Attachment Gain Research Articles

A Rose by Any Other Name: The Long Intricate History of Localized Aggressive Periodontitis.

This review addresses the recent World Workshop Consensus Conference (WWCC) decision to eliminate Localized Aggressive Periodontitis (LAgP) in young adults as a distinct form of periodontitis. A "Consensus" implies widespread, if not unanimous, agreement among participants. However, a significant number of attendees were opposed to the elimination of the LAgP classification. The substantial evidence supporting a unique diagnosis for LAgP includes the (1) incisor/molar pattern of disease, (2) young age of onset, (3) rapid progression of attachment and bone loss, (4) familial aggregation across multiple generations, and (5) defined consortium of microbiological risk factors including Aggregatibacter actinomycetemcomitans. Distinctive clinical signs and symptoms of LAgP are presented, and the microbial subgingival consortia that precede the onset of signs and symptoms are described. Using Bradford-Hill guidelines to assess causation, well-defined longitudinal studies support the unique microbial consortia, including A. actinomycetemcomitans as causative for LAgP. To determine the effects of the WWCC elimination of LAgP on research, we searched three publication databases and discovered a clear decrease in the number of new publications addressing LAgP since the new WWCC classification. The negative effects of the WWCC guidelines on both diagnosis and treatment success are presented. For example, due to the localized nature of LAgP, the practice of averaging mean pocket depth reduction or attachment gain across all teeth masks major changes in disease recovery at high-risk tooth sites. Reinstating LAgP as a distinct disease entity is proposed, and an alternative or additional way of measuring treatment success is recommended based on an assessment of the extension of the time to relapse of subgingival re-infection. The consequences of the translocation of oral microbes to distant anatomical sites due to ignoring relapse frequency are also discussed. Additional questions and future directions are also presented.

Root surface biomodification in periodontal therapy: Biological rationale and clinical applications.

Regenerative periodontal therapy aims to form new cementum, periodontal ligament, and alveolar bone, all sealed by gingival tissue. The root surface acts as the wound margin during this regeneration process. Root surface biomodification (root conditioning/root decontamination), therefore, seems instrumental in promoting surface decontamination and enhancing tissue attachment by removing the smear layer, exposing collagen fibrils, and facilitating blood clot formation and stabilization. This review attempted to provide an all-encompassing, evidence-based assessment of the role of root surface biomodification in regenerative periodontal therapy, particularly in intrabony defects, furcation defects, and root coverage procedures. The reviewed evidence suggested that root conditioning agents, whether used independently or in conjunction with bone graft materials, biological agents, membranes, or connective tissue grafts, do not offer any clinical advantage regarding clinical attachment gain. Thus, integrating chemical methods with the mechanical root instrumentation process does not necessarily contribute to superior clinical outcomes.

Impact of Inflammatory Markers and Senescence-Associated Secretory Phenotype in the Gingival Crevicular Fluid on the Outcomes of Periodontal Regeneration.

The aim of this study was to test the molecular expression profile (senescence-associated secretory phenotype; SASP) in gingival crevicular fluid (GCF) prior to surgery in relation to the distribution of clinical success of periodontal regeneration. Forty consecutive patients presenting sites with residual probing pocket depth (PPD) ≥ 6 mm and intrabony defects ≥ 3 mm were treated through a minimally invasive surgical technique. Pre-operatively, GCF was sampled for inflammatory biomarker analysis related to SASP [interleukin (IL)-1β, IL-6, and IL-12; matrix-metalloproteinases (MMP)-8 and -9]. Better or worse responders were classified depending on the achievement of a composite outcome measure at 1-year [COM; PPD ≤ 4 mm and clinical attachment gain (CAL) gain ≥ 3 mm]. Correlation analyses and logistic regression models were performed. Periodontal regeneration led to significant improvements in mean clinical and radiographic parameters. Teeth achieving COM presented significantly lower amounts of SASP factors compared with non-successful teeth. Higher CAL gain, PPD reduction, and radiographic bone fill were negatively correlated with IL-1β and MMP-8 and -9 (p < 0.001), while IL-12 showed a direct relationship with CAL gain (p = 0.005) and PPD reduction (p = 0.038). Sites expressing higher SASP expression in the GCF before periodontal regeneration achieved worse clinical and radiographic outcomes.

