Outcome Of Periodontal Therapy Research Articles

Enhanced control of periodontitis by an artificial intelligence-enabled multimodal-sensing toothbrush and targeted mHealth micromessages: A randomized trial.

Treatment of periodontitis, a chronic inflammatory disease driven by biofilm dysbiosis, remains challenging due to patients' poor performance and adherence to the necessary oral hygiene procedures. Novel, artificial intelligence-enabled multimodal-sensing toothbrushes (AI-MST) can guide patients' oral hygiene practices in real-time and transmit valuable data to clinicians, thus enabling effective remote monitoring and guidance. The aim of this trial was to assess the effect of such a system as an adjunct to clinical practice guideline-conform treatment. This was a single-centre, double-blind, standard-of-care controlled, randomized, parallel-group, superiority trial. Male and female adults with generalized Stage II/III periodontitis were recruited at the Shanghai Ninth People's Hospital, China. Subjects received a standard-of-care oral hygiene regimen or a technology-enabled, theory-based digital intervention consisting of an AI-MST and targeted doctor's guidance by remote micromessaging. Additionally, both groups received guideline-conform periodontal treatment. The primary outcome was the resolution of inflamed periodontal pockets (≥4 mm with bleeding on probing) at 6 months. The intention-to-treat (ITT) analysis included all subjects who received the allocated treatment and at least one follow-up. One hundred patients were randomized and treated (50 tests/controls) between 1 February and 30 November 2022. Forty-eight tests (19 females) and 47 controls (16 females) were analysed in the ITT population. At 6 months, the proportion of inflamed periodontal pockets decreased from 80.7% (95% confidence interval [CI] 76.5-84.8) to 52.3% (47.7-57.0) in the control group, and from 81.4% (77.1-85.6) to 44.4% (39.9-48.9) in the test group. The inter-group difference was 7.9% (1.6-14.6, p < .05). Test subjects achieved better levels of oral hygiene (p < .001). No significant adverse events were observed. The tested digital health intervention significantly improved the outcome of periodontal therapy by enhancing the adherence and performance of self-performed oral hygiene. The model breaks the traditional model of oral health care and has the potential to improve efficiency and reduce costs (NCT05137392).

Genetic analysis of impaired healing responses after periodontal therapy in type 2 diabetes: Clinical and invivo studies.

This study aims to investigate the mechanisms underlying the impaired healing response by diabetes after periodontal therapy. Outcomes of periodontal therapy in patients with diabetes are impaired compared with those in patients without diabetes. However, the mechanisms underlying impaired healing response to periodontal therapy have not been sufficiently investigated. Zucker diabetic fatty (ZDF) and lean (ZL) rats underwent experimental periodontitis by ligating the mandibular molars for one week. The gingiva at the ligated sites was harvested one day after ligature removal, and gene expression was comprehensively analyzed using RNA-Seq. In patients with and without type 2 diabetes (T2D), the corresponding gene expression was quantified in the gingiva of the shallow sulcus and residual periodontal pocket after non-surgical periodontal therapy. Ligation-induced bone resorption and its recovery after ligature removal were significantly impaired in the ZDF group than in the ZL group. The RNA-Seq analysis revealed 252 differentially expressed genes. Pathway analysis demonstrated the enrichment of downregulated genes involved in the peroxisome proliferator-activated receptor (PPAR) signaling pathway. PPARα and PPARγ were decreased in mRNA level and immunohistochemistry in the ZDF group than in the ZL group. In clinical, probing depth reduction was significantly less in the T2D group than control. Significantly downregulated expression of PPARα and PPARγ were detected in the residual periodontal pocket of the T2D group compared with those of the control group, but not in the shallow sulcus between the groups. Downregulated PPAR subtypes expression may involve the impaired healing of periodontal tissues by diabetes.

Clinical Evaluation of Diode Laser as an Adjunct to Scaling and Root Planing in Patients With Chronic Periodontitis and Type II Diabetes Mellitus: A Split-Mouth Study.

