Supportive Periodontal Care Research Articles

Periodontal and peri-implant bleeding on probing in patients undergoing supportive maintenance: a cross-sectional study

ObjectiveAssessment of periodontal and peri-implant inflammation, evidenced by bleeding on probing (BOP), among partially dentate patients receiving supportive periodontal care (SPC).Material & methodsPatient charts from the Center for Dentistry and Oral Medicine of Goethe-University Frankfurt with at least one dental implant were reviewed. Measurements included probing pocket depth (PPD), BOP, and full-mouth bleeding and plaque scores for all teeth and implants.Results100 patients (median; lower/upper quartile: age 68.9; 62.6/76.5 years; 51 females, 6 smokers, 16 with anticoagulative medication, 6 localized stage III, 57 generalized stage III, 37 stage IV, 70 grade B, 30 Grade C, 22; 20/25 teeth left, 2; 1/4 implants) were examined. Peri-implant BOP (24; 11.5/41.5%) was significantly higher than BOP at teeth (14; 8/21.5%) (p < 0.001). A median of 0 (0/1) implants exhibited no BOP and 0 (0/1) only one site with BOP. Shallow pockets (PPD 1–3 mm) were significantly more frequent in teeth (93; 87/97%) than in implants (72.5; 58/94.5%; p < 0.001). Moderately deep pockets (PPD 4 and 5 mm) were less frequent in teeth compared to implants (6; 2/11%; 22; 5.5/33%; p < 0.001).ConclusionsPeri-implant sites exhibit a higher prevalence of BOP compared to periodontal sites in SPC patients.Clinical relevancePractitioners providing supportive periodontal care to patients with dental implants should anticipate a greater prevalence of BOP around implants compared to teeth.

Clinical outcomes and supragingival microbiota analysis around dental implants and teeth in patients with a history of periodontitis: a preliminary study of 6 months follow-up.

To investigate the supragingival microbiome surrounding dental implants and neighbouring tooth in periodontitis history and periodontally healthy patients. Subjects with a history of periodontitis (test) and periodontally healthy subjects (control) received one of two types of dental implants with different surface characteristics: sandblasted acid-etched (SLA) or precision dimension laser-treated (PDL). Periodontal clinical measurements were collected at baseline (V1), 3 months after implant placement (V4), at zirconia crown placement (V6) and 3 months after zirconia crown placement (V8). Supragingival bacterial microbiota was studied using Illumina MiSeq sequencing. Supragingival microbial community on SLA implants in test group significantly differed to control group at V8 (p < 0.05). A longitudinal shift displaying microbial dysbiosis occurred on SLA implants (p < 0.05) and adjacent teeth (p < 0.05) among test patients from V6 to V8. On PDL implants and the adjacent tooth, no significant difference between test and control groups from V6 to V8 (p > 0.05). Co-occurrence network in test group of SLA implants and the adjacent tooth at V8 showed increased disease-associated bacteria and reduced health-associated bacteria. Health-associated bacteria were dominant in control group of SLA implants at V8. The surface characteristics and prosthetic components of dental implants may be important risk factors in patients with a history of periodontitis. Dysbiosis of supragingival microbiome may predispose dental implants to peri-implant diseases. Thus, a strict supportive periodontal care plan is imperative to prevent early onset of biological complications.

A feasibility study to recruit, retain and treat periodontitis in volunteers with mild dementia, whilst monitoring their cognition

