Higher Clinical Attachment Level Research Articles

Assessment of Platelet-Rich Plasma Alone and Platelet-Rich Plasma Combined with Bioactive Glass in the Management of Intrabony Defect

ABSTRACT Objectives: To assess the function of platelet-rich plasma (PRP) both only and in combination with bioactive glass in intrabony defects. Materials and Method: Twenty patients were split into two groups with 10 samples each: group I with PRP alone, whereas group II was done with PRP in addition to bioactive glass. Following local anesthesia, full-thickness mucoperiosteal flaps were elevated in the afflicted site, the defect was debrided, and root planning with curettes was performed. Irrigation was then used while in group II- PRP along with bone graft (BG) preservationwas done. Suturing in group I was contained. At day 0 (baseline) and 6 months after surgery, the clinical parameters for probing depth, clinical attachment stage, and radiographic assessment were noted for both groups. Result: When comparing both groups, there was no statistically considerable variation. However, the intragroup comparison for pocket depth and clinical attachment level between baseline and 6 months was significant. Radiographic bone level was not considerably dissimilar across groups; however, it was significantly different between groups Conclusion: Reduced probing depth, higher clinical attachment level, and radiographic evidence of bone fill are clinical outcome measures that are associated with effective regenerative therapy.

Salivary parameters and periodontal inflammation in obstructive sleep apnoea patients

The aim of this cross-sectional study was to objectively assess the salivary flow rate and composition and periodontal inflammation in obstructive sleep apnoea (OSA) patients. The subjects, who underwent whole-night polysomnography or polygraphy, were referred for saliva sampling and periodontal examination. According to the severity of OSA based on the Apnoea Hypopnea Index (AHI) value, the subjects were classified into groups: no OSA (AHI < 5; N = 17), mild to moderate OSA (AHI 5–29.9; N = 109), and severe OSA (AHI > 30; N = 79). Salivary flow rate, pH, salivary electrolytes, and cortisol were measured from collected saliva samples. Periodontal examination included assessment of the number of teeth, dental plaque, bleeding on probing and periodontal measurements: gingival recession, probing pocket depth, clinical attachment level (CAL) and periodontal inflamed surface area (PISA) score. There were no significant differences in salivary flow rate, salivary pH, salivary electrolyte concentrations or electrolyte ratios among the groups classified according to the severity of OSA. However, subjects without OSA had higher salivary cortisol concentrations than OSA groups (p < 0.001). Increased plaque scores were associated with a higher AHI (r = 0.26; p = 0.003). According to the salivary flow rate, subjects with hyposalivation and reduced salivation had higher concentrations of salivary electrolytes and lower salivary pH than subjects with normal salivation. Subjects with hyposalivation had an increased Mg/PO4 ratio (p < 0.001) and a reduced Ca/Mg ratio (p < 0.001). Furthermore, subjects with severe OSA tended to have higher CALs and plaque volumes. In conclusion, under pathological conditions, such as OSA, multiple interactions might impact salivary flow and electrolyte composition. Complex interrelationships might affect the integrity of oral health, especially considering OSA severity, inflammation, concomitant diseases and medications.

Clinical and bacterial outcomes of photodynamic therapy in the treatment of chronic necrotizing ulcerative periodontitis

