Clinical Attachment Gain Research Articles

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.

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.

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.

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.

The Tunnel Wall Approach and Enamel Matrix Derivative to Cover Exposed Roots and Improve Clinical Attachment Levels in Cairo Class III Defects Associated with an Intrabony Lesion in the Anterior Area: Three Cases.

These case reports present a surgical technique to improve the clinical attachment level and cover the exposed root surface in Cairo Class III situations associated with a one- to two-wall combined intrabony defect in the anterior area. The tunnel wall approach combined previously described concepts and placed a CTG into a modified tunnel-type flap through a vertical releasing incision. The CTG acted both as a buccal soft tissue wall to stabilize the blood clot and as a space maintainer to coronally move the tissue. The decontaminated root surfaces were treated with enamel matrix derivative, and a bone filler material was placed from the bottom of the intrabony defect up to the cementoenamel junction to support the proximal soft tissue architecture. Healing of the four presented sites was uneventful. Clinical measurements up to 12 months showed significant probing depth reduction, clinical attachment gain, and coverage of the buccal recession in each case. Papilla improvement was reported in three cases. Radiographic examinations confirmed intrabony defect healing and the presence of embedded bone filler material in the soft tissue above the bone crest. The tunnel wall approach seems to be a valuable option to safely enhance the clinical attachment level and cover the exposed root in Cairo Class III situations associated with a one- to two-wall combined intrabony defect in the anterior area.

A Surgical Approach to Root Coverage and Correction of Mucogingival Conditions and Deformities in Mandibular Incisors with Isolated Gingival Recession: Free Mucogingival Graft. A Pilot Prospective Cohort Study.

The aim of this study was to present a periodontal plastic surgery approach to treat gingival recessions (GRs) and correct mandibular incisor mucogingival conditions and deformities. Isolated deep GRs (≥ 3 mm) in the mandibular incisors (n = 24 teeth) were treated: 66.6% of sites were recession types 2 or 3, and 58.3% of teeth were malpositioned. Recessions were treated using free mucogingival grafts (FMGs) harvested from the buccal aspect of donor teeth with altered passive eruption or healthy periodontal support, with < 3 mm between the cementoenamel junction and the buccal alveolar crest. Clinical parameters (GR, clinical attachment level, interproximal papilla tip location, keratinized tissue, vestibule depth) and root coverage esthetic score were evaluated at 9 months. FMG significantly reduced GR (P < .001) and increased keratinized tissue (P < .001) without loss of vestibule depth (P > .05). Mean root coverage was 94.37% ± 10.60%, mean residual GR was 0.08 ± 0.65 mm, and the mean root coverage esthetic score was 8.9 ± 1.24. Recession types 2/3 showed significant interproximal clinical attachment gain (P < .05). The interproximal papilla was significantly augmented at sites with papilla loss (P < .001). No clinical attachment loss (P = .346) was detected at donor sites. These results suggest that FMG is a promising root coverage approach for recession types 1, 2, and 3, correcting mucogingival conditions and deformities and reconstructing the interproximal papilla.

SURGICAL TREATMENT OF PERIODONTAL BONE DEFECTS THROUGH THE APPLICATION OF THE “SINGLE FLAP APPROACH” TECHNIQUE AND BIOMATERIALS

The introduction and application of ad hoc- flap designs for accessing even deep intrabony defects has led to a significant improvement in reconstructive outcomes after the use of guided tissue regeneration (GTR, Guided Tissue Regeneration) or enamel matrix derivatives (EMD). Although the additional beneficial effects of GTR and EMD are now known, in association with open curettage alone, the improvements in surgical techniques, in particular the introduction of new papilla preservation procedures, have resulted in a progressive increase in clinical attachment gain achievable with open curettage alone. The Single Flap Approach (SFA) is a simplified surgical procedure specifically designed for the treatment of periodontal bone defects. The key principle of this procedure consists in the elevation of a single mucoperiosteal access flap (buccal or oral), preserving the integrity of the interproximal supracrustal soft tissues. The article, in addition to the the oretical research and studies to date on the advantages of this surgical technique, brings in a detailed analysis the clinical case treated by the authors, analyzing the entire procedure step by step. Scientific research and their application in clinical cases have shown that SFA allows to minimize the trauma of the interproximal soft tissues by bringing reduced recession after surgery.