The primary goal of periodontal therapy is to arrest the inflammatory disease process which is done by non-surgical and surgical therapies in order to reduce the microorganisms.The outcome of periodontal therapy may not reveal the desired results owing to inaccessible areas for instrumentation, pathogenicity, resistance of the microorganisms, or even due to compromised host response to the treatment. Thus, adjunctive laser therapy has been proposed as a novel treatment modality in the treatment of periodontal disease. Aim: The aim of this study was to clinically evaluate the effect of a 980 nm diode laser (DEN10B; Wuhan Gigaa Optronics Technology Co., Ltd., Wuhan, China) therapy as an adjunct to scaling and root planing in patients with chronic periodontitis and type II diabetes. Twenty patients were divided into two groups in a split-mouth study design. Group I (Control) comprised mechanical debridement alone and Group II (test) comprised mechanical debridement followed by adjunctive laser therapy. The clinical parameters were recorded at baseline, six weeks, and three months, and the results were analyzed. There was a significant improvement in gingival and plaque index in the test group. Though there was no significant improvement in probing pocket depth and clinical attachment, the results in the test group were superior relative to the control group. Non-surgical periodontal therapy with adjunctive use of diode laser is effective in the management of generalized chronic periodontitis in patients with type II diabetes which led to a significant reduction in plaque score, gingival index score, probing pocket depth, and gain in clinical attachment level.

Gingival Biotypes and its Relation to Biologic Width, Alveolar Bone Thickness, Dehiscence and Fenestration in Mandibular Anterior Region: A CBCT Analysis Study.

Gingival biotype and its relationship to biologic width and alveolar bone thickness may affect surgical periodontal therapy outcomes. Hence, it is vital to assess the gingival biotype prior to any of these treatments for its success. The study aims to compare the thick and thin gingival biotype in the mandibular anterior region concerning biologic width, buccal bone thickness, prevalence and distribution of dehiscence, and fenestration in lower anterior teeth. A total of 30 patients were selected for the study based on the inclusion and exclusion criteria. The Cone Beam Computed Tomography analysis was performed in the mandibular anterior area to assess gingival thickness (biotype), biologic width, buccal bone thickness, dehiscence, and fenestrations. The data were analyzed using SPSS version 26. An independent t-test was used to assess the relationship between the variables. Our study identified an increased biologic width in the thick gingival biotype, a higher frequency of dehiscence in the thin gingival biotype than in the thick biotype, and a greater mean alveolar bone thickness in the thick biotype group. A statistical difference was not observed between the groups; however, the thick biotype showed better results than the thinner biotype for the periodontal parameters examined.

RATIONALE OF ANTIBIOTICS IN PERIODONTAL THERAPY

Periodontitis is an infection-driven inammatory condition that leads to destruction of the attachment apparatus of the tooth where, the major etiological factor leading to the destruction is plaque. Plaque act as a reservoir for the complex subgingival microbiota. Therefore, an inference here could be drawn that with the overall reduction of micro-organism, disease progression could be halted. Periodontal therapy aims at restoring balanced periodontal health along with the compatible oral microbiota. Treatment of periodontal disease aims at achieving a healthy periodontium and preventing the risk of recurrence or disease progression. Due to specic properties of biolm, the subgingival periodontal microbiota are more difcult to target which leads to dearth of clear protocols for the use of antibiotics and therefore, the development of specically designed strategies to treat the subgingival microbiota, as a biolm, is highly desirable. So, comes the use of antibiotics in periodontal therapy. Systemic antibiotics enter periodontal tissues via serum and can affect microorganisms outside the reach of adequate instrumentation and towards use of topical anti-infective chemotherapeutics. Antibiotic therapy delays subgingival recolonisation of the microbial pathogens by potentially suppressing the periodontal pathogens residing onto the oral surfaces. Antibiotic treatment strategies in conjugation with proper mechanical biolm disruption, eventually helps in maintaining the periodontal health by minimizing and eradicating subgingival periodontalpathogens and thereby, improves the status of clinical outcomes of periodontal therapy. This review henceforth, attempts to highlight the walk-on part of antibiotics in periodontal therapy.

