Surgical Periodontal Treatment Research Articles

The adjunctive use of antimicrobial photodynamic therapy, light-emitting-diode photobiomodulation and ozone therapy in regenerative treatment of stage III/IV grade C periodontitis: a randomized controlled clinical trial

ObjectivesTo assess the short-term efficacy of multiple sessions of antimicrobial photodynamic therapy (aPDT), light-emitting-diode (LED) photobiomodulation, and topical ozone therapy applications following surgical regenerative treatments on clinical parameters, patient-centered outcomes, and mRNA expression levels of VEGF, IL-6, RunX2, Nell-1, and osterix in gingival crevicular fluid samples in patients with stage III/IV, grade C periodontitis.Materials and methodsForty-eight systemically healthy patients were assigned into four groups to receive adjunctive modalities with regenerative periodontal surgical treatment. A 970 ± 15 nm diode laser plus indocyanine-green for aPDT group, a 626 nm LED for photobiomodulation group, and topical gaseous ozone were applied at 0, 1, 3, and 7 postoperative days and compared to control group. The clinical periodontal parameters, early wound healing index (EHI), and postoperative patients’ morbidity were evaluated. The mRNA levels of biomarkers were assessed by real-time polymerase chain reaction.ResultsNo significant difference in the clinical parameters except gingival recession (GR) was identified among the groups. For group-by-time interactions, plaque index (PI) and probing pocket depths (PD) showed significant differences (p = 0.034; p = 0.022). In sites with initial PD > 7 mm, significant differences were observed between control and photobiomodulation groups in PD (p = 0.011), between control and aPDT, and control and photobiomodulation groups in CAL at 6-month follow-up (p = 0.007; p = 0.022). The relative osterix mRNA levels showed a statistically significant difference among the treatment groups (p = 0.014).ConclusionsThe additional applications of aPDT and LED after regenerative treatment of stage III/IV grade C periodontitis exhibited a more pronounced beneficial effect on clinical outcomes in deep periodontal pockets.

Individualized digitally designed surgical template for guided soft tissue surgery in cases with severe gingival enlargement: A clinical application in hereditary gingival fibromatosis.

The purpose of this study was to present the use of computer-assisted periodontal surgery utilizing a novel surgical guide for cases with severe gingival enlargement through a clinical application in a patient with hereditary gingival fibromatosis. The treatment plan included nonsurgical periodontal therapy, surgical periodontal treatment, and regular periodontal maintenance before the initiation of orthodontic treatment. Due to the increased soft tissue thickness, a surgical guide with a novel design was fabricated to facilitate the periodontal surgery since most of the patient's teeth were malpositioned and underexposed due to fibromatosis. For this purpose, the patient's intraoral scan was merged with a CBCT image in order to plan surgical excisions based on the anatomy of the teeth and the bone contour. The customized surgical guide facilitated the gingivectomy by controlling not only the shape of the initial incisions but also their orientation toward the level of the cementoenamel junction, improving the efficiency of the clinical time compared with freehand surgery and assisting in the verification of the final soft tissue shape, based on the treatment plan. Digital technology through the superimposition of multiple data sets can assist in the diagnosis and multidisciplinary management of cases with gingival fibromatosis. The proposed design of the surgical guide can facilitate soft tissue surgery based on the digital treatment plan, leading to more predictable management of the soft tissue, especially in patients with severe gingival enlargement, as in cases with hereditary gingival fibromatosis or drug-induced gingival overgrowth.

Multidisciplinary Relationship between Periodontology and Orthodontic Department: A Clinical Audit Study

Objectives: This study aims to assess the current practice among postgraduate students in the multidisciplinary interaction between the Periodontology and Orthodontic Departments in the Faculty of Dentistry, UiTM Sungai Buloh; we conducted clinical audit research. Material and methods: Data retrieval from the Integrated Dental Record Management System (iDeRMS) was used to conduct our clinical audit. Results: After receiving orthodontic treatment, 25% of the referral cases, according to our study, needed non-surgical periodontal therapy. Additionally, we discovered that 16.7% of patients required surgical periodontal treatment after being sent for orthodontic care. Conclusion: A multidisciplinary approach might be necessary to successfully treat periodontal disease. As periodontal therapy is a requirement for the success of orthodontic treatment, and orthodontic treatment contributes to preserving periodontal health, a reciprocal link between the two specialities is essential.

