Hygienic Phase Research Articles

Multi-nutrients and periodontal disease - a new adjunct to improving treatment outcomes? A randomised placebo-control clinical trial.

This study by Laky et al. is a single-centre, double-blinded randomised placebo-controlled clinical trial, examining the effects of micronutrient supplementation in combination with non-surgical hygiene phase therapy (nsHPT)for Stage III and IV periodontal disease. The study was carried out at the Medical University of Vienna (Austria), School of Dentistry. The patients enrolled in the study were randomised to receive a commercially available multi-nutrient supplement (containing: vitamin C, vitamin E, zinc, selenium, alpha-lipoic-acid, cranberry extract, grapeseed extract, and coenzyme Q10) or a cellulose placebo to take for 2 months, alongside a course of non-surgical hygiene phase therapy. At baseline, the patients had a periodontal index screening (PSI) performed. Patients scoring >3 and meeting the inclusion criteria were enrolled in the trial. Oral hygiene instruction and patient education was performed, followed by 1 or more sessions of nsHPT depending on the clinical assessment of each patient, and a full periodontal probing depth (PPD) chart was recorded. The patients were then randomised to receive either the multi-nutrient supplement or the placebo to take twice daily for 8 weeks. Following this 8-week period the PPD as well as bleeding on probing (BOP), gingival recession (GR) and clinical attachment loss (CAL) were measured. The randomisation was carried out by a study-independent member of staff at the centre using a computer programme. A total of 149 patients were assessed for eligibility for this trial. Out of these patients, 83 were deemed to be unsuitable for the trial as they failed to meet the inclusion criteria, and 24 declined to participate. A total of 42 patients were then randomised to each arm of the study. The inclusion criteria included patients with Stage III and IV periodontal disease. Patients were deemed eligible if they met the following criteria: presence of 18 or more scorable teeth (excluding 3rd molars); >4 teeth with PPD of >6 mm; CAL > 5 mm, and no previous periodontal treatment in the past. Percentage bone loss at the most severe site, smoking status, and presence of diabetes and diabetic control were all taken into consideration. Patients were deemed ineligible for the trial if they were pregnant or under 18 years old. Exclusion criteria also included: recent periodontal abscess; a past or current co-morbidity which may confound the results of the study or endanger patients partaking in the study (i.e. malignancy, rheumatoid arthritis, and other severe systemic conditions); and obesity. PPD was used as the primary variable in this study. Other measured outcomes such as GR, CAL, BOP and other measurements taken, such as papillary bleeding index (PBI) and papillary inflamed surface area (PISA), were considered as secondary outcome variables. A variety of tests were used in order to assess the collected data. The Kolmogorov‒Smirnov test and Levene test were used for the equality of variances, and ICC and 95% CI were used when comparing periodontal chartings for PPD (in mm). Chi-square or Fisher tests were used for categorical data between intervention and placebo. The baseline and reevaluation data was compared using the McNemar test. All data was analysed using statistical software. Significant data is indicated by a p value < 0.05. The number of patients included for analysis was reduced to n = 20 for the intervention group and n = 19 for the placebo group. Patients were lost due to a variety of reasons including need for antibiotics and lost to follow-up. The authors concluded that in each arm of the trial, periodontal and hygiene parameters improved overall. The results show that the intervention group had a significantly higher reduction in PPD; however, following data analysis, these findings were found to be statistically insignificant. The authors conclude that the addition of a multi-nutrient supplement, alongside nsHPT for patients undergoing treatment for Stage III and IV periodontal disease, showed a reduction in PPD and BOP when compared with a placebo and nsHPT.

Five-year radiological findings from a randomized controlled trial of four periodontitis treatment strategies.

