Non-surgical Mechanical Debridement Research Articles

Evaluation of the effect of Er,Cr:YSGG laser application on peri-implant crevicular fluid receptor activator of nuclear factor-kappa B ligand and osteoprotegerin levels in the non-surgical treatment of peri-implantitis: A randomized clinical trial.

This study aimed to investigate the effect of erbium, chromium doped:yttrium,scandium,gallium,garnet (Er,Cr:YSGG) laser application combined with non-surgical mechanical debridement (MD) on clinical parameters and peri-implant crevicular fluid receptor activator of nuclear factor-kappa B ligand (RANKL) and osteoprotegerin (OPG) levels in the treatment of peri-implantitis. A total of 49 patients who underwent non-surgical treatment of peri-implantitis were randomly divided into two groups. The control group (n=26) received MD alone, while the laser group (n=23) received MD+Er,Cr:YSGG. The clinical parameters (bleeding on probing [BoP], gingival index [GI], plaque index [PI], probing depth [PD]), marginal bone loss (MBL), and biochemical parameters (RANKL and OPG) were measured at baseline (T0) and 6 months after treatment (T1). There was a statistically significant decrease in all the clinical parameters in both groups at T1 compared to T0 (p<0.05). The BoP, PD, MBL, and RANKL reductions were significantly higher in the laser group than in the control group (p=0.046, p=0.014, p=0.047, p=0.045, respectively). The OPG levels significantly increased at T1 in the laser group (p=0.01). The OPG/RANKL ratio increased significantly in both groups at T1, which favored the laser group (p=0.034). Although both treatment methods were influential in treating peri-implantitis, the laser group (MD+Er,Cr:YSGG) yielded more favorable results by reducing clinical inflammation and improving biochemical parameters. Based on these findings, Er,Cr:YSGG laser may be a beneficial adjunctive treatment in this patient group.

Ozonized gels vs chlorhexidine in non-surgical periodontal treatment: A randomized clinical trial.

To evaluate the efficacy of newly introduced ozonated gels compared with conventional chlorhexidine gel in the home management of periodontal patients. 30 patients with bilateral periodontal disease (severity I, complexity II) were enrolled (split-mouth study design). After nonsurgical mechanical periodontal debridement, the teeth were randomly divided into two groups: teeth in the Control group were treated with a chlorhexidine-based gel to aid oral hygiene maneuvers for 2 weeks after the first visit, while teeth in the Test group were treated in the same way with ozone-based gels. After the baseline assessment, the follow-up included assessments at 1, 2, and 6 months. The variables evaluated were clinical attachment loss (CAL), probing pocket depth (PPD), bleeding on probing (BoP), plaque control record (PCR), recession (R), and tooth mobility (TM). For CAL, PPD, BoP, and PCR, significant intragroup differences were found for both groups (p < 0.05), in contrast to intergroup differences (p > 0.05). No significant differences were found for R and TM. Nonsurgical mechanical periodontal debridement with adjunctive use of ozone and chlorhexidine was found to be effective in periodontal treatment. Ozone could be suggested as an alternative to chlorhexidine.

Influence of mechanical debridement with adjunct probiotic therapy on clinical status and salivary cortisol levels in patients with periodontal inflammation.