Full Title: Evaluation of general dentists' perspectives on periodontal surgery Running Title: General dentist and periodontology

Objective: Periodontal treatments are a very important part of general dentistry. This study aimed to evaluate general dentists' perspectives on surgical and non-surgical periodontal treatments and to examine the decision criteria of these dentists to refer their patients to a periodontist. Materials and Methods: The survey used in this study consisted of 28 questions and was delivered to general dentists online. The survey primarily asks dentists about their gender, age, information about the institution they work in, and years of professional experience. Other questions in the survey include topics related to periodontal examination, referral to a periodontist for phase 1 periodontal treatment, referral for periodontal surgical treatment, surgical treatments applied and their frequency, and periodontal surgical treatment procedures. Results: A total of 171 general dentists (85-male, 86-female) with an average age of 34±10 answered the survey questions. The rate of participants who stated that they performed the phase 1 periodontal treatment of their patients themselves was 77.8%, while the rate of those who performed the surgical periodontal treatment themselves was 20.5%. No statistically significant relationships were obtained between the participants' gender, the institution they work in, and their responses regarding periodontal diagnosis and treatments. (p>0.05) The rates of performing a periodontal examination and obtaining a periodontal index in the first session are 70.1% and 38.0% for dentists working in private practice, while they are 44.1% and 14.7% for dentists working in a public hospital. In addition, it has been determined that all physicians who perform surgical treatments themselves work in private practice. (p<0.05) Conclusion: It has been determined that general dentists mostly apply non-surgical treatments themselves, but often refer them to a periodontist for surgical treatments. It was revealed that the working institution was effective in the decision to refer to a periodontist, but gender or professional experience was not effective.

Effect of supportive periodontal therapy on tooth loss in regular and irregular compliant smokers and non-smokers: A retrospective cohort Study with a follow-up up to 50 years

Introduction: The aim of this study is to compare retrospectively tooth loss (TL) rates in two cohorts, regular vs irregular compliant individuals, and smokers vs non-smokers, with a follow-up up to 50 years. Methods: Chart data were collected from 192 patients undergoing supportive periodontal therapy (SPT) after non-surgical and/or surgical periodontal treatment for 10 - 50 (mean 24.89 ± 10.23) years. Patients were categorized as RC (attending regularly to their scheduled SPT with maximum delay of 6 months), and IC (patients missed at least one of the recall visits but continued to come on an irregular basis with a maximum delay of 18 months). Patients were then classified as smokers and non-smokers. Univariate comparisons between cohort groups were performed to assess significant differences at the level of baseline characteristics. Bivariate analyses were also performed between the main outcome variable (tooth loss) and baseline characteristics of the participants. Two negative binomial regression models were carried out in order to control confounding factors. Results: A total of 4870 (25.36 ± 4.08) teeth were present at baseline. 423 (2.2 ± 3.44) teeth were lost during follow-up (SPT), corresponding to 0.07, 0.11, 0.08, and 0.09 TL annually among RC, IC, smokers, and non-smokers, respectively, with significant difference present only between RC and IC. Age > 40 years was found to increase TL rates. Conclusions: Compliance with SPT affects TL rates after a mean of 24.89 years of follow-up. RC showed less TL than IC patients. Smoking did not reach statistical significance.