ObjectivesDementia patients are challenging to manage dentally. This study determined whether individuals with mild dementia and periodontitis, could be recruited, retained and demonstrate sustained oral health improvements over 2 years following personalised professional periodontitis treatment. The feasibility of same visit cognition measurements was assessed. MethodsA non-randomised study in individuals with mild dementia, capacity to consent, periodontitis and ≥6 teeth. Following enrolment and dental/cognitive assessments, personalised periodontal treatment, followed by 3-monthly supportive periodontal care was performed. Cognitive and periodontal assessments were undertaken at 6, 12, 24-months. Participants and project-partners fed back on homecare regimens. Results18 participants were recruited, 15 completed 12- & 8 completed 24-months, 1 participant failed to attend one appointment, and early study termination due to COVID19. From baseline to 12-months mean percentage bleeding sites, Turesky plaque score ≥2 and periodontal pockets ≥4 mm decreased significantly (34.4 vs 14.75, p < 0.01; 78.49 vs 57.5, p < 0.01; 18.38 vs 5.14, p < 0.001). Significant change from baseline was retained at 24-months for mean percentage periodontal pockets ≥4 mm (14.47 vs 4.29, p < 0.05; n = 8). Cognition declined significantly to 12-months (mean ACEIII 71.47 vs 65.40, p < 0.05), but not between 12- and 24-months (67.5 vs 65.38, n = 8). Most reported home-care regimen as easy/OK to follow. ConclusionsMild dementia participants with periodontitis can be recruited, retained in a 24-month study and periodontally treated with personalised professional and at-home care regimens. Cognitive assessments can be performed at the same treatment visit. This demonstrates sustained engagement and supports oral health compliance can be successful in challenging cohorts.

Applying current European periodontitis clinical practice guidelines is not feasible even for the richest countries in the world.

Clinical practice guidelines aim to enhance the quality, equality and consistency of care but often demand more time than is available, rendering adherence impractical and exceeding feasible resources. The 2017 introduction of a new periodontal classification system by the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP) sought to refine clinical and epidemiological practices by serving as the basis for clinical practice guidelines and epidemiological investigations around the world. Following this classification, the EFP recommends supportive periodontal care visits every 3-12 months for all periodontitis cases. Given that in Norway, approximately 72% of the adult population are identified as periodontitis cases under the current AAP/EFP case definition, this poses a significant demand on healthcare resources. We calculated that between 60% and 70% of all estimated available working hours available for adult dental care provided by dentists and dental hygienists in Norway in 2017 would be spent on supportive periodontal care visits alone if the recommendations were to be met. This situation calls for a reevaluation of disease definitions and clinical practice guidelines to ensure they are practical, financially feasible and patient-outcome relevant.

Exploring the accuracy of tooth loss prediction between a clinical periodontal prognostic system and a machine learning prognostic model.

The aim of this analysis was to compare a clinical periodontal prognostic system and a developed and externally validated artificial intelligence (AI)-based model for the prediction of tooth loss in periodontitis patients under supportive periodontal care (SPC) for 10 years. Clinical and radiographic parameters were analysed to assign tooth prognosis with a tooth prognostic system (TPS) by two calibrated examiners from different clinical centres (London and Pittsburgh). The prediction model was developed on the London dataset. A logistic regression model (LR) and a neural network model (NN) were developed to analyse the data. These models were externally validated on the Pittsburgh dataset. The primary outcome was 10-year tooth loss in teeth assigned with 'unfavourable' prognosis. A total of 1626 teeth in 69 patients were included in the London cohort (development cohort), while 2792 teeth in 116 patients were included in the Pittsburgh cohort (external validated dataset). While the TPS in the validation cohort exhibited high specificity (99.96%), moderate positive predictive value (PPV = 50.0%) and very low sensitivity (0.85%), the AI-based model showed moderate specificity (NN = 52.26%, LR = 67.59%), high sensitivity (NN = 98.29%, LR = 91.45%), and high PPV (NN = 89.1%, LR = 88.6%). AI-based models showed comparable results with the clinical prediction model, with a better performance in specific prognostic risk categories, confirming AI prediction model as a promising tool for the prediction of tooth loss.

Evaluation of Safety, Patient Perception and Efficacy of a New Cymenol-Based Mouth Rinse Formulation: A Randomized Clinical Trial

The aim of this study was to evaluate a newly formulated mouth rinse containing cymenol in patients undergoing supportive periodontal care in terms of safety (primary outcome) and the impact on dental biofilm and gingival inflammation (secondary outcomes). This research was designed as a pilot, controlled, randomized, parallel, triple-blinded, single-center, clinical trial of a 12-week duration. Adverse events and product perception were assessed by a questionnaire. Clinical, patient-reported outcomes (PROs), compliance, tooth staining, dentin hypersensitivity and microbiological variables were also evaluated. Student T, Mann–Whitney-U and Chi-square tests were applied. Thirty participants (15 per group) were included, randomized and followed for 12 weeks. No adverse events were reported. The questionnaire showed an overall rating of 7.2 (out of 10) in the experimental group and of 8.2 in the control group (p = 0.165) at 12 weeks. No statistically significant differences were observed in terms of gingival health, tooth staining, dentin hypersensitivity or microbiological outcomes between groups at baseline, 6- and 12-week visits. The adjuvant use of the new mouth rinse formulation proved to be as safe as the control product and no significant differences were observed in terms of clinical efficacy.

