Pocket Depth Reduction Research Articles

Regenerative surgical treatment of furcation defects: A systematic review and Bayesian network meta-analysis of randomized clinical trials.

To investigate the clinical performance of regenerative periodontal surgery in the treatment of furcation defects versus open flap debridement (OFD) and to compare different regenerative modalities. A systematic search was conducted to identify RCTs evaluating regenerative surgical treatment of furcations with a minimum of 12-month follow-up. Three authors independently reviewed, selected and extracted data from the search conducted and assessed risk of bias. Primary outcomes were tooth loss, furcation improvement (closure/conversion) (FImp), gain of horizontal bone level (HBL) and attachment level (HCAL). Secondary outcomes were gain in vertical attachment level (VCAL), probing pocket depth (PPD) reduction, PROMs and adverse events. Data were summarized into Bayesian standard and network meta-analysis in order to estimate direct and indirect treatment effects and to establish a ranking of treatments. The search identified 19 articles, reporting on 20 RCTs (19 on class II, 1 on class III furcations) with a total of 575 patients/787 defects. Tooth loss was not reported. Furcation closure ranged between 0% and 60% (10 trials), and class I conversion from 29% to 100% (six trials). Regenerative techniques were superior to OFD for FImp (OR=20.9; 90% CrI=5.81, 69.41), HCAL gain (1.6mm), VCAL gain (1.3mm) and PPD reduction (1.3mm). Bone replacement grafts (BRG) resulted in the highest probability (Pr=61%) of being the best treatment for HBL gain. Non-resorbable membranes+BRG ranked as the best treatment for VCAL gain (Pr=75%) and PPD reduction (Pr=56%). Regenerative surgery of class II furcations is superior to OFD. FImp (furcation closure or class I conversion) can be expected for the majority of defects. Treatment modalities involving BRG are associated with higher performance.

Regenerative surgery versus access flap for the treatment of intra-bony periodontal defects: A systematic review and meta-analysis.

The aim of this systematic review was to compare clinical, radiographic and patient-reported outcomes (PROMs) in intra-bony defects treated with regenerative surgery or access flap. A systematic review protocol was written following the PRISMA checklist. Electronic and hand searches were performed to identify randomized clinical trials (RCTs) on regenerative treatment of deep intra-bony defects (≥3mm) with a follow-up of at least 12months. Primary outcome variables were probing pocket depth (PPD) reduction, clinical attachment level (CAL) gain and tooth loss. Secondary outcome variables were Rec, radiographic bone gain, pocket "closure," PROMs and adverse events. Meta-analysis was carried out when possible. To evaluate treatment effect, odds ratios were combined for dichotomous data and mean differences for continuous data using a random-effect model. A total of 79 RCTs (88 articles) published from 1990 to 2019 and accounting for 3,042 patients and 3,612 intra-bony defects were included in this systematic review. Only 10 of included studies were rated at low risk of bias. A total of 13 meta-analyses were performed. All regenerative procedures provided adjunctive benefit in terms of CAL gain (1.34mm; 0.95-1.73) compared with open flap debridement alone. Both enamel matrix derivative (EMD) and guided tissue regeneration (GTR) were superior to OFD alone in improving CAL (1.27mm; 0.79-1.74mm and 1.43mm; 0.76-2.22, respectively), although with moderate-high heterogeneity. Among biomaterials, the addition of deproteinized bovine bone mineral (DBBM) improved the clinical outcomes of both GTR with resorbable barriers and EMD. Papillary preservation flaps enhanced the clinical outcomes. The strength of evidence was low to moderate. EMD or GTR in combination with papillary preservation flaps should be considered the treatment of choice for residual pockets with deep (≥3mm) intra-bony defects.

Role of probiotics containing Lactobacillus reuteri in adjunct to scaling and root planing for management of patients with chronic periodontitis: a meta-analysis.