Patient-reported outcome measures after periodontal surgery

ObjectivesThe present study aimed to explore the impact of different periodontal surgical treatments on the quality of life and postoperative morbidity.Materials and methodsThe present study is a single-center, prospective, observational cohort trial. One hundred fifty-five patients, referred to the Periodontal Department of Bologna University who needed periodontal surgical treatment, were recruited. The self-reported perception of the postoperative course was assessed using the following anonymous questionnaires: Italian oral health impact profile (I-OHIP-14), visual analog scale (VAS) to evaluate the intensity of the pain, and 5-point Likert scale.ResultsPatients reported a mean OHIP-14 total score of 9.87±8.5 (range 0–42), significantly influenced by the female sex, flap extension, and periodontal dressing. A mean VAS score of 2.96±2.39 (range 0–9) was calculated, and was found to be influenced by the presence of vertical releasing incisions and palatal flap extension. Of the 155 subjects, 40 (25.8%) patients reported bleeding as a post-surgical complication, 96 (61.9%) swelling, 105 (67.7%) eating discomfort, and 44 (28.4%) reported speech discomfort.ConclusionsWithin the limitations of the nature of the present study, periodontal surgical procedures have a low impact on patients’ quality of life evaluated through the OHIP-14 and VAS pain questionnaires.Clinical relevancePeriodontal surgical procedures are safe procedures, with a limited duration of postoperative discomfort as well as the incidence of complications.

Bhdramustadi Churna a Miracle Herb for Dantachala (Tooth Mobility) – A Case Series

Background: Mukha is considered as one of the Nava Dwaras. Danta is one of the Sapta-Anga of Mukha according to Acharya Bhavprakash. Dantchala is one of Danta Roga according to Acharya Vagbhatta. Dantachala is a prevalent oral health issue affecting individuals globally, often leading to discomfort and impaired oral functions. In contemporize science, Dental mobility treatment is non-surgical and surgical periodontal treatment, splinting and occlusal adjustment. Acharyas has mentioned local therapies for its management. Material and methods: The study was a consecutive case series on four patients of Dantchala (~tooth mobility). In whom Lepana (~applying paste) with Bhdramustadi Churna (5 gm) mixed with Go-Mutra for 1 hour twice a day, after that Gandusha(~gargles) with Dashamoola Kwatha (5 gm) for 21 days was chosen as main treatment modalities. Here selected patients have History of accidental trauma in respected teeth. Result: Increased keratinization & regeneration of normal gingival tissues and Anti-inflammatory and Antibacterial properties, reduction of local inflammation so restoration of normal tissue occurs. Conclusion: The study concluded that after given treatment patient got complete relief. No adverse effect of treatment was observed.

Evaluation Of Gingival Biotype And Recession Following Non-Surgical Periodontal Treatment Using 3-Dimensional Scan Methods.

The study evaluated the position of gingival margins in anterior teeth using clinical and 3-dimensional (3D) optical scanning method among patients subjected to non surgical periodontal treatment (NSPT). A single arm, longitudinal study was undertaken at the Archway Dental Center, University of Manchester, UK. History and clinical examination were done. Gingival recession, attachment loss (AL), and periodontal probing depth (PD) were recorded at baseline and 12-weeks follow-up. NSPT was done using hand and ultrasonic instruments. Impressions were made, the resultant gypsum models were scanned to generate 3D images. The change in the gingival level and thickness of facial gingiva were assessed. Out of eight patientsrecruited, three were lost to follow up. The 3D scan showed a poor correlation with the clinical assessment of gingival recession in anterior teeth following NSPT (r=- 0.0089). Recession did not improve after NSPT (p= 0.20).

Changes in the level of cytokines in the saliva of hypertensive patients with chronic periodontitis after scaling and root planning

