Subgingival Scaling Research Articles

Non-Surgical Periodontal Therapy With Ankaferd Blood Stopper In Patients With Bleeding Disorder: A Case Series

Objectives: Ankaferd, medicinal plant extract, has previously been used in Turkish traditional medicine as a hemostatic agent. Bleeding disorders are rare condition require specialist management. Ankaferd Blood Stopper (ABS) may be a useful agent for non-surgical periodontal therapy in these patients. The aim of this case-series study was to estimate the effects of local ABS application to manage bleeding following non-surgical periodontal therapy in these patients. Methods: Ten gingivitis patients (9 males, 1 female) aged 20-33 years were selected with bleeding disorders (Haemophilia A, von Willebrand disease and Glanzmann’s Thrombasthenia). Non-surgical periodontal therapy including oral hygiene instructions and supraand subgingival scaling procedures were performed in one appointment, after consultation with the hematologist, without systemic substitution of coagulation factors. After the completion of scaling, ABS was locally applied to gingival crevicular to reduce bleeding. A secondary hemorrhage did not occur in any of the patients and gingival tissue healing proceeded without any complications. Results: In the present case series, local application of ABS to gingival pockets following supraand subgingival scaling procedures was effective to manage bleeding in these patients. Conclusion: Our cases clearly showed that ABS provides benefit for non-surgical periodontal therapy in bleeding disorders.

Periodontal effects of 0.25% sodium hypochlorite twice‐weekly oral rinse. A pilot study

The study aimed to evaluate the effect of 0.25% sodium hypochlorite twice-weekly oral rinse on plaque and gingivitis in patients with minimally treated periodontitis. The study included 30 patients with periodontitis, it lasted 3mo, and it was performed as a randomized, controlled, single-blinded, clinical trial in parallel groups. Fifteen patients rinsed for 30s with 15mL of a fresh solution of 0.25% sodium hypochlorite (test) and 15 patients rinsed with 15mL of water (control). Clorox(®) regular bleach was the source of the sodium hypochlorite. At baseline and at 2wk, the study patients received professional subgingival irrigation for 5min with either 0.25% sodium hypochlorite or water, but no subgingival or supragingival scaling. The presence or absence of supragingival plaque on facial and lingual surfaces was determined by visual inspection; each tooth was dried with air and mouth mirror rotation was used to provide light reflection to identify plaque on smooth surfaces and at the tooth line angles. Gingival bleeding within 30s after probing to full pocket depth was assessed in six sites of each tooth. Adverse events were evaluated by questionnaire and visual examination. All 30 patients in the study completed the baseline and the 2wk parts of the study and a subset of 12 participants completed the 3mo part of the study. The sodium hypochlorite rinse group and the water rinse group, respectively, showed increases from baseline to 3mo of 94% and 29% (3.2-fold difference) in plaque-free facial surfaces, of 195% and 30% (6.5-fold difference) in plaque-free lingual surfaces, and of 421% and 29% (14.5-fold difference) in number of teeth with no bleeding on probing. The differences in clinical improvement between the sodium hypochlorite rinse group and the water rinse group were statistically significant. No adverse events were identified in any of the study patients, except for minor complaints about the taste of bleach. A twice-weekly oral rinse with 0.25% sodium hypochlorite produced marked decreases in dental plaque level and bleeding on probing and may constitute a promising new approach to the management of periodontal disease. Long-term controlled studies on the effectiveness of sodium hypochlorite oral rinse are needed and encouraged.

Clinical Evaluation of Chlorine Dioxide for Disinfection of Dental Instruments

This study aimed to clinically evaluate the disinfection efficacy of chlorine dioxide (ClO2) for used dental instruments. An imprint culture technique demonstrated that ultrasonic cleaning of intraorally applied dental mirrors in 0.02% ClO2 for 10 minutes resulted in compete removal of microorganisms for 10 subjects. Hepatitis C virus (HCV) RNA was detected by real-time polymerase chain reaction on periodontal curettes after subgingival scaling in four HCV-infected patients and was completely removed by the same treatment procedure. Therefore, the combination of ultrasonic cleaning with ClO2 may provide an alternative to toxic disinfectants, such as glutaraldehyde and sodium hypochlorite, for disinfecting dental instruments.