The null hypothesis is that there is no difference in periodontal parameters and salivary cortisol levels (CL) among patients with periodontal inflammatory conditions (PIC) who receive non-surgical mechanical debridement (NSMD) with or without adjunct probiotic therapy (PT). The aim of this study was to assess the influence of NSMD with and without adjunct PT on clinical status and whole salivary CL in patients with PIC. Participants were randomly divided into four groups: Group-1: NSMD alone (n=19); Group-2: NSMD + PT (n=18); Group-3: PT + oral hygiene instructions (OHI) (n=17); and Group-4: PT alone (n=18). Lactobacillus rhamnosus SP1 (2×107 colony-forming units/day) was used for PT. Plaque and gingival indices (PI and GI), probing depth (PD) and clinical attachment loss (AL) were assessed, and whole salivary CL was assessed at baseline and at 6-week follow-up. Marginal bone levels were assessed at baseline and demographic data was collected using a questionnaire. Sample-size estimation was performed, and statistical significance was determined at p<0.05. At follow-up, PI (p<0.01), GI (p<0.01), and PD (p<0.01) were significantly higher in PT + OHI and PT alone groups compared with individuals who underwent NSMD + PT and NSMD alone. At baseline and follow-up, there was no significant difference in CL in all groups. There was no statistically significant correlation between age, gender, PI, PD, GI, clinical AL, salivary flow rate, education status and salivary CL in all groups at baseline and follow-up. NSMD continues to be the "gold standard" and most reliable treatment strategy for managing PIC. It is imperative to reach a consensus regarding the duration, dosage, and frequency of PT that would yield optimal results for managing PIC.

NON-SURGICAL TREATMENT OF PERI-IMPLANTITIS: CASE REPORT

Background: Dental implants are an effective, reliable and widely implemented clinical treatment option for the replacement of missing teeth. But although showing predictable successful outcomes, problems are not rare, and nowadays intensively are discussed the related biological complications. And while peri-implant diseases are becoming frequent health issues in dental offices, commonly accepted and applied treatment protocols are still missing. Materials and methods: In this article, we present a case of acute peri-implantitis. A male patient, 50 years old, systemically healthy and non-smoker, complained of pain, oedema and bleeding in the site of an implant placed 5 years ago. The clinical evaluation revealed red and swollen mucous and the presence of a peri-implant abscess. After probing, extensive bleeding and suppuration were observed. The probing depth on the distal site of 4.5 implant was 7mm and the X-ray evaluation showed significant bone loss at this site. The case was resolved completely with non-surgical mechanical debridement combined with systemic antibiotic therapy and subsequent regular peri-implant maintenance therapy. Results: The case demonstrates satisfactory results with a gain of radiographic bone level as it is seen on the X ray imaging, comparing the initial bone level and the bone level 6 months after active treatment. Resolution of peri-implant soft tissue inflammation (no bleeding on probing, no suppuration) is also observed. Conclusion: Non-surgical therapy of peri-implantitis is effective in arresting progressive bone loss and can achieve radiographic bone fill.

Resolution of peri-implant mucositis at tissue- and bone-level implants: A 6-month prospective controlled clinical trial.

The objective of the study was to compare resolution of inflammation of naturally occurring peri-implant mucositis (PM) at tissue-level (TL) and bone-level (BL) implants after non-surgical mechanical debridement. Fifty-four patients with 74 Implants with PM were allocated in two groups (39 TL and 35 BL implants) and treated by means of subgingival debridement using a sonic scaler with a plastic tip without adjunctive measures. At baseline and at 1, 3, 6months, the full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), probing depth (PD), bleeding on probing (BOP), and modified plaque index (mPlI) were recorded. The primary outcome was BOP change. After 6months, the FMPS, FMBS, PD, and number of implants with plaque decreased statistically significantly in each group (p < .05); however, no statistically significant differences were found between TL and BL implants (p > .05). After 6months, 17 (43.6%) TL and 14 (40%) BL implants showed a BOP change in (17.9%) and (11.4%), respectively. No statistical difference was recorded between groups. Within the limitations of present study, the findings showed no statistically significant differences in terms of changes in clinical parameters following non-surgical mechanical treatment of PM at TL and BL implants. A complete resolution of PM (i.e., no BOP at all implant sites) was not achieved in both groups.

Novel use of chloro-aluminum phthalocyanine assisted photodynamic therapy helps in periimplant healing among smoking patients.