Immediate orthodontic treatment after regeneration of periodontal intrabony defects: A long-term retrospective study

Background/purposeOrthodontic movement is often necessary for periodontally compromised patients to enhance esthetics, function, and long-term occlusal stability. However, the impact of orthodontic treatment immediately following the regeneration of intrabony defects on periodontal healing remains a topic of debate. The objective of this long-term case series study was to test the hypothesis that orthodontic treatment performed immediately after regenerative procedures for periodontal intrabony defects did not adversely affect periodontal healing. Materials and methodsThis case series study involved nine periodontally compromised subjects with a total of 17 intra-bony defects. Orthodontic brackets were applied immediately before surgery. Flaps were raised, and diseased roots were debrided. All intra-bony defects were filled with alloplastic bone grafts and covered with resorbable membranes, except for one defect treated with Emdogain. All patients initiated orthodontic treatment immediately after periodontal regenerative surgery. Clinical parameters, including probing depth, attachment level, and bone fill, were assessed at baseline and during final maintenance therapy. ResultsThe mean follow-up duration was 12.8 years. None of the 17 surgically regenerated teeth were lost. The mean reduction in probing depth was 3.94 mm (95% confidence level, 3.19–4.68; P < 0.001), with a mean clinical attachment gain of 3.47 mm (95% confidence level, 2.90–4.03; P < 0.001). The mean radiographic bone fill was 4.89 mm (P < 0.001). ConclusionBased on the findings of this long-term case study, it can be concluded that immediate orthodontic treatment does not adversely affect the maturation process of periodontal regeneration outcomes and can be maintained for more than ten years.

Effectiveness of photodynamic therapy on the treatment of chronic periodontitis: a systematic review during 2008-2023.

This study investigated the effect of photodynamic therapy on chronic periodontitis patients and then evaluated the microbial, immunological, periodontal, and clinical outcomes. The significant effects of photodynamic therapy obtained by in vitro and in vivo studies have made it a popular treatment for periodontal diseases in recent years. Photodynamic therapy is a novel bactericidal strategy that is stronger, faster, and less expensive than scaling and root planing. This study registered on PROSPERO (CRD42021267008) and retrieved fifty-three randomized controlled trials by searching nine databases (Medline, Embase, Scopus, Open Gray, Google Scholar, ProQuest, the Cochrane Library, Web of Science, and ClinicalTrials.gov) from 2008 to 2023. Of 721 records identified through database searches following title and full-text analysis, and excluding duplicate and irrelevant publications, 53 articles were included in this systematic review. Fifty of the 53 eligible studies fulfilled all the criteria in the Joanna Briggs Institute's (JBI's) Checklist for RCTs; the remaining articles met 9-12 criteria and were considered high quality. The present study showed that photodynamic therapy in adjunct to scaling and root planing has the potential to improve periodontal parameters such as clinical attachment loss or gain, decrease in bleeding on probing, and probing pocket depth. In addition, photodynamic therapy decreases the rate of periodontal pathogens and inflammation markers, which, in turn, reduces the progression of periodontitis. Photodynamic therapy is considered a promising, adjunctive, and low-cost therapeutic method that is effective in tissue repair, reducing chronic periodontitis, reducing inflammation, and well-tolerated by patients.