Probiotics, nowadays are the effective in management of chronic periodontitis when used as an adjunct to non-surgical periodontal therapy. However, the beneficial effects of probiotics are varied with the nature of bacterial strain. Our meta-analysis aims at evaluating the magnitude of improvement in clinical and microbiological parameters, with administration of Lactobacillus reuteri alone in adjunct to scaling and root planning (SRP). A digitalized database search was made in MEDLINE (PubMed), Scopus, CENTRAL (Cochrane Registry of Trials), Web of Science, and EMBASE, to identify eleven randomized clinical trials published within last decade (2009-2019), with double blind, placebo controlled study design. The data extraction was carried out and subject to both qualitative and quantitative synthesis. The primary outcomes assessed were gain in clinical attachment level (CAL), reduction in probing pocket depth (PPD), and reduction in microbial levels. The meta-analysis plots were used to assess all the clinical outcomes. The mean difference of reduction in PPD at 21 days (MD-0.61) and 3 months (MD-0.40), and CAL gain at 3 month (MD-0.30) showed favourable response in the sites treated with probiotics containing Lactobacillus reuteri in addition to SRP. The meta-plots for major peridonto-pathogens constructed at 21 days follow-up, showed short-term effective reduction. Within the limits of the study, Lactobacillus reuteri containing probiotics showed a significant clinical and microbiological benefit, however, the favourable effect was shown to be short-term.

Impacts of non-impacted third molar removal on the periodontal condition of adjacent second molars.

The aim of this study was to determine how the removal of non-impacted third molars (N-M3s) affects the periodontal status of neighboring second molars (M2s). The periodontal condition of M2s for which the neighboring N-M3s were removed (more than 6months previously) and those with intact N-M3s was analyzed in a cross-sectional observation study. In an additional case series, periodontal changes in M2s in response to adjacent N-M3 removal were observed during a 6-month follow-up period. A total of 457 patients with 1,301 M2s were enrolled in this cross-sectional observational study. Compared to M2s with neighboring N-M3s, M2s without neighboring N-M3s (teeth removed more than 6months previously) exhibited a 0.27-mm reduction in the average pocket depth (PD) (p<.001) and a 0.38-fold reduced risk of at least one probing site with PD ≥5mm (PD5+) (p<.001). Subsequently, a 41-case follow-up study showed that 6months after neighboring N-M3 extraction, the PD of the M2s decreased by 0.31mm (p<.001), while the incidence of PD5+ decreased by 21.9% when compared to the parameters detected before tooth extraction (p=.004). Removing N-M3s was associated with an improved periodontal condition in neighboring M2s.

Human Clinical and Histologic Evaluations of Laser-Assisted Periodontal Therapy with a 9.3-μm CO² Laser System.

This investigation was designed to evaluate the healing response of 9.3-μm CO2 laser-assisted periodontal therapy. Five patients presenting with moderate to severe periodontitis, with an initial pocket depth (PD) ≥ 5 mm and with teeth predetermined to be surgically extracted, were enrolled and consented to treatment with full-mouth CO2 laser-assisted therapy. The laser treatment was carried out in the Ultraguide Mode at a setting of 0.25-mm spot size, with an average power of 0.65 to 1.15 watts and 20% mist. The laser tip was passed from the gingival margin and down apically to the base of the pocket with a sweeping L motion. The teeth were intensely scaled with piezoultrasonic instrumentation afterwards. A second pass of the laser tip was performed for the study teeth. At 9 months, all patients were clinically reevaluated. For sites with an initial pocket depth of ≥ 7 mm, a mean PD reduction of 3.97 ± 1.36 mm and a mean clinical attachment level gain of 3.54 ± 1.54 mm were achieved, resulting in a mean PD of 3.91 ± 0.77 mm. En bloc biopsy samples of four teeth were obtained and analyzed; two demonstrated histologic evidence of new bone formation while the other two healed with a long junctional epithelium with minimal inflammatory infiltrate. Further long-term clinical studies are needed to investigate the treatment stability obtained with a 9.3-μm CO2 laser compared to conventional surgical therapy. Nevertheless, the encouraging clinical results indicated that adjunctive use of the 9.3-μm CO2 laser-assisted periodontal therapy can be beneficial for treatment of periodontally compromised patients.

