OHLLT technique employs a high-power diode laser in combination with hydrogen peroxide solutions to facilitate the liberation of singlet oxygen, which possesses antibacterial attributes, within the periodontal pockets. The existing literature indicates their potential to promote the regeneration of tooth support tissues. Objective: The aim of this study is to assess the subjective pain levels reported by patients who have undergone surgery using the OHLLT protocol versus those who have undergone surgery using the LANAP technique. Methods: A total of 20 individuals with a stage III–IV periodontitis diagnosis were recruited for the study. The participants were randomly divided into two groups, each consisting of 10 individuals: Group 1, comprising patients treated according to the LANAP protocol, and Group 2, comprising patients treated according to the OHLLT protocol. After their initial session of nonsurgical periodontal therapy, individuals provided feedback regarding their level of pain, utilizing a Numerical Rating Scale (NRS) comprising time intervals of 0 h (T0), 6 h (T1), 12 h (T2), 24 h (T3), 48 h (T4), and 7 days (T5). The Wilcoxon–Mann–Whitney statistical test was employed to assess the variations in NRS scores between Group 1 and Group 2 at each recording period. (p ≤ 0.05). In addition, a microbiological assessment of the bacterial load in the periodontal region was conducted on all subjects using real-time PCR testing at two time points: prior to treatment (T0) and seven days post-treatment (T5). Results: The findings of this study indicate that the OHLLT group exhibited significantly lower pain levels compared to the LANAP group at all time intervals, except for the preoperative period, where no significant difference was observed (p < 0.05). Group 2 exhibited a more rapid decrease in pain, as demonstrated by a score test approaching zero within 24 h. The quantity of periodontal bacteria seen seven days post-treatment was similar between the two groups and was found to be decreased compared to the pre-treatment levels. Conclusions: The OHLLT and LANAP regimens have demonstrated efficacy in the nonsurgical management of periodontal disease. Nevertheless, it should be noted that the OHLLT approach does not subject the patient to any thermal hazards, unlike the LANAP method. The postoperative discomfort experienced following the OHLLT procedure is indeed reduced, as this technique is characterized by lower invasiveness and reduced dependence on the operator.

Artificial intelligence in dental education: ChatGPT's performance on the periodontic in-service examination.

ChatGPT's (Chat Generative Pre-Trained Transformer) remarkable capacity to generate human-like output makes it an appealing learning tool for healthcare students worldwide. Nevertheless, the chatbot's responses may be subject to inaccuracies, putting forth an intense risk of misinformation. ChatGPT's capabilities should be examined in every corner of healthcare education, including dentistry and its specialties, to understand the potential of misinformation associated with the chatbot's use as a learning tool. Our investigation aims to explore ChatGPT's foundation of knowledge in the field of periodontology by evaluating the chatbot's performance on questions obtained from an in-service examination administered by the American Academy of Periodontology (AAP). ChatGPT3.5 and ChatGPT4 were evaluated on 311 multiple-choice questions obtained from the 2023 in-service examination administered by the AAP. The dataset of in-service examination questions was accessed through Nova Southeastern University's Department of Periodontology. Our study excluded questions containing an image as ChatGPT does not accept image inputs. ChatGPT3.5 and ChatGPT4 answered 57.9% and 73.6% of in-service questions correctly on the 2023 Periodontics In-Service Written Examination, respectively. A two-tailed t test was incorporated to compare independent sample means, and sample proportions were compared using a two-tailed χ2 test. A p value below the threshold of 0.05 was deemed statistically significant. While ChatGPT4 showed a higher proficiency compared to ChatGPT3.5, both chatbot models leave considerable room for misinformation with their responses relating to periodontology. The findings of the study encourage residents to scrutinize the periodontic information generated by ChatGPT to account for the chatbot's current limitations.

Knowledge, Attitude and Perception Regarding Artificial Intelligence in Periodontology: A Questionnaire Study.