Beyond learning with cold machine: interpersonal communication skills as anthropomorphic cue of AI instructor

Prior research has explored the impact of diverse anthropomorphic interventions on the effectiveness of AI (artificial intelligence) instructors. However, the exploration of interpersonal communication skills (e.g., self-disclosure) as anthropomorphic conversational cues for AI instructors is rare. Considering the positive impact of the self-disclosure of human instructors and guided by the social penetration theory (Altman & Taylor, 1973) and computers are social actors (CASA) paradigm (Nass & Moon, 2000), this study explores the role of self-disclosure by AI instructors and the mediating role of emotional attachment between AI instructors’ self-disclosure and students’ learning experiences (learning interest and knowledge gain). Additionally, it examines the differences in students’ emotional attachment, learning interest, and knowledge gain between AI and human instructors. Through a 2 (AI instructor vs. human instructor) × 2 (self-disclosure: yes or no) experiment, this study concluded that 1) consistent with human instructors, self-disclosure by AI instructors led to higher emotional attachment, learning interest, and knowledge gain; 2) emotional attachment played an important mediating role in AI instructor self-disclosure and students’ learning interest and knowledge gain; and 3) in the context of self-disclosure, students exhibited similar levels of emotional attachment to both AI and human instructors, with no significant differences observed. Regarding learning outcomes, while students demonstrated a greater interest in learning during courses taught by AI instructors, the difference in knowledge gained from AI and human instructors was not significant. The results of this study contribute to the understanding of the anthropomorphic cues of AI instructors and provide recommendations and insights for the future use of AI instructors in educational settings.

Impact of periodontal phenotype on the outcome of subgingival instrumentation in Stage II and III, Grade A and B periodontitis.

The influence of periodontal phenotype (PP) has been documented in the outcomes of various surgical periodontal interventions such as crown lengthening, mucogingival surgery, implant restoration, and open flap debridement. Previous studies with smaller sample sizes have assessed the role of PP on the outcome of nonsurgical periodontal therapy with inconsistent results. The aim of the current interventional study is to estimate the influence of PP on the outcome of subgingival instrumentation in Stage II and III, Grade A and B periodontitis. Fifty-two patients (n = 27 thick PP and n = 25 thin PP) underwent subgingival instrumentation using ultrasonic scalers and curettes under local anesthesia in a single sitting, and periodontal parameters were recorded at baseline, 2, 4, and 6 months. The McNemar and Chi-square tests were applied for categorical data, whereas the Wilcoxon signed-rank test and Mann-Whitney U-test were applied for continuous data in intra- and intergroup comparisons, respectively. Significantly better improvements in deeper pockets (>5 mm) with thick PP were observed. Loss of attachment was found in thin, bleeding on probing (BOP)-negative sites with an initial probing depth of ≤3 mm. However, BOP-positive sites belonging to both groups exhibited higher improvements in terms of clinical parameters. Probing depth, PP, and periodontal inflammation recorded in terms of BOP influence the gain in clinical attachment following subgingival instrumentation.

Prehydrated collagenated cortico-cancellous heterologous bone gel and papillae tunneling for isolated intrabony defects: 12-month noninferiority trial.

This study assessed the effectiveness of prehydrated collagenated xenogenic bone gel and a collagenated cortico-cancellous heterologous bone mixture in conjunction with papillae tunneling techniques (PTT) for treating isolated periodontal intraosseous defects. Twenty patients with periodontitis stage III/IV and at least one deep isolated interdental 2/3-wall intraosseous defect were included in the study. Surgical incisions were made vertically at the adjacent tooth or horizontally at the mucogingival junction. A full-thickness flap was then carefully lifted under the papillae using special tunneling instruments. The root surfaces were completely cleaned, and the defects were randomly filled with either prehydrated collagenated bone gel (test group; n = 10) or collagenated cortico-cancellous heterologous bone mixture (control group; n = 10). Wounds were closed with microsurgical sutures. We predicted that the lower 95% confidence interval for the difference between the two procedures would exceed a prespecified noninferiority threshold. All wounds closed sufficiently to prevent biomaterial exposure. The test and control groups showed similar mean pocket depth reduction (3.5 ± 1.0vs. 3.9 ± 1.7 mm; p = 0.52), similar gingival recession (-0.10 ± 0.99vs. 0.2 ± 0.8 mm; p = 0.46), and similar clinical attachment gain (3.6 ± 1.51vs. 3.7 ± 1.8 mm; p = 0.89) at the 12-month follow-up. All results were below the noninferiority margin of the sample. At 12 months, prehydrated collagenous bone gel performed similarly to collagenous heterologous bone granules in the treatment of intraosseous lesions with PTT. In addition, both biomaterials preserved soft tissue with minimal further recession at 1 year. When combined with PTT, collagenous xenogeneic bone granules and prehydrated collagenous bone gel achieve comparable clinical outcomes in intrabony defects.The study was registered under the NCT04782921 on ClinicalTrails.