Regenerative potential of cultured gingival fibroblasts in treatment of periodontal intrabony defects (randomized clinical and biochemical trial).

Defective cellular elements constitute an important challenge to achieve predictable periodontal regeneration. In an attempt to improve the cellularity of periodontal defects, gingival fibroblasts were implanted without their associated extracellular elements in periodontal defects to expose them to periodontal tissue mediators. In order to investigate the regenerative potential of gingival fibroblasts translocated into periodontal defects, the present study was designed to clinically and biochemically investigate the use of gingival fibroblasts (GF) and their associated mesenchymal stem cells (GMSC) in the treatment of intrabony periodontal defects. A total of 20 subjects were randomly divided into two groups (n=20). Group I: ten patients were included with ten intrabony periodontal defects that received β-calcium triphosphate (β-TCP) followed by collagen membrane defect coverage, while group II: (10 patients) ten periodontal defects received cultured gingival fibroblasts (GF) on the β-TCP scaffold and covered by a collagen membrane. The clinical evaluation was carried out at the beginning and at 6months. Gingival crevicular fluid (GCF) samples were collected directly from the test sites for the quantitative measurement of PDGF-BB and BMP-2 using the ELISA kit at 1, 7, 14, and 21days after surgery. Group II reported a significantly greater reduction in vertical pocket depth (VPD) and CAL gain compared with group I after 6months. Radiographic bone gain was statistically higher in group II compared with group I. A significantly higher concentration of PDGF-BB was observed in group II on days 1, 3, and 7 compared with group I. Translocation of gingival fibroblasts from gingival tissue to periodontal defects could be a promising option that increases cellular elements with regeneration potential. The concept of total isolation of gingival fibroblasts using occlusive membranes must be re-evaluated.

Clinical efficacy of minimally invasive surgical (MIS) and non-surgical (MINST) treatments of periodontal intra-bony defect. A systematic review and network meta-analysis of RCT's.

The aim of this systematic review was to explore the efficacy of different minimal invasive surgical (MIS) and non-surgical (MINST) approaches for the treatment of intra-bony defect in terms of clinical attachment level (CAL) gain and periodontal pocket depth (PPD) reduction. A detailed review protocol was designed according to PRISMA guideline. Online search was conducted on PubMed, Cochrane library and Embase. Only randomized clinical trials (RCTs) testing MIS or MINST procedure, with or without the application of a regenerative tool for the treatment of intra-bony defect, were included. Cochrane checklist for risk of bias assessment was used. Network meta-Analysis (NMAs) was used to rank the treatment efficacy. Nine RCTs accounting for 244 patients and a total of 244 defects were included. Only two studies were at low risk of bias. CAL gain for included treatment ranged from 2.58 ± 1.13mm to 4.7 ± 2.5mm while PPD reduction ranged from 3.19 ± 0.71mm to 5.3 ± 1.5mm. On the basis of the ranking curve, MINST showed the lowest probability to be the best treatment option for CAL gain. Pairwise comparisons and treatment rankings suggest superiority for regenerative approaches (CAL difference 0.78mm, (0.14-1.41); P < 0.05) and surgical treatment elevating only the buccal or palatal flap (CAL difference: 0.95mm, (0.33-1.57); P < 0.05). Minimally invasive surgical (MIS) and non-surgical (MINST) periodontal therapy show promising results in the treatment of residual pocket with intra-bony defect. MIS procedures represent a reliable treatment for isolated intra-bony defect.