IntroductionCytokines have a key role in the pathogenesis of both hypertension and periodontitis. Salivary diagnosis is a promising field with numerous clinical applications. Since limited studies have been carried out on how salivary inflammatory cytokines can be determined and how well periodontal disease and hypertension might react to scaling and root planning (SRP). The goal of this study was to identify the pattern of changes in salivary inflammatory cytokines in chronic periodontitis subjects with hypertension after nonsurgical periodontal therapy. MethodsIt included observational trial recruited 94 chronic periodontitis patients, 44 of whom had hypertension. All subjects have undergone non- surgical periodontal treatment. The clinical periodontal parameters included gingival index (GI), plaque index (PI), and probing of pocket depth (PPD). Unstimulated saliva was collected to determine the inflammatory biomarkers (using a commercial Elisa kit) both before and after SRP ResultsIn comparison to non-hypertensive participants, the periodontal PPD was significantly higher in hypertensive subjects. All clinical parameters in the first examination, except for PI, were significantly higher in hypertensive than in non-hypertensive subjects. Plaque Index, GI, and PPD parameters at first visit and after finishing treatment positively correlated with salivary IL-1β, excluding pretreatment GI. The current results demonstrate the presence of a positive correlation between diastolic blood pressure and TNF (r = 0.330 and P = 0.029). All patients enrolled in this study showed a significant increase in the salivary levels of IL-4 after SRP. ConclusionsThe current study offer important and valuable information concerning the practical application of pro-inflammatory and anti-inflammatory cytokines as useful biomarkers and indicators for determining the outcome of SRP and progression of chronic periodontitis in patients with hypertension.

Non Surgical Periodontal Treatment Effect on Il-17 and Il-18 levels in gingival crevicular fluid of stage III/IV, molar/incisor pattern Periodontitis

Non Surgical Periodontal Treatment Effect on Il-17 and Il-18 levels in gingival crevicular fluid of stage III/IV, molar/incisor pattern Periodontitis

Factors that affected the efficacy of non-surgical periodontal treatment carried out by postgraduate periodontology students

The training of postgraduate students in periodontology has a significant clinical impact. The overall assessment of the efficacy of non-surgical treatment of periodontitis, has value to inform training protocols as well as assess the quality of clinical service delivery. Furthermore, obstacles to successful treatment can be identified. The aim of the study was to determine the effectiveness of non-surgical periodontal treatment, as well as the factors that may determine treatment outcome at the postgraduate clinic in the Periodontology Department at the University of the Western Cape, Tygerberg Dental Hospital, between 2016 and 2018. A cross-sectional record-based study of 100 patients was conducted. Demographic, social, clinical, treatment data were obtained from the hospital files. Periodontal parameters including bleeding index (BI), Pocket Probing depth (PPD), Plaque index (PI), and clinical attachment level (CAL), were recorded at the initial visit (Pre-treatment) and follow-up visits (Post-treatment), and the final treatment outcomes were calculated based on the differences of these parameters’ values between the initial visit and the last follow-up visit. Data were presented as mean and range for continuous variables and as a frequency for categorical variables. Statistical analyses were performed to determine if there was a relationship between the varied factors and treatment outcome with p < 0.05 as statistically significant. The results showed that all 100 patients demonstrated a marked reduction in PPD, PI, BI, and loss of CAL. The overall mean PPD reduction was 0.32 (0.5), the mean reduction in PI and BI were 37.2 (24.08) and 34.61 (22.78), respectively, and the mean clinical attachment gain was 0.42 (0.97) mm. Treatment outcome showed no difference in PPD, PI, BI, and CAL between females, smokers, and patients with systemic conditions compared to males, non-smokers, and patients without systemic conditions. On the other hand, patients who underwent more maintenance treatment visits over a period longer than 2 months duration had significantly better outcomes compared to patients who had less than two months of duration of treatment. This study proved the effectiveness of the non-surgical surgical periodontal treatment at the postgraduate periodontal clinic. Treatment duration and frequency of recall visits were the most influential factor impacting the treatment outcome.