To intrude or not to intrude? A systematic review of the controversy surrounding orthodontic intrusion on reduced periodontium

The main objective of this review was to evaluate the effects of orthodontic intrusion on patients with reduced periodontium. Additionally, this review aims to explore the potential for attachment gain and tissue regeneration in these patients and identify optimal therapeutic conditions to mitigate any negative effects of intrusion. A systematic review was conducted according to the PRISMA 2020 statement. Duplicate electronic searches of the PubMed, Cochrane, EMC Premium, and Science Direct databases were performed by two independent reviewers. Data extraction and quality assessments, including risk of bias evaluation using the Cochrane and ROBINS-I tools were conducted. From an initial pool of 418 articles, 29 were selected after title and abstract screening for full-text review. Following thorough full-text reading, 15 studies were ultimately included in the analysis. The total number of patients included in the studies is 528, who underwent orthodontic intrusion on reduced periodontium. Studies indicated a decrease in periodontal pocket depth and an increase in clinical attachment with ortho-periodontal treatment. Alveolar bone level outcomes varied, showing both increases and losses. Authors generally observed improved papillary regeneration and reduced gingival recessions. Clinical studies involving combined ortho-periodontal treatment showed that orthodontic intrusion on a reduced but healthy periodontium can be considered a beneficial treatment for the periodontium, provided that potential adverse effects are carefully monitored.

Efficacy of autologous platelet rich fibrin (PRF) and hydroxyapatite bioactive glass (HABG) in the management of intra bony defects -A randomized controlled trial

The ultimate aim of periodontal therapy is regeneration. Traditionally, many techniques and agents were used. The therapeutic outcome in treatment of intra bony defects can be augmented with the use of growth factors alongside bone grafts. The present clinical trial was designed to assess the efficacy of an alloplastic composite graft and the combination of autologous platelet rich fibrin with the graft in the management of intra bony defects. A total of 45 systemically healthy patients with intra bony defects indicated for flap surgery were selected from the outpatient department of periodontics. The patients were divided into three groups with the help of a computer generated random number table. Age, sex, and periodontal parameters (probing pocket depth, clinical attachment level, gingival marginal level, plaque index, modified sulcus bleeding index) and presence of intra bony defects were recorded. The defects in group I patients were treated with autologous PRF along with the graft, group II with graft, and group III with open flap debridement alone. All the patients were recalled at 3, 6, 9 months after surgery, and the periodontal parameters were recorded in each recall. The baseline parameters were compared with 9 month post op periodontal parameters by non parametric test for ANOVA (Kruskal Wallis). Maximum pocket depth reduction (5.86±1.03) maximum gain in attachment (4.64± 1.08), reduction in modified sulcus bleeding index were seen in group I, which is statistically significant between the groups. Though change in gingival marginal level is minimum for group I (1.21± 0.42), it was not statistically significant. Group I showed the maximum percentage of sites with bone fill (92.9%) which was also statistically significant when analyzed by the chi-square test. The Combination of autologous PRF with the hydroxy apatite bioglass graft in the management of intra bony defects showed improved clinical and radiographic outcome.

Antimicrobial peptides in treatment of Stage III Grade B periodontitis: A randomized clinical trial.