Adjunctive subgingival application of Chlorhexidine gel in nonsurgical periodontal treatment for chronic periodontitis: a systematic review and meta-analysis

BackgroundSubgingival applications of chlorhexidine (CHX) gel are commonly used as an adjunct in nonsurgical periodontal treatment (NSPT) for chronic periodontitis (CP). However, there is lack of systematic review and meta-analysis justifying the effects of adjunctive CHX gel on clinical outcomes. The objective of this meta-analysis was to evaluate the efficacy of adjunctive subgingival administration of CHX gel in NSPT compared to NSPT alone for CP.MethodsAn electronic search of four databases and a manual search of four journals were conducted up to August 2019. Only randomized controlled trials reporting on the clinical outcomes of subgingival use of CHX gel adjunct to scaling and root planing (SRP), as compared to SRP alone or with placebo, for at least 3 months were included. Primary outcomes were probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain at 3 and 6 months, when data on at least three studies were obtained.ResultsSeventeen studies were included for qualitative analysis and seven studies for quantitative analysis (four studies for the application of CHX gel adjunct to SRP at selected sites with at least pocket depth ≥ 4 mm and three studies for comparison of full-mouth disinfection (FMD) with subgingival use of CHX gel and full-mouth scaling and root planing (FMSRP). For subgroups, the clinical outcomes between adjunctive use of Xanthan-based CHX gel (XAN-CHX gel) and CHX gel were analyzed. Results indicated a significant improvement of PPD reduction following local adjunctive administration of XAN-CHX gel for SRP at selected sites (MD: 0.15 mm). However, no difference was found in CAL gain. Moreover, no significant difference was observed in PPD and CAL at both 3 and 6 months post-treatment between FMD and FMSRP.ConclusionAdjunctive subgingival administration of XAN-CHX gel at individual selected sites in NSPT appears to provide slight benefits in PPD reduction compared to NSPT alone for CP. Due to the lack of high-quality studies, further studies with larger sample sizes and strict standards are needed to confirm the conclusions.

A Comparative Study of Platelet-rich Fibrin (PRF) and Titanium-prepared Platelet-rich Fibrin (T-PRF) in Management of Endo-perio Lesions

The aim of the study was to compare the platelet-rich fibrin (PRF) and titanium-prepared platelet-rich fibrin (T-PRF) in the management of endo-perio lesions. This study was conducted with 140 patients who are affected by endo-perio lesions, and the patients were divided into two groups. In group I, patients were treated with PRF, and in group II, patients were treated with T-PRF. Endodontic treatment was done in all cases, following a standardized aseptic method. Probing pocket and relative attachment level were recorded after 3 months and 6 months in both groups. After 3 months, the mean change of probing pocket depth (PPD) was 68% in group I and 33.41% in group II. The intergroup distinction was not significant (p > 0.05), whereas the intragroup evaluation was significant (p < 0.05). The mean change after 6 months was 42.59% in group I and 43.90% in group II. The difference was not significant (p > 0.05). After 3 months, the mean% change of relative attachment level (RAL) was 31.20% in group I and 31.60% in group II. The intergroup distinction was not significant (p > 0.05), whereas the intragroup evaluation established a considerable discrepancy (p < 0.05). The mean change after 6 months was 40.82% in group I and 42.12% in group II. Both PRF and T-PRF were effective in inducing a reduction in pocket depth and useful in gaining attachment level. With the use of PRF and T-PRF, the complex case of endo-perio lesions can be efficiently managed.

Plasma rich in growth factors (PRGF) in non-surgical periodontal therapy: a randomized clinical trial.

The aim of this split mouth, double blinded, randomized clinical trial was to evaluate the clinical efficacy of use of Plasma rich in growth factors (PRGF) as an adjunct to scaling and root planing (SRP) in the treatment of periodontal pockets. Twenty six patients (15 males, 11 females) diagnosed with generalized periodontitis with Pocket Depth > 5mm and plaque index score < 1.5, were randomly allocated by using computer generated random sequence, into two groups, one treated with intra-pocket application of PRGF adjunct to SRP and other with SRP alone. The clinical outcomes like pocket depth (PD), relative attachment level (RAL) and sulcus bleeding index (SBI) were assessed at baseline, 3 months and 6 months. Twenty two patients (44 sites) were analyzed at the end of 6 month follow-up, using SPSS 20.0v software. There was a significant statistical difference observed between both the groups favouring SRP +PRGF group in terms of PD (p = 0.007) and RAL (p = 0.021) at the end of 6 month follow-up. Also there was a statistical significant difference (< 0.001) at all time points compared to baseline, for all parameters in intra-group comparison. Moreover, the sites with PD>4mm necessitating further treatment after 6-month follow-up were significantly lesser for SRP+PRGF group. The use of PRGF technology in non-surgical periodontal therapy, by single intra-pocket application in to periodontal pockets as an adjunct to SRP, in chronic periodontitis patients, was found to be effective in reduction of pocket depth and gain in clinical attachment level.