Supportive periodontal care with or without subgingival instrumentation: Microbiological results of a 2-year randomized clinical trial.

To compare the subgingival microbiota of patients receiving supportive periodontal care (SPC) with and without subgingival instrumentation, over 2 years. This study was a randomized clinical trial that included 62 participants (50.97 ± 9.26 years old; 40 females) who completed non-surgical periodontal therapy. Participants were randomly assigned to receive oral prophylaxis with oral hygiene instructions alone (test) or in combination with subgingival instrumentation (control) during SPC. Pooled subgingival biofilm samples were obtained from four sites per patient at SPC baseline and at 3, 6, 12, 18, and 24 months. Real-time polymerase chain reaction was used for absolute quantification of Eubacteria and the target bacteria Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola. Data were analysed using generalized estimating equations, taking into consideration the clustering of observations within individuals. No significant differences were found between the experimental groups regarding the mean counts of Eubacteria and target bacteria, as well as the periodontal parameters at the sampled sites. Although significant variability in bacterial counts was present during SPC, all counts after 2 years were not statistically different from those at baseline. Bacterial counts were associated with the presence of plaque, bleeding on probing, mean probing depth ≥3 mm, and follow-up period. SPC with or without subgingival instrumentation can result in comparable subgingival microbiological outcomes. clinicaltrials.gov: NCT01598155 (https://clinicaltrials.gov/study/NCT01598155?intr=supragingival%20control&rank=4#study-record-dates).

Step 4 for the treatment of periodontal diseases: implementing a supportive periodontal care programme

The long-term success of periodontal treatment is critically dependent on the implementation of a regular programme of supportive periodontal care (SPC). An SPC programme involves regular recall intervals of between 3 and 12 months according to a range of factors, including patient compliance, presence of risk factors and severity of initial disease. An SPC visit will include repeat examination of the periodontal tissues, assessments of gingival bleeding and probing depths, patient plaque control and presence of new deposits. Reinforcement of OH procedures is carried out, and any professional mechanical removal of deposits carried out as required. Evidence of relapse of disease may require referral for further active therapy. CPD/Clinical Relevance: Successful periodontal treatment in the long term is dependent on a regular supportive periodontal care programme.

Early and late implant loss in a university-based periodontal setting: A retrospective analysis on 1821 patients and 2639 implants over a period of 18 years.

The aim of this study was to retrospectively analyze the implant failure rate, not due to peri-implantitis, in periodontally compromised patients rehabilitated with at least one dental implant placed in a specialist university setting over the last 18 years. Records of patients receiving dental implants at the Department of Periodontology, University of Bern, Switzerland, between 2005 and 2022 were analyzed. Data on 1821 patients with 2639 implants were retrieved. Fifty-nine patients experienced implant loss (rate at patient level: 3.2%) out of which 2.1% were early and 1.1% late implant losses, respectively. The majority of the 59 patients were males (68%) and 27.1% were smokers. Eight mm implants were lost with the highest rate (42.4%) followed by 10 mm implants (31.8%). The rate of lost maxillary implants was more than twice as high compared with that of mandibular implants (69.7 vs. 30.3%). Within the study limitations, the implant failure rate in this cohort of patients enrolled in regular supportive periodontal and peri-implant care, was low.

Supportive periodontal care in dental practice: Part 1 - the importance and implications for general dental practitioners.