To evaluate the effects of antimicrobial peptides (AMPs) on Stage III Grade B periodontitis. This trial abided by the principle of consistency test, approved by ethics committee and registered in clinical trials. All qualified 51 patients with Stage III Grade B periodontitis were randomly divided into three groups: SRP group, SRP with minocycline hydrochloride (Mino group) as Control groups, and SRP with AMPs (AMP group) as the Test group. Clinical examinations and subgingival plaques were monitored at baseline and at 7 and 90 days after treatment in the SRP, SRP with AMP and Mino groups. The AMP group (Test group) had a reduced PD (Periodontal probing depth) and an attachment gain significantly higher than SRP and Mino groups (Control groups) at day 90. The abundance of periodontal pathogens was decreased in the AMP group at 7 and 90 days compared with the SRP group and Mino group. Only the AMP group showed an increase the abundance of periodontal probiotics including Capnocytophaga, Gemella, and Lactobacillus at 7 and 90 days. This study shows that AMPs as an adjunct to SRP promote additional clinical and microbiological benefits in the treatment of Stage III Grade B periodontitis.

Peran photodynamic therapy dalam perawatan periodontal non-bedah

Introduction: The main of non-surgical periodontal treatment is mechanical debridement. However, the treatment success rate is greatly influenced by ease of mechanical instrument access. Therefore, adjunctive antimicrobial therapy is indicated for complete removal of periodontal pathogen. Since long term systemic antimicrobial treatment can cause resistency, local antimicrobial treatment such as photodynamic therapy may serve as a better choice. Literature review: Photodynamic therapy (PDT) consists of 3 elements: photosensitizer, oxygen, and visible light. After photosensitizer binds with target cells, they are activated by visible light with suitable wavelength, thus producing singlet oxygen and Reactive Oxygen Species (ROS) to create toxic environment for anaerobic periodontal pathogen. PDT increases clinical attachment gain in both chronic and aggressive periodontitis treatment. It also decreases bleeding on probing and pocket depth. Discussion: The advantages of PDT are non invasive, short treatment time required, and reduced possibility of antimicrobial resistency. The disadvantages of PDT are tissue thermogenesis effect and temporary pigmentation of gingiva by photosensitizer. Several precautions should be made while using PDT such as adequate eye protection, irrigation, and isolation. Conclusion: Combination of mecahnical debridement and PDT is proven effective to increase clinical parameters and decrease bacterial burden in peridontitis treatment.

Clinical Efficacy of Platelet Derivatives in Periodontal Tissue Regeneration: An Umbrella Review.

This umbrella review aimed to consolidate the best available evidence regarding the clinical efficacy of platelet derivatives in the treatment of periodontal defects associated with periodontitis and in the management of mucogingival deformities. The "umbrella review" strategy was used to identify systematic reviews and meta-analyses. The search was performed without language restrictions and updated at the end of February 2023. The PubMed and Scopus databases, together with gray literature, were included in the search. The search yielded 412 studies. Subsequently, 12 articles were selected for further examination based on relevance. Finally, eight systematic reviews and meta-analyses were assessed. Regarding intrabony defects, in terms of clinical attachment level (CAL) gain, platelet-rich fibrin (PRF) was observed to lead to a statistically significant attachment gain compared to surgical therapy alone. PRF was also found to show greater CAL gain compared to platelet-rich plasma (PRP) and other biomaterials. The parameter probing depth decreased significantly when PRF was used compared to surgical therapy alone (P < 0.05). Similar results were seen when leukocyte- and platelet-rich fibrin (L-PRF) was applied. In terms of radiographic bone fill, both PRF and PRP showed significantly greater bone fill compared to surgical therapy. Regarding the results of periodontal plastic surgery, PRF favored a slight root coverage compared to the coronally displaced flap. This result depended on the number of PRF and L-PRF membranes used, but Emdogain or connective tissue graft produced better results regardless. However, an improvement in the healing of periodontal tissues was reported. Therapies with platelet derivatives applied to intrabony defects provided superior regenerative results compared to monotherapies, except in the case of root coverage.

