Clinical Attachment Level Loss Research Articles

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 < 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.

Prognostic value of a composite outcome measure for periodontal stability following periodontal regenerative treatment: A retrospective analysis at 4 years.

Recently, a composite outcome measure (COM) was proposed to describe the short-term results of periodontal regenerative treatment. The present retrospective study aimed at evaluating the prognostic value of COM on clinical attachment level (CAL) change over a 4-year period of supportive periodontal care (SPC). Seventy-four intraosseous defects in 59 patients were evaluated at 6 months and 4 years following regenerative treatment. Based on 6-month CAL change and probing depth (PD), defects were classified as: COM1 (CAL gain ≥3mm, PD ≤4mm); COM2 (CAL gain<3mm, PD ≤4mm); COM3 (CAL gain ≥3mm, PD>4mm); or COM4 (CAL gain<3mm, PD>4mm). COM groups were compared for "stability" (i.e., CAL gain, no change in CAL or CAL loss<1mm) at 4 years. Also, groups were compared for mean change in PD and CAL, need for surgical retreatment, and tooth survival. At 4 years, the proportion of stable defects in COM1, COM2, COM3, and COM4 group was 69.2%, 75%, 50%, and 28.6%, respectively, with a substantially higher probability for a defect to show stability for COM1, COM2, and COM3 compared with COM4 (odds ratio 4.6, 9.1, and 2.4, respectively). Although higher prevalence of surgical reinterventions and lower tooth survival were observed in COM4, no significant differences were detected among COM groups. COM may be of value in predicting CAL change at sites undergoing SPC following periodontal regenerative surgery. Studies on larger cohorts, however, are needed to substantiate the present findings.

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

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

Immunological and Bacteriological Monitoring of Periodontal Tissue in Pregnancy

We determine periodontal pathogens in periodontal pockets from pregnant women with periodontitis and associate it to the C reactive protein (CRP), nitrates, immunoglobulin A and G (Ig A and G), and myeloperoxidase (MPO) levels in saliva to identify some biomarkers as tools to predict the periodontal status from pregnant. The samples were obtained from periodontal pockets and saliva from 100 pregnant women (PW) and 50 non-pregnant women (NPW). Every patient was evaluated by: 1) probing depth (PD) and loss of clinical attachment level (CAL); 2) in saliva; CRP, MPO, Ig A and G) and nitrite concentrations, 3) in periodontal pockets: P.gingivalis, T.forsythia, T.denticola, P.intermedia, A.actinomycetemcomitans. InfoStat/P 2008 software was used with a p-value &lt;0.05. Clinical parameters showed stages I and II of PD in both groups. P.intermedia and A.actinomycetemcomitans were observed only in periodontal pockets from PW. The CAL was higher in pregnant of the 3rd trimester than in the other stages and was associated with low levels of IgA and the presence of P.intermedia and T. forsythia in the same trimester. The levels of IgA in saliva would reflect the immunological situation in pregnant women. This could be used to monitor the immune status of the gingival tissues during pregnancy.

Comparative analysis of the effect of 4MATRIX with and without PRF on regeneration of infrabony periodontal pockets

