Periodontal Pocket Depth Research Articles

Dental Hygienists' Influence on Oral Health Knowledge, Attitudes and Behavioural of Patients and Effectiveness on Improving Patients' Periodontal Status-Evaluations of a Hospital Based Oral Hygiene Training Program in China.

To evaluate the possibility of integrating dental hygienists (DHs) into the dental field in China, and investigate its effectiveness on improving patients' knowledge, attitudes, self-care behaviours as well as their periodontal status. A hospital-based oral hygiene training program was developed at Sir Run Run Shaw Hospital's (SRRSH) Dental Clinic with the support of two registered DHs from Loma Linda University in California. A questionnaire evaluating oral health knowledge, attitudes and behaviours was conducted in patients who visited SRRSH's Dental Clinic. Scores of oral health knowledge and proportions of positive oral health attitudes and favourable self-care behaviours were estimated between patients treated and not treated by DHs (DH group and NDH group). The improvements in patients' periodontal conditions following non-surgical periodontal therapy (NSPT) administered by DHs at the Dental Clinic of SRRSH, as assessed through the measurement of periodontal pocket depths and the incidence of bleeding upon probing. Patients in DH group exhibited relatively better results in several aspects of oral health knowledge, attitudes and behaviours, compared to those in NDH group. Moreover, NPST performed by DHs significantly improved the periodontal status of the patients, with a remarkably reduction in periodontal pocket depth and bleeding on probing. Integrating DHs into SRRSH's Dental Clinic showed effectiveness in enhancing patients' oral health knowledge, attitudes, behaviours and succeeded in improving patients' periodontal status. This program demonstrated that incorporating DHs into dental care team is not only practical but also enhances the value of the dental workforce in China.

Clinical Efficacy of CBCT and 3D-Printed Replicas in Molar Autotransplantation: A Controlled Clinical Trial.

To evaluate the efficacy of the combined cone-beam (CBCT)/3D-replicas protocol on the clinical and radiographic outcomes of autotransplanted molars. Controlled clinical trial registered ISRCTN13563091 from August 2019 to September 2022. Patients aged 13-22 years requiring permanent premolar extraction and having at least one non-erupted third molar were enrolled at the Institute of Stomatology, Stradins University, Riga, Latvia. Patients in the 3D-replicas (n = 30) underwent maxillary CBCT scans and had 3D-printed replicas of the third molar fabricated, while the control group (n = 28) did not. The clinical outcomes included tooth mobility, bleeding on probing, and periodontal pocket depth assessed at 3, 6, and 12 months. The radiographic outcomes included root development, obliteration, periapical status, and crown changes at 12 months. Of the 55 patients assigned to interventions, 46 completed the study. No significant differences in survival and radiographic outcomes were found between the control (n = 22) and 3D-replica group (n = 24): root development (p = 0.3), root resorption (p = 0.057), periapical status (p = 0.7), and crown/root ratio change (p = 0.4). Logistic regression showed no significant associations between radiologic predictors (root resorption: p = 0.4; periapical status: p > 0.9; root development: p = 0.8). Significant clinical outcome predictors included total operative time (β = 0.0043, p = 0.049), Moorrees' stage (stage 4: β = -0.31, p < 0.001; stage 5: β = -0.39, p < 0.001), and four donor placement times (β = 0.93, p < 0.001), but group assignment was not a significant predictor. The CBCT/3D-replica protocol showed no significant differences in the clinical or radiological outcomes. The high success rates in both groups suggest that the protocol is valuable primarily for optimizing surgical efficiency and as a training tool for clinicians.

Comparison of two treatment modalities in the management of gingival enlargement during orthodontic treatment: a randomized clinical trial.

