Periodontal Attachment Research Articles

Exploring the Link between Periodontal Disease and Systemic Conditions: Implications for Alzheimer’s, Parkinson’s, and Rheumatoid Arthritis

ABSTRACT Background: There is a growing correlation between periodontal disease, a common inflammatory disorder that affects the tissues supporting the teeth, and several systemic diseases. Materials and Methods: Two hundred patients from a tertiary care hospital, ages 50–75, participated in this cross-sectional research. The subjects were split up into four groups: 50 individuals with rheumatoid arthritis, 50 with Alzheimer’s disease, 50 with Parkinson’s disease, and 50 with periodontal disease. To evaluate periodontal condition, including clinical attachment loss and pocket depth, thorough oral exams were performed. Measurements were made of serum biomarkers for inflammation, such as interleukin-6 (IL-6) and C-reactive protein (CRP). Multivariate regression models were used to examine correlations between the severity of periodontal disease and the underlying systemic diseases. Results: In all groups, there were significant relationships between higher levels of indicators of systemic inflammation and the severity of periodontal disease. In comparison to healthy controls (CRP mean value: 2.1 mg/L; IL-6 mean value: 6.4 pg/mL), participants with periodontal disease had higher mean levels of CRP (5.6 mg/L) and IL-6 (mean value: 12.8 pg/mL). Furthermore, compared to those with rheumatoid arthritis, those with Alzheimer’s and Parkinson’s disorders showed higher levels of pocket depth and periodontal attachment loss. Conclusion: In conclusion, the results point to a possible connection between systemic diseases such rheumatoid arthritis, Parkinson’s disease, and Alzheimer’s.

Clinical study of the effectiveness of the use of metronidazole-based gels in the occurrence of inflammatory periodontal diseases without violations of periodontal attachment (literature review)

At this moment inflammatory diseases of the oral cavity are widespread in the world among people of different ages. Metronidazole is widely used as an effective drug for their treatment. This review is aimed at analyzing modern literature sources that tell about the role of metronidazole in the treatment of inflammatory disorder of oral cavity.

Formulation and evaluation of herbal gel containing ethanolic extract of Momordica charantia against socransky’s periodontal pathogens of the oral cavity-an in vitro study

Background: Periodontitis is a multifaceted disease initiated by periodontal pathogens which when left untreated results in inflammation of the supporting tissues of the teeth, resorption of alveolar bone, loss of the periodontal ligament attachment, periodontal pocket formation and/or recession of the gingiva. Hence, the current study aimed at evaluating the efficacy of Momordica charantia leaves extract on Socransky’s periodontal pathogens and formulating a herbal gel for subgingival local drug delivery for the potential treatment of moderate periodontitis. Methods: M. charantia leaves were authenticated from a recognized taxonomist. They were coarsely powdered following which an ethanol-based extract preparation was done. The extract obtained was then assessed for minimum inhibitory concentration, minimum bactericidal concentration followed by gel formulation which was then subjected to time kill assay and zone of inhibition on periodontal pathogens, the efficacy of which was comparatively evaluated against 0.12% chlorhexidine (CHX) gluconate. Kruskal-Wallis Test was employed with the statistical significance set at p≤0.05. Results: The concentration of M. charantia ethanolic extract against periodontal pathogens was determined to be 1 gm/100 ml and a statistically significant difference was found in the effectiveness between the gel so formulated and CHX. Conclusion: The antibacterial activity was evident in the ethanolic extract of M. charantia which when used to formulate a herbal gel against anaerobic periodontal pathogens demonstrated efficacy comparable to that of CHX.