Early analgesia after periodontal treatment in dogs: a comparison of three analgesic protocols

The analgesic effects of carprofen, morphine and bupivacaine on early oral pain after periodontal treatment in dogs have been poorly investigated. Forty-five client-owned dogs (8.5 ± 6.4 kg and 7.8 ± 3.2 years) scheduled for periodontal treatment were allocated to carprofen, morphine and bupivacaine groups (n = 15 each). The study was designed as a prospective, randomised, double “blinded” clinical study. Carprofen (CAR, 4 mg/kg, subcutaneously) or morphine (MOR, 0.3 mg/kg, intramuscularly) was given thirty minutes before the dogs were placed under anesthesia. Bilateral maxillary and mandibular nerve blocks were performed with bupivacaine (BUP, 1 mg/kg), after the induction of anesthesia. Dogs were anaesthetised with medetomidine-propofol-isoflurane and reversal was carried out using atipamezole. Periodontal painful sub-gingival scaling was performed in all dogs. Periodontal treatment lasted for up to one hour. A modified University of Melbourne Pain Score (UMPS, 0–28 points), Visual Analog pain Scale (VAS, 0–100 mm), plasma glucose (Glu) and serum cortisol (Cor) levels were assessed before administration of analgesics (MOR-0, CAR-0, BUP-0) and two hours thereafter, that is thirty minutes after atipamezole administration (MOR-2, CAR-2, BUP-2). Analgesia rescue with tramadol (2 mg/kg intramuscularly) was provided for animals with modified UMPS over 14 or VAS over 50 points. Differences in Glu and Cor values were analysed with analysis of variance (ANOVA) for repeated measures, in UMPS and VAS over time for each group with the Friedman test and pre- and postoperatively using the Mann-Whitney U-test. Differences were considered significant at P < 0.05. Analgesia rescue was provided to one patient of the CAR group and one patient of the MOR group. No differences in UMPS values between groups were detected. A significant increase in VAS values after treatment was detected in all groups. Plasma glucose levels significantly increased in MOR-2 compared to MOR-0 and CAR-2. Serum cortisol levels significantly increased in MOR-2 compared to MOR-0, CAR-2 and BUP-2. The results of this study indicate that bupivacaine nerve blocks could be superior to carprofen, which in turn could be superior to morphine, for early analgesia (up to two hours) following sub-gingival scaling for periodontal treatment in dogs.  

Effect of periodontal initial therapy on teeth with chronic periodontitis and secondary occlusal trauma

To evaluate the effect of subgingival scaling/root planning (SRP) and occlusal adjustment on clinical and occlusal parameters in teeth with chronic periodontitis and secondary occlusal trauma. Eighteen patients with chronic periodontitis and occlusal trauma were included and randomly divided into group A and group B. On day 0, group A was treated by full-mouth subgingival scaling and root planning, and group B was treated by occlusal adjustment in occlusal trauma site. On day 28, group A was treated by occlusal adjustment in occlusal trauma site, and group B was treated by full-mouth subgingival scaling and root planning. Probing depth (PD), attachment loss (AL), bleeding index (BI) were evaluated on 0, 28 and 56 d, and the occlusal time (OT) and the percentage of occlusal force were evaluated on 0, 28 and 56 d in occlusal trauma site. The data was statistically analyzed. In baseline, the PD[(4.42 ± 1.41) mm vs (4.36 ± 1.38) mm], AL [(2.75 ± 1.32) mm vs (2.63 ± 1.37) mm] and BI [(2.20 ± 0.81) vs (2.24 ± 0.89)] of the full-mouth showed no significant difference between the two groups (P > 0.05). There was no significant difference in PD [(5.21 ± 1.21) mm vs (5.08 ± 1.12) mm], AL [(4.94 ± 1.47) mm vs (4.89 ± 1.32) mm], BI [(2.61 ± 0.92) vs 2.50 ± 0.79)], OT [(1.29 ± 0.39) s vs (1.34 ± 0.35) s] and the percentage of occlusal force [(6.8 ± 2.1)% vs (7.4 ± 1.7)%] in occlusal trauma site between the two groups(P > 0.05). After SRP therapy, the PD,AL,BI and OT were significantly decreased (P < 0.05).The clinical parameters exhibited no significant difference after only occlusal adjustment(P > 0.05).On 56 d, the reduction in clinical parameters was not significantly different between the two groups(P > 0.05),however the reduction of OT and the change of the percentage of occlusal force in group A [(0.85 ± 0.41) s, (2.2 ± 2.2)%] were more significant than those in group B [(0.70 ± 0.38) s; (1.5 ± 1.6)%] (P < 0.05). After occlusal adjustment, the increase of OT in group A [(0.21 ± 0.11) s] was lower than that in group B [(0.67 ± 0.37) s]through the 28-day observation period (P < 0.05). Occlusal adjustment alone is inadequate for control and management of periodontitis.SRP therapy can eliminate the inflammation and decrease the OT of tooth with occlusal trauma.The combination of SRP and occlusal adjustment may achieve more stable results.