Radiographic findings from long-term studies of periodontitis treatment have rarely been reported. Although bone destruction is a prominent feature of periodontitis, the long-term effect on alveolar bone levels of different treatment strategies, with or without adjunctive metronidazole (MTZ), has not been reported. We investigated the 5-year radiographic outcome of therapy in patient groups treated with conventional scaling and root planing (SRP) or same-day full-mouth disinfection (FDIS), with or without adjunctive MTZ. Following a 3-month oral hygiene phase, 184 periodontitis patients were randomly allocated to one of four treatment regimens: (i) FDIS+MTZ; (ii) FDIS+placebo; (iii) SRP+MTZ; or (iv) SRP+placebo. Following active treatment, patients received biannual maintenance. In total, 161 patients (87.5%) completed the 5-year follow-up examination, at which the radiographic bone level (RBL), clinical attachment level, probing pocket depth, presence of plaque, and bleeding were recorded again. At the 5-year follow up examination, minor radiological bone loss was observed in the intervention groups FDIS+placebo, SRP+MTZ, and SRP+placebo; by contrast, the FDIS+MTZ group did not show any change in RBL. Full-mouth disinfection did not generally perform better than conventional SRP performed over a period of 2 to 4weeks.

Esthetic and Functional Rehabilitation of a Patient with Amelogenesis Imperfecta Using Adhesive and Non-Invasive Techniques: A Case Report

Introduction: Limited evidence is available on adhesive dentistry in the management of amelogenesis imperfecta (AI). The presentation, the conservative management with adhesive techniques, and the outcome of hypoplastic AI are discussed. Case Report: Autosomal dominant, hypoplastic AI was diagnosed, on a 36-year-old woman, presented with unesthetic teeth and a history of frequent decay with subsequent complications. Following the hygienic phase, stabilization of caries and root canal treatment (RCT) were done. Coronal restoration of endodontically treated teeth and light-cured direct composite veneering were done in the restorative phase. Surveyed crowns, mucosa-borne partial denture, and a resin-bonded bridge were prescribed in the prosthetic phase. The patient was pleased with the improved masticatory ability and esthetics. Discussion: A stepwise least invasive, yet esthetically acceptable treatment options based on adhesive techniques are successful in hypoplastic AI.

Implantological and mucogingival treatment approach in a patient with cerebral palsy

This article includes the report of a clinical case of a 41-year-old female patient with cerebral palsy and hypothyroidism. The treatment comprised the three stages of periodontal therapy comprising hygienic phase I accompanied by phase II that compromises guided implant placement and horizontal guided bone regeneration with soft tissue conditioning through the placement of a connective tissue graft through the VISTA technique and finally phase III of maintenance.

Cytokine profiles and the dynamic of gingivitis development in humans.

To investigate the relationship between cytokine profiles and "fast" and "slow" patterns of gingival inflammation development. Forty-two adults participated in an experimental gingivitis study, comprising a 2-week hygiene phase (clinical examination and professional cleaning); a 3-week induction phase (absence of oral hygiene); and a 2-week resolution phase (re-establishment of oral hygiene). Plaque and gingival inflammation scores were assessed. Interferon-gamma (IFN-γ), interleukin (IL)-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, and tumour necrosis factor-alpha (TNF-α) from gingival crevicular fluid were collected and measured by multiplex ELISA. Group-based-trajectory-modelling (GBTM) was used to model cytokine profiles over the induction phase. The effect of gingival inflammation on cytokine levels over time was estimated with mixed-effects modelling. GBTM analysis revealed two cytokine profiles, "non-organized response" (IL-4, IL-6, IL-8, IL-12, and IL-13) and "organized response" (IL-2, IL-10, and TNF-α). Among the "slow" responders, neither cytokine profile was associated with gingivitis. In contrast, a "fast" response was associated with a higher "non-organized response" factor (coef. 0.14) and a lower "organized response" factor (coef. -0.03). A "fast" gingivitis development was associated with a higher "non-organized response" and a lower "organized response", which may elucidate the role of individual variability in gingivitis susceptibility.