To evaluate the clinical and biochemical peri‑implant parameters using chloro‑aluminum phthalocyanine-(CAP) mediated antimicrobial photodynamic therapy (PDT) as an adjunct to non-surgical mechanical debridement (NSD) in cigarette smokers (CS) and never-smokers (NS) with peri‑implantitis. Thirty-two patients with peri‑implantitis [Group CS - 16 and Group NS - 16] were recruited for the trial. The study participants underwent two therapies: PDT+NSD and NSD alone. The clinical peri‑implant parameters assessed in this clinical trial were bleeding on probing (BP), crestal bone loss (CBL) peri‑implant pocket depth (PD), and peri‑implant plaque scores (PS), respectively. Peri-implant crevicular fluid was sampled and the quantification of interleukin (IL)-1β and tumor necrosis factor-alpha (TNF-α) was performed using enzyme linked immunosorbent assay (ELISA). BP was significantly reduced at 6 months after PDT+NSD in CS groups. Mean PD significantly reduced after both PDT+NSD and NSD subgroups within both NS and CS groups. Only at 6 months did PDT+NSD showed statistically significantly reduced IL-1β levels in the NS group. TNF-α levels significantly reduced in CS group with PDT+NSD and NSD alone at both 3 months and 6 months follow up. CAP-assisted PDT helped to improve the clinical and cytokine levels after non-surgical peri‑implant mechanical debridement in treating peri‑implantitis patients in smokers.

A Systematic Review and Meta-Analysis of the Clinical Outcomes for Adjunctive Physical, Chemical, and Biological Treatment of Dental Implants With Peri-Implantitis.

The present systematic review evaluated the efficacy of adjunctive therapies in the treatment of peri-implantitis. Studies comparing the outcome of conventional surgical- or nonsurgical mechanical debridement with the addition of an adjunctive therapeutic modality were identified through an electronic and hand search of available literature. Following data extraction, meta-analyses were performed on the primary outcome measures. The effects of the adjunctive therapies on bleeding on probing (13 studies), probing pocket depth (9 studies), and radiographic bone level changes (7 studies) were analyzed to evaluate potential clinical benefit. Heterogeneity was expressed as the I2 index. Fixed and random effect models were demonstrated. The potential benefit of adjunctive therapies over control procedures was evaluated in 18 studies, representing a total of 773 implants. Quality assessment of the studies found only 3 studies to be at a low risk of bias. Meta-analysis among the different additional modalities revealed chemical therapy demonstrating significant effects in probing pocket depth reduction (0.58 mm; 0.44-0.72) and radiographic bone level gain (0.54 mm; 0.16-0.92). No significant improvements in bleeding on probing reduction were found using any adjunctive therapy. Available evidence on the benefits of adjunctive therapy to nonsurgical or surgical mechanical debridement in the treatment of peri-implantitis is limited by low numbers of standardized, controlled studies for individual therapies, heterogeneity between studies, and a variety of outcome measures. The lack of effect of any adjunctive therapy in reducing bleeding on probing questions the overall effectiveness over conventional treatment. The long-term clinical benefit potential of these therapies is not demonstrated.

Shift in the submucosal microbiome of diseased peri-implant sites after non-surgical mechanical debridement treatment.

The object of this prospective study was to assess the submucosal microbiome shifts in diseased peri-implant sites after non-surgical mechanical debridement therapy. Submucosal plaques were collected from 14 healthy implants and 42 diseased implants before and eight weeks after treatment in this prospective study. Mechanical debridement was performed using titanium curettes, followed by irrigation with 0.2% (w/v) chlorhexidine. Subsequently, 16S rRNA gene sequencing was used to analyze the changes in the submucosal microbiome before and after the non-surgical treatment. Clinical parameters and the submucosal microbiome were statistically comparable before and after mechanical debridement. The Alpha diversity decreased significantly after mechanical debridement. However, the microbial richness varied between the post-treatment and healthy groups. In network analysis, the post-treatment increased the complexity of the network compared to pre-treatment. The relative abundances of some pathogenic species, such as Porphyromonas gingivalis, Tannerella forsythia, Peptostreptococcaceae XIG-6 nodatum, Filifactor alocis, Porphyromonas endodontalis, TM7 sp., and Desulfobulbus sp. HMT 041, decreased significantly following the non-surgical treatment. Non-surgical treatment for peri-implant diseases using mechanical debridement could provide clinical and microbiological benefits. The microbial community profile tended to shift towards a healthy profile, and submucosal dysbiosis was relieved following mechanical debridement.