Men with HIV have increased alveolar bone loss

BackgroundPeriodontal health in men with HIV remains understudied, despite suggestions of associations between HIV infection and gingival pocketing, periodontal attachment loss, and gingival inflammation. As antiretroviral therapy (ART) has improved the quality of life for people living with HIV (PLWH), aging-related risk factors and comorbidities, including periodontitis, have emerged. This study aims to assess alveolar bone height, gingival crevicular fluid (GCF) cytokines, and periodontal disease activity in men with and without HIV.MethodsNinety-three men (50 HIV+, 43 HIV-) aged 35–70 years were recruited from Columbia University Irving Medical Center clinics. Periodontal examination, GCF collection, and intraoral radiographs were collected. Statistical analysis was conducted with t-tests for continuous variables and chi-squared tests for categorical variables.ResultsWhile no significant differences were observed in bleeding on probing, clinical attachment loss and pocket depths, men with HIV exhibited significantly greater alveolar crestal height on radiographs compared to men without HIV (HIV + 3.41+/-1.35 mm, HIV- 2.64+/-1.01 mm; p = 0.004), reflecting greater alveolar bone loss.ConclusionsMen living with HIV demonstrate increased alveolar bone loss compared to those without HIV, possibly mediated by elevated IL6 levels. These results underscore the importance of comprehensive oral health management in PLWH and highlight the need for further research understanding the mechanisms linking HIV infection, cytokine dysregulation, and periodontal health.

Exploring the Impact of Catechins on Bone Metabolism: A Comprehensive Review of Current Research and Future Directions.

Background/Objectives: Degenerative musculoskeletal diseases represent a global health problem due to the progressive deterioration of affected individuals. As a bioactive compound, catechins have shown osteoprotective properties by stimulating osteoblastic cells and inhibiting bone resorption. Thus, this review aimed to address the mechanism of action of catechins on bone tissue. Methods: The search was applied to PubMed without limitations in date, language, or article type. Fifteen articles matched the topic and objective of this review. Results: EGCG (epigallocatechin gallate) and epicatechin demonstrated action on the osteogenic markers RANKL, TRAP, and NF-κβ and expression of BMPs and ALP, thus improving the bone microarchitecture. Studies on animals showed the action of EGCG in increasing calcium and osteoprotegerin levels, in addition to regulating the transcription factor NF-ATc1 associated with osteoclastogenesis. However, it did not show any effect on osteocalcin and RANK. Regarding human studies, EGCG reduced the risk of fracture in a dose-dependent manner. In periodontal tissue, EGCG reduced IL-6, TNF, and RANKL in vitro and in vivo. Human studies showed a reduction in periodontal pockets, gingival index, and clinical attachment level. The action of EGCG on membranes and hydrogels showed biocompatible and osteoinductive properties on the microenvironment of bone tissue by stimulating the expression of osteogenic growth factors and increasing osteocalcin and alkaline phosphate levels, thus promoting new bone formation. Conclusions: EGCG stimulates cytokines related to osteogenes, increasing bone mineral density, reducing osteoclastogenesis factors, and showing great potential as a therapeutic strategy for reducing the risk of bone fractures.

Fabrication and evaluation of a biodegradable electrospun chip loaded with chlorhexidine for periodontal disease

Electrospinning technique is used for the manufacturing matrices of drug delivery systems. This study aimed at fabricating and evaluating an electrospun chip for prolonged retention and controlled drug release at the lesion site. A biodegradable electrospun chip loaded with chlorhexidine (BESC-CHX) was manufactured to treat periodontal diseases. Then, physicochemical properties and efficacy of BESC-CHXs were investigated. The CHX content of BESC was analyzed using high-performance liquid chromatography. The antimicrobial activity and anti-inflammation effects of BESC-CHX were assessed using a disc diffusion assay and a periodontal disease model. BESC-CHX, which is composed of 700 nm fibers, was observed by scanning electron microscopy. Many BESC-CHX batches maintained consistent CHX levels, with a drug entrapment efficiency of 83.3 %. The chip released CHX for seven days and was completely degraded in artificial saliva. BESC-CHX exhibited 99.99 % antimicrobial activity against 11 species of microorganisms. In a beagle periodontal disease model, BESC-CHX demonstrated improvements in periodontal probing depth and clinical attachment level, but these changes were not statistically significant. However, alveolar bone regeneration was observed in cementoenamel junction-alveolar bone crest measurements. The lowest inflammation scores were observed in this group. These findings suggest that BESC-CHXs may be beneficial for the treatment of periodontal disease.