Comparison of Regenerative Potential of Platelet-rich Fibrin Alone and in Combination with Bovine Bone Graft in Intraosseous Defect by Single Flap Approach: A Clinical and Radiographic Study.

ABSTRACTAim:To compare the regenerative potential of platelet-rich fibrin alone and in combination with bovine bone graft in intraosseous defect by the single flap approach.Materials and Methods:A total of 32 sites of intrabony defects were selected and were treated with platelet-rich fibrin (PRF) alone or in combination with bovine bone graft. Clinical parameters [Gingival index (GI), probing depth (PD), clinical attachment level (CAL), Gingival recession, and radiographic parameters (defect fill, alveolar crest level, and defect depth)] were recorded at baseline, 3 months, and 6 months.Results:Statistical analysis was done by independent and paired t-test. There were statistically significant changes in GI, PD reduction, CAL gain, defect fill, alveolar crest level changes, and defect depth resolution from baseline, 3 months, and 6 months in both the groups (P < 0.001). On intergroup comparison, Group II showed statistically significant changes in a reduction in pocket depth and defect depth resolution at P < 0.001.Conclusion:PRF in combination with bovine bone graft was more effective in the treatment of intrabony defects.

The Effect of Lactobacillus salivarius SGL03 on Clinical and Microbiological Parameters in Periodontal Patients.

The destruction of periodontal tissues during periodontitis is the result of the immune-inflammatory reactions to the bacteria of dental biofilm. Probiotics may reduce dysbiosis by the modification of the dental microbiome, which can influence the immune-inflammatory mechanisms. The aim of this study was to estimate the clinical and microbiological parameters, before and after 30 days of application of the dietary supplement containing Lactobacillus salivarius SGL03 or placebo. The study was conducted in 51 patients with stage I or II periodontitis during the maintenance phase of treatment. The clinical parameters and the number of colony forming units (CFU) of bacteria in supragingival plaque were assessed before and after 30 days of the oral once daily administration of the dietary supplement in the form of suspension containing L. salivarius SGL03 or placebo. There were no changes in the PI scores between and within the groups. The value of BOP decreased in both groups. In the study group the significant reduction of the mean pocket depth was revealed (from 2.5 to 2.42, p = 0,027) but without the difference between the groups. There were no significant changes in the number of bacteria within the groups. In the control, but not the study group, positive correlations were observed between the clinical parameters (variables) and the number of bacteria. The use of the dietary supplement containing L. salivarius SGL03 may reduce pocket depth despite the lack of changes in other clinical parameters and the number of bacteria in supragingival plaque.

Efficacy of omega 3 fatty acid as an adjunct in the management of chronic periodontitis: A randomized controlled trial