POST DENTAL AND ORAL – MAXILLOFACIAL IMPLANT NEUROPATHY OF TRIGEMINAL NERVE

The introduction and application of ad hoc- flap designs for accessing even deep intrabony defects has led to a significant improvement in reconstructive outcomes after the use of guided tissue regeneration (GTR, Guided Tissue Regeneration) or enamel matrix derivatives (EMD). Although the additional beneficial effects of GTR and EMD are now known, in association with open curettage alone, the improvements in surgical techniques, in particular the introduction of new papilla preservation procedures, have resulted in a progressive increase in clinical attachment gain achievable with open curettage alone. The Single Flap Approach (SFA) is a simplified surgical procedure specifically designed for the treatment of periodontal bone defects. The key principle of this procedure consists in the elevation of a single mucoperiosteal access flap (buccal or oral), preserving the integrity of the interproximal supracrustal soft tissues. The article, in addition to the the oretical research and studies to date on the advantages of this surgical technique, brings in a detailed analysis the clinical case treated by the authors, analyzing the entire procedure step by step. Scientific research and their application in clinical cases have shown that SFA allows to minimize the trauma of the interproximal soft tissues by bringing reduced recession after surgery.

Systemic Antibiotics as an Adjunct to Subgingival Debridement: A Network Meta-Analysis.

This review aimed to evaluate the effectiveness of systemic antibiotics as adjunctive treatment to subgingival debridement in patients with periodontitis. Randomized controlled trials were included that assessed the effectiveness of systemic antibiotics in improving periodontal status, indicated by clinical attachment gain level, probable pocket depth reduction, and bleeding on probing reduction of patients with any form of periodontitis at any follow-up time. Network meta-analyses with a frequentist model using random effects was employed to synthesize the data. The relative effects were reported as mean difference with a 95% confidence interval. Subsequently, all treatments were ranked based on their P-scores. A total of 30 randomized controlled trials were included in this network meta-analyses. Minimally important clinical differences were observed following the adjunctive use of satranidazole, metronidazole, and clindamycin for clinical attachment gain level and probable pocket depth reduction. For bleeding on probing reduction, minimally important clinical differences were observed following the adjunctive use of metronidazole and a combination of amoxycillin and metronidazole. However, the network estimates were supported by evidence with certainty ranging from very low to high. Therefore, the findings of this network meta-analyses should be interpreted with caution. Moreover, the use of these antibiotics adjunct to subgingival debridement should be weighed against possible harm to avoid overuse and inappropriate use of these antibiotics in patients with periodontitis.

Splith mouth randomized control trial comparison of T-PRF and subepithelial connective tissue graft in the treatment of maxillar multiple gingival recessions.

The aim of this study is to compare the treatment efficacy of the bilateral multiple gingival recession areas with a titanium-platelet-rich-fibrin (T-PRF) and subepithelial connective tissue graft (SCTG) combined with a modified coronal advanced flap (MCAF) and the clinical results. In the study, 118 maxillary bilateral multiple Miller I recessions were treated. Gingival index, plaque index, probing pocket depth, gingival thickness, recession height, recession width, keratinized gingival width and open root surface area were measured at baseline and at 6months. Postoperative pain levels Visual Analog Scale, healing status, wound healing index evaluated with. The results of both groups pre and postoperative were compared. The initial recession height was 2.15 ± 1.0 mm in the T-PRF group; 2.04 ± 0.80 mm in the SCTG group. After 6months, the mean root closure rate was 61.77%, 75.31% in T-PRF and SCTG group, respectively. Clinical attachment gain was achieved in both groups compared to baseline. When the results were compared, the gains achieved in the SCTG group were statistically significantly higher. İt was determined that patient satisfaction was higher in T-PRF group and wound healing was faster. Considering the advantages of T-PRF such as providing effective results in the treatment of defects, patient satisfaction and rapid recovery; It can be applied as an alternative to SCTG. T-PRF can be an alternative to SCTG in the treatment of gingival recessions.