AimThe aim was to compare the effect in improvement of periodontal pocket depth (PPD) and clinical attachment level (CAL) between application of 4MATRIX and 4 MATRIX combined with PRF in advanced periodontal disease during follow-up of 6, 12 and 18 months. MethodsThirty patients of both genders aged 25–50 years were included. The patients were clinically and radiologically diagnosed with generalized advanced chronic periodontitis with the presence of periodontal pockets with a depth of ≥ 5 mm bilaterally in the upper jaw. Both sides were treated with a flap intervention in all patients. On one side a bone substitute 4MATRIX was applied, and the other side was treated with an application 4MATRIX and PRF. The clinical assessment and measurements were performed in four stages, immediately before the intervention, and then 6, 12 and 18 months after the intervention. PPD and CAL were determined in all four timepoints. ResultsPPD was the highest at zero time before the surgery for both groups and was 5.56 ± 0.28 mm. In the postoperative follow-up period, the PPD value decreased gradually with the lowest average value of 5.10 ± 0.18 mm after 18 months in Group I and 4.67 ± 0.13 mm in Group II (p < 0.001, respectively). Moreover, comparing the values of PPD at 6, 12 and 18 months after the surgery, a significant difference was found between the patients from the 4MATRIX vs 4MATRIX + PRF (p < 0.001 respectively). The postoperative follow-up period showed a decrease in CAL value with the lowest value after 18 months. A significant difference in CAL was found between the four measurement times (p < 0.001, respectively). The average level of CAL was the highest before surgical treatment in both groups. The intergroup analysis of CAL after 18 months in group I (4MATRIX) was 5.27 ± 0.17 mm and in group II 4.10 ± 0.14 mm (p < 0.001). ConclusionTreatment of adult patients with advanced chronic periodontitis with periodontal pockets of ≥ 5 mm bilaterally in the upper jaw using 4MATRIX and 4MATRIX + PRF showed improvement of PPD and lower CAL loss after 18 months of the treatment. In the group treated with 4MATRIX + PRF patients showed the highest improvement in PPD and CAL loss. The analysis of treatment with 4MATRIX and 4MATRIX + PRF showed the lowest values after 18 months of the treatment.

Outcomes of reconstructive periodontal surgery with different types of barrier membranes

Relevance. Reconstructive periodontal surgery is one of the most effective methods of restoring tooth-supporting apparatus damaged by microbial inflammation and destruction. For this purpose, they use non-resorbable and resorbable biomaterials, which act as a temporary barrier between the tissues with different mitotic potential during early healing. Since the properties of barrier membranes determine the degree of invasiveness and postoperative morbidity, and, finally, the success of the surgery, it is relevant to study the outcomes of periodontal reconstruction with one of the modern collagen membranes cross-linked by ribose.Purpose. To comparatively assess the outcomes of periodontal reconstructions with a resorbable and non-resorbable barrier material.Material and methods. The study is a prospective randomized blind controlled clinical trial. The study included 37 patients (14 men, 23 women) aged 45-65 years, who, after the initial therapy, underwent 62 guided tissue regenerations using e-PTFE and resorbable collagen membrane cross-linked by ribose. The study compared the clinical and radiographic results before and 18 months after the surgery. We evaluated the probing depth (periodontal pocket), gingival recession level, loss of clinical attachment level, width and height of periodontal infrabony defects, gain in clinical attachment level. The material was statistically processed using StatSoft STATISTICA 10.0.1011 for Windows. The statistical unit is a periodontal defect.Results. In the postoperative period, the main (31%) and control (42%) groups exhibited the areas of membrane exposure; 16 periodontal defects, only in the control group, demonstrated the extensive membrane exposure, of which 11 membranes were prematurely removed due to infection of the reconstruction site. In the main group, fibrin allowed exposed area healing in the usual time without medical assistance. After 18 months, the gain in the clinical attachment level was 3.5 mm in the main group versus 2.8 mm in the control group (at p=0.03) with a significant decrease in the probing depth compared to that before treatment; the level of recession also changed positively, although not significantly. The type of periodontal defect (the parameter is higher in three-wall and two-wall defects) appeared to remarkably influence the gain in clinical attachment level.Conclusion. The study evidenced that the resorbable cross-linked collagen membrane demonstrated clinically acceptable outcome of the damaged periodontium reconstruction due to, first of all, increased predictability of the course of the early postoperative period, a significant reduction in morbidity and invasiveness of intervention.

Long-term clinical outcomes of periodontal regeneration with enamel matrix derivative: A retrospective cohort study with a mean follow-up of 10 years.