This clinical trial aimed to evaluate and compare the effectiveness of diode laser gingivectomy, conventional gingivectomy, and nonsurgical periodontal treatment (NSPT) in the management of gingival enlargement (GE) during orthodontic treatment. forty-five healthy, orthodontic patients with labial gingival enlargement on the 6 anterior teeth were selected and randomly assigned to one of the groups (Conventional, Laser, and NSPT). Clinical parameters including clinical crown length (CCL) , periodontal pocket depth (PPD), and vertical gingival overgrowth index (vGOi) were recorded at baseline, 1 month, 3 months, and 6 months. Postoperative pain was evaluated at 1,3, and 7 days. Esthetic satisfaction and acceptance of the procedure were recorded on day 10 and repeated after 6 months. Statistically significant results were obtained for mean reduction in PPD for conventional, laser, and NSPT groups (-1.43, -.1.75, and -0.9 mm, respectively; P < 0.001), CCL gain (1.45, 1.7, and 0.38 mm, respectively; P<0.001) and mean vGOi score (-1.14, -1.29 and -0.76, respectively; P<0.001) over 6 months. Both test groups showed greater statistically significant changes in clinical parameters over 6 months compared to NSPT (P<0.001). There was a gradual decrease in postoperative pain for all three groups over 7 days, with conventional group showing statistical difference in mean pain score on days 1 and 3 compared to other groups. Both conventional and laser gingivectomies were more effective in controlling enlargement over non-surgical periodontal treatment alone at 1, 3, and 6 months. laser and conventional gingivectomies as adjunctive treatments achieved superior results when compared to NSPT alone in the treatment of GE and gingival inflammation during orthodontic treatment, with no significant clinical differences between the two treatments.

Beyond The Usual Suspects: A Challenging Case Of Radix Entomolaris With Endodontic-Periodontal Lesion: A Case Report

The purpose of this case report is to present an unusual endodontic periodontal lesion along with radix entomolaris in tooth 46 in a 31-year-old female patient with intermittent pain and sensitivity to hot and cold stimuli. Clinical examination revealed deep dentinal caries and periodontal pocket depth of 5mm in tooth #46.The radiographic examination revealed an extra distal root with a periapical radiolucency in tooth #46. patient was diagnosed with irreversible pulpitis and chronic apical periodontitis, with secondary periodontal involvement due to an endodontic-periodontal lesion. Non-surgical root canal treatment was performed, followed by canal obturation with resin-based sealer and final restoration with a porcelain fused to metal crown. After a 3-month follow-up, the patient remained asymptomatic, radiographs showed bone reposition, and periodontal probing depth decreased, indicating successful treatment.

The Hidden Danger - Understanding Periodontal Pocket

The conversion of junctional epithelium to pocket epithelium is regarded as a hallmark in the development of periodontitis. Knowledge of factors contributing to the initiation and progression of pocket formation is important. It may result in the development of better preventive measures and improved healing outcomes after therapeutic interventions. destruction of the structural integrity of the junctional epithelium, which includes disruption of cell-to-cell contacts and detachment from the tooth surface, consequently leading to pocket formation, disequilibrates this delicate defense system. One of the main variables used to evaluate the clinical success of periodontal therapy is periodontal pocket depth reduction. Therefore, reflecting on how the periodontal pocket process's role has helped guide how we perform and interpret periodontal research is important. A full understanding of periodontal pocket etiology is required to design a more precise treatment strategy and avoid the advancement of periodontal disorders.

Anti-inflammatory effectiveness of Peperomia pellucida (L.) Kunth in rats induced with periodontitis

BackgroundPeriodontitis, marked by deep periodontal pocket depth (PPD), facilitates bacterial colonization and inflammation, necessitating adjunctive therapies. Although 0.2 % chlorhexidine (CHX) mouthwash is effective, its side effects have led to the search for alternative treatments. Peperomia pellucida (L.) Kunth, known as Pepper Elder, is a traditional medicinal plant with potential as an adjunctive herbal therapy for periodontitis. ObjectiveThis study aimed to investigate the anti-inflammatory efficacy of Peperomia pellucida extract in rats with induced periodontitis. MethodsA post-test control group design was used in this laboratory experimental study. Four groups of Wistar strain Rattus norvegicus rats were utilized: a Pristine group (without periodontitis), a negative control group (induced periodontitis only), a positive control group (induced periodontitis and administered 0.2 % CHX), and an experimental group (induced periodontitis and administered 2.5 μL of Pepper Elder extract). Each treatment group received daily administration for one week. PPD measurements were taken on days 0, 3, 5, and 7. Blood serum was collected on day 7 for ELISA to measure IL-1β, TNF-α, IL-10, and IL-13 levels. Statistical analysis was performed using the Kruskal-Wallis test with a post hoc LSD and Mann-Whitney test. ResultsThe extract-treated rats showed a decrease in PPD, with significant differences between the extract group and the negative control group (p < 0.05). TNF-α levels in the extract group differed significantly from the negative control group (p < 0.05) but not from the Pristine and positive control groups. IL-1β levels differed significantly only from the negative control group. IL-10 levels were significantly different from both the Pristine and negative control groups, while IL-13 levels differed significantly only from the negative control group. ConclusionPeperomia pellucida (L.) Kunth extract exhibits anti-inflammatory effects in rats with induced periodontitis.