Non‐surgical periodontal therapy decreases serum elastase levels in aggressive but not in chronic periodontitis

Assessment of the effect of non-surgical periodontal therapy (SRP) on serum inflammatory parameters in patients with untreated aggressive (AgP) and chronic (ChP) periodontitis. Overall, 31 ChP and 29 AgP were examined clinically prior to and 12weeks after SRP (subgingival scaling of all pockets within 2days) with systemic antibiotics for patients positive for Aggregatibacter actinomycetemcomitans (14 AgP, 9 ChP). Blood was sampled prior to, one day, 6, and 12weeks after the first SRP visit. Serum elastase, C-reactive protein (CRP), lipopolysaccharide-binding protein (LBP), interleukin (IL) 6, 8, and leukocyte counts were assessed. At baseline, serum elastase, CRP, and LBP were significantly (p<0.01) higher in AgP than ChP. Serum elastase, CRP, LBP, and IL-6 were significantly (p<0.001) elevated one day after scaling in both groups. Both groups showed significant clinical improvement (p<0.001). A significant difference was observed regarding change of serum elastase 12weeks after SRP between AgP and ChP (p=0.015). Multiple regression analysis revealed AgP, African origin, and bleeding on probing to be associated with more pronounced elastase reduction. CRP reduction was associated with African origin, systemic antibiotics, and baseline probing pocket depth. SRP results in serum elastase reduction in AgP but not in ChP.

Effect of periodontal treatment on the clinical parameters of patients with rheumatoid arthritis: study protocol of the randomized, controlled ESPERA trial.

BackgroundRheumatoid arthritis (RA) is a chronic inflammatory disorder that leads to joint damage, deformity, and pain. It affects approximately 1% of adults in developed countries. Periodontitis is a chronic oral infection, caused by inflammatory reactions to gram-negative anaerobic bacteria, and affecting about 35 to 50% of adults. If left untreated, periodontitis can lead to tooth loss. A significant association has been shown to exist between periodontitis and RA in observational studies. Some intervention studies have suggested that periodontal treatment can reduce serum inflammatory biomarkers such as C-reactive protein, or erythrocyte sedimentation rate. We hypothesize that periodontitis could be an aggravating factor in patients with RA, and that its treatment would improve RA outcomes. The aim of this clinical trial is to assess the effect of periodontal treatment on the biological and clinical parameters of patients with RA.Methods/designThe ESPERA (Experimental Study of Periodontitis and Rheumatoid Arthritis) study is an open-label, randomized, controlled trial. Subjects with both RA and periodontitis will be recruited at two university hospitals in southwestern France. In total, 40 subjects will be randomized into two arms (intervention and control groups), and will be followed up for 3 months. Intervention will consist of full-mouth supra-gingival and sub-gingival non-surgical scaling and root planing, followed by systemic antibiotic therapy, local antiseptics, and oral hygiene instructions. After the 3-month follow-up period, the same intervention will be applied to the subjects randomized to the control group.The primary outcome will be change of in Disease Activity Score in 28 Joints (DAS28) at the end of the follow-up period. Secondary outcomes will be the percentages of subjects with 20%, 50%, and 70% improvement in disease according to the American College of Rheumatology criteria. Health-related quality of life assessments (the Health Assessment Questionnaire and the Geriatric Oral Health Assessment Index) will also be compared between the two groups.DiscussionEvidence-based management of potential aggravating factors in subjects with active RA could be of clinical importance, yet there are few randomized controlled trials on the effect of periodontal treatment on the clinical parameters of RA. The ESPERA trial is designed to determine if non-surgical periodontal treatment could improve clinical outcomes in patients with active RA, and the quality of life of these patients.Trial registrationThe ESPERA Trial was registered in Current Controlled Trials [ISRCTN79186420] on 2012/03/20. The trial started recruiting on 2012/03/06.