: Periodontitis is conventionally treated with both surgical and nonsurgical methods. Various adjuncts have been used previously with compromised efficacy. Recently omega-3(ώ-3) polyunsaturated fatty acids (PUFA) including docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) were shown to have therapeutic anti-inflammatory and protective actions in inflammatory diseases including periodontitis. The purpose of the present study was to evaluate and compare the clinical efficacy of ώ-3 fatty acids as an adjunct to scaling and root planing in the treatment of periodontitis. 110 Patients were selected for the study out of which 20 were excluded (12 not meeting the inclusion criteria and 8 refused to participate). 90 patients (48 in test and 42 in the control group) after randomisation through a coin toss method were enrolled in a single-blind randomised controlled trial conducted in the Periodontics department of a dental college. Full mouth subgingival scaling and root planing and ώ-3 fatty acid 500 mg (EPA/DHA 180/120 mg), BD daily for 1 month was given to the test group and subgingival scaling and root planing only was given to the control group. Clinical parameters like probing pocket depth, clinical attachment level, plaque index and gingival index were recorded at baseline, 1 and 3 months and were compared. Statistical analyses demonstrated a significant reduction in probing pocket depth (t = 65.56, P = 0.000) and (t = 51.69, P = 0.000) at 1 and 3 months, respectively, in test group compared to baseline and control group. There was a significant gain in clinical attachment level (t = 63.29, P = 0.000) and (t = 31.03, P = 0.000) at 1 and 3 months, respectively, in test group compared to baseline and control group. The gingival index shows an appreciable reduction in both groups, and in test group, it is statistically significant at 3 months (t = 2.15, P = 0.03). There was no statistical significant reduction in plaque index at 3 months (t = 0, P = 0.997). The present study showed that adjunctive use of ώ-3 fatty acids proved to be beneficial over scaling and root planing alone in the treatment of chronic moderate periodontitis. The beneficial effects were in terms of significant improvements in clinical parameters, probing pocket depth, and clinical attachment level and gingival index. Dietary modulation is now emerging as an adjunct to periodontal therapy. Hence, omega-3 fatty acid may be used routinely in the management of chronic periodontitis.

Clinical Audit of Minimally Invasive Nonsurgical Techniques in Active Periodontal Therapy

Periodontitis is one of the most widespread diseases worldwide. Many efforts have been made to increase the efficacy of periodontitis therapy as much as possible. Recently, minimally invasive nonsurgical techniques (MINST) were introduced in the periodontal field as an alternative to minimally invasive surgical techniques (MIST). This clinical audit aims to evaluate the results of MINST in the initial phase of treatment for periodontitis. One hundred seven patients with periodontitis who were treated with MINST between 2013 and 2017 and reevaluated after 2 months were included in this clinical audit. The primary outcome analyzed was the proportion of pocket closure. The secondary outcomes were tooth extraction before active periodontal therapy, full-mouth plaque score (FMPS) change, full-mouth bleeding score (FMBS) change, average probing pocket depth (PPD) reduction, and average clinical attachment level (CAL) gain between the baseline and reevaluation values. A total of 2,407 teeth were included in the analysis. At the patient level, the treatment resulted in a mean pocket closure rate of 71.6 ± 15.7% for sites with an initial PPD ≥5 mm. The treatment was statistically significantly (p < 0.001) more effective with respect to the primary outcome compared with expected values reported in a recent meta-analysis (57%). The subgroup analysis revealed statistically significant differences between single and multirooted teeth and between shallow (5-6 mm) and deep pockets (≥7 mm) at the baseline. Nonsurgical periodontal therapy with MINST achieved satisfactory results that were better than expected based on the scientific literature. Single-rooted and shallow pockets showed the best proportion of pocket closure at the reevaluation after treatment. Minimally invasive nonsurgical techniques can be the treatment of choice when approaching periodontally diseased patients with nonsurgical periodontal therapy.

A new flap design compared with other flap designs on postoperative pocket depth following surgical removal of mandibular third molar

Introduction: Surgical removal of mandibular third molars is the most frequently performed minor oral surgical procedure. Aims: This study aims to evaluate its effect on periodontal status of second molars at 3 and 6 months' follow-up comparing extractions done by three different flap techniques. Settings and Design: Prospective randomized control clinical study. Subjects and Methods: Ninety medically healthy controls of both gender, aged between 18 and 50 years who underwent surgical removal of impacted mandibular third molars were divided into Group A, Group B and Group C wherein Bayonet flap, modified envelope flap and envelope flap was raised, respectively. Pocket depth at distobuccal and distolingual aspect of adjacent second molar was measured and compared for each group at preoperative as well as 3 and 6 months' follow-up. Statistical Analysis Used: ANOVA, paired t-test, and Tukey post hoc test using SPSS software. Results: There was no statistically significant difference found between pocket depths distal to second molars following impacted third molar extraction between three different flap groups. However, a significant reduction of pocket depth was noted from 3 to 6 months' follow-up for all three flap groups. Conclusions: Flap designs used for impacted third molar extractions do not contribute toward the alteration of periodontal health of second molars.