Antibiotics in reconstructive dentistry

These guidelines concern the administration of systemic antibiotics in reconstructive dentistry. While the general guidelines for antibiotic prophylaxis apply to patients at risk, the prophylactic administration of antibiotics is only indicated in very rare cases in healthy patients: chamber-preserving measures with autologous grafts during extractions in the hygiene phase and implantation with controlled bone regeneration in the surgical phase.

Periodontitis with Stage III, Grade C. Case report

Periodontal disease affects patients’ health compromising the shape, function and aesthetics of the entire stomatognathic system, leading to significant deterioration in the quality of life of the patient. Using the actual classification, we will evaluate the stages of disease of the periodontium depending on the severity, complexity of treatment and degrees according to the level of risk that the patient may present with. This clinical case proposes a comprehensive treatment of a 58-year-old male patient with periodontitis accompanied by the new classification of periodontal diseases to make an adequate diagnosis, based on updated scientific evidence. Both clinical and radiological assessments were performed as well as measurements of the depth of periodontal pockets using the WHO periodontal probe. These were recorded in the periodontogram to determine the pathology and staging of disease (Stage III, Grade C according to World Workshop), also taking into account the patient’s tobacco and coffee addiction. The treatment plan consists of different phases: Systemic phase, hygienic phase, corrective phase and maintenance phase. The amount of cigarettes the patient consumed per day affected the treatment, despite the advice about the harmful effects of smoking. However, the depths of periodontal pockets were reduced and the patient’s oral hygiene improved.

Short-term outcome of regenerative surgery treating peri-implantitis

To evaluate the short-term outcome of regenerative surgery for peri-implantitis therapy. From March 2018 to January 2019, 9 patients with 10 implants who suffered from peri-implantitis were included in the present research. Vertical bone defect at least 3mm in depth with 2 or more residual bone walls was confirmed around each implant by radiographic examination. Restorations were replaced by healing abutments on 3 implants with the consent of the patients. Guided bone regeneration surgery was performed after a hygienic phase. During surgery, full thickness flaps were elevated on both buccal and lingual aspects. Titanium curette was used for inflammatory granulation tissue removal and implant surface cleaning. The implant surface was decontaminated by chemical rinsing with 3% hydrogen peroxide solution. After being thoroughly rinsed with saline, the bone substitutes were placed in bone defects which were covered by collagen membranes. 6 months after non-submerged healing, the clinical parameters including peri-implant probing depth (PD, distance between pocket bottom and peri-implant soft tissue margin) and radiographic bone level (BL, distance form implant shoulder to the first bone-to-implant contact) were used to evaluate the regenerative outcome. PD was measured at six sites (mesial, middle and distal sites at both buccal and lingual aspects) around each implant, and BL was measured at the mesial and distal surfaces of each implant on a periapical radiograph. The deepest PD and largest BL of each implant ranged from 6-10 mm and 3.2-8.3 mm respectively. All the implants healed uneventfully after surgery. The mean peri-implant PD at baseline and 6 months after surgery were (6.2±1.4) mm and (3.1±0.6) mm respectively, and a mean (3.0±1.5) mm radiographic bone gain was observed, P<0.01. Treatment success was defined as: no sites with residual PD≥6 mm, no bleeding on probing, and BL elevation of at least 1 mm. Nine implants from 8 patients fulfilled the success criteria. Residual pockets with 6 mm in depth and bleeding on probing could be detected in only one implant. Within the limitation of the present research, guided bone regeneration surgery can be used for the treatment of bone defect that resulted from peri-implantitis. Significant PD reduction and radiographic bone gain can be obtained after 6 months observation.