Efficacy of subgingival minocycline hydrochloride delivery as an adjunct to non-surgical mechanical debridement for the treatment of peri-implantitis in patients with type-2 diabetes mellitus.

The aim was to assess the efficacy of subgingival minocycline hydrochloride (MH) delivery with non-surgical mechanical debridement (NSMD) for treating peri-implantitis in patients with type-2 diabetes mellitus (DM). Type-2 diabetic and non-diabetic patients with peri-implantitis were included. In the test-group, patients underwent NSMD with a single session of MH delivery. In the control-group, patients underwent NSMD alone. Hemoglobin A1c (HbA1c), modified plaque-index (mPI), modified gingival index (mGI), probing-depth (PD) and crestal bone loss (CBL) were measured at baseline and at 6-month follow-up. Level of significance was set at p<0.01. Thirty type-2 diabetic and 30 healthy individuals with peri-implantitis were included. There was a significant reduction in mPI (p<0.01), PD (p<0.01) and mGI (p<0.01) at 6 months among patients with and without type-2 DM in the test and control groups. There was no significant difference in peri-implant parameters in all patients at the 6-month follow-up. There was no significant difference in HbA1c and CBL among patients with and without type-2 DM in the test and control groups when baseline values were compared with those at 6 months of follow-up. A single application of subgingival MH delivery is as effective as NSMD alone for the treatment of peri-implantitis in type-2 diabetic patients.

Efficacy of adjunct subgingival minocycline delivery for treatment of peri-implantitis in moderate cigarette smokers.

Localized subgingival minocycline hydrochloride (MH) delivery as an adjuvant to with non-surgical mechanical debridement (NSMD) is useful for the treatment of periodontitis; however, there are no trials that have assessed the efficacy of subgingival MH delivery with NSMD for the treatment of peri-implantitis in cigarette-smokers and non-smokers. This randomized controlled trial assessed the efficacy of subgingival MH delivery with NSMD for the treatment of peri-implantitis in cigarette-smokers. Self-reported current cigarette-smokers and non-smokers with peri-implantitis were encompassed. These individuals were subdivided into 2-subgroups. Patients in test- and control groups received NSMD with and without a single delivery of subgingival MH. Modified-gingival-index (mGI), modified-plaque-index (mPI), probing-depth (PD) and crestal-bone-loss (CBL) were measured at baseline and at 6-months' follow-up. Demographic-data was also collected. Level of significance was set at p<0.01. Twenty-four cigarette-smokers and 24 non-smokers with peri-implantitis were included. There was a significant reduction in mPI (p<0.01), mGI (p<0.01), PD (p<0.01) at 6-months among patients with and without type-2 DM in test- and control-groups. There was no significant difference in peri-implant mPI, PD and mGI, patients with and without type-2 diabetes in test- and control-groups at 6-months of follow-up. There was no significant difference in CBL in all patients at 6-months of follow-up. A single application of subgingival MH delivery is as effective as NSMD alone for the treatment of peri-implantitis in cigarette-smokers and non-smokers.

Assessment of salivary alpha amylase and mucin-4 before and after non-surgical treatment of peri-implant mucositis