A Randomized Controlled Experiment Evaluating the Effect of Endodontic Therapy with Various Intracanal Medicaments on Periodontal Attachment Level in Endodontic-Periodontal Lesions. A 12 Month Study with 4 Intracanal Medicaments

A Randomized Controlled Experiment Evaluating the Effect of Endodontic Therapy with Various Intracanal Medicaments on Periodontal Attachment Level in Endodontic-Periodontal Lesions. A 12 Month Study with 4 Intracanal Medicaments

Efficacy of different protocols of non-surgical periodontal therapy in patients with type 2 diabetes: A systematic review and meta-analysis.

The aim of the present systematic review of the literature and meta-analysis was to evaluate the efficacy of different protocols of NSPT without any adjunctive therapy in subjects with type 2 diabetes, by considering clinical and patient-centered outcomes. For the purposes of the study randomized controlled clinical trials with more than 3-month follow-up were searched in MEDLINE, EMBASE, and Cochrane Central. Then the articles were screened for inclusion and considered based on the protocols adopted, the outcome measure, follow-up, and the level of glycemic control. A total of 23 articles about 22 studies were included. NSPT was more effective than just oral hygiene measures/no treatment in reducing periodontal probing depth (PPD) and clinical attachment loss (CAL) at 3 months (0.47 mm [0.29-0.65 mm] and 0.50 mm [0.24-0.76 mm], respectively) and 6 months (0.56 mm [0.28-0.84 mm] and 0.45 mm [0.13-0.77 mm], respectively for PPD and CAL) follow-up (very low and low level of evidence). The meta-analysis found no evidence of a difference between full-mouth disinfection versus quadrant protocol clinical outcomes (very low level of evidence). One study found no evidence of a difference in periodontal clinical response between good versus poor glycemic control. Based on the results of the present research NSPT protocols could be considered more efficacious than others in terms of clinical outcomes in subjects with type 2 diabetes. Moreover, NSPT resulted in efficacious improvement of periodontal parameters and HbA1c levels compared to no treatment or oral hygiene instructions alone.

The anti-inflammatory effect of a magnoliae cortex and Zea mays L. extract mixture in a canine model of ligature-induced periodontitis

BackgroundPeriodontitis is common in dogs. It is characterized by destruction of the supporting tissues of the teeth due to the host-immune response triggered by plaque. Magnoliae cortex and Zea mays L. extract showed anti-inflammatory and anti-microbial effects, respectively. This study aimed to evaluate improvement in periodontitis following the administration of Magnoliae cortex and Zea mays L. extract in dogs. Periodontitis was experimentally induced in 10 beagle dogs. Five dogs were administered 40 mg of Magnoliae cortex extract and 20 mg of Zea mays L. extract orally once per day for 2 months (MZ group), whereas the other group received empty gelatin capsules (control group). Periodontal clinical parameters, complete blood count, serum chemistry parameters, and tissue inflammatory cytokines and chemokine expression were assessed before and after combined oral extracts administration.ResultsThe complete blood count and serum chemistry results of all dogs were within normal ranges. Gingival inflammation in MZ group was significantly better than that in the control group at 4 and 8 weeks post-medication (PM; p < 0.05). The periodontal pocket depth and clinical attachment loss at 8 weeks PM in the MZ group were significantly lower than the baseline values (p < 0.05). The incidence of bleeding on probing in the MZ group was significantly lower than that in the control group at 4 weeks PM (p < 0.05). Throughout the medication period, the percentages of CD4 + and CD8 + T cells were higher and lower, respectively, in the MZ group. However, these differences were only significant at 8 weeks PM. The expression of the inflammatory cytokines IL-1β, IL-6, IL-17, and TNF-α and the chemokine IL-8 in the inflamed tissues was lower in the MZ group, and the two groups showed a significant difference in TNF-α expression.ConclusionsCombined administration of Magnoliae cortex and Zea mays L. extract improved the clinical symptoms of periodontal disease in dogs. This beneficial effect may be partly due to the inhibitory effects of these extracts on the inflammatory response.