Onychophagia and postorthodontic isolated gingival recession: Diagnosis and treatment

This clinical report describes the diagnosis and the management of isolated-type recession defects of complex etiology in 2 healthy postorthodontic patients. The lesions were confined to 1 mandibular incisor and were associated with an abnormal buccolingual inclination of the affected tooth despite a lingual retainer made with a round stainless steel twisted wire. After careful questioning, it was determined that the recession defects were indirect effects of habitual onychophagia. The concomitant fingernail-biting habit and the lingual bonded retainer led to the indirect development of bone dehiscence and, consequently, gingival recession.

Short term effect of combined use of amoxicillin and metronidazole at different time of non-surgical periodontal treatment for aggressive periodontitis

To evaluate the short term clinical results of scaling and root planning (SRP) only, SRP combined with amoxicillin (AMX) and metronidazole (MTZ) after supragingival scaling or after SRP in the treatment of aggressive periodontitis (AgP). A total of 45 patients with AgP were randomly divided into SRP group, SRP with AMX + MTZ after supragingival scaling group and AMX + MTZ after SRP group. Subgingival scaling and root planning were performed one week after supragingival scaling and finished within 1 month. AMX and MTZ were given for 7 days immediately after supragingival scaling or the last time of SPR. Clinical examinations including probing depth (PD), attachment level (AL) and bleeding index (BI) were performed at baseline and 8 weeks after non-surgical periodontal treatment by the same examiner. There were more PD reduction and AL gain in both AMX + MTZ after supragingival scaling group and AMX + MTZ after SRP group compared with SRP group [2.5 (1.8, 3.3) mm, 2.3 (1.9, 2.7) mm vs. 1.8 (1.3, 2.1) mm, P < 0.05]; [0.9 (0.5, 1.4) mm, 0.8 (0.4, 1.3) mm vs. 0.4 (0.2, 1.0) mm, P < 0.05]. In sites PD ≥ 7 mm, PD reduction was more in AMX + MTZ after supragingival scaling group than AMX + MTZ after SRP group [4.0 (3.0, 5.0) mm vs. 4.0 (3.0, 4.0) mm, P < 0.05)]. The combined use of AMX and MTZ during non-surgical periodontal treatment for patients with AgP was effective in short term. In patients with most sites PD ≥ 7 mm, AMX and MTZ could be taken after supragingival scaling, but the long-term clinical effects needs further investigation.

Comparison of treatment effect between periodontal subgingival scaling with the special series of ultrasonic inserts and Gracey curette

To compare the special series of ultrasonic inserts with Gracey curettes in the effectiveness and efficiency for non-surgical periodontal treatment. A total of 30 patients with moderate to advanced chronic periodontal disease were treated with both ultrasonic inserts (ultrasonic group) and Gracey curettes (Gracey group) according to a prospective, randomized, controlled, one-blind, "split-mouth" design. Twenty-six cases were available for the whole follow-up period. Plaque index (PLI), bleeding index(BI), probing depth (PD), attachment loss (AL) were evaluated before and 6 weeks after treatment. Treatment time was recorded. The severity of pain during treatment and teeth sensitivity after treatment were evaluated by the visual analogue scale (VAS). Differences in clinical parameters were analyzed with the Wilcoxon signed ranks test and Mann and Whitney U-test. No significant differences in any of the clinical parameters were observed at baseline between the two groups. The mean value of PD, BI, PLI, AL decreased in both ultrasonic group and Gracey group. At moderately deep site (initial PD between 4 mm and 5 mm), PD [M(Q(25), Q(75))] changed in the ultrasonic group from 4.0 (4.0, 4.5) mm to 3.0 (3.0, 3.0) mm (P < 0.001) and in the Gracey group from 4.0 (4.0, 5.0) mm to 3.0(3.0, 3.0) mm (P < 0.001). At deep sites (initial PD ≥ 6 mm) PD [M(Q(25), Q(75))] changed in the ultrasonic group from 7.0(6.0, 7.0) mm to 5.0(4.0, 7.0) mm (P < 0.001) and in the Gracey group from 7.0 (6.0, 7.0) mm to 5.0(4.0, 6.0) mm(P < 0.001). In the furcation area, PD [M(Q(25), Q(75))] changed from 5.0(4.0, 7.0) mm to 3.0(3.0, 5.0) mm (P < 0.001) in both Gracey group and ultrasonic group. However, the average time of active instrumentation was (2.41 ± 0.61) min/tooth in the ultrasonic scaling and (2.71 ± 0.61) min/tooth in the Gracey curette (P < 0.001). VAS scores [M(Q(25), Q(75))] of pain during treatment was 5.0(3.0, 6.7) in the ultrasonic group and 5.9 (4.9, 8.0) in the Gracey group (P = 0.001). VAS scores [M(Q(25), Q(75))] of sensitivity after treatment was 4.0 (1.8, 6.0) in the ultrasonic group and 4.9 (2.0, 8.0) in the Gracey group (P = 0.043). Treatment with the special series of ultrasonic inserts was as effective as the Gracey curette during initial therapy period in all clinical parameters measured and has the advantage of being quicker.