Outcomes of periodontal therapy: Strengthening the relevance of research to patients. A co-created review.

Periodontitis is a long-term condition affecting up to half of the population globally and causing significant impacts on life quality. Successful management depends on taking life-long ownership of the condition by those affected. There is a wealth of research to inform on management options. However, most of the research has been designed by professional experts with outcomes to gauge benefits and harms based on parameters that inform on the disease process but which might not be informative to support decision-making in people with lived experience (PWLE) of periodontal ill-health (including both patients and carers). The importance of relevant outcomes is highlighted in the concept of the "expert patient" which aims to strengthen the capacity of PWLE to make health-care choices that are important for them, elements of which are likely to be already familiar to many clinicians delivering periodontal health care. Therefore, the voice and collaboration of PWLE in research are recognised as crucial to developing high quality, relevant evidence especially for long-term conditions. In this paper, we review what is known about the relevance of treatment outcomes to PWLE. We also examine the degree to which PWLE have been involved in identifying outcomes that are important to them as well as the diversity and therefore representativeness of PWLE recruited for studies. We consider why having more relevant outcomes could enhance the expertise of PWLE in managing their periodontitis. We then conclude with key learnings from our review which we hope will encourage more rapid development of these initiatives in periodontology for the benefit of global health and wellbeing.

Obesity as a modifying factor of periodontal therapy outcomes: local and systemic adipocytokines and oxidative stress markers.

Adipocytokines and oxidative stress (OS) are involved in the pathogenesis of both obesity and periodontitis. The aim of this study was to evaluate periodontal therapy outcomes in terms of serum and gingival crevicular fluid (GCF) levels of adipocytokines and OS markers in obese patients with periodontitis, in order to have an insight into the association between obesity and periodontitis. A total of 39 patients (20 obese, 19 non-obese) with periodontitis were included in this study. Clinical periodontal parameters were assessed; serum and GCF levels of adipocytokines and OS markers were evaluated by ELISA at baseline and 3months after non-surgical periodontal therapy. Significant improvements in clinical periodontal parameters were observed in both groups at 3months (p < 0.01). While serum levels of TNF-α, leptin, and total oxidant status (TOS) in the obese group were higher at baseline (p < 0.01), leptin levels remained higher at 3months despite a significant decrease (p < 0.01). Although NSPT improved GCF levels of total antioxidant status (TAS) and TOS in both groups, they were significantly different between the groups after therapy (p < 0.05). It seems that leptin, TNF-α, and TOS contribute to systemic inflammatory and oxidative state in patients with obesity. Despite improvements in clinical periodontal parameters, obesity might be a modulating factor in the development and progression of periodontal disease in terms of some adipocytokines and OS markers. Since the global burden of both obesity and periodontitis is continuously increasing, the management of these inflammatory diseases has become more important. The current study contributes to our understanding of the role of OS and adipocytokines on the relationship between obesity and periodontitis by response to periodontal treatment.

Comparison of Change in Periodontal Risk in Adult Patients Following Phase I Therapy – A Preliminary Study

Periodontal risk assessment is essential to ensure the successful outcome of periodontal therapy. Various assessment tools have been devised over the years of which the periodontal risk assessment(PRA) tool by Lang &amp; Tonetti is one of the more authentic tools, and it assesses the risk of severity of periodontal disease by taking into account various components which are a combination of risk factors, indicators, and markers. The present study used this tool to evaluate the change in periodontal risk following phase 1 periodontal therapy. Following the approval from the institutional ethical committee, 299 male and female patients aged 18 to 60 years undergoing comprehensive clinical care (CCC) at ISNC dental clinics from October 2020 until April 2021 were selected, and PRA was assessed at baseline (before phase 1 therapy) and following a re-evaluation of phase 1 therapy (4-6 weeks after phase 1 therapy). All the parameters of the Lang and Tonetti’s PRA model were recorded, and the periodontal risk was calculated accordingly. The data collected was entered into a Microsoft excel sheet. Statistical analysis was carried out using SPSSV 22 software. The results showed significant differences in essential risk parameters – sites with bleeding on probing(BOP), alveolar bone loss, and polygon surface area for risk. (P&lt;0.05). These were the expected parameters to change following phase -1 therapy, thus having a profound influence on the periodontal risk. However, chi-square values showed no changes in systemic and general factors and smoking. (P&gt;0.05) These factors are usually permanent and often impossible to eliminate, even if under control. Concerning smoking, even if the patients quit or reduce the number of cigarettes smoked, the alteration in risk levels is minimal or negligible. Thus, Phase 1 periodontal therapy significantly influences the risk levels in adult patients.