Synergy of Regenerative Periodontal Surgery and Orthodontics Improves Quality of Life of Patients with Stage IV Periodontitis: 24-Month Outcomes of a Multicenter RCT.

In stage IV periodontitis patients with pathologic tooth migration (PTM), interdisciplinary treatment includes regenerative periodontal surgery (RPS) with an application of biomaterials and orthodontic therapy (OT) to restore function, esthetics and thereby quality of life (QoL). In a 24-month randomized trial we explored the synergy between regenerative medicine and biomechanical force application. The following methods were used: Forty-three patients had been randomized to a combined treatment comprising RPS and subsequent OT starting either 4 weeks (early OT) or 6 months (late OT) post-operatively. Clinical periodontal parameters and oral health-related QoL (GOHAI) were recorded up to 24 months. We obtained the following results: Mean clinical attachment gain (∆CAL ± SD) was significantly higher with early OT (5.96 ± 2.1 mm) versus late OT (4.65 ± 1.76 mm) (p = 0.034). Pocket closure (PPD ≤ 4 mm) was obtained in 91% of defects with early OT compared to 90% with late OT. GOHAI-scores decreased significantly from 26.1 ± 7.5 to 9.6 ± 4.7 (early OT) and 25.1 ± 7.1 to 12.7 ± 5.6 (late OT). Inconclusion, teeth severely compromised by intrabony defects and PTM can be treated successfully by RPS followed by early OT with the advantage of an overall reduced treatment time. As a result of the combined periodontal-orthodontic therapy, the oral health-related QoL of patients was significantly improved. Early stimulation of wound healing with orthodontic forces had a favorable impact on the outcomes of regenerative periodontal surgery.

Factors that affected the efficacy of non-surgical periodontal treatment carried out by postgraduate periodontology students

The training of postgraduate students in periodontology has a significant clinical impact. The overall assessment of the efficacy of non-surgical treatment of periodontitis, has value to inform training protocols as well as assess the quality of clinical service delivery. Furthermore, obstacles to successful treatment can be identified. The aim of the study was to determine the effectiveness of non-surgical periodontal treatment, as well as the factors that may determine treatment outcome at the postgraduate clinic in the Periodontology Department at the University of the Western Cape, Tygerberg Dental Hospital, between 2016 and 2018. A cross-sectional record-based study of 100 patients was conducted. Demographic, social, clinical, treatment data were obtained from the hospital files. Periodontal parameters including bleeding index (BI), Pocket Probing depth (PPD), Plaque index (PI), and clinical attachment level (CAL), were recorded at the initial visit (Pre-treatment) and follow-up visits (Post-treatment), and the final treatment outcomes were calculated based on the differences of these parameters’ values between the initial visit and the last follow-up visit. Data were presented as mean and range for continuous variables and as a frequency for categorical variables. Statistical analyses were performed to determine if there was a relationship between the varied factors and treatment outcome with p &lt; 0.05 as statistically significant. The results showed that all 100 patients demonstrated a marked reduction in PPD, PI, BI, and loss of CAL. The overall mean PPD reduction was 0.32 (0.5), the mean reduction in PI and BI were 37.2 (24.08) and 34.61 (22.78), respectively, and the mean clinical attachment gain was 0.42 (0.97) mm. Treatment outcome showed no difference in PPD, PI, BI, and CAL between females, smokers, and patients with systemic conditions compared to males, non-smokers, and patients without systemic conditions. On the other hand, patients who underwent more maintenance treatment visits over a period longer than 2 months duration had significantly better outcomes compared to patients who had less than two months of duration of treatment. This study proved the effectiveness of the non-surgical surgical periodontal treatment at the postgraduate periodontal clinic. Treatment duration and frequency of recall visits were the most influential factor impacting the treatment outcome.

Effect of Ocimum sanctum L as LDD in periodontal therapy.