Supportive periodontal care is an essential component of maintaining the outcome of periodontal treatment. It is essential to ensure cost benefit to both patients and the health services where millions are spent on treating patients with periodontal disease. The dentist must be able to recognise the crucial and important role they play in providing supportive care and therapy to periodontally compromised patients, either independently or as part of a wider dental team, over and above the various challenges they may experience in the provision of such care in general dental practice. The timely intervention with treatment or referral during this phase will help reduce the risk of tooth loss and adverse consequences to the dentist and their team by way of litigation. The aim of this paper is to provide an update on the delivery of supportive periodontal care in general dental practice with a particular reference to the role of the dentist.

Supportive periodontal care in dental practice: Part 2 - perceptions of locally referring UK general dental practitioners.

Background Supportive periodontal care (SPC) is important in maintaining periodontal treatment outcomes. Hospital services provide specialist periodontal care at high costs. On completion of treatment, patients are discharged back to the general dental practitioner (GDP) to provide SPC. This project aimed to evaluate the change in GDPs' understanding of SPC over more than 20 years.Method A validated questionnaire about SPC was sent to GDPs during 1996 (397) and 2020 (300), with a response rate of 74% and 52%, respectively. The anonymous data were entered on a Microsoft Excel spreadsheet for analysis.Results In total, 98.5% of the GDPs in 1996 and 97% in 2020 perceived SPC to be highly important. Additionally, 49% in 2020 had a better understanding of SPC when compared to 1996 (42%). Finally, 70-74% (1996, 2020) of the GDPs indicated that they were responsible for SPC; however, 13-16% said that they were not.Conclusion and clinical relevance Notwithstanding the lower response rate in 2020, there has been an improvement in understanding and awareness of responsibility of SPC among GDPs. Reported challenges of provision were related to education and funding. If GDPs are to effectively deliver SPC, education and current funding should be addressed to prevent compromised treatment outcomes for patients.

Periodontal pockets: Predictors for site-related worsening after non-surgical therapy-A long-term retrospective cohort study.

To evaluate site-related changes in periodontal pocket depth (PPD) after non-surgical periodontal therapy and to identify predictors for PPD changes in a retrospective patient data analysis. PPD, clinical attachment level, bleeding on probing, tooth mobility (TM), furcation involvement (FI), abutment status, adherence to supportive periodontal care (SPC) and SPC follow-ups were obtained from fully documented patient data before periodontal therapy (baseline, T0), after active periodontal therapy (APT, T1) and during SPC (T2). PPD changes were classified into deteriorated or unchanged/improved at the site level. Multi-level logistic regression analysis was performed to identify factors influencing PPD changes during SPC. This retrospective study included 51 females and 65 males (mean T0 age: 54.8 ± 10.1 years, 25 smokers, 12 diabetics) suffering from Stage III/IV periodontitis. Evaluation outcome: T0/16,044 sampling sites/2674 teeth; T1/15,636/2606; T2/14,754/2459. During 9.0 ± 2.3 years SPC, PPD decreased (-1.33 ± 0.70 mm) by 21.8% of the sites, remained unchanged by 41.4% and increased (1.40 ± 0.78 mm) by 36.8%. Distopalatal FI (p < .001, odds ratio [OR]: 0.252, 95% confidence interval [CI] for OR: 0.118-0.540), residual pockets (p < .001, OR: 0.503, 95% CI: 0.429-0.590) and TM Degrees I-III (Degree I: p = .002, OR: 0.765, 95% CI: 0.646-0.905; Degree II: p = .006, OR: 0.658, 95% CI: 0.489-0.886; Degree III: p = .023, OR: 0.398, 95% CI: 0.180-0.879) correlated significantly with increasing PPD. Over 75% of PPD remained unchanged or increased during SPC. Distopalatal FI, TM Degrees I-III and residual pockets after APT lead to worsening of periodontal pockets.