Differences in results of infrabony pocket treatment with addition of platelet rich fibrin and platelet rich plasma gel in DFDBA bone graft

Treatment of infrabony pocket makes use of bone graft material demineralized freeze dried bone allograft (DFDBA) from different individuals which has undergone demineralization process and it is osteoinductive. Enhancement of growth factor was done by adding platelet rich fibrin (PRF) and platelet rich plasma (PRP). PRP is activated with an addition of calcium chloride CaCl2) to form gel. The method used to apply the bone grafting material is open flap debridement OFD). This research aimed to reveal the differences in the results of infrabony pocket treatment using PRF and PRP gel with an addition of DFDBA. The sample was taken from 20 infrabony pocket points divided into 2 groups, 10 infrabony pocket were treated with OFD+DFDBA+PRF and the other were treated with OFD+DFDBA+PRP gel. Pocket depth (PD) was measured on the baseline and the first and third month after treatment. Alveolar bone height was measured using cone beam computed tomography (CBCT) radiograph on the baseline to the third month after treatment. The results of this research showed that there was difference in the results of infrabony pocket treatment using PRF and PRP gel with an addition of DFDBA which could be observed from a reduction in PD from the baseline, month 1 and month 3 as well as reduction in alveolar bone height from the baseline to month 3. This research concluded that infrabony pocket treatment PRF application yields better results than PRP gel application in terms of PD and alveolar bone height reduction.

Clinical outcomes of adjunctive indocyanine green-diode lasers therapy for treating refractory periodontitis: A randomized controlled trial with in vitro assessment

It is still challengeable to treat periodontal pockets refractory to mechanical debridement. This study is to evaluate the potential of indocyanine green (ICG)-diode laser-based photothermal therapy (PTT) for solving this dilemma. Bone marrow-derived mesenchymal stem cells (BMSCs) and periodontal ligament cells (PDLCs) were incubated with phosphate-buffered saline, chlorhexidine, or ICG, non-irradiated or irradiated with 810-nm diode lasers, and the cell viability was evaluated. Patients with teeth refractory to mechanical periodontal debridement on different quadrants were recruited. At baseline (T0), all examined teeth received scaling and root planing, and those on the test quadrant (PTT group) received ICG-diode laser treatment. The outcome was evaluated using clinical parameters and cytokines in the gingival crevicular fluids at 4-6 weeks (T1) and 6 months (T2). In ICG-treated cultures, the viability of BMSCs and PDLCs was recovered on day 4, and laser irradiation inhibited the metabolic activities of BMSCs. 22 patients with 30 control teeth and 35 PTT-treated teeth were examined. All examined teeth showed modest reductions in probing pocket depth (PPD), clinical attachment loss (CAL), bleeding upon probing (BOP), and plaque score at T1 and T2 and significant reductions in IL-1β and MMP-8 at T2. Compared with controls, BOP was reduced more prominently, IL-1β and MMP-8 were significantly lower, and reductions in PPD and CAL were slightly greater in the PTT group at T1 (0.05-0.19mm). ICG-diode laser-based PTT is compatible to periodontium and assists in faster resolution of gingival inflammation in periodontal pockets refractory to mechanical debridement.