Bmi‐1 alleviates alveolar bone resorption through the regulation of autophagy

AbstractBackgroundB‐cell‑specific Moloney MLV insertion site‐1(Bmi‐1)is a crucial osteopenic target molecule. The aim of this study is to explore the effects of Bmi‐1 on alveolar bone resorption and the underlying mechanisms in vitro and vivo.MethodsA Bmi‐1‐knockout (Bmi‐1−/−) mouse model was used to investigate the effect of Bmi‐1 on alveolar bone metabolism, with micro‐computed tomography imaging, histology, and immunohistochemistry staining. Furthermore, we utilized a ligature‐induced experimental periodontitis model to examine the impact of Bmi‐1‐knockdown (Bmi‐1±) on inflammatory alveolar bone resorption. Finally, we stimulated human periodontal ligament stem cells (hPDLSCs) with lipopolysaccharide (LPS) to explore the potential mechanism of Bmi‐1 overexpression in the process of osteogenesis.ResultsCompared with wild‐type mice, Bmi‐1−/− mice demonstrated more alveolar bone resorption by inhibiting osteogenesis, which was characterized by decreases in Runt‐related transcription factor 2 and type 1 collagen formation. In addition, Bmi‐1−/− mice had lower levels of autophagy markers such as Parkin and LC3, but higher levels of inflammation‐related factors such as interleukin (IL)‐6 and IL‐1β in periodontal tissues. In addition, Bmi‐1‐knockdown aggravated ligature‐induced alveolar bone loss. Under in vitro inflammatory conditions, Bmi‐1 overexpression stimulated osteoblast differentiation and inhibited the production of inflammatory factors, as well as the autophagy and apoptosis in hPDLSCs stimulated with LPS. When 3‐methyladenine (3‐MA), an autophagy inhibitor, was added, the osteogenic effect of Bmi‐1 was further enhanced.ConclusionsBmi‐1 alleviates alveolar bone resorption by regulating autophagy, indicating that it could be a potential target for periodontitis prevention and treatment.Plain Language SummaryPeriodontitis is a chronic inflammatory disease, which leads to progressive destruction of periodontal tissues, manifested as periodontal pocket formation, loss of periodontal attachment and alveolar bone resorption. Currently, there is a lack of effective treatments to regenerate damaged periodontal tissues. Therefore, it is of great clinical significance to explore new mechanisms of periodontitis and effective intervention targets. B‐cell‑specific Moloney MLV insertion site‐1 (Bmi‐1) is involved in the regulation of the cell cycle, DNA damage repair, autophagy, bone metabolism, tumor, and other physiopathological processes. Autophagy, as an important mechanism of intracellular self‐regulation, plays an indispensable role in the destruction and repair of periodontal tissues. The aim of this study was to investigate the role of Bmi‐1 on periodontal tissues and its intrinsic mechanism. The results revealed that Bmi‐1 regulates autophagy to protect periodontal tissues, suggesting that it may be a potential target for the prevention and treatment of periodontitis.

Comparative Antimicrobial Efficacy of Garlic and Guava Extracts on Oral Pathogens Using a Time Kill Assay: An In Vitro Study

Abstract Background: Periodontal disease is characterized by inflammation mediated by the host and related microbes, which leads to the loss of periodontal attachment and tooth loss. Due to an increase in bacterial resistance to antibiotics, there is a shift toward use of herbal medicines. Aim: The aim of the study is to compare the antimicrobial effect of aqueous garlic extract (AGE) and ethanolic guava extract (EGuE) on Tanerella forsythia and Porphyromonas gingivalis using the time kill assay Materials and Methods: AGE and EGuE are prepared. Ciprofloxacin was taken as the control. The MIC was performed for garlic, guava extract, and ciprofloxacin. P. gingivalis and T. forsythia were cultured, and the time kill assay was performed at 0 h, 5 min, 30 min, 1 h, and 2 h. Colonies were counted after 48–72 h for growth. Results: The minimal inhibitory concentration (MIC) results indicated that both EGuE and AGE exhibited superior antibacterial activity compared to ciprofloxacin, suggesting their potential as alternative or complementary antimicrobial agents. In a time kill assay, EGuE demonstrated a significant reduction in colony forming units (CFUs) at 30 min, 1 h, and 2 h, outperforming AGE and ciprofloxacin. Intragroup comparisons revealed that EGuE significantly reduced CFUs at 0 h and 5 min, while AGE showed no notable reduction over time. Conclusion: Overall, the study demonstrates the antimicrobial efficacy of EGuE and AGE against T. forsythia and P. gingivalis at higher concentrations. Hence, these extracts may serve as alternative antimicrobial agents against periodontal pathogens.