BackgroundThe present study was based on the null hypothesis that there is no difference in clinicoradiographic parameters and whole salivary alpha amylase (AA) and mucin-4 levels before and after non-surgical mechanical debridement (NSMD) of patients with peri-implant mucositis (PM). The aim was to assess whole salivary AA and mucin-4 levels before and after treatment of PM.MethodsPatients with PM (Group-1) and individuals without peri-implant diseases (Group-2) were included. Demographic data was collected and peri-implant modified plaque and bleeding indices (mPI and mBI, respectively), probing depth (PD) and crestal bone loss were measured at baseline. Levels of AA and mucin-4 were assessed in unstimulated whole saliva samples. All patients underwent full-mouth non-surgical periodontal therapy (NSPT) and NSMD; and clinical parameters and salivary biomarkers were re-assessed after 3 months. Level of significance was set at P < 0.01.ResultsTwenty-six and 32 individuals were included in groups 1 and 2, respectively. None of the participants had periodontitis. At baseline clinical periodontal parameters (PI [P < 0.001], GI [P < 0.001], clinical AL [P < 0.001] and PD [P < 0.001]) were significantly high in Group-1 than Group-2. At 3-month follow-up, there was a statistically significant reduction in clinical periodontal and peri-implant parameters (PI [P < 0.01], GI [P < 0.01], and PD [P < 0.01]) in Group-1 compared with their baseline values. At baseline, salivary AA levels were significantly high in Group-1 than Group-2 (P < 0.01). At 3-month follow-up, there was no significant difference in whole salivary AA levels among patients in groups 1 and 2.ConclusionsThe AA and mucin-4 levels are potential biomarkers for evaluation of peri-implant diseases including PM. Mechanical instrumentation continues to be the most predictable treatment option for the management of peri-implant diseases.

The effectiveness of adjunctive measures in managing peri-implant mucositis: an umbrella review.

ObjectivesThe purpose of this umbrella review was to gather and summarize the data from published systematic reviews (SRs) that compared non-surgical mechanical debridement (NSMD) with and without the use of adjunctive treatments on the management of peri-implant mucositis (PIM).Materials and methodsA protocol was developed and registered in PROSPERO (CRD42021254350) before the systematic search for the SRs. Seven electronic databases, including Cochrane Library, Embase (via Ovid), MEDLINE (via Pubmed), Proquest, Prospero, Scopus and Web of Science, were searched for published reviews. The search for unpublished and informally published reviews was further attempted in the last four databases. The methodological quality of the included reviews was assessed using AMSTAR 2.ResultsTwelve included SRs assessed clinical studies published between 2014 and 2020, including a total of seventeen primary clinical trials. All SRs summarized data from individual studies and provided a narrative conclusion regarding the effectiveness of the adjunctive treatments. Only six SRs performed a meta-analysis (MA) of additional benefits of the adjunctive therapy for PIM, with results indicating no significant difference between the different treatment modalities. The overall confidence was adjudged ranging from critically low to low using AMSTAR 2 and significant additional benefits of any adjunctive treatments in comparison with NSMD were not apparent.ConclusionOverall, the reviewed evidence did not support the use of adjunctive treatments for improvement of clinical outcomes in PM management as compared to NSMD alone.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40729-022-00426-2.

Clinical Outcome of Treating Peri-Mucositis and Peri-implantitis with Adjunctive Enamel Matrix Derivative Application: A Systematic Review

&lt;p&gt;Purpose: Enamel matrix derivative (EMD), the active component of Emdogain&amp;reg;, has been demonstrated to affect cytokines related to fibroplasia, angiogenesis, inflammation, and chemotaxis both in vitro and in vivo. However, whether the adjunctive application of EMD has clinical benefits on treating peri-mucositis and peri-implantitis has not been investigated thoroughly. The aim of this systematic review is to investigate the clinical outcomes of treating peri-implant diseases with adjunctive EMD application. Materials and Methods: A systematic search of multiple electronic databases including PubMed, Cochrane library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and Scopus was carried out based on the PICOs structure for articles published up to September 2020. The primary outcomes were bleeding on probing (BoP), probing depth (PD), and radiographic bone level (RBL). Data and risk of bias were explored qualitatively. Results: The search identified 942 studies with 7 studies included for qualitative analysis. These studies reported 200 participants with 270 implants diagnosed with peri-mucositis (n=41) and peri-implantitis (n=229). For implants with peri-mucositis, BoP reduced significantly (83 to 25%) at the 3-month follow-up period for those treated with non-surgical mechanical debridement combined with adjunctive EMD (EMD group), while there was limited improvement for those treated by mechanical debridement alone (control group). PD also decreased (4.5 to 3.12 mm) in EMD group whereas an increase to 5.17 mm was demonstrated in the control group. For cases diagnosed with peri-implantitis, the high prevalence rate (83% - 100%) of BoP at baseline was significantly reduced in 2 prospective studies at the 2-10-years follow-up after surgical debridement, surface decontamination with bone graft, and EMD application. However, there was no statistical difference between surgical treatment with or without adjunctive EMD application in the other randomized controlled trials (RCTs) and half of the implants still demonstrated persistent BoP. Moreover, the PD can also be reduced significantly from 8.12 to 3.17 mm for those treated with adjunctive EMD while the RBL reduced from 4.41 to 2.31 mm at 2-10 year follow-up. The overall survival rate was 85-100% at 2-10 years follow-up. Conclusion: This review investigated the efficacy of adjunctive EMD for treating peri-implant diseases and was able to demonstrate its effect in reducing PD, reducing BoP, and increasing survival rate of treated implants from 2 to 10 years. The beneficial impacts of traditional surgical therapy on implants diagnosed with peri-implantitis were investigated; however, in terms of treating peri-implantitis, the definite efficacy of adjunctive usage of EMD should be determined based on more quantitative analysis and research in future.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Effect of photobiomodulation after non-surgical mechanical debridement on cortisol levels in the peri-implant sulcular fluid among patients with peri-implant mucositis.