Chloro-aluminum phthalocyanine-mediated photodynamic therapy in the treatment of stage-II chronic periodontitis among smokers.

To assess the clinical periodontal, bacterial, and immunological outcomes of chloro-aluminum phthalocyanine-mediated photodynamic therapy (PDT) as an adjunct to dental scaling (DS) versus DS alone among cigarette smokers (CS) and never-smokers (NS). A total of 26 patients (13 CS and 13 NS) with clinical and radiographic diagnosis of stage-II chronic periodontitis were recruited. Each patient from both groups were subjected with two parallel therapies (split-mouth): PDT + DS (test side) and DS alone (control side). Periodontal parameters were investigated by evaluating plaque scores (PS), bleeding on probing (BOP), probing depth (PD), clinical attachment loss (CAL), and alveolar bone loss (ABL). Subgingival plaque was collected to detect and quantify Porphyromonas gingivalis and Tannerella forsythia using real-time quantitative polymerase chain reaction (RT-qPCR) assay. Gingival crevicular fluid was sampled for the quantification of interleukin (IL)-1β and tumor necrosis factor-alpha (TNF-α) using enzyme linked immunosorbent assay. All assessments were performed at baseline, 3 months, and 6 months. Bleeding on probing was significantly reduced at 6 months after PDT + DS in CS groups (p < .05). Mean PD and CAL significantly reduced after both PDT + DS and DS subgroups and among NS and CS groups (p < .05). At 6 months follow-up, the copy number of both P.gingivalis and T.forsythia remained significantly high in CS group (p < .01). Only PDT + DS subgroup in CS significantly reduced the counts of P. gingivalis and T. forsythia at 3 months and 6 months (p < .05). Only at 6 months did PDT + DS showed statistically significantly reduced IL-1β levels in the NS group (p < .01). TNF-α levels significantly reduced in CS group with PDT + DS and DS alone at both 3 months and 6 months follow-up (p < .01). Chloro-aluminum phthalocyanine-mediated PDT helped to improve the non-surgical periodontal therapy outcomes among stage-II chronic periodontitis patients among smokers and never-smokers.

Applications of xenografts in periodontal regeneration

Periodontitis is a disease with a high prevalence among adults. If not treated, it can lead to loss of teeth. New attachment with periodontal regeneration is the ideal outcome of periodontal therapy since it results in reconstruction of the periodontium. The biological regenerative potential of the periodontium is high, and hence the bone grafts can be utilized to improve the outcome of periodontal therapy. The different bone replacement used in periodontology analyzed in this review are: autograft, allograft, alloplasts and xenografts. There has been a recent increase in interest in using xenografts in periodontal regeneration. Xenograft materials generally are biocompatible and widely accepted. When compared to open flap debridement, treatment of intrabony, furcation defects, sinus lift and socket preservation using xenografts are gaining increasing attention. The purpose of this review is to provide an overview of the different bone replacement grafts used in periodontal regeneration, methods of bone formation and fabrication of scaffolds. Emphasis is placed on the xenografts; its different sources and also the applications of xenografts used in periodontal regeneration.

Management of Gingival Recession by Coronally Advanced Flap with and Without Amniotic Membrane: A Clinical Study.