The effectiveness of autologous platelet-rich concentrates as an adjunct during nonsurgical periodontal therapy: a systematic review and meta-analysis of randomized controlled trials.

To evaluate the efficacy of autologous platelet concentrates (APC) on periodontal outcomes in nonsurgical therapy of periodontitis patients. Electronic search via Web of Science, MEDLINE via PubMed, Scopus, and Cochrane CENTRAL registry as well as manual search were done from June 2024 to July 2024 for relevant publication from inception until June 2024. The articles were assessed by 2 independent reviewers and deemed relevant when the interventional studies reported on periodontal outcomes after adjunctive APC were used in NSPT. The studies were excluded if it was not in English or unpublished. The risk of bias for each study was assessed using the Cochrane risk-of-bias tool (RoB 2). Fixed effect meta-analysis was conducted to measure the summary effect for change of periodontal pocket depth (PPD) and Clinical Attachment Level (CAL). The statistical heterogeneity between studies was also calculated using I2 test. A total of 607 records were found in the four electronic databases. Following the removal of duplicates and initial title screening, 16 full text articles from electronic search and 7 articles from manual search were assessed resulting in 13 studies included in the systematic review. The overall risk of bias showed most studies have moderate to high risk of bias. The fixed-effect meta-analysis showed summary effects favored the adjunctive use of APC in nonsurgical periodontal therapy but with high heterogeneity between the studies, particularly for CAL. The evidence on APC as adjunct in NSPT is limited by the small number of studies, moderate to high risk of bias in most studies and significant heterogeneity in the results.

Peri-implantitis induction and resolution around zirconia versus titanium implants.

This study compared titanium and zirconia implant ligature-induced peri-implant defect progression and response to regenerative surgical intervention. Eight tissue-level endosseous implants were placed in 6 mixed-breed foxhounds, with 2 zirconia and 2 titanium alternating in each hemimandible. Cotton ligatures were placed subgingivally for 16weeks followed by 8weeks of spontaneous progression. Standardized radiographs were captured every 2weeks to evaluate the rate of bone loss. Regenerative surgery was performed utilizing water-jet decontamination, enamel matrix derivative, and locally harvested autogenous bone. After 16weeks of healing, final radiographic bone levels as well as probing depths, recession, and clinical attachment levels were assessed. All 48 implants integrated successfully. The final average post-ligature radiographic defects were 2.88 and 3.05mm for titanium and zirconia implants, respectively. There was no significant difference between materials in the rate of radiographic bone loss (p=0.09). Following regenerative surgery, the total average amount of radiographic bone gain was 1.41 and 1.20mm for titanium and zirconia, respectively. The percentage of defect fill was 51.56% and 37.98% (p=0.03) for titanium and zirconia, respectively. Inter-group differences were minimal for clinical parameters at the time of sacrifice including periodontal pocket depths (p=0.81), recession (p=0.98), or clinical attachment levels (p=0.51). No significant difference was found in the rate of peri-implant defect development between titanium and zirconia implants. Both materials gained significant radiographic bone following regenerative surgery with significantly greater defect percentage fill in titanium implants. The final clinical parameters were similar in both groups.