Felipressina aumenta pressão arterial durante procedimento odontológico em pacientes hipertensos

Felypressin has been added to local anesthetic to increase the length of the anesthetic effect and reduce toxicity during dental procedures. However, the effect on blood pressure remains uncertain, and this may be highly relevant in the dental treatment of hypertensive patients. To investigate the effect of felypressin on blood pressure in hypertensive patients with controlled BP. 71 subjects with these characteristics and in need of periodontal treatment were studied. After 10 minutes of rest, local anesthesia (prilocaine) was infiltrated with and without addition of felypressin. Then, a deep subgingival scaling was performed. Blood pressure was measured by an automated oscillometric device (DIXTAL DX2010). Ten minutes after the administration of the anesthetic, peak anesthetic action was recorded. The State-Trait Anxiety Inventory (STAI) was used to assess the patients' trait anxiety. Systolic blood pressure increased after anesthesia, regardless of association with felypressin, throughout the dental procedure (p<0.05) and this response can be explained, at least in part, by the trait anxiety levels of the subjects. However, a further increase in diastolic blood pressure was observed when prilocaine was associated with felypressin (p<0.05), but this response did not change with trait anxiety levels. Felypressin increased the diastolic blood pressure of hypertensive patients with controlled blood pressure. Patients with high trait anxiety presented increases in systolic blood pressure upon some procedures, suggesting that an increase in blood pressure might also be related to fear or anxiety.

Efecto del tratamiento periodontal sobre la microbiota subgingival en pacientes con preeclampsia

Introduction. Few studies have described subgingival microbiota in pregnant women with mild preeclampsia.Objective. Clinical periodontal and subgingival microbiota changes were identified in pregnant women with mild preeclampsia after periodontal treatment.Materials and methods. In a secondary analysis of a randomized clinical trial, 57 preeclamptic women were studied at Hospital Universitario del Valle in Cali, Colombia. Thirty one women were randomized to the periodontal intervention group (subgingival scaling and planing ultrasonic and manual) during pregnancy and 26 to the control group (supragingival prophylaxis). Periodontal clinical parameters and subgingival microbiota were characterized at the time of acceptance into the study and again atpostpartum. Eight periodontopathic bacteria and 2 herpesviruses were assessed by polymerase chain reaction. Chi-square, McNemar or Student’s t tests were used, with a significance level of p≤0.05.Results. Both groups were comparable in the clinical and microbiological variables at baseline. Periodontal treatment reduced the average pocket depth in the intervention group from 2.4±0.3 to 2.3±0.2 mm (p&lt;0.001) and in control group 2.6±0.4 to 2.44±0.4 mm, (p&lt;0.001) and bleeding index 16.4±1.5% to 7.9±0.7% in the intervention group(p&lt;0.001) and 17.1±1.8% to 10±0.9% in the control group (p=0.002). The frequency of detection of microorganisms did not differ significantly between groups.Conclusion. Scaling/root planning and supragingival prophylaxis significantly reduced the probing depth and gingival bleeding index. Periodontal treatment was not more effective than prophylaxis in reducing periodontopathic organisms or herpesvirus.