AimTo assess the clinical periodontal and microbiological parameters in patients having chronic necrotizing ulcerative periodontitis (NUP) after the administration of adjunctive photodynamic therapy and non-surgical periodontal therapy in smokers, mal-nutrition and HIV positive individuals. Materials and MethodsA total of 30 individuals with NUP were selected for the present clinical trial, where both Group I and Group II had equal number of patients, respectively (15 each). The groups were divided on the basis of provision of treatment where patients in Group I underwent scaling and root planing (SRP). Furthermore, Group II patients were subjected to adjunctive phtotodynamic therapy and SRP (aPDT + SRP). Full mouth plaque scores (fmpS), full mouth bleeding on probing (fmBOP), periodontal pocket depth (PPD) and clinical attachment levels (CAL) were the clinical periodontal parameters that were carefully evaluated. Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg) and Tannerella forsythia (Tf) were the bacteria species which were evaluated. The assessments were done at baseline, three (3) months and six (6) months, respectively. ResultsAll periodontal parameters including fmpS, fmBOP, PPD and CAL significantly improved in both Group I and Group II, respectively. Group II patients subjected to aPDT + SRP reported higher reduction in mean PPD in comparison to Group I patients at follow up (p < 0.05). At follow-up, similar results were also reported for CAL gain where Group II (aPDT +SRP) patients reported higher CAL gain in comparison to patients who underwent SRP only (p < 0.05). From baseline to follow-up, all the bacterial levels exhibited reduction in both study groups i.e Group I (SRP) and Group II (aPDT + SRP), respectively (p < 0.05). However, Group II patients prominent reduction in the counts of Aa and Tf at the three-month interval, whereas Aa seem to reduce in HIV and smoking individuals at the six-month interval. Moreover, the levels of Pg and Tf significantly reduced at 3 months and only Aa at 6 months in patients with mal-nutrition, respectively (p < 0.05). ConclusionThe use of photodynamic treatment as an adjunct to scaling and root planing enhanced clinical periodontal results and reduced bacterial content in patients having NUP.

Evaluation of the Association Between Metabolic Syndrome and Periodontal Disease

Background: Metabolic Syndrome (MetS) is a collection of conditions that puts people at an increased risk of cardiovascular disease. Objectives: The present study aimed to evaluate the association of periodontal disease severity and its parameters with MetS in a group of northwestern Iranian patients. Methods: The current study was conducted on 100 participants aged 25 - 78 (50 patients with MetS and 50 without MetS). Clinical and laboratory characteristics, periodontal components, including clinical attachment level (CAL), pocket depth (PD), and bleeding on probing (BOP), and the number of missing teeth were recorded. The differences between the two groups were evaluated by an independent sample t test. Results: The MetS group demonstrated significantly higher CAL, BOP, and missing teeth, which markedly increased by the number of MetS components. Nonetheless, the two groups did not reflect any difference in PD. Moreover, compared to participants without MetS, patients afflicted with MetS presented with more severe periodontal disease. Furthermore, CAL, BOP, and missing teeth were higher in patients with dyslipidemia, hypertension, and central obesity without dysglycemia than in the control group (P &lt; 0.05). Conclusions: MetS patients demonstrated more severe periodontal disease, and the number of MetS components increased the odds of the disease. In addition, higher periodontal parameters (except for PD) were detected in participants with MetS. Moreover, no considerable change was observed in the obtained results upon the elimination of diabetic patients.

A thermosensitive gel with an active hyaluronic acid ingredient that contains an octenidine preservation system as an adjunct to scaling and root planning: a randomized prospective clinical study.

To evaluate the adjunctive effect of a thermosensitive gel formulation that contains 0.8% oligo hyaluronic acid (HA) combined with a preservation system of octenidine HCl 0.625% and phenoxyethanol to scaling and root planing (SRP) as compared with SRP alone in the treatment of residual pockets of patients with stage 3 periodontitis. Thirty-four patients (21 males and 13 females) aged 29-78years (51.3 ± 13.1) with stage 3 periodontitis were recruited to participate in the present split-mouth study. None of the patients has been previously treated for periodontitis. Plaque index (PI), probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were evaluated at baseline and at 3 and 6months posttreatment. Full-mouth SRP was performed in all residual pockets ≥ 5mm. Treatment was performed by means of ultrasonic and hand instruments and lasted 45-60min. The gel was applied subgingivally in the test sites immediately after SRP (baseline) and 1month later. The paired t-test for two means was applied to test the statistical significance of the change from baseline within each arm and determine the difference between groups. The level of significance was set at 0.05 for all tests. Mean PD reductions between baseline and 3 and 6months were 1.98mm and 2.79mm for the test and 1.22mm and 1.50mm for the control group, respectively. Comparisons between the test and control groups revealed that SRP + gel yielded statistically significantly higher PD reductions compared to SRP alone (p < 0.0001). Compared to baseline, CAL and BOP values improved statistically significantly in both groups, although the test group presented statistically significantly higher CAL gains and BOP reductions than the control group (P < 0.0001). In residual pockets of stage 3 periodontitis patients, the local application of a thermosensitive gel with an active HA ingredient and a preservation system of octenidine HCl 0.625% in conjunction with SRP may additionally improve the clinical outcomes obtained with SRP alone. A novel HA and octenidine containing thermosensitive gel effectively improved the clinical parameters in stage 3 periodontitis patients over a 6-month period.