The utilization of artificial intelligence (AI) and machine learning (ML) models has brought about a significant transformation in the manner in which periodontists gather information, evaluate associated risks, develop diverse treatment alternatives, anticipate and diagnose dental conditions that compromise periodontal health. The principal objective of this prospective study was to examine periodontists' understanding and acceptance of the application of AI in the realm of periodontology. This observational study was conducted on 275 participants based on questionnaire using Google Forms. These forms were pre-validated and subsequently circulated among periodontists in Maharashtra via various social media platforms. The study, in its entirety, comprised four open-ended questions on participants' demographics and 14 closed-ended questions, all of which were presented to the participants in English. These questions aimed to elicit participants' awareness, knowledge, attitudes, and perspectives regarding emerging applications of AI in the field of periodontology. To analyze the collected data, researchers employed the widely utilized Statistical Package for Social Sciences (SPSS) version 22.0. A 75% response rate was achieved and 68% of the respondents were female. 62% periodontists were aware of AI; however, only 24% were aware of its working principles. Most respondents agreed with the use of AI in periodontal diagnosis; however, they disagreed with the use of AI in predicting clinical attachment loss (69%). 80-82% respondents felt that AI should be a part of postgraduate training and should be implemented in clinical practice. However, most periodontists do not use AI for diagnostic or research purposes. 49% periodontists felt that AI does not have better diagnostic accuracy than periodontists, and therefore cannot replace them in the future. Most periodontists possessed a reasonable level of understanding regarding the utilization of AI in the domain of periodontology and expressed a desire to incorporate it into their diagnostic and treatment planning processes for periodontal conditions. Additional endeavors must be undertaken to enhance periodontists' awareness concerning the effective implementation of AI within their professional practice, with the aim of facilitating personalized treatment planning for their respective patients. It is postulated that the integration of AI will augment the likelihood of achieving favorable outcomes within the realm of periodontology.

Gender inequality among the editorial boards of periodontology and implantology journals.

The aim of the present study was to investigate gender composition of the editorial board members of the journals in the field of periodontology and implantology. A rigorous search was performed through Web of Science database to identify journals, scoping on the periodontology and implantology research fields. Data on journal's demographic information, gender of the editorial board members were gathered from the journals fulfilling the predefined inclusion/exclusion criteria. Variables including journal impact factor and quartiles were extracted as well. The proportion of women in the editorial team in periodontology journals was 27.3%, whereas it was almost 19% in implantology journals. As for editorial leadership, these ratios were 22.1% and 19.8%, respectively. There were significantly less women than men in editor-in-chief position in periodontology journals (p = 0.042). Journal metrics had no impact on the gender distribution of editor-in-chief positions in both fields. Women seem to be under-represented as editorial leaders or board members in journals of periodontology and implantology. The proportion of women in periodontology journals has increased in the last decade; however, there is still a clear need for further increase to have a gender balance.

Pink Aesthetics: Gummy Smiles and Gingival Recession.

The ideal smile is one where there is harmony between the 'white' (tooth) and 'pink' (periodontal) aesthetics. The developments in the field of periodontology have enhanced aesthetic outcomes when managing excessive gingival exposure in a 'gummy' smile or excessive tooth exposure in gingival recession cases. This paper aims to outline the aetiology, classification, and management of both a 'gummy' smile and gingival recession, putting a spotlight on aesthetics.

Artificial Intelligence in Identifying Dental Implant Systems on Radiographs.

Health care is entering a new era where data mining is applied to artificial intelligence. The number of dental implant systems has been increasing worldwide. Patient mobility from different dental offices can make identification of implants for clinicians extremely challenging if there are no past available records, and it would be advantageous to use a reliable tool to identify the various implant system designs in the same practice, as there is a great need for identifying the systems in the field of periodontology and restorative dentistry. However, there have not been any studies devoted to using artificial intelligence/convolutional neural networks to classify implant attributes. Thus, the present study used artificial intelligence to identify the attributes of radiographic images of implants. An average accuracy rate of over 95% was achieved with various machine learning networks to identify three implant manufacturers and their subtypes placed during the past 9 years.

Theory-based behavioral change interventions to improve periodontal health.

Periodontal disease is a significant global health burden affecting half of the world's population. Given that plaque and inflammation control are essential to the attainment of periodontal health, recent trends in preventive dentistry have focused on the use of behavioral models to understand patient psychology and promote self-care and treatment compliance. In addition to their uses in classifying, explaining and predicting oral hygiene practices, behavioral models have been adopted in the design of oral hygiene interventions from individual to population levels. Despite the growing focus on behavioral modification in dentistry, the currently available evidence in the field of periodontology is scarce, and interventions have primarily measured changes in patient beliefs or performance in oral hygiene behaviors. Few studies have measured their impact on clinical outcomes, such as plaque levels, gingival bleeding and periodontal pocket reduction, which serve as indicators of the patient's disease status and quality of oral self-care. The present narrative review aims to summarize selected literature on the use of behavioral models to improve periodontal outcomes. A search was performed on existing behavioral models used to guide dental interventions to identify their use in interventions measuring periodontal parameters. The main models were identified and subsequently grouped by their underlying theoretical area of focus: patient beliefs (health belief model and cognitive behavioral principles); stages of readiness to change (precaution adoption process model and transtheoretical model); planning behavioral change (health action process approach model, theory of planned behavior and client self-care commitment model); and self-monitoring (self-regulation theory). Key constructs of each model and the findings of associated interventions were described. The COM-B model, a newer behavioral change system that has been increasingly used to guide interventions and policy changes, is discussed with reference to its use in oral health settings. Within the limitations of the available evidence, interventions addressing patient beliefs, motivation, intention and self-regulation could lead to improved outcomes in periodontal health. Direct comparisons between interventions could not be made due to differences in protocol design, research populations and follow-up periods. The conclusions of this review assist clinicians with implementing psychological interventions for oral hygiene promotion and highlight the need for additional studies on the clinical effects of behavioral model-based interventions.