Effect of Mechanical Debridement on Distal Periodontal Aspects of Second Molars After the Extraction of Third Molars: A Systematic Review

The risk of periodontal defects after the extraction of third molars continues to challenge clinicians. Intervention trials, including subgingival scaling and/or root planing, were systematically reviewed. Data sources included the Cochrane Oral Health Group Trials Register and MEDLINE. The primary outcome was postoperative change in pocket probing depth (PD). The electronic search yielded 751 abstracts, and manual searching added one study. From them, four trials fulfilled the inclusion criteria and were selected for review. The overall sample size of the studies was small, ranging from 15 to 30 participants. Only one trial was considered to present with low risk for bias in the sequence generation, the concealment of allocation to treatment, and the strategy for masking. The lack of information provided by the authors of the remaining studies resulted in unclear or high risk of bias for the chief dimensions of trial quality. The heterogeneity of the studies did not allow the use of meta-analysis to summarize the results of several studies. Preliminary evidence originating from a small study suggests that ultrasonic root debridement of the second molar and a three-visit plaque control program may have a beneficial effect on PD levels on the second molar. The available intervention trials on this topic have important limitations, and, consequently, there is insufficient evidence to recommend the use of mechanical debridement of second molars after the extraction of third molars.

Effects of Periodontal Therapy on Systemic Markers of Inflammation in Patients With Metabolic Syndrome: A Controlled Clinical Trial

The systemic inflammation in both metabolic syndrome (MetS) and periodontitis is a common denominator of the association of these conditions with higher risk of atherosclerosis. The current study investigates whether periodontal therapy may reduce systemic inflammation in patients with MetS and reduce cardiovascular risk. A parallel-arm, double-blind, randomized clinical trial of 1-year duration in patients with MetS and periodontitis was conducted. Participants were randomized to an experimental treatment group (ETG) (n = 82) that received plaque control and root planing plus amoxicillin and metronidazole or to a control treatment group (CTG) (n = 83) that received plaque control instructions, supragingival scaling, and two placebos. Risk factors for cardiovascular disease were recorded; serum lipoprotein cholesterol, glucose, body mass index (BMI), C-reactive protein (CRP) and fibrinogen concentrations, and clinical periodontal parameters were assessed at baseline and every 3 months until 12 months after therapy. The primary and secondary outcomes were changes in CRP and fibrinogen levels, respectively. The baseline patients' characteristics of both groups were similar. No significant changes in lifestyle factors, frequency of hypertension, BMI, serum lipoprotein cholesterol, and glucose levels were observed during the study period. The periodontal parameters significantly improved in both groups 3 months after therapy (P = 0.0001) and remained lower than baseline up to 12 months. The improvement of periodontal status was significantly greater in the ETG (P = 0.0001). A multiple linear regression analysis, controlled for sex, smoking, hypertension, and extent of periodontitis, demonstrated that CRP levels decreased with time and that this reduction was significant at 9 (P = 0.024) and 12 (P = 0.001) months in both groups, without difference between the groups. Fibrinogen levels significantly decreased in the ETG at 6 and 12 months but not in the CTG. Reduction of periodontal inflammation either with root planing and systemic antibiotics or with plaque control and subgingival scaling significantly reduces CRP levels after 9 months in patients with MetS.

In vitro comparison of subgingival scaling of Er-Yag laser with ultrasonic devices

In vitro comparison of subgingival scaling of Er-Yag laser with ultrasonic devices

Selective serotonin reuptake inhibitors and oral bleeding complications after invasive dental treatment

The purpose of this study was to examine the frequency of oral bleeding complications after invasive dental procedures in patients taking selective serotonin reuptake inhibitor (SSRI) medications. In this retrospective cohort study, we included dental patients who had invasive dental treatment and were taking an SSRI medication. Data collected included demographics, medical history, dental visits and procedures, and use of adjunctive measures to control bleeding. Primary outcomes included documentation of return visits or phone calls to the dental clinic or emergency department (ED) for oral bleeding, and oral bleeding or use of blood products for inpatients. There were 92 patients taking SSRIs who had 145 invasive procedure visits, consisting of extractions, implant surgery, alveoloplasty, periodontal surgery, subgingival scaling and root planning, and biopsy. There were 110 extraction visits yielding a total of 167 extractions. Among all patients, there was 1 return visit to the clinic and 1 telephone call with a chief complaint of oral bleeding. The frequency of oral bleeding complications after invasive dental treatment is low to negligible in patients on SSRI medications.