Ocimum sanctum L (Tulsi) has various properties like antibacterial, anti-inflammatory and anti-oxidant. To compare the effect of the local-drug delivery system containing 2% Ocimum sanctum L (Tulsi) as an adjunct to scaling and root planing (SRP).The main aim of the study was to evaluate the efficacy of Ocimum sanctum L (Tulsi) gel with Tetracycline fibers (Actisite) for the treatment of periodontitis patients. 40 subjects with periodontitis (pocket depth of 5 mm) were selected and divided into 2 groups Group I: Ocimum sanctum L (Tulsi) gel (n= 20) and Group II: Tetracycline fibers (Actisite) (n = 20). Clinical parameters assessed were Gingival Index , Plaque Index , Probing Depth and Clinical Attachment Loss were assessed at baseline, 1 month, 3 months, 6 months, 8 months. Our results showed that Gingival index and Plaque index for for GROUP I: Ocimum sanctum L (Tulsi) and GROUP II: Tetracycline fibers (Actisite)are not statistically significant p>0.05 for baseline, at 1 month, 3 months, 6 months, 8 months. Probing depth and Clinical attachment are not significant p>0.05 for baseline, at 1 month, 3 months, 6 months, and statistically significant difference seen at 8 months p<0.05. 2% Ocimum sanctum L (Tulsi) gel can be effectively used as an adjunct to scaling and root planing. When used as an adjunct to scaling and root planing, it helps in reduction of pocket depth and gain of clinical attachment. Ocimum sanctum L (Tulsi) showed promising results when compared to Tetracycline fibers (Actisite).

Er:YAG laser-assisted comprehensive periodontal pocket therapy for residual periodontal pocket treatment: A randomized controlled clinical trial.

This study evaluated the effectiveness of a novel pocket therapy (Er:YAG laser-assisted comprehensive periodontal pocket therapy [Er-LCPT]) for residual pocket treatment, compared with conventional mechanical treatment alone, in a randomized controlled clinical trial. Two sites in 18 patients having residual periodontal pockets of ≥5mm depth, extant following initial active therapy, or during supportive therapy, were randomized into two groups in a split mouth design: the control group received scaling and root planing (SRP) by curette, and the test group received Er-LCPT using curette and laser. With Er-LCPT, after root debridement, inflamed connective tissue on the inner gingival surface and on the bone surface/within extant bone defects was thoroughly debrided. Furthermore, removal of proximate oral epithelium and coagulation of the blood clot in the pocket entrance were performed with laser. Clinical parameters were evaluated, before and after treatment, through 12months. Both groups showed significant improvements in clinical parameters. With Er-LCPT, pocket debridement was thoroughly and safely performed, without any adverse side effects and complications, and favorable healing was observed in most of the cases. At 12months, Er-LCPT demonstrated significantly higher probing pocket depth reduction (2.78mm vs. 1.89mm on average; p=0.012, Wilcoxon signed-rank test), clinical attachment gain (1.67mm vs. 1.06mm; p=0.004) as primary outcomes, and reduced BOP value (0.89 vs. 0.56; p=0.031), compared with SRP alone. The results of this study indicate that Er-LCPT is more effective for residual pocket treatment, compared with SRP alone.

Effect of photobiomodulation adjunct to periodontal therapy on individuals with type 2 diabetes mellitus regarding periodontal clinical parameters: a systematic review and meta-analysis.

The purpose of this study is to evaluate the scientific evidence on the impact of photobiomodulation adjunct to non-surgical periodontal treatment on individuals with type 2 diabetes mellitus (T2DM). The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed. A protocol was registered in the International Prospective Registry of Systematic Reviews (PROSPERO #CRD42022310756). The research was carried out in seven databases, with no restrictions regarding the year of publication. Our work included studies that compared periodontal clinical parameters among individuals undergoing non-surgical periodontal therapy associated with photobiomodulation and a control group of individuals undergoing non-surgical periodontal treatment. Study selection, data extraction, and risk of bias assessment (RoB 2.0) were performed by two review authors. Meta-analysis was performed. Mean difference (MD) and a 95% confidence interval (CI) were provided. Three hundred forty-one studies were identified, of which eight studies were included. The meta-analysis demonstrated that photobiomodulation adjunctive to periodontal therapy in individuals with diabetes resulted in a greater reduction in probing depth and greater attachment gain in comparison to periodontal treatment alone (p < 0.05). The included studies exhibited a low risk of bias. Photobiomodulation adjunct to periodontal therapy contributes to the improvement of periodontal clinical parameters in individuals with T2DM.