Critical appraisal of systematic reviews of intervention studies in periodontology using AMSTAR 2 and ROBIS tools.

Systematic reviews of intervention studies are used to support treatment recommendations. The aim of this study was to assess the methodological quality and risk of bias of systematic reviews of intervention studies in in the field of periodontology using AMSTAR 2 and ROBIS. Systematic reviews of randomized and non-randomized clinical trials, published between 2019 and 2020, were searched at MedLine, Embase, Web of Science, Scopus, Cochrane Library, LILACS with no language restrictions between October 2019 to October 2020. Additionally, grey literature and hand search was performed. Paired independent reviewers screened studies, extracted data and assessed the methodological quality and risk of bias through the AMSTAR 2 and ROBIS tools. One hundred twenty-seven reviews were included. According to AMSTAR 2, the methodological quality was mainly critically low (64.6%) and low (24.4%), followed by moderate (0.8%) and high (10.2%). According to ROBIS, 90.6% were at high risk of bias, followed by 7.1% low, and 2.4% unclear risk of bias. The risk of bias decreased with the increased in the impact factor of the journal. Current systematic reviews of intervention studies in periodontics were classified as low or critically low methodological quality and high risk of bias. Both tools led to similar conclusions. Better adherence to established reporting guidelines and stricter research practices when conducting systematic reviews are needed. Key words:Bias, evidence-based dentistry, methods, periodontics, systematic review.

Ozone Therapy in Periodontics: A Review

Oral cavity is in dynamic interaction with external environment exposing it to various microorganisms their colonization and the host defense that aimed for their removal. Formation and development of dental biofilm and its potential to harbor specific microorganisms is directly linked with some of the most common oral ailments like dental caries diseases affecting periodontium. The conventional protocol to treat such ailments primarily include removal of biofilm along with adjunctive course of antibiotics. However these modalities have limitations in their efficacy. Ozone is a natural gas present in the earth stratosphere and acts as a potent oxidant. At low doses ozone has several favorable therapeutic applications in medicine as well as in dental pathologies. Particularly ozone as a treatment modality was used for the first time in dentistry in the 1930s when it was proposed as a disinfectant and wound-healing agent. Owing to its strong oxidation property with the formation of free radicals and its capacity to directly destruct almost all microorganisms it is known as a potential antioxidant anti-inflammatory immunomodulatory anti-hypoxic biosynthetic and antimicrobial agent. In addition ozone has a therapeutic effect that promotes wound healing and improves blood supply. Three most common forms in which ozone can be administered for its therapeutic use are gaseous aqueous and oil forms out of which the gaseous application of ozone is critically evaluated because of its possible side effects on the respiratory system. The objective of the current article was to compile and document various application of ozone in the field of periodontology. Research was based on peer-reviewed sources found through MedlinePubMed Google scholar search and other reviews and journals.

Animal models for testing biomaterials in periodontal regeneration.

Periodontitis is a prevalent oral disease. It can cause tooth loss and has a significant impact on patients' quality of life. While existing treatments can only slow the progression of periodontitis, they are unable to achieve complete regeneration and functional reconstruction of periodontal tissues. As a result, regenerative therapies based on biomaterials have become a focal point of research in the field of periodontology. Despite numerous studies reporting the superiority of new materials in periodontal regeneration, limited progress has been made in translating these findings into clinical practice. This may be due to the lack of appropriate animal models to simulate the tissue defects caused by human periodontitis. This review aims to provide an overview of established animal models for periodontal regeneration, examine their advantages and limitations, and outline the steps for model construction. The objective is to determine the most relevant animal models for periodontal regeneration based on the hypothesis and expected outcomes.