Macrophage activity is associated with gingival inflammation: Soluble CD163 in an experimental gingivitis study

AimThis study aimed to investigate the association between gingival inflammation and levels of soluble CD163 (sCD163), a macrophage-specific marker associated to inflammation, in young adults participating in an experimental gingivitis study. MethodsForty-two university students volunteered to participate in the study, which comprised three phases: a two-week Hygiene Phase (clinical examination and professional cleaning); a three-week Induction Phase (absence of oral hygiene); and a two-week Resolution Phase (reestablishment of oral hygiene). Clinical recordings of plaque (Modified Quigley and Hein Plaque Index) and gingival inflammation (Modified Gingival Index) were collected weekly during the Induction Phase, and after two weeks during the Resolution Phase. Levels of sCD163 from gingival crevicular fluid (GCF) were collected during Induction and Resolution Phases and measured by ELISA. Group-based-trajectory-modeling (GBTM) was used to model patterns of sCD163 throughout the Induction Phase. Mixed-effects multilevel models were used to estimate the effect of gingival inflammation on sCD163 over time. ResultsLevels of sCD163 increased steadily over time, however, sCD163 showed a lagged response to gingival inflammation. GBTM analysis identified two groups for sCD163: one with a “linear” trajectory of sCD163 over the Induction Phase (n = 35), and another with a “quadratic” (n = 7) increase of sCD163 at the end of the Induction Phase. Stratified analysis by the sCD163 groups revealed that “linear” sCD163 growth was associated with both GCF volume and gingival inflammation but lagged in time, while a “quadratic” growth was associated with gingival inflammation and time. ConclusionsMacrophage activity is associated with gingival inflammation and can be detected at early stages of gingivitis. However, while in most participants a “linear” trajectory of sCD163 over the development of gingival inflammation was observed, among few individuals an exacerbated increase of sCD163 levels in GCF was noticed particularly at the end of the Induction Phase.

Oral hygiene revisited. The clinical effect of a prolonged oral hygiene phase prior to periodontal therapy in periodontitis patients. A randomized clinical study.

The aim of the present study was to investigate the effect of a 3-month strict oral hygiene phase on key parameters of periodontitis: plaque, bleeding on probing (BOP) and probing pocket depth (PPD). Forty-four patients with severe periodontal disease were randomly allocated to a test or a control group. The test group completed a 3-month strict oral hygiene phase. The control group did not receive any instructions or motivation on oral hygiene until after the 3-month period. Plaque, BOP and PPDs were registered on four sites of each tooth at baseline and after 3months in both groups, as well as after the postponed hygiene phase in the control group. A statistically significant and profound reduction in plaque, BOP and PPD was observed after the 3months in the test group. No change to the better occurred in the control group. A 3-month strict oral hygiene phase in patients referred for periodontal therapy reduced plaque, BOP and pocket depth to such an extent that it could affect therapy planning.

Oral hygiene phase revisited: How different study designs have affected results in intervention studies.

Every periodontal researcher have been taught, and every textbook in periodontics have advocated, that a phase in which the patient is meticulously motivated and instructed in proper oral hygiene-the oral hygiene phase-must be included in any periodontal intervention. However, how is this oral hygiene phase actually portrayed in periodontal intervention studies, and how much space have this important phase received in the planning and carry-through of intervention studies? The purpose of this letter to the editor was to review current literature in the period 1975/01/01-2017/12/31 on periodontal, mechanical intervention studies in order to see what focus the oral hygiene phase had received in these articles. The result showed that the oral hygiene phase is variable in length and content, variable in claimed result, insufficiently described, and invariably amalgamated with the scaling and root planing which is the intervention or part of an intervention. The consequences of these findings are discussed and suggestions proposed for more harmonized and calibrated oral hygiene phase introduced to avoid biased and inflated results of interventions.

The adjunctive effect of a titanium brush in implant surface decontamination at peri-implantitis surgical regenerative interventions: A randomized controlled clinical trial.