BackgroundDespite the large body of evidence on the efficacy of enamel matrix derivative (EMD) in the treatment of periodontal intrabony defects, few studies reported long‐term data (≥10‐year).MethodsPeriodontal patients treated with regenerative surgery with EMD between 1999 and 2012 were invited to participate in a clinical examination. The following clinical parameters were recorded and compared at baseline (T0), 6 months after surgery (T1) and after at least 8 years of follow‐up (T2): probing depth (PD), gingival recession (GR), clinical attachment level (CAL), plaque and bleeding scores. The primary outcome variable was CAL change.ResultsForty‐one patients with 75 treated teeth were available for analysis. Out of these, 68 (tooth survival rate: 90.7%) reached the latest follow‐up with a mean observation period of 10.3 years (range: 8.0 to 21.3). The most frequent reason for tooth loss was recurrence of periodontal disease. Tooth survival curves showed a statistically significant difference between smokers and non‐smokers (P = 0.028). Mean CAL changed from 8.43 ± 1.86 (T0) to 6.47 ± 1.70 (T1) (P < 0.001) and to 5.91 ± 1.83 (T2) (P < 0.001). At T1, a CAL gain of ≥3 mm was measured in 35% of the defects whereas at T2 it was detected in 51% of cases.ConclusionsWithin their limitations, the present results have shown that in intrabony defects, the clinical improvements obtained following regenerative surgery with EMD can be maintained on a mean period of 10 years. Smoking status and maxillary molars were correlated with an increased risk for tooth and CAL loss, respectively.

Utility of procalcitonin as an early diagnostic marker of bacteremia in individuals with periodontitis Stage II and III.

The aim of the present study is to assess the ability of procalcitonin (PCT) to differentiate between periodontal health and Stage II and III periodontitis. We further assessed, if PCT can reflect early bacteremia induced by non-surgical periodontal treatment (NSPT). Sixty-four systemically healthy individuals were divided into Group I, periodontally healthy, and Group II, Stage II and III periodontitis. NSPT was done for both the groups. Standardized serum and salivary samples were obtained and analyzed for PCT levels using highly sensitive double antibody sandwich enzyme-linked immunosorbent assay at baseline and 2 weeks. In addition, the serum levels of PCT were recorded at immediate and 1-hour post-NSPT. Mean PCT levels (saliva=0.03ng/mL and serum=0.05ng/mL) in periodontally healthy group were considerably lower than that in the periodontitis group (saliva=0.22ng/mL and serum=1.85ng/mL) with significant intergroup comparison at P< 0.001. Post NSPT the mean serum PCT values increased from 1.854ng/mL to 1.871ng/mL at the immediate interval and remained at 0.879ng/mL after 2 weeks at P< 0.001. Spearman correlation showed highly significant positive correlation between serum and salivary PCT values to clinical attachment level (CAL) at P< 0.001 and rho=0.78 and 0.75, respectively. Linear regression model showed serum PCT to be a significant predictor for CAL. Screening for serum PCT levels in patients with periodontitis could act not only as a guide to assess the bacterial load and use of antibiotics but also as a predictor for CAL loss in patients with periodontitis.

Efficacy of alternative or additional methods to professional mechanical plaque removal during supportive periodontal therapy: A systematic review and meta-analysis.

To systematically review the literature addressing the following focused questions: "What is the efficacy of either (#1) alternative or (#2) additional methods to professional mechanical plaque removal (PMPR) on progression of attachment loss during supportive periodontal therapy (SPT) in periodontitis patients?". A systematic search for randomized clinical trials was performed. Change in clinical attachment level (CAL) from baseline was the primary outcome. Routine PMPR performed with either a combination of ultrasonic/hand instruments or Er:Yag laser showed similarly effective in preventing CAL loss. Moreover, a routine SPT regimen based on PMPR led to stability of CAL irrespective of a daily sub-antimicrobial doxycycline dose (SDD). Finally, an adjunctive photodynamic therapy (PDT) did not enhance the magnitude of CAL gain when sites with probing depth ≥4mm were repeatedly treated. After pooling all data, the results of the meta-analysis showed no statistical differences in CAL change from baseline: mean overall CAL change was -0.233mm (95% confidence interval: -1.065, 0.598; p=.351). Weak evidence indicate that in treated periodontitis patients enrolled in a 3-4month SPT based on PMPR, Er:Yag laser (as alternative), SDD and PDT (as additional) do not produce a greater clinical effect on periodontal conditions compared to PMPR.

Comparison of periodontitis patients' classification in the 2018 versus 1999 classification.