Association between periodontitis and fibrotic progression of non-alcoholic fatty liver among Japanese adults.

Non-alcoholic fatty liver (NAFL) is known to develop into liver fibrosis, which increases the risk of liver cirrhosis and liver cancer. The association between periodontal condition and fibrotic progression of NAFL is unclear. This study aimed to clarify this longitudinal association. Among 4812 participants aged 35-64years undergoing annual health check-ups between 2003 and 2004, and follow-up 5years later, 392 participants were diagnosed with NAFL. After excluding participants with liver fibrosis at baseline, 341 participants were followed up for 5years. NAFL disease fibrosis score of ≥-1.455 was used to evaluate the probability of the presence of liver fibrosis. During the follow-up period, 10.6% of participants progressed to liver fibrosis. A higher clinical attachment level (CAL) tended to be associated with the incidence of liver fibrosis in the logistic regression analysis (odds ratio [OR] 1.82, 95% confidence interval [CI], 0.94-3.49, p=.074). The stratified analysis by obesity revealed a significant association with higher CAL in obese participants (OR 2.87, 95% CI, 1.23-6.69, p=.015), but not in non-obese participants. Higher CAL was associated with an increased probability of liver fibrosis in obese adults with NAFL.

Association of Lipid Profile and Body Mass Index with Periodontal Status in Patients with Dyslipidemia with and without Lipid-lowering Medication: A Cross-sectional Study.

To investigate the relationship between periodontal parameters and lipid profiles. A total of 48 subjects with dyslipidemia, consisting of 33 subjects who did not receive lipid-lowering medication (NLM) and 15 subjects who did receive lipid-lowering medication (LM) were enrolled in this cross-sectional study. Sixteen systemically healthy subjects were recruited as controls. The plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL) were measured. The levels of triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) levels were determined. The variables related to high cholesterol levels, including age, gender, waist circumference, and body mass index (BMI), were evaluated. The LM group had a statistically significantly higher CAL in comparison with either the control or the NLM groups. TG was statistically significantly correlated with PD (ρ = 0.398, p = 0.001) and CAL (ρ = 0.349, p = 0.005). HDL-C was negatively correlated with PI (ρ = -0.371, p = 0.003), GI (ρ = -0.284, p = 0.025), and PD (ρ = -0.289, p = 0.023). The stepwise multiple regression analysis showed that BMI was statistically significantly associated with percentage of sites with BOP (β = 0.367, p = 0.003) and PD (β = 0.392, p = 0.002). CAL was statistically significantly influenced by age (β = 0.496, p < 0.001) and HDL-C (β = -0.259, p = 0.026). TG and HDL-C levels were correlated with periodontal status. BMI was found to be a stronger predictor of periodontal inflammation than serum lipid levels. No benefit of lipid-lowering medication on periodontal status was revealed.

LL-37 and hBD-2 in the gingival crevicular fluid of smokers and nonsmokers with periodontitis