Repeated local delivery of hyaluronic acid gel as adjunctive treatment of residual pockets in periodontitis patients undergoing supportive periodontal care. A randomized controlled clinical trial

ObjectivesTo assess the effect of hyaluronic acid (HyA) application as adjunct to re-instrumentation of residual pockets in patients undergoing regular supportive periodontal care (SPC).MethodsChronic periodontitis patients (stage III and IV, grade B and C) with 4 interproximal residual pockets were randomly assigned to the test (HyA gel) or control (saline) group. After subgingival instrumentation, test or control substance was applied subgingivally, then daily supragingivally for 3 months, and if required a second time after subgingival re-instrumentation after 3 months. Clinical and patient reported outcome parameters were recorded every 3 months for 12 months. Pocket closure [probing pocket depth (PPD) ≤ 4mm with absence of bleeding on probing (BoP) at PPD = 4mm] was the main outcome parameter.ResultsFifty-six patients (221 experimental sites) were analysed. Pocket closure was achieved in 56.8 and 46.6% of the experimental sites in the test and control group, respectively (p > 0.05), while median PPD and PPD distribution (< 5mm/5mm/ > 5mm) differed significantly between groups in favour of the test group, at 12 months. Further, significantly fewer sites in the HyA group required re-instrumentation at 3 months, and sites in the HyA group showed a tendency for lower odds to remain diseased compared to the control group (OR 0.48, 95%CI 0.22–1.06). The odds for a site to remain diseased after 12 months increased significantly in the presence of plaque (OR 7.94, 95%CI 4.12–15.28), but in general, decreased significantly over time (OR 0.48, 95%CI 0.28–0.81).ConclusionRe-instrumentation of residual pockets in SPC patients, per se, leads to a significant increase in pocket closure over time; this was impeded by poor plaque control. Repeated local application of HyA results in fewer sites requiring re-instrumentation and might slightly improve the rate of pocket closure. (clinicaltrials.gov registration nr. NCT04792541).Clinical relevanceHyA gel is easy to apply, well accepted by patients, and may have some positive effect in terms of fewer sites requiring re-instrumentation at 3 months and higher pocket closure rate at 12 months.

Clinical evaluation of a novel protocol for supportive periodontal care: A randomized controlled clinical trial.

The aim of this study was to compare the clinical efficacy and the patient perception of subgingival debridement with either guided biofilm management (GBM) or conventional scaling and root planing (SRP) during supportive periodontal care (SPC). Forty-one patients in SPC were randomly assigned to either treatment with GBM or SRP every 6 months. The primary outcome was the percentage of bleeding on probing (BoP) at 1 year. Moreover, pocket probing depths (PPD), recession, and furcation involvements were also measured. Full-mouth and specific site analyzes were performed at baseline, 6 and 12 months of SPC. Patient comfort was evaluated using a visual analogue scale (VAS) at 12 months. At 1 year, mean BoP percentage decreased from 12.2% to 9.0% (p=0.191) and from 14.7% to 7.9% (p=0.004) for the GBM and SRP groups, respectively. Furcation involved multirooted teeth but no through-and-through lesions were significantly fewer in the GBM than in the SRP group after 12 months (p=0.015). The remaining parameters showed slight improvement in both groups without any statistically significant differences between the two groups after 1 year. Pain evaluation as patient reported outcome measures (pain evaluation) was in favor (p=0.347) of the SRP group, while overall satisfaction was similar for both groups. Treatment time was not statistically significantly different between the two groups (p=0.188). In well-maintained SPC patients, SRP protocols resulted in significant clinical improvements in terms of BoP; however, for the other clinical improvements, similar efficacy for both GBM and SRP was observed.

Efectos de la furcación sobre la supervivencia molar en pacientes sometidos a tratamiento periodontal

Objective: This study aims to analyze the survival time of molar tooth according to furcation involvement (FI) classification among periodontally treated patients under a supportive periodontal care program. Materials and Methods: A retrospective study was con-ducted among 77 periodontitis patients with 240 molars who had undergone periodontal therapy that were followed up with supportive periodontal therapy (SPT) for at least five years. Periodontitis patients’ data were retrieved from the periodontic clinical record. The clinical parameters of all involved molars and treatment modality were recorded at baseline and SPT. Results: A total of 69 (28.8%) molars were extracted during active periodontal therapy, while 17 (7.1%) were lost during SPT. The 5-year survival rate of molars was 83.5% (95% confidence interval [CI], 76.9-88.4) for FI=0 (n=141), 81.0% (95% CI, 56.9-92.4) for FI=I (n=18), 50.0% (95% CI, 33.8-64.2) for FI=II (n=21), and 25.0% (95% CI, 6.9-48.8) for FI=III (n=4). Additionally, the 10-year survival rate for molars with FI = III was 12.5% (95% CI, 1.0-39.2), which was lower than that of molars with FI = 0 (77.1%; 95% CI, 69.7-83.0). Conclusions: The presence of a high degree of FI classifica-tion, especially Class III, is associated with a lower survival rate of molars among periodontally treated patients. Retention of molars is possible on a long-term basis through a maintenance program of periodontal therapy.