We aimed to assess how the 2018 and 1999 classifications of periodontal diseases reflect (a) patients' characteristics, (b) disease severity/extent/progression and (c) tooth loss (TL) during observation period. A total of 251 patients were followed over 21.8±6.2years. For the 1999 classification, using clinical attachment level (CAL), patients were classified as localized/generalized, mild/moderate/severe and aggressive/chronic periodontitis. For the 2018 classification, patients were staged according to their CAL or bone loss (BL) and the number of lost teeth (stages I-IV). Further factors like probing pocket depths (PPD) or furcation involvement modified the stage. The extent was sub-classified as generalized/localized. Patients were graded according to the BL/age index, smoking and/or diabetes. According to the 1999 classification, most patients suffered from generalized severe chronic periodontitis (203/251) or generalizedaggressive periodontitis (45/251). Patients with aggressive periodontitis were younger and less often female or smokers. They showed similar TL (0.25±0.22 teeth/patient*year) as generalized severe chronic periodontitis patients (0.23±0.25teeth/patient*year). According to the 2018 classification, most patients were classified as generalized III-C (140/251), III-B (31/251) or IV-C (64/251). Patients' age, smoking status, CAL, PPD and BL were well reflected. TL differed between IV-C (0.36±0.47), generalized III-C (0.21±0.24) and localized forms (0.10-0.15). Patients' characteristics, disease severity/extent/progression and TL were well reflected by the 2018 classification.

Long-term assessment of periodontal disease progression after surgical or non-surgical treatment: a systematic review.

The primary aim of this systematic review was to assess the evidence on periodontal disease progression after treatment in patients receiving supportive periodontal therapy (SPT) and to identify predictors of clinical attachment level (CAL) loss. A protocol was developed to answer the following focused question: In adult patients treated for periodontitis, what is the disease progression in terms of CAL loss after surgical or non-surgical treatment? Randomized controlled clinical trials, prospective cohort studies, and longitudinal observational human studies with a minimum of 5 years of follow-up after surgical or non-surgical treatment that reported CAL and probing depth changes were selected. Seventeen publications reporting data from 14 investigations were included. Data from 964 patients with a follow-up range of 5–15 years was evaluated. When the CAL at the latest follow-up was compared to the CAL after active periodontal therapy, 10 of the included studies reported an overall mean CAL loss of ≤0.5 mm, 3 studies reported a mean CAL loss of 0.5–1 mm, and 4 studies reported a mean CAL loss of >1 mm. Based on 7 publications, the percentage of sites showing a CAL loss of ≥2 mm varied from 3% to 20%, and a high percentage of sites with CAL loss was associated with poor oral hygiene, smoking, and poor compliance with SPT. The outcomes after periodontal therapy remained stable over time. Disease progression occurred in a reduced number of sites and patients, mostly associated with poor oral hygiene, poor compliance with SPT, and smoking.

Periodontitis affects glucoregulatory hormones in severely obese individuals

ObjectiveTo evaluate the effect of periodontitis (PD) on glucoregulatory hormones in obesity, never explored so far, a cross-sectional study was conducted in 110 severely obese, non-diabetic individuals.MethodsWe collected clinical periodontal parameters, including probing pocket depth (PPD), bleeding on probing (BOP), clinical attachment level (CAL). Insulin, glucagon, GLP-1 and GIP were measured after 3 days of standardized diet.ResultsForty-seven subjects had periodontitis (PD+) and 63 did not (PD−). PD+ showed 30.3% of gingival sites with PPD > 4 mm, 55.2% of BOP sites and a mean CAL loss of 4.1 mm. Compared with PD−, PD+ had higher glucagon (26.60 [25.22] vs 3.93 [7.50] ng/l, p < 0.0001) and GIP levels (10.56 [13.30] vs 6.43 [8.43] pmol/l, p < 0.001), while GLP-1 was reduced (11.78 [10.07] vs 23.34 [16.80] pmol/l, p < 0.0001). Insulin did not differ. In PD+, after adjustment for confounders, PPD was positively related to glucagon (β = 0.424, p = 0.002) and inversely to GLP-1 (β = −0.159, p = 0.044).ConclusionsWe describe for the first time an impaired incretin axis coupled with a relative hyperglucagonemia in obese non-diabetic individuals with PD, that might contribute to deteriorate their glucose tolerance and partially explain the higher risk of diabetes observed in these patients.