To evaluate an additional mechanical approach, a titanium brush, in the implant surface decontamination performed during the regenerative surgical therapy of peri-implantitis. A randomized double-blinded clinical trial, with a 1-year follow-up, was carried out. After a hygienic phase, peri-implantitis-affected implants were randomly assigned to a control or to a test group. In the control group, implant surface was decontaminated both mechanically and chemically with 3% H2 O2 and plastic ultrasonic scalers, respectively, while in the test group, a titanium brush was also applied. Intrabony defects in both groups were filled with an alloplastic material (β-tricalcium phosphate and hydroxyapatite) and covered with a collagen membrane. The primary outcome was the reduction in probing pocket depth (PPD) at the deepest site. Thirty patients were included, 15 in each group. At 12months, reduction in PPD was 4.87 (standard deviation [SD] 1.55) mm and 2.85 (SD: 1.91) mm, respectively (p=0.009). The correspondent figures for residual PPD were 3.6 (SD: 0.91) and 4.92 (SD: 1.26) mm, respectively (p=0.007). The additional use of a titanium brush during regenerative treatment of peri-implantitis resulted in statistically significant benefits in terms of PPD reduction after 12months.

No differences in microbiome changes between anti-adhesive and antibacterial ingredients in toothpastes during periodontal therapy.

AimThis subgroup analysis of a 12‐week randomized, double‐blind, and two‐center trial aimed to evaluate whether two different toothpaste formulations can differentially modulate the dental microbiome.Material and MethodsForty one mild to moderate periodontitis patients used as an adjunct to periodontal treatment either a toothpaste with anti‐adhesive zinc‐substituted carbonated hydroxyapatite (HA) or with antimicrobial and anti‐adhesive amine fluoride/stannous fluoride (AmF/SnF2) during a 12‐week period. Plaque samples from buccal/lingual, interproximal, and subgingival sites were taken at baseline, 4 weeks after oral hygiene phase, and 8 weeks after periodontal therapy. Samples were analyzed with paired‐end Illumina Miseq 16S rDNA sequencing. The differences and changes on community level (alpha and beta diversity) and on the level of single agglomerated ribosomal sequence variants (aRSV) were calculated with analysis of covariance (ANCOVA) and likelihood ratio test (LRT).ResultsInterproximal and subgingival sites harbored predominately Fusobacterium and Prevotella species associated with periodontitis, whereas buccal/lingual sites harbored mainly Streptococcus and Veillonella species associated with periodontal health. Alpha and beta diversity did not change noticeably differently between both toothpaste groups (P > 0.05, ANCOVA). Furthermore, none of the aRSVs showed a noticeably different change between the tested toothpastes during periodontal therapy (P adj .> 0.05, LRT).ConclusionThe use of a toothpaste containing anti‐adhesive HA did not induce statistically noticeably different changes on microbial composition compared to an antimicrobial and anti‐adhesive AmF/SnF2 formulation.

Treatment of maxillary molar with furcation involvement - Case report

Purposes: The aim of this clinical report is to discuss the advantages and the steps of the root separation and resection approach in a maxillary molar with a class III furcation of the palatine root with a follow-up of 24 months. Case report: A patient with tooth mobility and bleeding after probing, was diagnosed with a Chronic Periodontitis Generalized Moderate and Localized Severe. Hygienic phase with oral hygiene instructions, scaling and root planning was performed. Due to class III furcation of the palatine root of the teeth 16 and some remaining pockets deepths, was decided to execute an apical repositioning flap on the 1st sextant among with the palatine root amputation combined with the endodontic treatment. During the surgical procedure, it was also performed a reduction of the palate thickness from teeth 15 to 17; in distal area of the 17 a distal wedged was performed in order to remove all the pockets. After the surgery, the patient was inserted in a long-lasting individualized supportive periodontal treatment.This case has a follow up of 24 months. Conclusions: Similar survival rates are described in the literature when we compared the root amputation with the dental implants survival rate, but the first one is cheaper and allows to keep the natural tooth. We can’t forget that the periodontitis is a risk factor of peri-implantitis. This clinical case shows that, with a high motivated patient and with the complete periodontal treatment, is possible to obtain excellent results with root separation and resection in maxillary molars class III.