Case report: Hypodontia and short roots in a child with Fraser syndrome

Fraser syndrome is a rare autosomal recessive disorder of which there has only previously been one case reported in the dental literature. The main characteristics are cryptophthalmos, syndactyly and genital abnormalities. Orofacial findings reported are: facial asymmetry, cleft lip and palate, high arched palate, dental crowding, fusion of primary teeth, dental hypoplasia, malocclusion, and supragingival calculus. A 15 year old girl with Fraser syndrome attended Bradford and Airedale salaried dental services complaining of painful mandibular anterior teeth. On examination she presented with hypodontia, shortened roots, and the mandibular anteriors had a titanium trauma splint fixed to reduce the mobility. This had been placed 4 years previously by a paediatric specialist. However oral hygiene was poor around it and therefore the patient had calculus and gingivitis. The splint was removed followed by subgingival scaling under local analgesia, fissure sealants of all posterior teeth, regular oral hygiene instruction and scaling, and occasional use of chlorhexidine gel. She has been reviewed regularly with frequent scalings over two years. This case reports the possibility of hypodontia and short roots being associated with Fraser syndrome.

Effects of nonsurgical periodontal therapy on C-reactive protein and serum lipids in Jordanian adults with advanced periodontitis

Data on whether periodontal therapy affects serum CRP levels are inconclusive. The aim of this study was to determine if nonsurgical periodontal therapy has any effect on CRP and serum lipid levels in patients with advanced periodontitis. Thirty-six systemically healthy patients, ≥ 40 years of age and with advanced periodontitis, were recruited for the study. Patients were randomized consecutively to one of two groups: the treatment group (n = 18) or the control group (n = 18). Treated subjects received nonsurgical periodontal therapy, which included oral hygiene instructions and subgingival scaling and root planing. Systemic levels of inflammatory markers [C-reactive protein (CRP) and the lipid profile] were measured at baseline and 3 mo after periodontal therapy. Nonsurgical periodontal therapy in the treatment group resulted in a significant reduction in the serum CRP level. The average CRP level decreased from 2.3 mg/dL at baseline to 1.8 mg/dL (p < 0.005) after 3 mo of periodontal therapy. The average reduction (95% confidence interval) in CRP was 0.498 (95% confidence interval = 0.265-0.731). In the treatment group, the reduction in CRP was significantly, linearly and directly correlated with the reduction in the plaque index, the gingival index and the percentage of sites with pocket depth ≥ 7 mm (Pearson correlation coefficient = 0.746, 0.425 and 0.621, respectively). Nonsurgical periodontal therapy had no effect on the lipid parameters. This study demonstrated that nonsurgical periodontal therapy results in a significant reduction in the serum CRP level. The effect of this outcome on systemic disease is still unknown.

American Academy of Periodontology Statement on the Efficacy of Lasers in the Non‐Surgical Treatment of Inflammatory Periodontal Disease

American Academy of Periodontology Statement on the Efficacy of Lasers in the Non‐Surgical Treatment of Inflammatory Periodontal Disease

Microscope-controlled glass bead blasting: a new technique

Microscope-controlled glass bead blasting: a new technique Peter Kotschy1, Sascha Virnik2, Doris Christ3, Alexander Gaggl21Private Practice, Vienna, Austria; 2Department of Oral and Maxillofacial Surgery, Central Hospital, Klagenfurt, Austria; 3Klagenfurt, AustriaObjective: The aim of periodontal therapy is the healing of periodontal inflammation; the protection of the attachment and the alveolar bone; and the regeneration of the periodontal structures. In the therapy of periodontitis, supra- and subgingival scaling and root planing plays a main role. The procedure described combines perfect root cleaning without scaling and root planing and minimal invasive periodontal surgery without a scalpel.Material and methods: Glass beads of 90 &micro;m were used with the kinetic preparation unit PrepStart&reg; under a pressure of 0.5&ndash;5 bar. This technique was practised only under visual control using the OPMI&reg; PRO Magis microscope. Seven examinations were carried out at baseline after 3, 6, 12, 18, 24, and 36 months.Results: Time shows a statistically significant influence on all of the considered target variables (P &lt; 0.0001 for all). As the according estimate is negative, probing depth decreases over time. The major decrease seems to be during the first 6 months. Considering probing depth, plaque on the main effect root shows significant influence (again, P &lt; 0.0001 for all). Observations with high probing depth at the beginning were faster than those with low probing depth. The same characteristic appears by attachment level. Patients with more loss of attachment show more gain.Conclusions: Using microscope-controlled glass bead blasting results in a perfectly clean root surface using visual control (magnification 20&times;). Microscope-controlled glass bead blasting is therefore a good alternative to periodontal surgery.Keywords: periodontal therapy, microscope, periodontitis