Abstract Introduction The association between smoking and periodontal diseases has been described in clinical and epidemiological studies. Objective The aim of this study was to compare the LL-37 and human β-defensin-2 (hBD-2) levels in crevicular fluid of patients with generalized periodontitis in smokers (S) and nonsmokers (NS). Material and method A total of 35 patients with generalized periodontitis stages III and IV, 15 NS (11 female, 4 male) and 20 S (7 female and 13 male), were included in the study. The evaluated clinical parameters were bleeding on probing (BOP), probing depth (PD) and clinical attachment level (CAL). Enzyme-linked immunosorbent assays were performed to quantify the LL-37 and hBD-2 levels in the gingival crevicular fluid of these patients. The results were analyzed statistically with the level of significance set at 5%. Result In relation to periodontal clinical parameters, no statistically significant difference was observed for BOP and PD between groups S and NS. There was a higher CAL in the S group than in the NS group (p = 0.0095). There was no statistically significant difference between the levels of LL-37 and hBD-2 when comparing groups S and NS (p&gt;0.05). Conclusion It was concluded that smokers have a higher clinical attachment loss than nonsmokers, but that smoking did not influence the levels of LL-37 and hBD-2 in the gingival crevicular fluid in periodontitis.

Chronic Periodontitis is a Risk Factor of Renal Dysfunction in Patients with Type 2 Diabetes.

This study explores the association between chronic periodontitis and renal dysfunction in type 2 diabetic mellitus (T2DM) patients. An observational study was conducted in 169 T2DM patients with chronic periodontitis. Patients were divided into 2 groups according to presence of normal renal function (n=111) and renal dysfunction (n=58), and oral health behavior-related variables were obtained by questionnaire. Periodontal status was examined, and pocket probing depth (PD), clinical attachment level (CAL), and bleeding index (BI) were measured. The severe periodontitis group had a significant higher HbA1c level (8.53 ± 1.61%) as compared with the mild and moderate periodontitis groups (7.68±1.58%) and (7.35±1.45%), P=0.001. Compared with patients with normal renal function, patients with renal dysfunction had a higher PD value, higher CAL value, fewer remaining teeth, and were less likely to have remaining teeth ≥20. The percentage of sites with PD ≥4 mm (52.8% vs. 41.67%) was significantly greater in patients with renal dysfunction. There was no difference in the scores of oral health knowledge assessment between the 2 groups. After adjustment by gender, age, BMI, smoking, hypertension, and HbA1c, the percentage of the sites with PD≥4 mm was an independent risk factor of renal dysfunction in T2DM patients. In patients with T2DM, those with periodontitis may be more susceptible to decreased kidney function.

Non-surgical Periodontal Therapy With Adjunctive Topical Metronidazole + Piroxicam Gel Compared With Piroxicam Gel in the Treatment of Chronic Periodontitis

Background: Host modulation therapy represents a treatment concept in which drug therapies are applied as an adjunctive therapy to conventional periodontal treatments to counteract the destructive effects of the host inflammatory response. Methods: This is a randomized split-mouth clinical trial in which a total of 40 outpatients diagnosed with mild-moderate chronic periodontitis with at least two pairs of contralateral anatomically matching proximal tooth surfaces showing probing depth of ≥5 mm were enrolled. Full-mouth scaling and root planing (SRP) was performed for all patients and pockets larger than 5 mm were selected for application of the studied gels. The selected sites were randomly divided into group A (piroxicam + metronidazole) and group B (piroxicam). Recall appointments were scheduled every two weeks within 3 months. The periodontal parameters, assessed in the molar teeth, also recorded that changes in clinical parameters during the study. Results: A total of 34 patients, with mean age of 45.2±8.6 (range 32-60) years, none of whom developed unpleasant side effect, were enrolled. Plaque index was significantly higher in group A; further it was a statistically significant difference in Bleeding on probing levels in group A at the baseline to last interval recall while current study. The results exhibited significant reductions in pocket depth within 3 months when compared to the baseline values, while the combination adjunctive therapy was more effective to reduce pocket depth. Furthermore, both groups showed a statistically significant mean reduction in clinical attachment level (CAL), but in the test group A had a higher CAL gain than in the control group B (P=0.039). Conclusions: The use of a combination of drugs can help reduce the clinical signs of periodontal disease, therefore, by changing the patient’s health habits along with periodontal treatment, the mechanical treatment that a microbial plaque can be obtained, and then the use of piroxicam + metronidazole gel as a complementary therapy, the recovery process can be accelerated.

Active matrix metalloproteinase-8 and periodontal bacteria-interlink between periodontitis and inflammatory bowel disease?