Stan przyzębia mieszkańców Białegostoku w wieku od 65 do 74 lat – badania wstępne

Background. Routine epidemiology examinations of the periodontium in adults (regional and supraregional) are necessary to evaluate their health and to undertake proper preventative actions (prophylactic and therapeutic) pertaining to periodontitis.Objectives. The aim of the study was to evaluate the oral hygiene and periodontal status of citizens aged 65–74 years residing in a big city in the Podlaskie province.Material and Methods. The study included 72 randomly chosen Białystok citizens (51 women and 21 men). While recording the patients’ medical history, special attention was paid to cigarette smoking. The condition of oral hygiene and periodontal status were evaluated. The following parameters were tested: API (approximal plaque index), PI (plaque index), BOP (bleeding on probing), PD (probing depth) and CAL (clinical attachment level). Moreover, the mean number of preserved teeth, the percentage of persons with at least 20 preserved natural teeth and the percentage of edentulism were evaluated.Results. Mean API was 66.16% ± 47.33, PI – 57.82% ± 49.39 while BOP – 26.74% ± 44.27. PD was estimated at 2.13 mm ± 1.62, while the loss of CAL was found in 61.08 ± 27.43 sites. The coefficient of nicotine addiction was 675 ± 475.13. The mean number of preserved teeth was 13.36 ± 8.18, while maintained chewing function was found in 27.78% of the individuals and edentulism in 12.5% of the cases.Conclusion. The periodontal status of Białystok citizens aged 65–74 years is unsatisfactory. The percentage of persons with preserved chewing function is low and thus the need for periodontal treatment and rehabilitation of the masticatory apparatus is high.

Videoscope Assisted Minimally Invasive Surgery (VMIS): 36-Month Results.

Clinical outcomes from videoscope assisted minimally invasive surgery (VMIS) at 36 to 58 months are reported. Fourteen patients having sites with residual probing depth (PD) of at least 5 mm and 2 mm loss of clinical attachment level (CAL) after initial non-surgical therapy were treated with VMIS. At 36 months or greater post-surgery there was a statistically significant improvement (P <0.001) in mean PD and CAL (PD: 3.80 ± 1.18 mm, CAL: 4.16 ± 1.18 mm) in all surgical sites compared with baseline. There was a mean improvement in soft tissue height (0.36 ± 0.64 mm, P = 0.03). In most cases, patients reported no postoperative discomfort. Improvements from VMIS appear to be favorable when compared with previously reported results of periodontal regenerative surgery. All improvements were stable over time. The lack of post-surgical recession after VMIS has not been reported with traditional regenerative surgery.

Enfermedades periodontales como un problema de salud pública: el desafío del nivel primario de atención en salud

Over the last few years there has been a consensus that the approach of periodontal diseases should be accompanied by a focus on public health, since it is recognised that both gingivitis and periodontitis are major public health problems due to their high prevalence, the obvious damage caused to people, the high cost of treatment, and being preventable. Despite the absence of evidence of representative studies of prevalence of periodontitis, Chile does not escape this reality. However based on existing reports, it can be established that children have a high frequency of gingivitis that increases with age, and the general population has a high inflammatory component in their gums. Meanwhile, in adolescents there is already evidence of destruction of periodontal tissues, measured by loss of clinical attachment level, and this destruction increases significantly in adults and the elderly, and is largely responsible for the loss of teeth in the population. Its main risk indicators include age, gender, education level, socioeconomic status, access to health, and smoking. There is a relationship with chronic non-communicable diseases, and share common risk factors with these. Despite the efforts of the individual approach, there is still a high prevalence of these diseases, suggesting that the approach should be focused more towards strengthening at primary health care level. This should include interdisciplinary and between-speciality tasks, promoting healthy lifestyles, oral hygiene habits, tobacco and dietary counselling, and early detection of disease.