Impact of the COVID-19 pandemic on publication rate in periodontology and implantology in Turkey

Objective: The aim of the present study was to evaluate the impact of the COVID-19 pandemic on the number of publications in the field of periodontology and implantology in Turkey. Material and Methods: A sensitive search strategy was developed to identify relevant articles, focusing on the periodontology and implantology research fields published two years before and after the declaration of the pandemic (March 2020). The search was performed through Web of Science, Medline, SCOPUS and CENTRAL databases. A three-stage screening (titles, abstract, full-text) was carried out in duplicate and independently by two reviewers. Results: A total of 382 studies were identified before the pandemic and 307 studies during the pandemic. While there was a downward trend in the number of observational studies (185 vs 168), the number of clinical trials (CCT/RCT) slightly increased compared to the pre-pandemic period (72 vs 74). Conclusion: Limited to the selected period of time (two years) and field, publication rate on periodontology and implantology in Turkey was decreased during the pandemic. Although the present research highlights current trends, large-scale investigations are needed to probe consequences of COVID-19 pandemic on research activities in the long-run. KEYWORDS COVID-19; Implantology; Periodontology; Publication; Sars-CoV-2; Pandemic.

Piezo-surgery in periodontics.

Periodontitis is a chronic inflammatory disease of the tooth-supporting structures. The treatment of this condition is primarily based on the removal of local factors and the restoration of the bony architecture. Furthermore, in the modern era of dentistry, successful implant therapy frequently necessitates strong osseous support. Traditionally, osseous surgery has been performed using either manual or motor-driven instruments. Both methods, however, have advantages and disadvantages. A novel surgical approach utilising a piezoelectric device has recently been introduced in the field of periodontology and oral implantology. This narrative review article discusses the numerous applications of this novel technique of piezosurgery in periodontology.

The Future Perspective of Hyaluronic Acid Gel in the Management of Aggressive Periodontitis

Over these past few years, there are certain recently developed therapeutic approaches in the field of Periodontology, whose main motive is to achieve the comfort level by the patient. These therapeutic approaches are either used as an adjunct to conventional treatment approaches or as a substitute for the conventional treatment approaches. However over these few years one of the material on which various researches have been carried out is the hyaluronic acid upon which when investigations carried out indicated to be used in regenerative surgery as a membrane as mainly because of its bacteriostatic effects (particularly Aggregatibacter actinomycetemcomitans, Prevotella oris and Staphylococcus aureus) on wound contamination. Thus taking the bacteriostatic property of hyaluronic acid into consideration this editorial review highlights that how hyaluronic acid gel in future can be used as a useful adjunct in the management of aggressive periodontitis cases.

Detection of Natural and Simulated Periodontal Defects Using Cone-Beam Computed Tomography and Digital Intraoral Radiography

Objective: In this study, it was aimed to compare the diagnostic value of cone beam computed tomography (CBCT) and digital intraoral periapical imaging methods in the diagnosis of periodontal defects, and the comparison of observers practicing dentistry in the field of periodontology and 3 other observers specialized in various branches was evaluated. Methods: 7 dry mandible and 5 dry maxilla were used in this study. A total of 111 artificial and natural defects (dehiscence, furca, fenestration, vertical defects) on the anterior, premolar and molar region were imaged with digital imaging techniques using different exposure parameters and scanned with CBCT. Results: According to the results of this study, CBCT is a more reliable method in the evaluation of all periodontal defects compared to CCD and PSP. 60 and 70 kVp with 0.01 irradiation time in CCD and 70 kVp 0.25 irradiation time in PSP is not suitable for detecting defects owing to high contrast. In the evaluation of periodontal defects, there was no single observer who had good results, different imaging methods and varying results were obtained in different defects. Conclusion: This study showed that the CBCT method has some diagnostic value for detecting all natural and simulated periodontal defects but it should only be used in cases where clinical evaluation and conventional radiographic imaging do not provide the information necessary for an adequate diagnosis and proper periodontal treatment planning.

Bibliometric Analysis of the Literature on Periodontology

The literature in the field of Periodontology as indexed in MEDLINE covered in PubMed for the period 2000–2019 were retrieved for this study. A total of 38336 records/publications were identified in the field of Periodontology, it is noticed that there is a minor fluctuation trend in publications of Periodontology research productivity year after year. It is also observed that there is a fluctuation trend of records in the study of Indian records. It was found that 50.93% of records are journal articles in the field of Periodontology. The United States is the prime publisher and published 17754 records. RGR has decreased and the Dt has shown an increasing trend, but both results were in the minor fluctuation trend in this study period. A total of 89 journals were identified as important journals in the field of Periodontology. The result of 89 important journals published by different countries; the United States dominated the first rank; followed by England and India. Activity Index is greater than 100 in the study period of ten years out of twenty years, which exposes that those years were more activity of Periodontology research in India compare to the World's publications.