The aim of this study was the investigation of concentration and prevalence of selected periodontal pathogenic bacteria and concentration of active matrix metalloproteinase-8 (aMMP-8) within a group of patients with inflammatory bowel diseases (IBD) and to compare the results with a group of healthy control subjects (HC). Fifty-nine IBD patients with Crohn`s disease (CD, n=30) or ulcerative colitis (UC, n=29) and 59 HC were included in this cross-sectional study. Based on periodontal probing depth (PD) and clinical attachment level (CAL), periodontitis was classified as healthy/mild, moderate, or severe. aMMP-8 was analyzed from gingival crevicular fluid using enzyme linked immunosorbent assay. Eleven selected periodontal pathogenic bacteria were analyzed in subgingival plaque samples using polymerase chain reaction. IBD patients showed higher CAL (P<0.01), more severe periodontitis (P=0.04), gingival bleeding (P<0.01) and aMMP-8 concentration (P<0.01) than HC. Only in CD, increasing severity of periodontitis was associated with an increase in aMMP-8 concentration (P=0.02). The prevalences of Eubacterium nodatum and Eikenella corrodens were significantly lower in IBD compared to HC (P=0.01). Additionally, the prevalence of Eikenella corrodens was significantly higher in CD compared to the UC group (P=0.04). Further statistically significant differences in selected bacteria between IBD and HC or CD and UC groups could not be found (P>0.05). The results reveal changes in host immune response of IBD patients in terms of aMMP-8. Only in CD increasing aMMP-8 was associated with severity of periodontal disease. The role of periodontal pathogenic bacteria in the interrelationship between IBD and periodontitis remains unclear.

Comparative evaluation of probing depth and clinical attachment level using a manual probe and Florida probe.

Background:To compare and evaluate the intra- and inter-examiner efficacy and reproducibility of the first-generation manual (Williams) probe and the third-generation Florida probe in terms of measuring pocket probing depth (PD) and clinical attachment level (CAL).Materials and Methods:Forty subjects/4000 sites were included in this comparative, cross-sectional study. Group- and site-wise categorizations were done. Based on gingival index, PD, and CAL, patients were divided into four groups, i.e., periodontally healthy, gingivitis, mild to moderate periodontitis, and severe periodontitis. Further, based on these parameters, a total of 4000 sites, with 1000 sites in each category randomly selected from these 40 patients, were taken. Full mouth PD and CAL measurements were recorded with two probes, by Examiner 1 and on Ramfjord teeth by Examiner 2.Results:Full mouth and Ramfjord teeth group- and site-wise PD obtained with the manual probe by both the examiners were statistically significantly deeper than that obtained with the Florida probe. The full mouth and Ramfjord teeth mean CAL measurement by Florida probe was higher as compared to manual probe in mild to moderate periodontitis group and sites, whereas in severe periodontitis group and sites, manual probe recorded higher CAL as compared to Florida probe.Conclusion:Mean PD and CAL measurements were deeper with the manual probe as compared to the Florida probe in all the groups and sites, except for the mild-moderate periodontitis group and sites where the CAL measurements with the manual probe were less than the Florida probe. Manual probe was more reproducible and showed less interexaminer variability as compared to the Florida probe.

Association Between Periodontal Disease and Chronic Obstructive Pulmonary Disease: A Reality or Just a Dogma?

In the past few years, the association between chronic obstructive pulmonary disease (COPD) and periodontal disease has been promulgated. The present study is aimed at determining the association between these two diseases. This observational study includes 501 individuals consisting of 102 patients (case group) having COPD and 399 individuals as controls. Individuals in the case group were well-functioning and ambulatory patients having COPD as determined by their history and their values of forced expiratory volume in 1 second (FEV1) and forced vital capacity. Periodontal status was evaluated by the following five indices: 1) plaque index; 2) oral hygiene index (OHI); 3) gingival index (GI); 4) probing depth (PD); and 5) clinical attachment level (CAL). Lung function test was performed by all the patients (case group), who were then graded into mild, moderate, severe, and very severe. Preliminary analysis was performed to identify the covariates in this study. Individuals in the case group had significantly higher CAL, PD, and OHI (P <0.0001) compared with the control group after adjusting for covariates. A significant negative correlation was observed between FEV1 values and CAL, PD, and GI, thus indicating a trend in which severity of lung obstruction increased as these periodontal indices worsened. Although the present study cannot ascertain causal association, it provides substantial evidence that poor periodontal health is associated with obstructive lung disease.