The aim of this was to compare the efficacy of photobiomodulation after non-surgical mechanical debridement (MD) on cortisol levels (CL) in peri-implant sulcular fluid (PISF) among patients with peri-implant mucositis. Patients with peri-implant mucositis were encompassed. All patients underwent non-surgical MD with (test group) and without (control group) a single application of photobiomodulation. Demographic data were collected and PISF was collected. Peri-implant modified plaque index (mPI), modified gingival index (mGI), probing depth and crestal bone loss were measured, and CL in PISF were recorded. All clinical parameters and PISF CL were re-assessed at 4months of follow-up. p<.05showed statistical significance. Seventeen (14 males and 3 females) and 17 (15 males and 2 females) patients with peri-implant mucositis were recruited in test and control groups. The mean age of patients in the test and control groups was 46.1±6.5 and 50.2±2.7years respectively. At baseline, mPI, mGI, PD and PISF volume and CL in control and test groups were similar. At follow-up, there was a significant reduction in mPI (p<.001), mGI (p<.001), PD (p<.001) and PISF volume (p<.001) and CL (p<.001) in both groups compared with baseline. There was no difference in mPI, mGI, PD and PISF volume and CL in test and control groups at follow-up. In short term, non-surgical MD with photobiomodulation does not offer additional benefits in terms of reducing soft-tissue inflammatory parameters and PISF CL in patients with peri-implant mucositis.

Influence of adjunctive non-surgical peri‑implant therapy on clinical and salivary cytokine profile in obese patients

AimThe present study aimed to evaluate the impact of Photodynamic therapy (PDT) and Er,Cr:YSGG laser (ECL) adjunct to nonsurgical mechanical debridement (NSMD) in comparison to conventional NSMD in overweight individuals with peri‑implant disease on peri‑implant inflammatory parameters and cytokine levels of IL-6 and TNF-α in Peri-implant crevicular fluid (PICF) Materials and MethodsRecruitment of volunteers was performed from the outpatient department according to predefined inclusion and exclusion criteria. Group 1 consisted of obese participants who underwent peri‑implant mechanical debridement (MD); group 2, obese participants who experienced MD adjunct to ECL, and in group 3, obese participants were treated with MD and adjunct PDT. Clinical periodontal parameters, plaque index (PI), bleeding index (BI) and probing depth (PD) along with crestal bone loss (CBL) were assessed at baseline, 3 months, and 6 months. PICF was collected to evaluate the levels of IL-6 and TNF-α. Kruskal–Wallis and Bonferroni post hoc test were employed for the comparison of peri‑implant inflammatory parameters and PICF cytokine profiles among the study groups. ResultsClinical peri‑implant parameters (PI, BI and PD) at baseline among subjects in group 1, group 2 and group 3 were comparable (p > 0.05). At 3 months follow up, mean scores of peri‑implant PI, BI, and PD (P <0.05) in group 1 (control) were significantly higher compared to group 2 (ECL) and 3 (PDT) (p < 0.05). At 6 months follow-up, PI and BI mean scores among groups 1, 2, and 3 were comparable (p>0.05). At 6 months participants in groups 2 and 3 noted significant difference (p<0.05) compared to baseline with no difference noted in the control group (p>0.05). ConclusionPhotodynamic therapy and Er, Cr: YSGG adjunct to NSMD demonstrated significant improvement in peri‑implant inflammatory parameters in obese individuals. Multicentric clinical trials are suggested to extrapolate the findings of the present study.