Periodontitis stage and grade modifies the benefit of regular supportive periodontal care in terms of need for retreatment and mean cumulative cost.

This study aimed to characterize the periodontal breakdown during supportive periodontal care (SPC) and to quantify the corresponding cost-effectiveness of periodontal therapy. Data were obtained from charts of patients who received active periodontal therapy (APT) with a minimum follow-up of ≥10 years. Analysis was done to identify factors associated with the incidence of additional sub-gingival instrumentation (SGI) and/or surgery (SUR) during SPC and mean cumulative cost of recurrence was calculated. All relevant data were collected. In all, 442 patients were included. Over the follow-up period, 62% of Stage I and II patients and 72% of Stage III and IV patients required further treatment following the APT; 56.5% of SGI patients and 78.6% of SUR patients received a second intervention. SUR patients received more SUR during the follow-up period (p = .035). Stage III and IV patients received more SUR during SPC than Stage I and II patients (p = .001). Grade C patients received more SUR during the follow-up period (p < .05). During the 5-year period preceding retreatment, the mean SPC visits were lower for patients who did not require retreatment (p < .001). Risk factors such as regularity of maintenance, smoking and diabetes were related to a higher chance of receiving SUR during the follow-up period (p < .05). The mean cumulative costs indicated less recurrence cost for compliers in Stage III and IV or Grade B and C but not for those in Stage I and II or Grade A. The risk of relapse in the maintenance population may be correlated with higher stage and grade, patient compliance, modifiable risk factors and the nature of the treatment provided during APT. The total cost of treatment of recurrences was lower for compliers in Stage III/IV and Grade B/C compared with erratic compliers with the same severity and risk.

Orthodontic treatment in stage IV periodontitis patients: Timing, management and long-term prognosis

Patients affected by severe periodontitis can develop a secondary malocclusion due to pathologic tooth migration that, if untreated, can hinder the maintenance of the entire dentition. In these cases, the combination of the appropriate stepwise periodontal therapy together with orthodontic treatment may become essential to re-establish health, aesthetics and function, leading to patient satisfaction and long-term stability. However, to successfully perform orthodontic tooth movement in stage IV periodontitis patients is paramount to carefully plan the treatment with a interdisciplinary approach, respecting the correct timing of the different phases of treatment, adapting biomechanics and appliance design individually, considering loss of periodontal support suffered from each patient. At the end of orthodontic treatment, after eventual prosthetic procedures, life-long retention and supportive periodontal care are needed to ensure good long-term prognosis. The present review describes the diagnostic, prognostic and therapeutic challenges associated with the combined ortho-perio treatment of stage IV periodontitis patients, providing both a literature and expert-based support for a biologically-orientated approach.

Oral health conditions in patients under antiresorptive therapy are comparable to unexposed during supportive periodontal care