Influence of Smoking on Periodontal and Implant Therapy: A Narrative Review

smoking is considered the most modifiable risk factor for periodontal disease. the aim of this narrative review is to emphasize the effect of smoking on periodontal and implant therapy. The authors reviewed the literature reporting the clinical outcomes of smoking on periodontal surgical and nonsurgical treatment. The impact of smoking on implant therapy and sinus lifting procedures were also reviewed. Periodontal and implant therapy outcomes are adversely affected by smoking. Smokers respond less favorably to periodontal therapy and periodontal flap procedures as compared to nonsmokers. Clinical outcomes for smokers are 50-75% worse than for nonsmokers. Studies reveal that smokers experience a significantly lower reduction in pocket depth compared to nonsmokers as well as less bone growth after treating infra-bony defects with guided tissue regeneration. The relative risk of implant failure is significantly higher in patients who smoke 20 cigarettes or more per day compared to nonsmokers. Additionally, smoking has also been shown to increase postoperative wound dehiscence and infection rates following sinus floor elevation. Longitudinal studies on smoke cessation have shown a reduction in bone loss and probing depths for periodontitis patients after cessation compared to those who smoke. Smoking cessation can reduce probing depths and improve clinical attachment after nonsurgical periodontal therapy. There is insufficient evidence regarding the effect of smoking on peri-implantitis, as well as the loss of implants in the long-term.

Holistic Approach of Periodontitis Patient with Diabetes Mellitus: A Case Report

Diabetes mellitus (DM) is a common risk factor for patients with periodontal disease. Periodontitis patients with poor glycaemic control present with severe and advanced periodontal tissue destruction. A multidisciplinary approach between the periodontist and medical practitioner is clinically proven to maintain the patient's periodontal health and general well-being. This case report aims to raise the awareness and provide a basic guideline for medical and dental practitioners in identifying and managing periodontitis patients with undiagnosed DM particularly if patient is presented with recurrent periodontal abscess. A 34-year-old Malay lady presented with recurrent periodontal abscess and diagnosed with Periodontitis Stage III Grade C was treated holistically by the periodontist and a medical practitioner. The patient's compliance towards the periodontal treatment, routine medical check-ups, and medications has helped the patient achieved better periodontal health and controlled glycaemic level. Following her sixth periodontal re-evaluation in two years improvement in oral hygiene, resolution of gingival swelling and bleeding were seen after sequences of non-surgical, surgical periodontal treatment and patient’s compliance towards her medications and follow-up.

Patient related and tooth related risk factor of tooth loss after periodontal surgical treatment - prospective study

Patient related and tooth related risk factor of tooth loss after periodontal surgical treatment - prospective study

Efficacy of surgical periodontal treatment with and without photobiomodulation in the treatment of severe periodontitis: An evaluation of periodontal, microbiological, and cytokine levels

AimTo compare the efficacy of surgical periodontal treatment (SPT) alone and PDT-assisted surgery in participants with severe periodontitis. Material and methodsThe present clinical trial was completed by 64 participants (n = 32 each). The selection was made according to predefined inclusion and exclusion criteria. Patients in group A were treated with SPT only and participants in group B were treated with SPT adjunct to PDT. Microbiological assessment of P.Gingivalis; T. Forsythia and T.Denticola were evaluated using cultural analysis and periodontal parameters plaque score (PSc), bleeding on probing (BoP) periodontal depth (PD), and clinical attachment loss (CAL) at baseline and post-treatment at 6 months and 12 months were performed. The gingival crevicular fluid (GCF) was collected for the estimation of IL-1β and tumor necrosis factor-alpha (TNF-α) using an enzyme-linked immunosorbent assay (ELISA). For intra-group comparison and post hoc correction, Student's t-test along with Bonferroni was used. For the difference between follow-ups, an analysis of variance (ANOVA) multiple rank tests were incorporated. ResultsThe mean age of participants in the SPT group was 55.25±4.6yrs. Whereas, participants treated with PDT adjunct to SPT were 54.88±3.6yrs. Periodontal parameters (BoP, PD, PSc, CAL) showed no significant difference at baseline. At 6 months and 12 months follow-up, a significant difference in all parameters (BoP, PD, PSc, and CAL) was found in participants treated with SPT alone and PDT adjunct to SPT (p<0.05). Inflammatory biomarkers at 6-month and 12-month follow-ups, a statistically significant difference in the level of biomarkers (IL-1β and TNF-α) were observed in both groups from baseline (p<0.05). However, at baseline, no significant difference was noted in both groups (p> 0.05). The microbiological assessment showed a significant drop in the bacterial count in participants treated with both regimes i.e., SPT alone and PDT adjunct to SPT. ConclusionPhotodynamic therapy (PDT) adjunct to surgical periodontal treatment (SPT) in severe periodontitis improves microbiological and periodontal parameters and lowers the level of proinflammatory cytokines.