Purpose:Recently, human amniotic membrane (AM) has been reported to have regenerative potential that facilitate repair in the field of oral and periodontal surgeries.Methods:Eighteen subjects with bilateral Miller's class I gingival recession defects were selected. Subjects were allocated randomly to treatment with coronally positioned flap + amnion allograft (test group) and coronally positioned flap alone (control group). The clinical parameters used in this study were width of attached gingiva (AG), clinical attachment level (CAL), pocket depth (PD), width of keratinized gingiva (WKG), length of gingival recession (RL), width of gingival recession (RW).Results:The mean width of attached gingiva at the control sites (A) was found to be 1.33 ± 0.50 mm (range 1.00–2.00), 2.00 ± 0.71 mm (range 2.00–3.00) and 2.22 ± 0.67 mm (range 2.00–3.00) on day 0, 90 and 180, respectively. Thus, it was increased by 0.67 mm and 0.89 mm on day 90 and 180 compared to that of the baseline, which are 50% and 67%, respectively.Conclusions:It can be concluded that combined coronally advanced flap and amniotic membrane have additional advantage in the outcome of periodontal therapy in the management of gingival recession.

Treatment effects and periodontal status of chronic periodontitis after routine Er:YAG laser-assisted therapy.

BACKGROUNDRoutine preclinical interventions for patients with chronic periodontitis such as supragingival cleaning and subgingival curettage, establishing a balanced occlusal relationship, and irrigation with 3% hydrogen peroxide can relieve the symptoms to some extent. However, there is room for improvement in the overall effect. For example, Er:YAG lasers can quickly increase the temperature of the irradiated tissue, effectively eliminate dental plaque and calculus, reduce periodontal pockets, adjust periodontal microecology, and reduce the gingival sulcus. The content of factors in the liquid, and then achieve the purpose of treatment.AIMThe aim was evaluate the effect of Er:YAG laser-assisted routine therapy on the periodontal status in chronic periodontitis.METHODSBetween October 2018 and January 2020, 106 patients with chronic periodontitis in our hospital were randomly assigned to either the study or control group, with 53 patients in each group. The control group underwent routine therapy, and the study group underwent Er:YAG laser therapy in addition to routine therapy. We evaluated the treatment outcome in both groups. Periodontal status was determined by clinical attachment loss (CAL), gingival index (GI), periodontal probing depth (PD), dental plaque index (PLI), and sulcular bleeding index (SBI), inflammatory factors in the gingival crevicular fluid, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), IL-8], and colony forming units (CFUs).RESULTSTotal effectiveness in the study group (94.34%) was higher than that in the control group (79.25%, P < 0.05). The clinical parameters in the study group (PD, 5.28 ± 1.08 mm; CAL, 4.81 ± 0.79 mm; SBI, 3.37 ± 0.59; GI, 1.38 ± 0.40; PLI, 2.05 ± 0.65) were not significantly different from those in the control group (PD, 5.51 ± 1.14 mm; CAL, 5.09 ± 0.83 mm; SBI, 3.51 ± 0.62; GI, (1.41 ± 0.37; PLI, 1.98 ± 0.70) before treatment (P > 0.05). However, after treatment, the parameters in the study group (PD, 2.97 ± 0.38 mm; CAL, 2.71 ± 0.64 mm; SBI, 2.07 ± 0.32; GI, 0.51 ± 0.11; PLI, 1.29 ± 0.34) were lower than those in the control group (PD, 3.71 ± 0.42 mm; CAL, 3.60 ± 0.71 mm; SBI, 2.80 ± 0.44; GI, 0.78 ± 0.23; PLI, 1.70 ± 0.51) (P < 0.05). Differences in crevicular TNF-α, IL-6, and IL-8 levels in the study (TNF-α, 7.82 ± 3.43 ng/mL; IL-6, 11.67 ± 2.59 ng/mL; IL-8, 12.12 ± 3.19 pg/mL) and control groups (TNF-α, 9.06 ± 3.89 ng/ml, IL-6, 12.13 ± 2.97 ng/mL, IL-8, 10.99 ± 3.30 pg/mL) before therapy (P > 0.05) were not significant. Following treatment, the parameters were significantly lower in the study group (TNF-α, 2.04 ± 0.89 ng/mL; IL-6, 4.60 ± 1.26 ng/mL; IL-8, 3.15 ± 1.08 pg/mL) than in the control group (TNF-α, 3.11 ± 1.07 ng/mL; IL-6, 6.25 ± 1.41 ng/mL; IL-8, 4.64 ± 1.23 pg/mL, P < 0.05). The difference in the CFU of the study group [(367.91 ± 74.32) × 104/mL and control group (371.09 ± 80.25) × 104/mL] before therapy was not significant (P > 0.05). The CFU decreased in both groups following therapy, however, the CFU values were lower in the study group [(36.09 ± 15.26) × 104/mL] than in the control group [(45.89 ± 18.08) ×104/mL] (P < 0.05).CONCLUSIONCombining Er:YAG lasers with routine measures significantly improved the overall periodontal therapy outcomes by improving periodontal status and reducing oral levels of inflammatory factors and CFUs.