Long-term outcome following regenerative periodontal treatment of intrabony defects

This study aimed to evaluate the long-term outcome of the regenerative periodontal therapy of an intrabony defect in terms of tooth survival and clinical attachment level (CAL) stability. The association between failure and patient as well as tooth variables was assessed. Treatment records of the patients who received regenerative surgery and re-evaluation at 1-year post-surgery were screened. Patient and tooth variables, defect characteristics, and types of treatments were collected. Periodontal parameters were retrieved before regenerative surgery (baseline), 1-year post-surgery, and every visits of supportive periodontal treatment (SPT) until failure, including tooth loss or CAL loss ≥2mm was found. In this study, treatment records from 89 patients were included. These patients continued SPT from 0.5-11.16years. Of these patients, 92.1% survived from tooth loss, while 61.8% survived from CAL loss ≥2mm compared to 1-year post-surgery. At the sites with residual pocket depth<5mm, patients attending SPT>80% had a significantly less percentage of teeth with CAL loss ≥2mm compared to 1-year post-surgery than those attending SPT<80%. However, at the sites with residual pocket depth≥5mm, no significant difference in the percentage of teeth with CAL loss ≥2mm was found between patients attending SPT>80% or<80%. Smoking, patient's compliance, and residual pocket depth after regenerative surgery were significantly associated with tooth loss. However, these factors were not significantly associated with CAL loss compared to baseline or 1-year post-surgery.

Association of chronic periodontitis with metabolic syndrome: A cross-sectional study.

Background:Prevalence of metabolic syndrome (MeS) is high among Asians, including Indians and is rising, particularly with the adoption of modernized lifestyle. Various studies have reported a significant relationship between periodontal status and MeS. The objective of this study is to investigate the association between periodontitis and MeS.Materials and Methods:The study included 259 subjects (130 cases with chronic periodontitis, 129 controls without chronic periodontitis) who underwent medical and periodontal checkup. Five components (obesity, high blood pressure, low- and high-density lipoproteins, cholesterol, hypertriglyceridemia, and high plasma glucose) of MeS were evaluated, and individuals with ≥3 positive components were defined as having MeS. The periodontal parameter was clinical attachment level (CAL) on the basis of which cases were selected with moderate (CAL loss 3–4 mm) and severe (CAL loss ≥5 mm) generalized chronic periodontitis. The association between chronic periodontitis and MeS components was investigated using odds ratios (ORs) and 95% confidence intervals (CIs).Results:The association of MeS and chronic periodontitis was strong and significant with OR: 2.64, 95% CI: 1.36–5.18, and P < 0.003. Comparison of mean values of components of MeS between cases and controls reveals that the mean waist circumference (mean difference: −4.8 [95% CI: 7.75–−1.84], P < 0.002) and mean triglycerides level (mean difference: −25.75 [95% CI: −49.22–−2.28], P < 0.032) were significantly higher in cases than in control groups. Although mean systolic blood pressure, diastolic blood pressure, and fasting blood sugar level were higher in cases (125.77, 82.99 and 86.38, respectively) compared with control (122.81, 81.3 and 83.68, respectively), it was statistically insignificant.Conclusion:The results of this study suggest that there is a strong association between chronic periodontitis and MeS. The association was independent of the various potential confounding risk factors affecting the chronic periodontitis such as age, sex, residential background, and tobacco consumption.

Long-Term Effect of Four Surgical Periodontal Therapies and One Non-Surgical Therapy: A Systematic Review and Meta-Analysis.

The aim of this systematic review is to evaluate the long term (≥ 2 years) effect of four surgical and non-surgical therapies in treating periodontal disease. An electronic search of four databases and a hand search of peer-reviewed journals for relevant articles were conducted. Prospective human controlled clinical trials were included that compared surgical therapy to non-surgical therapy in ≥ 10 patients diagnosed with chronic periodontitis with a follow-up period of ≥ 2 years and that reported change in probing depth (PD) and clinical attachment level (CAL) after the therapy. Random effect meta-analysis was performed to compare the outcome of surgical and non-surgical therapy in shallow, moderate, and deep PD. Eight human prospective clinical trials were included. In 1- to 3-mm PD, scaling and root planing (SRP), modified Widman flap (MWF), and osseous surgery (OS) resulted in 23.2%, 39.4%, and 61.39% CAL loss, respectively; SRP, MWF, and OS resulted in increased mean PD of 2.5%, 3.3%, and 6.3%, respectively. In 4- to 6-mm PD, SRP, MWF, and OS resulted in 8.4%, 6.5%, and 5.22% CAL gain, respectively; SRP, MWF, and OS resulted in 18.7%, 25.4%, and 30.8% PD reduction, respectively. In PD ≥ 7 mm, SRP, MWF, and OS resulted in 9.8%, 14.2%, and 9.38% CAL gain, respectively; SRP, MWF, and OS resulted in mean PD reduction of 21.6%, 33.1%, and 42.8%, respectively. Surgical therapy had significantly more CAL loss than non-surgical therapy in shallow PD. In moderate PD, MWF had significantly more PD reduction than SRP, and there was significantly less CAL gain with surgical therapy. In deep PD, OS had significantly higher PD reduction than SRP.