Nivel de cumplimiento de las fases del tratamiento periodontal en las clínicas odontológicas de la Universidad de Santo Tomás

Objetivo: determinar el nivel de cumplimiento de las fases del tratamiento periodontal registrado en las historias clínicas de pacientes que atienden a las clínicas odontológicas de la Universidad Santo Tomás, Bucaramanga durante el 2016.Materiales y métodos: se realizó un estudio observacional de corte transversal, se tuvieron en cuenta 171 historias clínicas que cumplían todos los criterios de selección, se evaluaron variables sociodemográficas, semestre del estudiante que atendía al paciente, compromiso sistémico, diagnóstico periodontal, y registro de las fases del tratamiento periodontal.Resultados: la fase de mantenimiento tuvo mayor nivel de incumplimiento (99,4%), seguida de la fase de reevaluación (98,8%). La fase higiénica presentó un incumplimiento del 57,3%. Dentro de las fases que requieren o no de su cumplimiento; la fase urgencia, evidenciada por dos personas, solo una de estas cumplió; en la fase sistémica, el 69,6% asistió a la consulta para el tratamiento periodontal y en la fase correctiva, se presentó un incumplimiento del 78,9%.Conclusión: el estudiante debe recalcar en cada atención al paciente la importancia de cumplir con cada una de las fases del tratamiento periodontal, especialmente, con la asistencia a las fases de reevaluación y mantenimiento, ya que se evidenció en estas un alto porcentaje de incumplimiento.

Agrandamiento gingival farmacoinducido: Serie de casos

Introducción: El agrandamiento gingival (AG) es una condición benigna de la cavidad oral que se caracteriza por el crecimiento excesivo en masa y volumen de la gingiva. Esta lesión no es únicamente provocada por factores hereditarios ni de deficiente higiene oral, sino también por ingesta de medicamentos, entre los cuales se encuentran fármacos antihipertensivos, anticonvulsivantes e inmunosupresores. Objetivo: Sensibilizar respecto a la prevención o atención temprana en pacientes con patologías que ameritan el uso de antihipertensivos y anticonvulsivantes, conjuntamente con el odontólogo para tratar o evitar el agrandamiento gingival farmacioinducido (AGFI) Materiales y métodos: Se reporta una serie de casos clínicos de pacientes con agrandamiento gingival por distintos fármacos, entre los que se encuentran fenitoina, amlodipino y nifedipino; se aplicaron medidas de fase higiénica periodontal y gingivectomía para obtener mejores efectos. Resultados: Se obtuvieron resultados satisfactorios con una disminución considerable del AGFI. Conclusiones: Es importante el manejo integral en conjunto con el médico tratante para realizar seguimiento del fármaco que pueda encontrarse generando agrandamiento gingival. Emplear un abordaje inicial con estrategias de higiene periodontal, y en casos severos y como último recurso la intervención quirúrgica periodontal con gingivectomía y gingivoplastia.

The effect of supportive periodontal therapy after periodontal treatment : A 1-year follow up.

Purpose : Preservation of the periodontal health of the treated patient requires supportive periodontal therapy for the elimination of periodontal disease. After Phase I therapy is completed, patients are placed on a schedule of periodic recall visits for maintenance care to prevent recurrence of the disease. The amount of tooth loss would be the most relevant criterion in an evaluation of the effect of periodontal treatment, but this would require studies with extremely long follow-up periods. Thus the most commonly used outcome criteria in clinical research have been clinical attachment level change, reduction of pocket depth and bleeding frequency. The purpose of this case study is to identify the effect of supportive periodontal therapy after periodontal flap surgery. Materials &amp; Methods : Following routine hygienic phase of treatment, patients with chronic periodontitis received surgical periodontal treatment. Bleeding on probing, pocket depth and clinical attachment level were measured at baseline, pre-operation and 1 year follow up. All procedures were performed by one operator. Results : One year a total of 28 patients (58sites) to recheck remained, when conducted maintenance program after periodontal flap surgery was observed reduction of bleeding frequency, pocket depth and improvement of clinical attachment level. Conclusion : The results from this study indicate that supportive periodontal therapy after periodontal flap surgery is effective for reduction of bleeding frequency, pocket depth and gain of clinical attachment level.