The effect of non-surgical and surgical mechanical root debridement on infrabony defects: a retrospective study

The aim of this retrospective study was to assess the outcomes of non-surgical and surgical mechanical root debridement for the treatment of infrabony defects and explore potential prognostic factors. Treated infrabony defects followed for at least 1 year were selected. All data pertaining to the clinical outcomes were recorded. Multi-level regression analysis and Cox Proportional-Hazards Models were used to assess the immediate (3–6 months) clinical outcomes, survival of the treated teeth, and factors influencing these results. 132 patients were included in the analysis. The analysis showed 1.42 ± 1.71 and 2.23 ± 1.64 mm in pocket depth (PD) reduction, 0.13 ± 1.83 and 0.08 ± 1.76 mm in clinical attachment level (CAL) gain, and 1.29 ± 1.56 and 2.15 ± 1.33 mm increase in gingival recession (REC) for the non-surgical and surgical groups, respectively. The 5-year survival rates were 93% for the non-surgically and 90% for the surgically treated teeth. Several factors affected clinical outcomes and tooth survival. Within its limitations, the treatment of infrabony defects with non-surgical and surgical mechanical root debridement was found to result in moderate but significant PD reduction, nevertheless, this may also be attributable to the resultant REC.

Novel Approach to Dental Biofilm Management through Guided Biofilm Therapy (GBT): A Review.

Dental biofilm plays a very crucial role in the etiopathogenesis of periodontal andperi-implant diseases. Over the past decade, tremendous research has been carried outto know the structure of biofilm and the mechanism by which it causes the destruction of supporting tissues of tooth or implant. Periodontal or peri-implant therapy usually begins with primarily removing thebiofilm and is considered as non-surgical mechanical debridement. Although scaling and root planing (SRP) is regarded as a gold standard for mechanical plaque debridement, various other means of biofilm removal have constantly been evolving. These may vary from different scaling systems such as vector systems to decontamination of pockets with LASER therapy. Nowadays, a new concept has emerged known as “guided biofilm therapy” (GBT). It is beneficial in removing the biofilm around the tooth and implant structures, resulting in better or comparable clinical outcomes than SRP. These results were substantiated with the reduction in the microbial load as well as the reduction in the inflammatory cytokines. This review will highlight the various aspects of GBT used in periodontal and peri-implant disease.

Efficacy of Antibiotic Versus Probiotics As Adjuncts to Mechanical Debridement for the Treatment of Peri-Implant Mucositis.

The objective was to compare the efficiency of probiotic therapy (PT) vs antibiotic therapy (AT) as adjuvants to nonsurgical-mechanical debridement (NSMD) for the treatment of peri-implant mucositis (Pi-M). Volunteers with Pi-M were encompassed. Therapeutically, patients were randomly divided into 3 groups: (a) Group 1: NSMD + PT; (b) Group 2: NSMD + AT; and (c) Group 3: NSMD alone. Peri-implant plaque index (PI), bleeding on probing (BOP), probing depth (PD), and crestal bone loss (CBL) were recorded at baseline and at 3 and 6 months follow-up. P < .05 was selected as the indicator of statistical significance. Forty-two male individuals (14, 14, and 14 in Groups 1, 2, and 3, respectively) were included. At 3 and 6 months of follow-up, PI (P < .01), BOP (P < .01), and PD (P < .01) were higher in Group 2 than Group 1. At 3 months of follow-up, PI (P < .01), BOP (P < .01), and PD (P < .01) were higher in Group 3 than Group 2. At 6 months of follow-up, PI, BOP, and PD were comparable in Groups 2 and 3. In Group 3, PI, BOP, and PD were comparable with the respective baseline values at 6 months of follow-up. The CBL in all groups remained unchanged up to 6 months of follow-up. The NSMD with adjuvant PT is more effective than adjunct AT for the treatment of Pi-M for up to 3 months.