Five years clinical results following treatment of human intra-bony defects with an enamel matrix derivative: A randomized controlled trial

Introduction. Emdogain® represents an extracellular matrix derivative that controls and promotes periodontal regeneration. Several studies have demonstrated that the treatment of periodontal defects with Emdogain® leads to improvements in clinical parameters. However, long-time clinical trials establishing clinical usefulness of Emdogain® are scarce. Therefore, the present randomized split mouth, controlled study was undertaken to evaluate the effectiveness of Emdogain® as an adjunct to open flap debridement for the treatment of intra-bony defects over a period of 5 years. Materials and methods. The study population consisted of 15 chronic periodontitis patients with bilateral interproximal osseous defects. The test group was treated by open flap debridement with EDTA 24% (PrefGel®) followed by enamel matrix derivative (Emdogain®). The control group was treated by open flap debridement with EDTA 24% (PrefGel®). Results. After 1 and 5 years, both the test and control groups showed significant mean PPD reduction. A greater reduction in mean Probing Pocket Depth (PPD) was observed in the test group (3.84 ± 1.05) as compared to the control group (1.92 ± 0.35). The mean Clinical Attachment Level (CAL) gain of 3.18 ± 0.87 mm was observed in the test group, while the control group displayed mean CAL gain of 1.60 ± 0.54 mm. The observed differences were found to be statistically significant in both the groups (p < 0.05). Percentage bone fill was significantly increased at 12 months post-surgery in test group (66.66 ± 7.8%) as compared to control group (31.71 ± 4.1%). Conclusion. The treatment with Emdogain resulted in a significantly higher CAL gain and PPD reduction in comparison with OFD and PrefGel®.

Clinical indicators of periodontal disease in patients with coronary heart disease: a 10 years longitudinal study.

Objectives: There is evidence about a possible relationship existing between periodontal diseases and coronary heart disease. The aim of the present longitudinal study was to investigate the changes in periodontal evolution after etiological periodontal treatment, comparing a healthy control group with another having coronary heart disease. Study Design: The study included initially 55 patients of which 44 finished it. They were placed into two groups: Healthy Control Group (HCG) n =9, and Coronary Heart Disease Group (CHDG) n=35. The gingival level (GL), probing depth (PD), clinical attachment level (CAL), plaque index (PI) and bleeding on probing (BOP) were measured to compare the periodontal status in both groups. The patients were examined and etiological periodontal treatment was performed and they were then examined at the end of 1 and 10 years. Statistical method: A one way-ANOVA and a MR-ANOVA were established; significance p<0.05. Results: No significant differences between both groups were detected on the first visit (p>0.5). However, at the second visit the CHDG presented a significantly higher PD (p<0.05) and PI (p<0.01). CHDG patients gradually increase PD through time and in comparison to the control group (p<0.041). CHDG patients present a significantly higher CAL loss (p<0.0385) and a significant increase in PI (p<0.0041) at the end of one year, while on the third visit no significant differences were detected in any of these indices. Likewise, a similar fact can be observed on evaluating BOP at the end of ten years causal treatment, a smaller decrease in the cardiac group was observed in regards to the initial values (p<0.001). Conclusion: Patients with coronary heart disease showed a worse evolution of periodontal indices than healthy ones, when referring to probing depth, plaque index and bleeding on probing index. Key words:Attachment loss, coronary heart disease, periodontal disease, risk factors.