Metabolic phenotyping of saliva to identify possible biomarkers of periodontitis using proton nuclear magnetic resonance.

The aim of this study was to propose biomarker candidates for periodontitis via untargeted metabolomics analysis. Metabolic profiling was performed using saliva samples from 92 healthy controls (H) and 129 periodontitis patients (P) in the discovery cohort using proton nuclear magnetic resonance spectroscopy. Random forest was applied to identify metabolites that significantly differentiated the control group from the periodontitis group. Candidate metabolites were then validated in an independent validation cohort. In the discovery set, the metabolic profiles of the P group were clearly separated from those of the H group. A total of 31 metabolites were identified in saliva, and 7 metabolites were selected as candidate biomarkers. These metabolites were further confirmed in the validation set. Ethanol, taurine, isovalerate, butyrate, and glucose were finally confirmed as biomarkers. Furthermore, the biomarker panel showed more than 0.9 of the area under curve value in both discovery and validation sets, indicating that panels were more effective than individual metabolites for diagnosing periodontitis. We identified five metabolite biomarkers that discriminated patients with periodontitis from healthy controls in two independent cohorts. These biomarkers have the potential for periodontal screening, detection of periodontitis, and monitoring of the outcome of periodontal therapy.

IL-13 gene polymorphisms (-1112 C/T and -1512 A/C) in patients with chronic and aggressive periodontitis: Effects on GCF and outcome of periodontal therapy.

IL-13 is the key cytokine in the regulation of inflammatory with an autoimmune disease and has an anti-inflammatory effect. This study aimed to compare IL-13 (-1112 C/T and -1512 A/C) gene polymorphisms in patients with aggressive periodontitis (AgP), chronic periodontitis (CP), and periodontally healthy group (C) and evaluate the effect of nonsurgical periodontal therapy on gingival crevicular fluid (GCF) IL-13 levels in patients. One hundred thirty patients with AgP, 120 patients with CP, and 70 periodontally healthy subjects were included in this study. Clinical parameters were recorded (plaque and gingival index, probing pocket depth, clinical attachment level), and GCF and blood samples were taken at baseline and 6-week. Nonsurgical periodontal therapy was performed in patients with periodontitis. Gene analyses (IL-13 - 1112C/T (rs1800925) and - 1512 A/C (rs1881457) were performed with real-time polymerase chain reaction (PCR) and cytokine levels were determined by an enzyme-linked immunosorbent assay method. AgP and CP patients showed significant improvement in clinical parameters after periodontal therapy (P < 0.05). According to results, genotype distributions and allele frequencies in IL-13 variants - 1112C/T and - 1512 A/C were found similarly in all groups (P > 0.05). In the AgP group, GCF IL-13 cytokine level is statistically significant and increased in 6 weeks; however, in the CP group, there is no statistically significant difference between baseline and 6 week. In the AgP group, baseline GCF IL-13 cytokine level is lower than those of the CP group and C group (P < 0.05). Within the limits of this study, IL-13 -1112 and -1512 gene polymorphisms have not been associated with AgP and CP, and GCF IL-13 cytokine level is increased after treatment in the AgP group.