Impact of periodontal therapy on oral bacterial composition in individuals diagnosed with advanced periodontal disease.

Introduction. Negative changes in the microbial composition have been extensively studied in individuals with periodontal disease.Gap Statement. The changes in the oral microbiota after treating this disease are still unknown.Aim. We sought to elucidate the distinctive traits of salivary microbiota in individuals displaying healthy gums and those with severe periodontitis (SP) and examine the influence of periodontal therapy.Methodology. Periodontal pocket depths were examined to determine disease severity. The presence and quantity of oral Helicobacter pylori (associated with periodontal disease) were determined. Sequencing of 16S ribosomal DNA and bioinformatic analyses were performed to assess oral bacterial compositions in patients.Results. Sequencing analysis of 16S ribosomal DNA revealed a significant reduction in the abundance of operational taxonomic units (OTUs) and Chao1 and Abundance coverage-based estimator(ACE) indices in the oral cavities of individuals with SP compared to those of the healthy controls. However, these parameters showed significant recovery after appropriate treatment severe periodontitis after treatment (TSP). Additionally, the levels of harmful Bacillales and Spirochetes significantly increased, whereas the presence of beneficial Euryarchaeota significantly decreased in the SP group. The TSP group exhibited considerably augmented abundances of Burkholderiaceae and Veillonella, while noteworthy reductions in the pathogenic microbiota (Clostridia, Fusobacteria and Spirochaetes) were noticed compared to those of the SP group. Functionally, these modified OTUs were extensively implicated in 41 metabolic pathways.Conclusion. Our study demonstrates that nonsurgical periodontal therapy can effectively reduce the diversity of the oral microbiota, thereby potentially enhancing the treatment efficacy in patients with periodontal disease.

Diagnostic Approaches of Palatogingival Groove: A Systematic Review

Palatogingival Grooves (PGG) constitute developmental anatomical irregularities primarily situated along the palatal aspects of the roots of maxillary incisors. Literature is sparse on diagnostic approaches of PGG. Our study aimed to alleviate clinicians the process of recognizing anomaly. Systematic electronic searches of scientific literature without publication date or language restriction were undertaken in 2023.11.03 research was conducted in PubMed, Willey Online Library, Science Direct and Medline Ovid. Using specific keywords 54 articles with 67 cases were included in our study according to inclusion and exclusion criteria. Pre-made Cochrane data extraction templates were used for frequency evaluation, nonparametric Spearman’s, Kendall rank correlation coefficients, Mann-Whitney U Test and Odds ratio was assessed by statistic to evaluate significant correlations. Most quantitively expressed symptoms of PGG included increased tooth mobility, appearance of purulent discharge, sinus tract and periodontal pocket with an average mean of 9,14 ± 2,30 mm along with painful vertical per-cussion. However, statistical assessment showed inverse correlation between in-creased mobility and painful percussion. Furthermore, quantitively, deeper perio-dontal pockets were accompanied by more prominent gingival alterations, however only one opposing significant correlation was noted between the depth of per-iodontal pocket and existence of additional root. Frequency evaluation revealed that IPR was the main diagnostic tool used in majority of cases. Deeper periodontal pocket was assessed by conjunction of two or three tools. CBCT was used most with deeper periodontal pocket averaging 9,75 ± 1,02 mm. In conclusion, quantita-tive data suggest that periodontal pockets averaging 9,14 ± 2,30 mm, I or II-degree mobility, painful percussion and purulent discharge are the main PGG characteristics, with sparce significant correlations between them. IPR was noted as the main roentgenological modality as should be used firstly when suspecting PGG, yet both quantitative and statistical data suggest that CBCT is ought to be used to alleviate the assessment.