Subgingival microbial consortia and the clinical features of periodontitis in adolescents

This study aimed to investigate the association between microbial consortia and the clinical features of periodontitis using a multilevel modeling approach. A total of 958 sites in 87 adolescents with periodontitis (cases) and 73 controls were microbiologically sampled and clinically examined. Associations between each of the clinical parameters clinical attachment, probing depth, supragingival plaque, calculus, bleeding on probing, and each of 18 bacterial species; and between the same clinical parameters and each of two microbial consortia identified, were investigated using mixed-effects regression modeling. Higher counts of Tannerella forsythia, Campylobacter rectus, and Porphyromonas gingivalis were all statistically significantly associated with higher values of clinical attachment level, probing depth, and bleeding on probing in the sampled site, when both case status and between-subject variance were accounted for. Higher counts for the consortium comprising the putative periodontopathogens were statistically significantly associated in a dose-response manner with both higher clinical attachment levels and with increased pocket depth. The counts for the consortium predominantly comprising the early-colonizer species were statistically significantly negatively associated with the presence of supragingival calculus, but positively associated with the presence of supragingival plaque. The study demonstrates a relationship between the counts of putative periodontopathogens and clinical attachment levels and probing pocket depths, even for low levels of these clinical parameters.

Association Between Respiratory Disease in Hospitalized Patients and Periodontal Disease: A Cross‐Sectional Study

Recent research indicated that periodontal infection may worsen systemic diseases, including pulmonary disease. Respiratory infections, such as pneumonia and the exacerbation of chronic obstructive pulmonary disease, involve the aspiration of bacteria from the oropharynx into the lower respiratory tract. A group of 100 cases (hospitalized patients with respiratory disease) and a group of 100 age-, sex-, and race-matched outpatient controls (systemically healthy patients from the outpatient clinic, Department of Periodontics, Government Dental College and Hospital, Calicut, Kerala, India) were selected for the study. Standardized measures of oral health that were performed and compared included the gingival index (GI), plaque index (PI), and simplified oral hygiene index (OHI). Data regarding probing depths and clinical attachment levels (CALs) were recorded at four sites per tooth and compared statistically. The χ(2) and Student t tests were used for statistical analyses. The comparison of study-population demographics on the basis of age, sex, education, and income showed no significant differences between groups. Patients with respiratory disease had significantly greater poor periodontal health (OHI and PI), gingival inflammation (GI), deeper pockets, and CALs compared to controls. In the case group, patients with a low income were 4.4 times more prone to periodontal disease compared to high-income patients. Smokers had significantly higher CALs compared to non-smokers in the control group. The findings of the present analysis support an association between respiratory and periodontal disease.

Five‐year results of a prospective, randomized, controlled study evaluating treatment of intra‐bony defects with a natural bone mineral and GTR

Treatment with a natural bone mineral (NBM) and a guided tissue regeneration (GTR) has been shown to promote periodontal regeneration. However, until now there are only very limited data on the long-term clinical results following this regenerative technique. To present the 5-year results of a prospective, randomized, controlled clinical study evaluating the treatment of deep intra-bony defects either with open flap debridement (OFD) and a combination of an NBM and GTR (test) or OFD alone (control). Nineteen patients diagnosed with advanced chronic periodontitis, and each of whom displayed one intra-bony defect, received randomly the test or the control treatment. Results were evaluated at baseline, at 1 and at 5 years following therapy. No statistically significant differences in any of the investigated parameters were observed at baseline between the two groups. At 1 year after therapy, the test group showed a reduction in mean probing depth (PD) from 9.1+/-1.1 to 3.7+/-0.8 mm (p<0.001) and a change in mean clinical attachment level (CAL) from 10.4+/-1.3 to 6.4+/-1.2 mm (p<0.001). At 5 years, mean PD and CAL measured 4.3+/-0.8 and 6.7+/-1.6 mm, respectively. At 5 years, both PD and CAL were statistically significantly improved compared with baseline (p<0.001) without statistically significant differences between the 1- and 5-year results. In the control group, mean PD was reduced from 8.9+/-1.3 to 4.9+/-1.2 mm (p<0.001) and mean CAL changed from 10.6+/-1.4 to 8.8+/-1.5 mm (p<0.01). At 5 years, mean PD and CAL measured 5.6+/-1.1 and 9.1+/-1.3 mm, respectively, and were still statistically significantly improved compared with baseline (p<0.01). No statistically significant differences were found between the 1- and 5-year results. The test treatment, at both 1 and 5 years, yielded statistically significantly higher CAL gains than the control one (p<0.01). Compared with baseline, at 5 years a CAL gain of > or =3 mm was found in nine defects (90%) of the test group but in none of the defects treated with OFD alone. It was concluded that (i) treatment of intra-bony defects with OFD+NBM+GTR may result in significantly higher CAL gains than treatment with OFD, and (ii) the clinical results obtained after both treatments can be maintained over a period of 5 years.