Identification of Porphyromonas gingivalis in Periodontally Healthy Adults and Chronic Periodontitis Patients Using Polymerase Chain Reaction

Context: Periodontitis, a complex multifactorial, polymicrobial infection, involves deterioration of the supporting tissues surrounding teeth. Among the polymicrobiota, Porphyromonas gingivalis is a keystone pathogen implicated in chronic periodontitis. Aim: Identification of P. gingivalis in periodontally healthy adults and chronic periodontitis patients using polymerase chain reaction (PCR). Settings and Design: This cross-sectional study was conducted at the Department of Periodontics, KLE V. K. Institute of Dental Sciences, Belgaum. The 60 patients were selected from the outpatient department considering the selection criteria, using convenience sampling. Materials and Methods: Patients were categorized into three groups: periodontally healthy, moderate, and severe periodontitis. Plaque index, probing depth, and clinical attachment level (CAL) were measured. The plaque samples were collected from patients and were cultured and analyzed for black-pigmented colonies, followed by biochemical characterization and DNA isolation. Samples showing bacterial DNA bands were further selected for PCR analysis with species-specific primer to confirm P. gingivalis. Statistical Analysis: Descriptive analysis was done using Kruskal–Wallis ANOVA, Chi-square, and Mann–Whitney U-test (P &lt; 0.05). Results: Age and gender showed no significance in the prevalence of P. gingivalis. P. gingivalis was absent in periodontally healthy patients and detected in 10% of moderate periodontitis and 50% of severe periodontitis patients (P = 0.0001). No statistical significance with the prevalence of P. gingivalis was observed between moderate and severe periodontitis patients. In severe periodontitis patients, P. gingivalis was significantly associated with higher mean pocket probing depth scores (P = 0.0073) and CAL scores (P = 0.0022). Conclusion: The prevalence of P. gingivalis was significant in both moderate and severe periodontitis patients; however, a higher prevalence was observed in severe periodontitis patients. PCR analysis revealed a significant rise in the frequency of P. gingivalis with an increased periodontal pocket depth and clinical attachment loss, indicating a correlation with the severity of periodontal destruction.

Nanoparticles in Periodontitis Therapy: A Review of the Current Situation.

Periodontitis is a disease of inflammation that affects the tissues supporting the periodontium. It is triggered by an immunological reaction of the gums to plaque, which leads to the destruction of periodontal attachment structures. Periodontitis is one of the most commonly recognized dental disorders in the world and a major factor in the loss of adult teeth. Scaling and root planing remain crucial for managing patients with persistent periodontitis. Nevertheless, exclusive reliance on mechanical interventions like periodontal surgery, extractions, and root planning is insufficient to halt the progression of periodontitis. In response to the problem of bacterial resistance, some researchers are committed to finding alternative therapies to antibiotics. In addition, some scholars focus on finding new materials to provide a powerful microenvironment for periodontal tissue regeneration and promote osteogenic repair. Nanoparticles possess distinct therapeutic qualities, including exceptional antibacterial, anti-inflammatory, and antioxidant properties, immunomodulatory capacities, and the promotion of bone regeneration ability, which made them can be used for the treatment of periodontitis. However, there are many problems that limit the clinical translation of nanoparticles, such as toxic accumulation in cells, poor correlation between in vitro and in vivo, and poor animal-to-human transmissibility. In this paper, we review the present researches on nanoparticles in periodontitis treatment from the perspective of three main categories: inorganic nanoparticles, organic nanoparticles, and nanocomposites (including nanofibers, hydrogels, and membranes). The aim of this review is to provide a comprehensive and recent update on nanoparticles-based therapies for periodontitis. The conclusion section summarizes the opportunities and challenges in the design and clinical translation of nanoparticles for the treatment of periodontitis.

Adjunctive Drug-Loaded Gel in the Treatment of Periodontitis: A Systematic Evaluation and Meta-Analysis