Exploring the Scope of Salivary Proteomics in Periodontal Diagnosis: A Narrative Review

Periodontal disorders are among the most widespread chronic illnesses globally which impact the tooth-supporting tissues and have a multitude of ramifications for one’s quality of life. The purpose of periodontal diagnostic methods is to offer meaningful information to clinicians about the type, location, and severity of periodontal disease so that disease monitoring and therapy may be established. Due to a lack of proper molecular diagnostic tools, their early detection is still difficult. Proteomics, the promising new “omics”, has become an important complementary tool to genomics providing novel information and greater insight into biology. The value of multidimensional peptide resolving approaches in the characterisation of complicated proteomes cannot be overstated and thus can very much be used as diagnostic biomarkers in periodontal world. Since proteomics is considered more intricate and complicated than genomics, the sound and rich facts of proteins concerned in periodontitis can be applied in the analysis, avoidance and management of periodontal diseases. Despite several novel protein markers being recently enlisted by discovery proteomics through various methods such as Enzyme Linked Immunosorbent Assay (ELISA), immunoassays with Mass Spectroscopy (MS), Protein Topography and Migration Analysis platform (ProtoMap), Matrix Assisted Laser Desorption (MALDI) etc., their routine diagnostic application is hampered by the lack of validation platforms that can rapidly, accurately and simultaneous quantify multiple proteins in large populations. Furthermore, saliva contains a non invasively collected store of clinically relevant biomarkers, which, if properly employed, might aid in early illness detection and monitoring. Hence, in this context, this review aims to discuss the unravelling field of proteomics in brief and the scientific sphere of its development from laboratory to clinical practice and its implications in the field of periodontology.

Prediction intervals should be included in meta-analyses published in dentistry.

This focus article aims to highlight the value of reporting prediction intervals (PIs) in random effects meta-analysis and to assess the prevalence of PI-reporting in periodontology and implant dentistry meta-analyses. We searched in the PubMed database for meta-analyses published in the fields of periodontology and implant dentistry. We selected meta-analyses related to primary outcomes with at least three trials. Additionally, we extracted information on the type of the meta-analysis model (fixed or random) and whether the random effects meta-analyses included PIs in addition to the 95% confidence intervals. Three-hundred and forty-nine meta-analyses were found in 94 systematic reviews. Two-hundred and sixty-three (75.4%) subgroup and full meta-analyses used the random-effects model, 81 (23.2%) used fixed-effect methods, and 5 (1.4%) did not specify the model used. In 75 systematic reviews, we found 231 meta-analyses with three or more trials (173 full meta-analyses and 58 subgroup meta-analyses). Only one systematic review reported PIs. Interpretation of the results of random effects meta-analyses which ignore heterogeneity can be misleading. Heterogeneity should be explored, and two common approaches include subgroup analyses and meta-regression. Random effects meta-analyses should include PIs because they convey the extent of heterogeneity in treatment effects across studies in a clinically relevant context.

A Novel Approach of Using Free Buccal Pad of Fat Combined With Modified Coronally Advanced Flap in Treating Localized Gingival Recession: A Technical Note

Background: Various surgical techniques have been proposed for the treatment of gingival recession (GR) in the form of either pedicled or free grafts. The free buccal pad of fat is an easy technique for harvesting a free graft for regenerative purposes and is currently gaining popularity and attention in the field of periodontology. The buccal fat pad is a fat tissue that is used as a novel source of mesenchymal cells (MSC). The aim of the current case report was to assess the efficacy of using a free buccal pad of fat in combination with a modified coronally advanced flap procedure (CAF) in treating localized gingival recession. Methods: A healthy 33-year-old male presented with gingival recession type 1 (RT1) affecting his upper right canine and was suffering from continuous sensitivity. Phase I therapy was performed six weeks before surgery. A modified CAF was raised to expose the recipient site and a free buccal fat pad graft (FBFP) was harvested and sutured in place. Results: The color of the tissues was nearly homogeneous two weeks following the surgical procedure. Maximum root coverage was 66.6% achieved at one month. However, a gradual relapse of 25% was noticed through the follow-up at three and six months postoperatively. Conclusion: The use of the FBFP in combination with a modified CAF can be excluded as a successful regenerative method for treating GR. However, further studies and randomized controlled clinical trials are recommended to confirm the effectiveness of this technique for the treatment of GR in the long term.

Abstracts from the World Federation for Laser Dentistry—Asia Pacific Division Virtual Conference July 16–17, 2021

Abstracts from the World Federation for Laser Dentistry—Asia Pacific Division Virtual Conference July 16–17, 2021