CLINICAL AND MICROBIOLOGICAL ASSESSMENT OF NON-SURGICAL TREATMENT OF CHRONIC PERIODONTITIS IN CONTROLLED AND UNCONTROLLED TYPE 2 DIABETIC PATIENTS.

SUMMARYChronic periodontitis is a common complication in diabetes. The aim of this study was to evaluate some clinical and microbiological parameters in controlled and uncontrolled type 2 diabetes mellitus (type 2 DM) patients compared to non-diabetic (NDM) individuals, as well as to assess the effect of non-surgical periodontal therapy on these parameters. The study was performed in 61 type 2 DM patients with periodontitis (group 1A: 29 patients having achieved good metabolic control, HbA1c <7%; group 1B: 32 patients with poor metabolic control, HbA1c ≥7%), and 31 NDM individuals suffering from periodontitis. Periodontal indices (plaque index, PI; gingival index, GI; probing pocket depth, PPD; and clinical attachment level, CAL) were measured and subgingival plaque samples were analyzed using polymerase chain reaction prior to treatment initiation and 3 months post-treatment. The results recorded on the majority of measured parameters indicated that differences in treatment success achieved in the three treatment groups were not statistically significant (∆PI p=0.646; ∆GI p=0.303; and ∆CAL p=0.233). Likewise, comparison of the effectiveness in microorganism reduction revealed no significant differences between DM groups and NDM patients. Therefore, study results supported the hypothesis that periodontal therapy outcome was unaffected by the level of glycemic control in patients with diabetes.

Effects of timing of adjunctive systemic antibiotics on the clinical outcome of periodontal therapy: A systematic review.

BackgroundMany systematic reviews and meta-analysis have indicated beneficial effects of adjunctive systemic antibiotics in periodontal therapy in specific situations. However, some essential issues such as the ideal time of their administration during periodontal therapy remain unanswered. This systematic review aimed to determine at which phase of periodontal treatment would adjunctive systemic antibiotics lead to the best clinical outcomes, during the active phase or in the reevaluation phase. Material and MethodsSearches in the databases Medline, Scopus and Cochrane Library were conducted. The randomized clinical trials and retrospective cohort studies comparing the clinical benefits of adjunctive systemic antibiotic administration in the active phase of periodontal treatment versus their administration in the reevaluation phase were included. The primary outcomes assessed were differences in clinical changes in periodontal pocket depth and clinical attachment loss at all post-treatment phases. ResultsOf the 6209 records identified, two randomized clinical trials and two retrospective cohort studies were eligible according to inclusion criteria. Two studies suggested there were greater clinical benefits when systemic antibiotics were prescribed during the active phase of periodontal therapy than in the reevaluation phase while two other studies showed no significant difference in clinical outcomes at 6 months between these two different timing of administration. ConclusionsThe evidence available and evaluated in this systematic review is of heterogeneous quality and limited by the restricted number of studies and their dissimilarities in their study design and outcome reporting. Despite insufficient evidence to determine the ideal time to the adjunctive systemic antibiotic administration in the periodontal therapy, it seems that prescription of systemic antibiotic at the active phase of periodontal therapy leads to better clinical outcomes. Key words:Active phase; periodontal therapy, periodontitis, reevaluation, systemic antibiotics, timing.

Familial tendency as a determinant of tooth loss during long-term periodontal therapy.