Healing of intrabony defects following treatment with an oily calcium hydroxide suspension (Osteoinductal). A controlled clinical study

The purpose of the present clinical study was to evaluate the healing of deep intrabony defects following the application of an oily calcium hydroxide suspension (OCHS). Thirty patients suffering from chronic periodontitis, each of whom displayed one intrabony defect, were randomly treated with access flap surgery (AFS) and the application of OCHS (test) or with AFS alone (control). The following clinical parameters were recorded at baseline and at 6 months after therapy: plaque index, gingival index, bleeding on probing, probing depth (PD), gingival recession, and clinical attachment level (CAL). No differences in any of the investigated parameters were observed at baseline between the two groups. At 6 months after therapy, the test group showed a reduction in mean PD from 7.7+/-1.5 to 2.9+/-0.9 mm (P<0.001) and a change in mean CAL from 9.6+/-2.1 to 5.5+/-2.5 mm (P<0.001). In the control group, the mean PD was reduced from 6.9+/-0.9 to 3.7+/-0.9 mm (P<0.001) and the mean CAL changed from 8.5+/-2.5 to 6.4+/-2.7 mm (P<0.001). OCHS resulted in statistically significant higher PD reductions (P<0.01) and CAL gains (P<0.05) than AFS alone. Within the limits of the present study, it can be concluded that: (1) at 6 months after surgery both therapies resulted in statistically significant PD reductions and CAL gains and (2) treatment with OCHS resulted in statistically significant higher CAL gains than treatment with AFS alone.

Healing of intra‐bony defects following treatment with a composite bovine‐derived xenograft (Bio‐Oss Collagen) in combination with a collagen membrane (Bio‐Gide PERIO)

The purpose of the present study was to compare clinically the treatment of deep intra-bony defects with a combination of a composite bovine-derived xenograft (BDX Coll) and a bioresorbable collagen membrane [guided tissue regeneration (GTR)] to access flap surgery only. Thirty-two patients, each of whom displayed one intra-bony defect, were treated either with BDX Coll+GTR (test) or with access flap surgery (control). The results were evaluated at 1 year following therapy. No differences in any of the investigated parameters were observed at baseline between the two groups. Healing was uneventful in all patients. At 1 year after therapy, the test group showed a reduction in the mean probing depth (PD) from 8.3+/-1.5 to 2.9+/-1.3 mm (p<0.001) and a change in the mean clinical attachment level (CAL) from 9.4+/-1.3 to 5.3+/-1.5 mm (p<0.0001). In the control group, the mean PD was reduced from 8.0+/-1.2 to 4.4+/-1.7 mm (p<0.001) and the mean CAL changed from 9.6+/-1.3 to 7.9+/-1.6 mm (p<0.01). The test treatment resulted in statistically higher PD reductions (p< or =0.05) and CAL gains (p<0.001) than the control one. In the test group, all sites (100%) gained at least 3 mm of CAL. In this group, a CAL gain of 3 or 4 mm was measured at 10 sites (62%), whereas at six sites (38%), the CAL gain was 5 or 6 mm. In the control group, no CAL gain occurred at three sites (19%), whereas at 10 sites (62%), the CAL gain was only 1 or 2 mm. A CAL gain of 3 mm was measured in three defects (19%). Within the limits of the present study, it can be concluded that the combination of BDX Coll+GTR resulted in significantly higher CAL gains than treatment with access flap surgery alone, and thus appears to be a suitable alternative for treating intra-bony periodontal defects.