Growth of the Omega 3 industry applied in non-surgical periodontal therapies in dental practitioners

The aim of this systematic review is to recognise the effects of dietary supplementation of Omega 3 (fatty acids) as an adjuvant in non-surgical periodontal therapy in patients with periodontitis. In the present research work, a Systematic Review of Randomised Clinical Trials on the supplementary use of Omega 3 in the diet of patients with periodontitis was carried out. The guidelines of the CONSORT 2010 statement were followed using different search equations and previously selected articles. The results show the synthesis of 12 articles selected for this study, providing information such as author, year, journal and quartile classification, among other parameters such as blood biomarkers present and periodontal clinical parameters. In conclusion, the analysis of the efficacy of Omega-3 as an adjunct to non-surgical periodontal therapy (NSPT) shows that, although improvements in clinical indicators such as calculus index (CIN), periodontal pocket depth and bleeding on probing are observed, the additional impact of Omega-3 has not been shown to be statistically significant. The variability in results may be due to differences in study designs, doses administered, and sample sizes, which limits the ability to establish a clear benefit of Omega-3 on these specific parameters.

The effect of a new 3-hydroxypyridine derivative LHT-2-20 on free radical oxidation in experimental periodontitis

Aim. To study the effect of a new complex compound LHT-2-20 (2-ethyl-6-methyl-3-hydroxypyridine-2-(3benzoyl phenyl)-propanoate) on free radical oxidation in experimental periodontitis.Materials and methods. The experimental study was performed on 195 white mongrel mice weighing 19–23 g and 137 white mongrel rats weighing 180–220 g. The effect of a new complex compound LHT-2-20 (2-ethyl-6methyl-3-hydroxypyridine-2-(3-benzoyl phenyl)-propanoate) on the intensity of free radical oxidation and the local state of periodontal tissues during a course of intragastric administration was studied on the experimental model of periodontitis. Statistical processing of the results was carried out using the SPSS Statistics 20.0 software package with the analysis of variance (ANOVA) and the parametric Tukey’s test.Results. The LHT-2-20 compound reduced elevated levels of primary and secondary lipoperoxidation products (conjugated dienes, malondialdehyde in plasma and in erythrocytes during spontaneous and iron-induced oxidation) already at the early stages of the experiment, bringing the studied parameters closer to the reference values by the end of the course of treatment. The use of the compound LHT-2-20 contributed to an increase in the activity of the main antioxidant enzymes (catalase and superoxide dismutase), normalizing them to baseline values by the end of the experiment. With the correction of free radical processes, the use of LHT-2-20 limited the local inflammatory response in periodontal tissues, which was confirmed by a decrease in gingival edema and hyperemia, bleeding, depth of periodontal pockets, and tooth mobility.Conclusion. The results of this study confirm the anti-inflammatory potential of the compound and the multiplicity of its effects due to the impact on the mechanisms of oxidative stress. The expediency of further study of the drug is justified by the prospect of creating a new drug and its subsequent wide clinical application as part of the complex therapy of periodontal inflammation.

The Effect of Selenase on Inflammatory and Cytoprotective Markers in Experimental Chronic Generalized Periodontitis

Epidemiological studies in recent decades have revealed a significant increase in the number of patients with periodontal diseases leading to tooth loss. Modern realities require improvement of drug treatment of periodontitis. The antioxidant Selenase, selenium derivative, is an interesting treatment strategy for periodontitis. The study was carried out with the aim to evaluate the healing effectiveness of Selenase in rats with chronic generalized periodontitis (CGP) by its effect on markers of inflammation and cytoprotection. Experimental CGP was modulated in Wistar rats by a calcium-deficient diet with the inclusion of a prooxidant. Selenase (50 mcg/kg) and Mexidol (ethylmethylhydroxypyridine succinate, 250 mg/kg) were administered intragastrically for 30 days. Levels of IL-1β, HIF-1α, HSP70, and TNF-α were determined in the blood after treatment using the enzyme immunoassay method. Experimental CGP was characterized by the development of hyperemia, swelling, and bleeding of the gums; mobility of teeth; and gingival pockets up to 8 mm against the background of increased inflammatory markers (IL-1β, TNF-α), and molecular markers of cytoprotection (HIF-1α, HSP70) in the blood, indicating a homeostatic response of the periodontium in response to inflammation and subsequent hypoxia. Administration of Selenase to rats with CGP produced pronounced healing effects: the reduction in the depth of periodontal pockets by 42.55 %, cessation of bleeding, and disappearance of swelling against the background of a decrease of inflammatory markers: IL-1β – by 44.6 %, and TNF-α – by 65.9 % (p &lt; 0.05). HIF-1α increased by 36.8 %, and HSP70 – by 71.1 % compared to those of the control group, which was not given the treatment (p &lt; 0.05). The results obtained suggest a significant influence of Selenase on HSP70-dependent mechanisms of endogenous cytoprotection. The results of the study found that the use of Selenase in experimental CGP is more effective than Mexidol.