Comparison of Non Surgical Periodontal Treatment Outcome and Clinician's Comfort Levels using LM ErgoMax over Hu-Friedy Hand Instruments-A Randomised Clinical Trial

Introduction: Non surgical periodontal therapy by scaling is done by using different sets of hand and motor driven instruments. The best instrument for non surgical periodontal therapy has to be identified, so that, it will benefit the clinicians in point of ergonomics and for patients in terms of less discomfort caused during scaling. Aim: To compare the effectiveness of Linear Monolithic (LM) instruments to Hu-Friedy instruments in non surgical periodontal treatment. Materials and Methods: The split-mouth randomised clinical trial study comprised 50 patients, who were selected from those attending the Department of Periodontics and Implantology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India, and who were classified with gingivitis or moderate to severe periodontitis according to American Academy of Periodontology (AAP) standards from 1999 and had not undergone any periodontal therapy in the previous six months to one year. The study was conducted from September 2021 to February 2022. Periodontal treatment outcomes were evaluated by plaque index, bleeding index, probing pocket depths, gingival index, and clinical attachment level. Clinicians comfort levels and handling characteristics of two sets of hand instruments (Test: LM instruments to control: Hu-Friedy instruments) were assessed by questionnaire consisting of 10 closed ended questions immediately after the non surgical therapy. The unpaired t-test was used for intergroup analysis and one-way ANOVA was used for intragroup analysis. Results: The mean gingival index scores for test and control sites at baseline were (1.65 and 1.72), at one week were (0.89 and 0.64) and at one month were (0.46 and 0.31). The mean periodontal pocket depth for test and control sites at baseline were (3.93 and 3.79), at one week were (3.40 and 3.25) and at one month were (3.18 and 2.42). A statistically significant difference seen in gingival index (p=0.001), sulcus bleeding index (p&lt;0.001), periodontal probing depths (p&lt;0.001) and clinical attachment level (p&lt;0.001) at one-month interval. Conclusion: The findings demonstrate that LM instruments have higher handling features and cutting efficiency than HuFriedy instruments, althou gh there is no significant difference in plaque index, gingival index, probing depth reduction, sulcus bleeding index, or clinical attachment level.

Cysts of Oral Cavity: Odontogenic Keratocyst; A Rare Case Report with a 6-Year Follow-Up

Aim: Odontogenic keratocyst is one of the rare odontogenic cyst, commonly affecting the mandible. It has a special mention in the field of oral surgery due to its varied presentation and high recurrence rate. There have been a few cases reported of outcomes of treatment of odontogenic keratocysts. The aim of this report was to illustrate the case of OKC in a patient and to describe the follow-up information and successful treatment of its. Methods: A 18-year-old Turkish girl was referred by her dentist to the periodontology clinic of the Faculty of Dentistry in November 2017, for the treatment of cyst in the mandibulary incisor region. The diagnosis of odontogenic keratocyst suggested clinically and radiographically was confirmed by the histopathological study. Treatment consisted of oral hygiene instruction, periodontal-endodontic treatment and resection of cyst. Results: Four weeks after surgery healing was occurred and six years later area of the lesion appeared completely normal as clinical and radiographically. There were no signs of local recurrence after a 6-year follow-up. Conclusion: The odontogenic keratocyst was treated successfully by surgical periodontal treatment.