Background: This meta-analysis aimed to systematically investigate the efficacy of drug-loaded gel adjuncts in the treatment of periodontitis. Methods: A comprehensive search was conducted in six databases, i.e., the China National Knowledge Infrastructure, WanFang Data, VIP Chinese Science and Technology Periodical Database, China Biology Medicine Disc, Cochrane Library, PubMed, and Web of Science, from the inception until Jun 2023. The search focused on randomized controlled trials that examined the application of drug-loaded gels in the treatment of periodontitis. Periodontal probing depth and clinical attachment level were the primary and secondary outcomes, respectively. Stata 15.0 and Review Manager 5.4 were employed to perform the meta-analysis using the selected articles that met the predefined criteria. Results: This study included 16 randomized controlled trials involving 1146 participants. Subgroup analyses based on the follow-up period revealed that the gel-based drug-assisted subgingival root planning intervention had more favorable effects on periodontal probing depth (standardized mean difference=0.50, 95% confidence interval=[0.32, 0.68], I2=56.0%, P=0.001) and clinical attachment level (standardized mean difference=0.47, 95% confidence interval=[0.29, 0.66], I2=57.0%, P=0.0007) than the subgingival root planning intervention alone. However, subgroup analysis based on the action mechanism of gel drugs showed no statistically significant differences in periodontal probing depth and clinical attachment level between groups. Conclusion: The application of the drug-loaded gel as adjunctive therapy for periodontitis effectively reduced periodontal probing depth and promoted clinical attachment level recovery. The findings provide evidence-based support for the efficacy, security, and rational use of drug-loaded gel in the treatment of periodontitis

Effect of impacted mandibular third molar extraction on periodontal microbiota and clinical parameters of adjacent teeth: A randomized clinical trial

It is urgently necessary to clarify the effect of extraction of impacted mandibular third molar (IMTM) on the periodontal tissue of adjacent second molars (ASMs). In this study, the ASM periodontal condition and pathogenic microbes were assessed before IMTM extraction and at 1, 4, 8 and 12 weeks postoperatively. Based on the inclusion and exclusion criteria, our study revealed that IMTM extractions adversely affected distal － periodontal probing depth (dPPD), attachment loss (dAL), plaque index (dPLI) and bleeding on probing (dBOP) within 8 weeks, but these indices gradually normalize after 12 weeks. The subgingival pathogens near the ASMs distal surface, Porphyromonas and Pseudomonas, were significantly increased postoperatively. Moreover, relevance of ASMs clinical indices and subgingival microbes after IMTM extractions was found. In contrast to the situation in chronic periodontitis, the effects of IMTM extraction on dPPD, dAL, dPLI and dBOP of ASMs were mainly correlated with Pseudomonas. Additionally, while the IMTM extractions have adverse distal periodontal indices of ASMs within 8 weeks and increase subgingival pathogens, the modified triangular flap (MTF) had fewer distal periodontal indices and less Pseudomonas. Compared to the traditional envelope flap and triangular flap, the MTF benefits the periodontal health, which could be considered as the priority option for IMTM extractions.

A clinical dilemma: Performing or avoiding root instrumentation in the treatment of the acute phase of endodontic‐periodontal lesions? A case report

AbstractBackgroundThis study presents the diagnois, management, and tissue response to an acute periodontal lesion with deep pocketing affecting a maxillary central incisor in a young patient devoid of caries or a history of periodontitis.MethodsClinical and radiographic examinations facilitated the diagnosis of the pathology as an endoperiodontal lesion (EPL) with root damage, exhibiting supracrestal invasive root resorption. Orthograde endodontic therapy was employed to decontaminate and seal the endodontic space. The resorptive site was treated through the endodontic access, debrided, and sealed. No periodontal therapy (surgical or nonsurgical) was performed. No mechanical instrumentation was performed within the pocketed root surface.ResultsAt 6‐month and 1‐year follow‐ups after endodontic therapy the periodontium displayed a physiologically healthy condition without pus or inflammation, exhibiting a circumferential probing depth of 2 mm, and absence of tooth mobility. These favorable outcomes persisted throughout a 4‐year follow‐up period.ConclusionsThe spontaneous healing of pocketing and abscess occurred without mechanical root instrumentation following endodontic therapy and treatment of external invasive root resorption in an EPL.Key Points Accurate diagnosis and identification of relevant etiologic factors are pivotal for effectively managing endodontic‐periodontal lesions. Once a diagnosis is established, the therapy focuses on eliminating the primary cause, followed by a subsequent diagnostic phase after healing. The definitive understanding of the diagnosis and etiology of endodontic‐periodontal lesions often becomes clear in retrospect, based on the outcomes of the therapy. When probing acute periodontal lesions, deep probing depths may occur without permanent loss of periodontal attachment. If the acute lesion was not induced by a periodontal cause and if no periodontal etiology arises secondarily, resolving the primary cause of the endoperiodontal lesion can lead to the spontaneous resolution of the pocketing. This results in spontaneous healing of periodontium without the need for intentional periodontal therapy. A clinical dilemma arises when considering periodontal treatment during the acute inflammatory phase of endo‐periodontal pathology. It is advisable to refrain from mechanical root instrumentation particularly if a clear periodontal cause is not apparent, to prevent from iatrogenic damage to periodontal fibers and the potential risk of gingival recessions. However, this does not imply avoiding periodontal therapy entirely for every case. Rather, it is recommended to delay the decision on root instrumentation until a new diagnostic phase is conducted following the healing of the endodontic etiology.