Clinical, radiographic and biochemical assessment of proximal cavities restored with composite resin using incremental vs. bulk packing techniques: One-year randomized clinical trial

BackgroundBulk-fill resin composites may suffer from recurrent caries around compound proximal restorations in posterior teeth, especially at the proximo-gingival interface.Over 12 months, will the bulk fill technique affect the caries recurrence rate at gingival margins when compared to the conventional incremental packing technique? How early will the first clinical, radiographical, and biochemical evidence of caries recurrence occur?MethodsAfter randomization, in 30 patients with two compound (OM or OD) supragingival lesions, one tooth was restored using the bulk fill technique on one side (group 1) (n = 15). In contrast, the other tooth on the other side was restored utilizing the incremental layering technique (group 2) (n = 15). Both teeth received restorative material (X-tra fil, Voco, Cuxhaven, Germany). The FDI criteria were used to evaluate restorations. As for the periodontal assessment, the gingival index, plaque index, papillary bleeding scoring index and periodontal pocket depth were evaluated. The gingival crevicular fluid (GCF) specimens were gathered, and MMP-9 was extracted and quantitated by ELISA. A customized radiographic template was designed, and 3D printed digital bitewing radiographs were taken. Assessments were done clinically, radiographically and biochemically at baseline (1 week) and after 3, 6 and 12 months. Data was statistically analyzed.ResultsThe null hypothesis was accepted clinically; no statistically significant differences appeared between bulk and incrementally filled posterior restorations. As for the radiographic assessment, the null hypothesis was accepted except for increased periodontal ligament width at 3 months. The null hypothesis for the biochemical evaluation was rejected as there were significant changes in levels of MMP-9 at different testing times.Conclusions1. With similar results but less sensitivity and significant time saving, the bulk fill technique can be considered an efficient alternative to the incremental fill technique in restoring proximal cavities. 2. Early evidence of caries recurrence can be correlated to an increase in the MMP-9 level in gingival crevicular fluid, followed by an increase in radiographic periodontal ligament width measurement.Trial registrationAn ethical approval from the Research Ethics Committee at the Faculty of Dentistry, October 6 University, (Approval No. RECO6U/5-2022). The study was registered at the Pan African Clinical Trials Registry on 24/07/2023 with an identification number (PACTR202307573531455).

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.

Poly-Ether-Ether-Ketone versus dead-soft coaxial bonded retainers: a randomized clinical trial. Part 2: periodontal health and microbial biofilm assessment.