Little evidence exists on how familial tendencies affect the long-term success of periodontal therapy. The aim of this study was to compare outcomes for two generations and their control patients treated in the same private practice. Parents and their children were observed for tooth loss between 1986 and 2017. Matching control groups were identified from the same practice, one for the parent and one for the children group. The control patients had no close family members with a history of periodontal diseases. Both the generations and control groups completed a similar course of periodontal therapy. The matching strategy aimed at making the groups as similar as possible with respect to well-known risk and prognostic factors. The data were analysed by multiple regression where the outcome was the number of teeth lost due to periodontal disease. A total of 435 patients were identified (148 parents, 154 children and 133 controls). 72 parents and 61 children (133) had more than 5years follow-up (average 15.5 and 12.9years, respectively). Balancing tests showed that the matching was successful. 65% of tooth loss was attributable to close family history. The regression showed that the parent generation lost 1.02 more teeth than the controls, while the children lost 0.61 more teeth. Having close family members with a history of periodontal diseases is a strong prognostic factor affecting the long-term outcome of periodontal therapy.

Is periodontitis and its treatment capable of changing the quality of life of a patient?

While clinical indicators, or so-called surrogate outcomes in periodontology, allow us to assess periodontal health and evaluate outcomes of periodontal therapy from a clinician's perspective, they cannot be used to evaluate patients' subjective perceptions of their health status or satisfaction with the received treatment. These can be assessed through patient-based outcomes, such as quality of life. The aim of this paper is to give an overview of the multidimensional concept of oral health-related quality of life (OHRQoL), its measures and association with plaque-induced, inflammatory periodontal diseases. Periodontitis and its clinical consequences, such as tooth loss, have a considerable negative effect on OHRQoL, while periodontal treatment and alleviation of the symptoms can lead to improvement in OHRQoL. Implant rehabilitation of missing teeth also seems to positively influence OHRQoL.

Stress reduction intervention and the initial periodontal therapy outcome in chronic periodontitis patients. a randomized controlled pilot study

Background: Psychosocial stress, have been implicated as risk indicators for periodontal disease. Minimal evidence in literature exists to assess the effect of stress reduction therapy (SRT) in the outcome of non-surgical periodontal therapy (NSPT).Objective: Hence, we aimed to explore the possibility of employing SRT in stressed patients as an adjunctive intervention in the management NSPT.Materials and Methods: Sixty male patients divided into Group 1 comprised of 20 unstressed chronic periodontitis patients receiving non-surgical periodontal therapy alone, Group 2a (20 stressed chronic periodontitis patients) received intervention focused on SPT with NSPT and Group 2b (20 stressed chronic periodontitis patients) received only NSPT without SPT. Their stress level was evaluated using a standard questionnaire method and salivary cortisol levels, at baseline and 3 months along with periodontal parameters.Results: There was significant reduction in stress parameters for Group 2a patients. The reduction of total periodontitis affected sites was highest in Group I patients (55.4%), followed by Group 2a patients (53.2%) and Group 2b patients (38%).Conclusion: SRT may result in comparable treatment outcome to unstressed chronic periodontitis patients. This study opens new avenues to investigate the effects of stress management as an adjunctive to conventional NSPT, which should be explored further.Â

New Perspectives in the Use of Biomaterials for Periodontal Regeneration.

Periodontitis is a disease with a high prevalence among adults. If not treated, it can lead to loss of teeth. Periodontal therapy aims at maintaining patient’s teeth through infection control and correction of non-maintainable anatomies including—when possible—regeneration of lost periodontal tissues. The biological regenerative potential of the periodontium is high, and several biomaterials can be utilized to improve the outcome of periodontal therapy. Use of different natural and synthetic materials in the periodontal field has been studied for many years. The main materials used today in periodontology analyzed in this review are: Resorbable and non-resorbable barrier membranes; autogenous, allogeneic, xenogeneic, and alloplastic bone substitutes; biological agents, such as amelogenins; platelet-derived growth factor; bone morphogenic proteins; rh fibroblast growth factor 2; teriparatide hormone; platelet concentrates; and 3D scaffolds. With the development of new surgical techniques some concepts on periodontal regeneration that were strictly applied in the past seem to be not so critical today. This can have an impact on the materials that are needed when attempting to regenerate lost periodontal structures. This review aims at presenting a rationale behind the use of biomaterials in modern periodontal regeneration