Role of Probiotics for the Treatment of Peri-Implant Mucositis in Patients With and Without Type 2 Diabetes Mellitus.

This study hypothesized that probiotic therapy (PT) does not offer additional benefits to mechanical debridement (MD) for the treatment of diabetic subjects with peri-implant mucositis (PM). This study compared the influence of PT as an adjunct to MD for the treatment of PM in type 2 diabetic and nondiabetic patients over a 12-month follow-up period. Patients with and without type 2 diabetes were included. PM patients were categorized into 2 groups based on the treatment procedure: (1) nonsurgical + PT and (2) nonsurgical MD alone. Demographics and education statuses were recorded. Gingival index (GI) and plaque index (PI), crestal bone loss (CBL), and probing depth (PD) were measured at baseline and after 6 and 12 months. Significant differences were detected with P < .01. The hemoglobin A1c level was significantly higher in patients with diabetes at all time durations than in patients without type 2 diabetes (P < .001). Baseline GI, PI, PD, and CBL were comparable in all groups. In patients with type 2 diabetes, there was no difference in PI, GI, PD, and CBL at 6- and 12-month follow-up. In patients without type 2 diabetes, there was a significant reduction in PI (P < .01), GI (P < .01), and PD (P < .01) at 6-month and 1-year follow-up as compared with baseline. In patients without type 2 diabetes, MD with or without adjunct PT reduced soft-tissue inflammatory parameters in patients with PM.

Comparison of an Herbal- and a 0.12% Chlorhexidine-based Oral Rinse as Adjuncts to Nonsurgical Mechanical Debridement in the Management of Peri-implant Mucositis: A Randomised Controlled Trial.

In the present randomised controlled trial (RCT), the authors hypothesise that herbal-based oral rinses are as effective as 0.12% chlorhexidine when used as adjuncts to non-surgical mechanical debridement (MD) in the management of peri-implant mucositis. The aim of the present RCT was to compare the efficacy of an herbal oral rinse with a 0.12% chlorhexidine-based oral rinse when used as adjuncts to non-surgical MD in the treatment of peri-implant mucositis. Adult patients with peri-implant mucositis were included. Participants were randomly allocated into 3 groups. In group 1, patients only underwent non-surgical MD. In groups 2 and 3, patients underwent non-surgical MD with adjunct rinsing with an herbal- and 0.12% CHX-based oral rinse, respectively. Peri-implant plaque index (PI) and bleeding-on-probing (BOP) and probing-depth (PD) were assessed at baseline and at 3, 6, and 12 weeks. Group comparisons were done and p < 0.01 was considered statistically significant. Forty-eight patients with peri-implant mucositis (16, 16, and 16 in groups 1, 2 and 3, respectively) were included. At baseline, there was no difference in PI, PD, BOP in all groups. In group 1, there was no statistically significant difference in PI and BOP at 6, and 12 weeks of follow-up compared with baseline. In groups 2 and 3, PI (p < 0.01) and BOP (p < 0.01) were statistically significantly higher at baseline than 3, 6, and 12 weeks of follow-up. In group 1, there was no statistically significant difference in PD at all time intervals. In groups 2 and 3, PD was statistically significantly higher at baseline than 3, 6, and 12 weeks of follow-up. In groups 2 and 3, there was no statistically significant difference in PI, BOP and PD at all intervals. Herbal- and 0.12% CHX-based oral rinses are useful adjuncts to MD for the treatment of peri-implant mucositis.