Periodontal Status, Inflammation, and Malnutrition in Hemodialysis Patients – Is There a Link?

Periodontal disease (PDD) was associated with inflammation, malnutrition, and higher mortality in hemodialysis (HD) patients. Cross-sectional observational study, aiming to assess the prevalence of PDD and the possible relationship among PDD, inflammation, and malnutrition in HD patients. Single HD center, 263 patients (age: 57.4±12.3years; 60% males; HD vintage 6.6±4.9years; the primary renal diseases were mainly primary glomerular nephropathies in 34% cases, with 11% diabetic nephropathy). Oral health status was assessed by the Silness and Loe plaque index, loss of clinical attachment level, periodontal pocket depth according to World Health Organization recommendations, by a single examiner. Patients were stratified by periodontal pocket depth (PPD): normal oral status/mild PDD (PPD < 4mm), moderate PDD (PPD 4-5mm), and severe PDD (PPD ≥ 6mm). Demographic, smoking status, hematologic, dialysis-related data and parameters of the nutritional (Subjective Global Assessment score, anthropemetrical, and biochemical) and inflammatory status were collected. Poor periodontal status was shown by 75% of patients, 23% of them with severe PDD. Patients with PDD were older; higher percentages of them were smokers, diabetics, had malnutrition, and inflammation. Subjects with severe PDD had higher HD vintage, lower hemoglobin, and required higher darbepoetin doses than those with healthy periodontium. Darbepoetin resistance index was higher in patients with severe PDD than in those with normal periodontium. Models of multivariable linear logistic regression for the potential promoters and for the consequences of PDD revealed smoking and HD duration as significant contributors; increased C-reactive protein was associated with severe PDD. Cross-sectional observational design. Impaired periodontal health is highly prevalent in HD patients. PDD is more frequent in elderly diabetic smokers and in those with longer HD vintage; smoking and HD duration seems to be the most important determinants. The prevalence is higher in malnourished and in inflamed patients; inflammation seems to accompany PDD and to influence anemia response to treatment.

Videoscope-assisted minimally invasive periodontal surgery (V-MIS).

Small incision surgery has become routine in many areas of medicine but has not been widely accepted in periodontal therapy. A videoscope to assist minimally invasive surgery (MIS) has been developed. The clinical outcomes from MIS performed using this videoscope (V-MIS) are reported. Patients were evaluated for residual defects following non-surgical therapy consisting of root planing with local anaesthetic. Thirty patients having 110 sites with residual pocket probing depth (PPD) of at least 5mm, 2mm loss of clinical attachment level (CAL), and radiographic evidence of bone loss were surgically treated. V-MIS was performed utilizing the videoscope for surgical visualization. At re-evaluation 6months post surgery, there was a statistically significant improvement (p<.001) in mean PPD and CAL (PPD 3.88±1.02mm, CAL 4.04±1.38mm) in 1, 2, and 3 wall defects. All PPD at re-evaluation were 3mm or less. There was a mean post-surgical increase in soft tissue height (0.13±0.61mm, p=0.168) with a decrease in recession. The improvement in PPD and CAL from V-MIS, in the authors' opinion, appears to be favourable when compared to previously reported results of periodontal regenerative surgery. The lack of post-surgical recession following V-MIS has not been reported with traditional regenerative surgery.