Retainers have the potential to detrimentally impact periodontal health and contribute to tooth decay. To investigate periodontal health and bacterial biofilm related to Poly-Ether-Ether-Ketone (PEEK) fixed retainers as compared to Dead-soft coaxial fixed retainer (DSC). A two-arm parallel groups single-centre randomized clinical trial. The trial included patients whose orthodontic treatment was completed and required retainers. Participants were randomly assigned into two retainer groups: PEEK retainers, prepared by computer-aided design and manufacturing into 0.8mm wire form, and DSC retainers. The objectives included assessing periodontal health through plaque accumulation index (PI), bleeding on probing (BOP), periodontal pocket depth (PPD), gingival index (GI), calculus index (CI), and alveolar bone height (ABH) assessment. Biofilm assessment involved bacteriological screening of aerobic, facultative anaerobic, mutans streptococci, and lactobacilli. The periodontal indices and microbiological screening as well as were assessed at the debonding stage (T0), 1-month (T1), 3-month (T3), and 6-month (T6) after the commencement of the trial, except for the ABH, which was recorded using periapical radiograph at T0 and T6. Single blinding of participants in addition to the bacteriological specialist. Initially, the trial enrolled 46 participants, aged between 12 and 28 years, and were randomly assigned to two groups, with 23 participants in each group. Subsequently, one participant withdrew from the trial, resulting in a total of 45 participants whose data were analysed. Assessment of the periodontal indices, excluding the CI (P = .480), revealed statistically but not clinically significant differences between groups after 6-month of retention (P = .016 of PI, P = .020 of BOP, P = .05 of PPD, and P = .01 of GI). There was slight plaque accumulation, normal PPD (approximately 1mm), healthy to mild gingivitis with a GI of less than 1 and BOP was around 10%. Concerning the ABH, there was a noticeable reduction in its score after 6 months, particularly in the PEEK group, although the difference was not statistically significant (P = .102). Furthermore, the bacteriological viable count did not show any significant difference between the groups during the recall visits. There have been no reported negative consequences. Blinding the assessor of periodontal indices was not feasible due to the nature of the intervention. The trial follow-up duration was limited. Both the PEEK and DSC retainers have comparable impacts on periodontal health and bacterial accumulation and composition during the retention period. NCT05557136.

Efficacy of Adjunctive Local Antimicrobials to Non-Surgical Periodontal Therapy in Pocket Reduction and Glycemic Control of Patients with Type 2 Diabetes: A Network Meta-Analysis.

This network meta-analysis [NMA] investigated the efficacy of adjunctive use of subgingivally delivered antimicrobials to non-surgical periodontal therapy [NSPT] in the glycemic control and periodontal pocket depth (PPD) reduction in patients with type 2 diabetes (T2D). Seven databases, grey literature, and registry platforms were searched up to February 2024 to identify randomized clinical trials (RCT) fulfilling the eligibility criteria. The risk of bias was assessed through Cochrane's tool (RoB 2). Two frequentist NMA were performed using a random-effects model to calculate mean differences (MD) as an effect measure and to quantitatively evaluate the glycated hemoglobin (HbA1c) and PPD. The certainty of evidence was assessed through the GRADE approach in a partially contextualized framework for interpreting results. Ten RCTs were included. In total, 261 patients were treated with eight different local antimicrobials adjuvants to NSPT (azithromycin gel, clarithromycin gel, tetracycline fiber or ointment, chlorhexidine gel, doxycycline nanospheres, minocycline gel, and satranidazole gel), while 249 patients received NSPT alone or associated to placebo. Considering PPD reduction (8 included studies), the best results were found after six months for satranidazole gel (MD -2.64mm; 95%CI -3.56, -1.72; moderate evidence certainty). For HbA1c control (7 included studies), doxycycline gel (MD - 0.80%; 95%CI -1.70, 0.10), chlorhexidine gel (MD -0.68%; 95%CI -1.34, -0.02), and tetracycline fiber (MD -0.62%; 95%CI -0.85, -0.39) showed promising results after three months (low evidence certainty). The adjunctive use of satranidazole gel probably reduces PPD after a 6-month follow-up, while doxycycline gel, chlorhexidine gel, and tetracycline fiber may decrease HbA1c values in patients with T2D and periodontitis treated with NSPT after a 3-month follow up.

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.

Combined application of Er:YAG laser and low-level laser in non-surgical treatment of periodontitis.