The association between early postoperative healing and the 12-month clinical and radiographic outcomes of guided tissue regeneration in aggressive periodontitis patients

This study evaluates the influence of early healing on clinical and radiological outcomes of guided tissue regeneration (GTR) procedures of vertical intrabony defects in patients with aggressive periodontitis (AgP) in a 12-month follow-up. The influence of patient-related, site-specific and technical aspects on optimal early wound healing was also assessed. This analysis included 25 patients with 61 intrabony defects. All sites were treated according to guidelines of minimally invasive surgical technique with the use of bone grafts and collagen membranes. Early post-operative healing was evaluated using the Early Wound-Healing Index (EHI). Changes in clinical and radiological parameters were assessed 12 months postoperatively. After 2 weeks, primary healing (EHI ≤3) was observed in 44 sites (72.13%) and secondary healing was present in 17 sites (22.87%) (EHI = 4). The presence of thin gingival phenotype was significantly associated with an increased risk of secondary healing (OR = 0.203; p = 0.014). At 12 months, GTR resulted in a significant clinical attachment level gain, as well as probing pocket depth reduction and radiographic defect depth reduction. Primary or secondary healing did not affect these outcomes. Thick gingival biotype might be a prerequisite for optimal early wound healing. However, the type of early healing seems not to affect the long-term outcomes after regenerative treatment in aggressive periodontitis patients.

Diagnosis and non-surgical treatment of peri-implant diseases and maintenance care of patients with dental implants – Consensus report of working group 3

The following consensus report is based on four background reviews. The frequency of maintenance visits is based on patient risk indicators, homecare compliance and prosthetic design. Generally, a 6-month visit interval or shorter is preferred. At these visits, peri-implant probing, assessment of bleeding on probing and, if warranted, a radiographic examination is performed. Diagnosis of peri-implant mucositis requires: (i) bleeding or suppuration on gentle probing with or without increased probing depth compared with previous examinations; and (ii) no bone loss beyond crestal bone level changes resulting from initial bone remodelling. Diagnosis of peri-implantitis requires: (i) bleeding and/or suppuration on gentle probing; (ii) an increased probing depth compared with previous examinations; and (iii) bone loss beyond crestal bone level changes resulting from initial bone remodelling. If diagnosis of disease is established, the inflammation should be resolved. Non-surgical therapy is always the first choice. Access and motivation for optimal oral hygiene are key. The patient should have a course of mechanical therapy and, if a smoker, be encouraged not to smoke. Non-surgical mechanical therapy and oral hygiene reinforcement are useful in treating peri-implant mucositis. Power-driven subgingival air-polishing devices, Er: YAG lasers, metal curettes or ultrasonic curettes with or without plastic sleeves can be used to treat peri-implantitis. Such treatment usually provides clinical improvements such as reduced bleeding tendency, and in some cases a pocket-depth reduction of ≤ 1mm. In advanced cases, however, complete resolution of the disease is unlikely.

Periodontal tray application of chlorine dioxide gel as an adjunct to scaling and root planing in the treatment of chronic periodontitis

ObjectiveClinical improvement after periodontal tray application of chlorine dioxide gel as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis was studied for a period of 30 days. Materials and methodsThe tray fabrication was performed in a dental laboratory using the Soft – Tray Sheets (Ultradent™), whereas scaling and root planing were done using ultrasonic scaler and hand instruments. A total of 36 subjects with chronic periodontitis were divided into 3 treatment groups: group I was treated with SRP procedure combined with the prescription-tray application of chlorine dioxide gel; group II was treated with SRP procedure with the application of chlorine dioxide alone; and group III was treated with SRP procedure alone. Clinical parameters examined were probing pocket depth (PPD) and papillary bleeding index (PBI); measurements were taken at baseline (day0) and 30 days after SRP (day 30). Comparison between treatment groups was tested statistically by Kruskal Wallis test and Analysis of Variance (ANOVA). ResultsThere were significant differences in the decrease of the average pocket depth and bleeding index in all the 3 treatment groups (P = 0.001). Decreases in the pocket depth of groups I, II, and III were 50.9%, 47.9%, and 27.8%, respectively. Decreases in the papillary bleeding index of groups I, II, and III were 88.2%, 68.9%, and 51.1%, respectively. ConclusionThe application of chlorine dioxide gel using the custom tray after SRP in the treatment of chronic periodontitis showed better clinical improvement in pocket depth reduction and bleeding index compared to SRP alone.