ObjectivesTo investigate oral health and oral health-related quality of life (OHRQoL) of patients under antiresorptive therapy (ART) during supportive periodontal care (SPC) considering history of medication-related osteonecrosis of the jaw (MRONJ).Materials and methodsIn this cross-sectional study, 100 patients (50 receiving ART (exposed) and 50 without ART (unexposed)) in regular SPC were enrolled for a clinical oral examination and the evaluation of OHRQoL using the OHIP-G14-questionnaire. History of MRONJ was assessed by anamnesis and reviewing patient records.ResultsThere were no statistically significant group differences in age (exposed: 70.00 ± 9.07 versus unexposed: 71.02 ± 8.22 years), sex, distribution of systemic diseases and duration of SPC (on average 8.61 ± 5.73 years). Number of teeth (21.02 ± 5.84 versus 21.40 ± 5.42), DMFT (18.38 ± 3.85 versus 17.96 ± 4.08), probing pocket depth (2.31 ± 0.20 versus 2.38 ± 0.26), clinical attachment level (3.25 ± 0.76 versus 3.46 ± 0.58) and bleeding on probing (15.07 ± 11.53 versus 15.77 ± 13.08) were also not significantly different. The OHIP-G14 sum-score was significantly higher in exposed participants (6.10 ± 6.76 versus 3.62 ± 5.22, p = 0.043). History of MRONJ was prevalent in 8% of patients under ART. Periodontal/peri-implant-related MRONJ were reported in three participants with cancer (n = 1 before and n = 2 after active periodontal therapy). History of MRONJ due to endodontic/restorative reasons was reported in one patient with osteoporosis.ConclusionsPatients under ART in SPC demonstrated similar clinical periodontal and dental status but lower OHRQoL compared to unexposed (not statistically significant). Patient awareness of the MRONJ-risk and appropriate preventive measures should be ensured.Clinical relevanceSPC in osteoporotic patients under ART appeared safe regarding MRONJ, but further investigations on the MRONJ-risk in patients with different risk-profiles are necessary.Study registration: clinicaltrials.gov (#NCT04192188).

Recent developments in the diagnosis, treatment, and management of Papillon-Lefèvre Syndrome.

A systematic search of PubMed, LIVIVO, and Ovid was conducted up to March 2021. These databases were searched for relevant clinical studies on periodontal treatment success in individuals with Papillon-Lefèvre syndrome (PLS). Clinical studies reporting successful treatment outcomes defined as the loss of four or fewer permanent teeth due to periodontitis and the arrest of periodontitis or probing depths of 5 mm or less in individuals with PLS followed up for ≥24 months were included, and data extracted. Twelve studies reporting on nine PLS patients met the inclusion criteria. The extracted main outcomes in the studies reporting successful periodontal treatment in PLS were as follows: (1) clinical and genetic diagnosis of PLS; (2) age at baseline; (3) initial dental, periodontal parameters, and microbiological assessment, if available; (4) description of disease progression and applied therapies; and (5) outcome and follow-up. Twelve studies reporting nine individuals were included. The timely extraction of affected or all primary teeth, compliance with oral hygiene instructions, supra- and subgingival debridement within frequent supportive periodontal care intervals, and adjunctive systemic antibiotic therapy in most patients affected a halt in disease progression. Suppression of Aggregatibacter actinomycetemcomitans below detection limits was associated with periodontal stabilization. An intensive, multidisciplinary approach with strict compliance may enable the decelerated progression of PLS-associated periodontitis. The early diagnosis of PLS and the suppression of A. actinomycetemcomitans below the detection level might be critical factors for treatment success. It required significant effort and patient compliance. The study emphasized the importance of timely interventions, oral hygiene maintenance, regular professional dental care, and, in some cases, systemic antibiotics.

Accuracy and applicability of periodontitis risk assessment tools: A critical appraisal.

Currently, periodontal risk assessment finds application at first visit (to identify individuals at high risk of either disease incidence, if still healthy, or disease progression, if already diseased) as well as at patient monitoring after active treatment and enrolment in a supportive periodontal care program. Although the current case definition of periodontitis embeds a prognostic determination (ie, periodontitis grade) that showed a predictive value for periodontitis-related tooth loss, some limitations of periodontitis grade call for the implementation of different risk assessment tools in clinical practice. For some of these, significantly higher accuracy in predicting tooth loss during supportive periodontal care was reported compared with periodontitis grade. Validated periodontal risk assessment tools may be functional to obtain greater adherence to the suggested preventive and treatment protocols, improve oral hygiene performance, and tailor supportive periodontal care. Interestingly, periodontal risk can also be informative of the risk of peri-implantitis in patients programmed for implant placement or rehabilitated with dental implants. A critical appraisal on the rationale behind risk assessment and the balance between the advantages and limitations of exercising risk assessment in periodontology is presented.