To compare the efficacy of combined treatment of Er:YAG laser (ERL) and low-level laser therapy (LLLT) with single laser applications, and scaling and root planing (SRP) for non-surgical periodontal treatment. In a randomized controlled trial, 25 non-smoking Stage II or Stage III periodontitis patients were recruited. The four intraoral quadrants were randomly assigned to four different treatments: (1) combined application with ERL plus SRP plus LLLT; (2) ERL plus SRP; (3) SRP plus LLLT; and (4) SRP. We assessed periodontal indexes, including probing depth (PD), clinical attachment level (CAL), bleeding index (BI), and plaque index (PLI), along with three cytokines (IL-1β, TNF-α, IL-10) from gingival crevicular fluid and red complex pathogens from subgingival dental plaque at baseline, 3 months, and 6 months. For initial moderate pockets (4mm≤PD≤6mm), quadrants treated with ERL+SRP+LLLT, ERL+SRP, and SRP+LLLT exhibited greater PD improvement compared to the control (SRP) quadrants at the 3-month follow-up (1.25±1.06, 1.23±1.12, 1.00±1.21vs. 0.98±1.21mm) and the 6-month follow-up (1.35±1.06, 1.23±1.17, 1.35±0.98vs. 0.98±1.23mm) (p=0.002). Quadrants treated with ERL+SRP+LLLT and SRP+LLLT showed more CAL gain means than the control quadrants at the 3-month follow-up (0.96±1.42, 0.61±1.39vs. 0.55±1.57mm) and the 6-month follow-up (0.84±1.54, 0.89±1.49vs. 0.48±1.68mm) (p=0.008). For initial deep pockets (PD≥7mm), the ERL+SRP+LLLT quadrants had more PD improvement and CAL gain compared to the control quadrants at follow-up. There were no significant differences in BI, PLI, inflammatory cytokines, and periodontal pathogens among the four groups. The combined application of ERL and LLLT demonstrated potential efficacy in reducing PD, particularly for deep pockets. To compare the therapy effect of combined use of Er:YAG laser (ERL) and low level laser therapy (LLLT) with single laser applications, and traditional periodontal treatment (SRP). A total of 25 nonsmoking patients with periodontitis were involved, and their mouths were divided into four sections, each receiving a different treatment: ERL+SRP+LLLT, ERL+SRP, SRP+LLLT, and SRP. Clinical indexes and laboratory indicators were assessed at baseline, 3 months, and 6 months. After six months, for initial moderate pockets, combined laser group and single laser group showed better improvements than traditional group in reducing the depth of periodontal pockets and increasing attachment levels. But for initial deep pockets, only combined laser group showed better improvement than traditional group. There were no significant differences in bleeding, plaque, inflammation, or harmful bacterial levels among the groups. These findings suggest that the integration of Er:YAG laser and lowlevel laser therapy into standard periodontal treatment may enhance the treatment's benefits in reducing pocket depth, especially for severe conditions.

Association between Periodontitis and Hypertension among Adult Population in Rwanda.

Background/Objectives: Mortality due to various non-communicable diseases, including hypertension, is increasing globally. Studies have reported that periodontitis, a chronic inflammatory disorder caused by oral pathogens, is a potential risk factor for hypertension. These pathogens can invade arterial walls, leading to vascular inflammation and endothelial dysfunction, which then increases the likelihood of developing hypertension. However, evidence of the association between periodontitis and hypertension remains limited. Therefore, the aim of this study is to determine whether periodontitis is associated with hypertension among adults in Rwanda. Methods: A cross-sectional study was carried out among 420 participants (hypertensive and non-hypertensive) at the University Teaching Hospital of Kigali (CHUK) and Ruhengeri Hospital in Rwanda. Periodontitis was assessed using clinical parameters: clinical attachment loss (CAL), bleeding on probing (BoP), and periodontal pocket depth (PDD). Hypertension was defined as a patient with a systolic or diastolic blood pressure (SBP/DBP) of ≥140/90 mmHg. Descriptive statistics, the Chi-square test, and logistical regression were performed using SPSS version 29 for statistical data analysis. Results: The prevalence of periodontitis was found to be 69.5% among hypertensive patients and 52.4% among non-hypertensive patients. Clinical attachment loss was 6.24 times (AOR = 6.24, 95% CI: 1.99-19.56) higher among hypertensive patients and the difference was significant (p = 0.001). Other periodontal parameters such as periodontal pocket depth and bleeding on probing showed a more significant association among hypertensive than non-hypertensive patients. Conclusions: Our study found a significant association between periodontitis and hypertension in Rwandan adults. However, further intervention studies are needed to explore causality and potential interventions.