A Reappraisal of the Accuracy of the Tactile Method for the Detection of the Subgingival Cementoenamel Junction: An In Vivo Study.

This article reappraises the accuracy and factors associated with the detection of the cementoenamel junction (CEJ) using the tactile method. A total of 111 tooth sites of 7 patients scheduled for flap surgery were selected for the study. The CEJ was detected in a blind manner using the conventional tactile method with a standard periodontal probe by a single, trained examiner. A custom-made stent was prepared to standardize the measurements and the distance from a fixed reference point on the stent to the CEJ was measured before (apparent CEJ) and after (real CEJ) opening a gingival flap. To evaluate the effect of local anesthesia (LA) on the measurement error, assessment with and without LA given prior to the measurement was also evaluated. The bone crest-CEJ distance at each site was also recorded in all sites. The measurement error of apparent versus real distance, if any, was compared using Cohen's weighted kappa coefficient (WKC) (± 1 mm). A weak WKC (WKC = 0.539) was found between the apparent and real CEJ distance. Higher WKCs were noted at posterior and proximal sites than the anterior and buccal/lingual sites, respectively (0.840 and 0.545 vs. 0.475 and 0.488). A higher confluence of the agreements was noted when CEJ distance was measured in anesthetized sites (WKC = 0.703). Sites without bone loss showed more coronal deviation of CEJ detection, as opposed to apical deviation seen at sites with bone loss. The conventional CEJ detection using the tactile method was relatively imprecise depending on the anatomical location of the tooth and the bone loss at the site of measurement. However, the detection accuracy improved when the sites were anesthetized. In clinical terms, our data, reported here for the first time imply that, in the absence of visual cues, posterior tooth site measurements of periodontal attachment loss were more reliable in comparison to the other sites. The bone crest level also impacted the measurement deviation to some extent, implying that, possible overestimate of clinical attachment loss may occur at sites without bone loss.

Periodontal Health and Microbiological Characteristics of Siwak (Chewing Stick) and Toothbrush Users: A Cross-Sectional Study

Abstract Objective Siwak is a chewing stick used to clean the teeth and oral structures. Many studies have been conducted to assess the potential use of siwak in dentistry and concluded that it can be an alternative to a toothbrush in reducing plaque and gingivitis. However, some observations have reported more periodontal attachment loss and gingival recession among siwak users. This study aimed to compare the periodontal health and oral microbial characteristics between siwak and toothbrush users. Materials and Methods This was a cross-sectional study, and participants were recruited from the public who attended community engagement programs. They were assigned to two groups based on whether they used siwak or a toothbrush. Participants who consented were examined for periodontal health. Supragingival and subgingival plaque samples were collected for bacterial identification and quantification. Statistical Analysis The SPSS package version 21.0 was used for data entry. Data normality was statistically tested using Kolmogorov–Smirnov and Shapiro–Wilk tests, while data comparison used either t-test or Mann–Whitney U test. Results A total of 36 participants were included in this study. The findings revealed that the plaque scores, bleeding scores, and periodontal pocket depths between siwak and toothbrush users were comparable (p &gt; 0.05). Both groups had no evidence of gingival recession. Most participants had bacteria with characteristics of Streptococcus spp., which were present in 12 toothbrush users and 6 siwak users. Conclusions The periodontal health status of siwak users was comparable to that of toothbrush users. Despite this, siwak users had fewer types of bacteria than toothbrush users, suggesting that siwak may serve as an alternative device to conventional toothbrushes for oral hygiene when properly used.