APPLICATION OF PLATELET RICH FIBRIN IN SURGICAL PERIODONTAL THERAPY: A CONTROLLED CLINICAL TRIAL

Purpose: The current study investigates the effectiveness of two surgical protocols for the treatment of periodontitis (Stage III or Stage IV) in the presence of angular bone defects. Materials and methods: Twenty patients diagnosed with periodontitis were randomly divided into two groups, each of 10 patients with radiographically proven infraosseous defects. The first group delivered surgical treatment with bone graft and platelet rich fibrin, the second group – only with bone graft. Clinical and radiographic parameters were assessed before and 6 months after the surgical procedure. Results: Statistically significant differences were found between both groups in the following parameters: probing pocket depth, clinical attachment gain, bone filling, and radiographic depth of the bone defect before and after periodontal surgery, described as bone filling in millimeters. Conclusion: The results show platelet rich fibrin as an autogenous material with promising potential. Its additional application to bone replacement materials can improve the clinical parameters and the expected filling of the vertical bone defects.

Clinical attachment loss in the use of adjunctive antimicrobial photodynamic therapy in Stages II-IV Grade C molar-incisor periodontitis: A systematic review and meta-analysis.

This systematic review and meta-analysis aimed to assess the extent of clinical attachment loss (CAL) as a clinical parameter in the efficacy of antimicrobial photodynamic therapy (aPDT) in non-surgical management of stage II-IV grade C molar-incisor pattern Periodontitis. This review protocol was conducted in accordance with PRISMA statements and is registered in PROSPERO (CRD42022321211). An electronic and manual search was conducted for relevant articles comparing the efficacy of aPDT versus scaling and root planning (SRP) alone or with amoxicillin/metronidazole (AMX/MET) published up until December 2021. The mean clinical attachment loss (CAL), probing depth (PD) reduction, and bleeding on probing (BOP) with a 95% confidence interval (CI) were pooled and compared between the two groups with CAL < and > 7 mm using a random-effect model after 3 and 6 months. To assess the heterogeneity of the findings, the I2 test was applied and Publication bias was evaluated by visual examination of the funnel plot symmetry. Analysis of 9 studies indicated a significant difference in clinical attachment gain in patients with CAL > 7 mm between the aPDT group and the SRP alone (mean difference=0.92, 95% CI=0.01-1.84, P=0.05) and SRP + AMX/MET (mean difference=0.91, 95% CI=-0.14-1.68, P=0.02) control groups. However, this difference was not significant in patients with CAL < 7 mm. Despite the limitations of the included studies, aPDT can be suggested for the improvement of clinical parameters in grade C molar-incisor pattern Periodontitis with CAL > 7 mm. However, its application in milder cases requires further investigation.

The influence of fixed prosthesis placement on the clinical effectiveness of non-surgical periodontal therapy

Fixed prostheses are essential for restoring teeth with compromised structures. However, the margins of prosthesis potentially create an interface that interferes with proper cleaning. This study evaluated whether the fixed prosthesis placement influenced the clinical effectiveness of non-surgical periodontal therapy (NSPT). Clinical records from 202 patients with generalized chronic periodontitis receiving NSPT at the National Taiwan University Hospital in 2012-2014 were included. The change and improvement ratio (IR) of clinical parameters following NSPT in the entire dentition or posterior region, and all or periodontitis-affected teeth/crowns (T/C) and sites were evaluated. The differences among natural teeth (NT), prosthetic crowns (PC), and abutments (AB) were compared by using Kruskal-Wallis tests followed by Dunn's post-hoc test. Gingival recession (REC) was greater in PC and AB groups than in the NT group before NSPT, while tooth mobility was also lower in the AB group. REC gain was lower in the AB group after NSPT, while mobility reduction was inferior in the PC and AB groups for all or periodontitis-affected T/C and sites. In periodontitis-affected T/C, IRs in probing pocket depth reduction and clinical attachment gain were lower in the PC group, and mobility reduction was lower in the AB group. The tendency in the posterior region is similar but was less pronounced than in the entire dentition. The effectiveness of NSPT and the improvement of periodontal parameters are reduced when fixed prostheses present. MB reduction is inferior in AB teeth relative to NT.