Evaluation of NETosis (Neutrophil Extracellular Traps) biomarkers in smokers and nonsmokers periodontitis patients

Background To evaluate the NETosis biomarkers citrullinated histone H3 (citH3), neutrophil elastase (ELA), calprotectin (CALPRO), and myeloperoxidase (MPO) as indicators of inflammation in the severe stages of periodontitis III and IV in both (smokers and nonsmokers) patients, and to determine the correlation between NETosis biomarkers and clinical periodontal parameters. Methods This study recruited male subjects with an age range of (20-60) years; 60 were stage III and stage IV periodontitis patients, 30 were cigarette smoker, and 30 were nonsmokers. After applying the inclusion and exclusion criteria to evaluate their eligibility for recruitment, 25 control subjects with a healthy periodontal status and good oral hygiene maintenance were included. Unstimulated saliva was obtained and evaluated using an enzyme-linked immunosorbent assay, and the following periodontal parameters were documented: [plaque index, bleeding on probing, periodontal pocket depth, and clinical attachment loss]. Results The mean levels of all salivary NETosis biomarkers citH3, ELA, CALPRO, and MPO were elevated in the periodontitis groups (smokers and nonsmokers) than in controls. Moreover, the mean NETosis biomarker‘s mean levels were significantly higher in smoker than in nonsmokers. In addition, the correlations were significant between CALPRO and CitH3 in smokers and between ELA and CitH3 in nonsmokers. Conclusions The results of this study showed that the chosen salivary biomarkers of NETosis revealed elevated clinical accuracy in differentiating the studied periodontitis groups (smokers and nonsmokers) from controls. In addition, cigarette smoking increases the risk of periodontitis, and neutrophils in smokers with periodontitis exhibited more susceptibility to form neutrophil extracellular traps when compared with nonsmokers.

Effectiveness of Mobile App Interventions to Improve Periodontal Health: Protocol for a Systematic Review and Meta-Analysis.

Periodontal health plays a key role as a shared reference point for evaluating periodontal diseases and identifying significant treatment outcomes. Providing adequate instruction and enhancing the motivation of patients to maintain proper oral hygiene are crucial factors for successful periodontal treatment, with self-performed regular oral hygiene identified as a critical factor in improving the outcomes of treatment for periodontal diseases. Recently, mobile health (mHealth) solutions, especially mobile apps, have emerged as valuable tools for self-management in chronic diseases such as periodontal disease, providing essential health education and monitoring capabilities. However, the use of mHealth apps for periodontal health is complex owing to various interacting components such as patient behavior, socioeconomic status, and adherence to oral hygiene practices. Existing literature has indicated positive effects of mHealth on oral health behaviors, knowledge, attitude, practice, plaque index score, and gingivitis reduction. However, there has been no systematic review of mobile apps specifically targeting patients with periodontal disease. Understanding the design and impact of mHealth apps is crucial for creating high-quality apps. The aim of this systematic review and meta-analysis is to evaluate the effectiveness of existing mobile apps in promoting periodontal health. A comprehensive search strategy will be performed in multiple electronic databases (PubMed, EBSCOhost, CINAHL Plus, Dentistry & Oral Sciences, ScienceDirect, Scopus, and Cochrane Central Register of Controlled Trials) with the following keywords in the title/abstract: "mobile application," "mobile health," "mHealth," "telemedicine," "periodontal health," "periodontitis," and "text message." Only randomized controlled trials will be included that assessed the following outcomes to measure periodontal health improvement: gingival index, bleeding index, periodontal pocket depth, and clinical attachment loss. Covidence will be used for data collection, and a PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) flowchart will be used to describe the selection process of the included, identified, and excluded studies. The Confidence in Network Meta-Analysis approach will be used for meta-analysis of the extracted data from the included studies. This review will not require ethical approval since no primary data will be included. As of July 2024, a total of 83 articles retrieved from various databases have been imported to Covidence with 13 articles deemed eligible for inclusion in the review. The review is currently ongoing and is expected to be complete by the end of 2024 with the results published in early 2025. This systematic review and meta-analysis will contribute to developing mobile apps with enhanced criteria to improve periodontal clinical outcomes. The review emphasizes the importance of mHealth and preventing periodontal disease, which can set the stage for informed global health care strategies. PROSPERO CRD42022340827; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=340827. DERR1-10.2196/50479.