The effectiveness of propolis on gingivitis: a randomized controlled trial.

A randomized, double-blind, controlled clinical trial was conducted to evaluate the effectiveness of a propolis rinse on induced gingivitis by using the co-twin study design. Twenty-one twin pairs (n=42) were enrolled in a gingivitis study with oral hygiene promotion (14 days) and gingivitis induction (21 days). During the gingivitis induction phase, one member of the twin pair was randomly assigned to a 2% typified propolis rinse, and the other was assigned a color-matched 0.05% sodium fluoride plus 0.05% cetylpyridinium chloride rinse (positive control). Patients rinsed twice daily with 20 mL for 30 seconds for 21 days. Gingivitis was measured on days -14 (baseline), 0 (after hygiene phase), and 21 (after no-hygiene phase) by using the Papillary Bleeding Score (PBS) and by standard digital imaging of the gum tissues (G-parameter). The 38 persons who completed the study (age 13-22 years) were well balanced according to PBS at baseline and G-parameter after the initial hygiene phase. After 21 days without oral hygiene, the propolis rinse and positive control rinse groups did not differ significantly for average PBS measurements or G-parameter. Use of a 2% typified propolis rinse was equivalent to a positive control rinse during a 21-day no-hygiene period.

Improving the reliability of inter-AS economic inferences through a hygiene phase on BGP data

Over the last few years researchers have tried to shed light on the economic features that drive the inter-domain routing of the Internet, by inferring economic inter-AS relationships from raw BGP data collected by research projects such as BGPmon, PCH, RIS and RouteViews. Although this kind of data contains spurious entries mostly caused by router misconfigurations on BGP border routers and showing up during BGP path exploration, none of the methodologies provide an adequate data hygiene phase, thus affecting the accuracy of the inferences drawn. In this paper we outline a new methodology that can purge a large amount of spurious routes from BGP raw data by leveraging on robust statistical concepts rather than on debatable thresholds. To quantify the performance of our methodology we apply an enhanced version of an existing economic tagging algorithm on non-cleaned and cleaned data respectively. We found that 42.01% of different AS paths advertised to BGP route collectors in July 2013 appear only in spurious routes and that, in the absence of an appropriate data hygiene phase, they can affect the accuracy of the economic inferences regarding about 8% of connections found in BGP raw data.

Clinical evaluation of porous hydroxyapatite bone graft (Periobone G) with and without collagen membrane (Periocol) in the treatment of bilateral grade II furcation defects in mandibular first permanent molars.

Background:Furcation invasions represent one of the most demanding therapeutic challenges in periodontics. This investigation assessed and compared the clinical efficacy of hydroxyapatite bone graft material when used alone and with collagen membrane in the treatment of grade II furcation defects.Materials and Methods:Ten patients with comparable bilateral furcation defects in relation to mandibular first molars were selected and treated in a split-mouth design. After the hygiene phase of therapy was completed, the groups were selected randomly either for treatment with hydroxyapatite bone graft (Periobone G) alone or with a combination of bone graft and guided tissue regeneration (GTR) membrane (Periocol). Clinical parameters like plaque index, gingival index, vertical probing depth, horizontal probing depth, clinical attachment level, position of marginal gingiva, and the amount of bone fill were used at baseline and at 3 and 6 months postoperatively.Results:At 6 months, both surgical procedures resulted in statistically significant reduction in vertical and horizontal probing depths and gain in the clinical attachment level.Conclusion:The use of combination technique yielded superior results compared to sites treated with bone graft alone. However, the difference was not statistically significant.