Long-term stability of infrabony defects treated with enamel matrix derivative alone: A retrospective two-centre cohort study.

To assess the long-term stability of attachment gain in infrabony defects (IBDs) 10 years after regenerative treatment with an enamel matrix derivative (EMD) alone. Two centres (Frankfurt [F] and Heidelberg [HD]) invited patients for re-examination 120 ± 12 months after regenerative therapy. Re-examination included clinical examination (periodontal probing depths (PPD), vertical clinical attachment level (CAL), plaque index (PlI), gingival index (GI), plaque control record, gingival bleeding index and periodontal risk assessment) and review of patient charts (number of supportive periodontal care [SPC] visits). Both centres included 52 patients (29 female; median baseline age: 52.0 years; lower/upper quartile: 45.0/58.8 years; eight smokers), each contributing one IBD. Nine teeth were lost. For the remaining 43 teeth, regenerative therapy showed significant CAL gain after 1 year (3.0; 2.0/4.4 mm; p < .001) and 10 years (3.0; 1.5/4.1 mm; p < .001) during which CAL remained stable (-0.5; -1.0/1.0 mm; p = 1.000) after an average SPC of 9 years. Mixed-model regression analyses revealed a positive association of CAL gain from 1 to 10 years with CAL 12 months post operation (logistic: p = .01) as well as a higher probability for CAL loss with an increasing vertical extent of a three-walled defect component (linear: p = .008). Cox proportional hazard analysis showed a positive association between PlI after 12 months and tooth loss (p = .046). Regenerative therapy of IBDs showed stable results over 9 years. CAL gain is associated with CAL after 12 months and decreasing initial defect depth in a three-walled defect morphology. Tooth loss is associated with PlI 12 months post operation. DRKS00021148 (URL: https://drks.de).

CLINICO-RADIOGRAPHIC EVALUATION OF GUIDED TISSUE REGENERATION USING COLLAGEN MEMBRANE AND BIPHASIC CALCIUM PHOSPHATE IN TREATMENT OF INTRABONY PERIODONTAL DEFECTS

Background: The ideal result of successful periodontal therapy is periodontal regeneration. Guided tissue regeneration is considered currently as gold standard for periodontal regeneration. Poor mechanical properties, biomaterials instability and lack of biocompatibility of regenerative membrane alone led to direct use of bioactive materials in defect area. So, this study was intended towards evaluation of effectiveness of resorbable membrane with bioactive molecule containing biphasic calcium phosphate determined by amount of bone fill both clinically and radiographically. Methods: A total of 20 intrabony defects from sixteen patients were selected. The study designed was Quasi experiment, a quantitative non randomized experimental trial. The clinical parameters like Plaque index, Gingival index, Pocket probing depth, Amount of Gingival recession and relative attachment level were recorded at baseline and after 6 months by using acrylic surgical stent following periodontal access flap surgery along with use of collagen membrane and alloplast bone graft. Radiographic parameters were taken using Orthopantomograph for measuring the radiographic bone fill at baseline and after 6 months. Data were analyzed using paired t-test and Wilcoxon sign rank test. Results: All the parameters post operatively were statistically significant. Clinically, gain in attachment was 2.1±1.25mm and pocket reduction was 3.35±1.39mm whereas linear radiographic bone fill was found to be 2.81±1.43mm. However, gingival recession was found to be increased post-operatively. Conclusions: The current study showed combination of bone alloplast and regenerative membrane yields promising results in treatment of human intrabony periodontal defects.