Effect of Non surgical Periodontal Therapy on Gingival Parameters of Diabetic and Non Diabetic Periodontitis Patients: A Prospective Clinical Study

Introduction: Non Surgical Periodontal Therapy (NSPT) has been an effective treatment for suppression of gingival inflammation and improvement of periodontal health in patients. Periodontitis and diabetes have an inter-relationship with each other. Surgical intervention is not always advisable for periodontitis with patients with diabetes. Hence, assessing the response of non surgical periodontal treatment in diabetic patients can lead to better and non invasive treatment options. Aim: To evaluate the effect of NSPT by observing changes in Gingival Index (GI), Plaque Index (PI), Clinical Attachment Loss (CAL), and volume of Gingival Crevicular Fluid (GCF) in diabetic and systemically healthy periodontitis patients. Materials and Methods: This was a prospective clinical study conducted in the Department of Periodontology, Rural Dental College, Loni, Maharashtra from January 2021 until June 2022. Total of 90 patients were assessed and were divided into three groups. Group A (n=30) included the patients with healthy periodontium and without any systemic disease. Group B (n=30) included the patients with controlled diabetes, with CAL in ranges of 3-4 mm (stage II periodontitis). Group C (n=30) included the patients who are systemically healthy, with CAL in ranges of 3-4 mm (Stage II periodontitis). Clinical parameters including GI, PI, Periodontal Probing Depth (PPD), CAL and volume of GCF were evaluated at baseline. NSPT was performed and parameters were evaluated after three months and then compared with baseline. Statistical analysis was done by descriptive statistics as mean, SD, percentage etc. Results: Total of 90 patients were included, among which 44 were male patients and 46 were females, within the age range of 18- 60 years. Patients were grouped 30 each in all three groups A, B and C with mean age 39.60±7.89, 45.70±10.02 and 43.90±9.64 respectively. The sites of group B showed statistically significant improvement in PPD at three months (1.80±0.76) compared to group C. Sites of group B also showed significant improvement in GI (1.46±0.45). There was no significant difference in the improvements of PI, Volume of GCF and CAL between group B and C at three months. Conclusion: The present study demonstrated marked improvements in the clinical parameters and their outcomes when the systemically healthy periodontitis patients and diabetic patients are treated with NSPT.

Use and Applicability of Ozone Therapy in Clinical Practice in Dentistry: An Integrative Review

Ozone is a colorless gas with a characteristic odor present in nature in the form of trivalent oxygen. In 2015, the Federal Council of Dentistry (CFO/Brazil) approved the use of ozone therapy and in 2018 the Ministry of Health (MS/Brazil) approved the application of Ozone Therapy as a Complementary Integrative Practice in the Unified Health System. Therefore, the objective of this study was to verify the applicability of ozone therapy in dental practice. This is an integrative literature review whose search was performed in the Medline/Pubmed, LILACS, SciElo, and Google Scholar databases. Studies published in the last 5 years in English, Portuguese or Spanish were eligible. After the search, 312 titles were found and after exclusion of duplicates and analysis of abstracts and full text, 13 articles were included in this review. The literature reports the application of ozone therapy in several areas in the treatment of acute and chronic diseases. As a mechanism of action, ozone has a direct antimicrobial effect, immunoregulation, antioxidant defenses, analgesic, and vasodilator effects. In dentistry, its applicability is mainly in preventive dentistry and as a complement in surgical procedur es, endodontic, and periodontal treatments.

Periodontal risk score: Initiation and model validation for 6,762 teeth.

Tooth-level prognostic systems are valuable tools for treatment planning and risk assessment of periodontally involved teeth. Recently the Miller-McEntire prognosis index was found to outperform comparable systems. However, it had some limitations. The present study aimed todevelop and evaluate the prognostic performance of a modified version that addresses most limitations of the previous model called the periodontal risk score (PRS). Data were retrieved retrospectively frompatients who received surgical and non-surgical periodontal treatment at a university setting.Data on medical history and smoking status at baseline and the last maintenance visitwere collected. Both univariate and multivariate Cox proportional hazard regression models were used to analyze the prognostic capability for predicting tooth loss due to periodontitis (TLP) risk. A total of 6762 teeth (281 patients) werefollowed up for a mean period of 22.6±6.34 (10-47.6y) years. The PRS was successfully able to stratify the risk of TLP at baseline when the three different classes of association were compared for anterior and/or posterior tooth loss. After controlling for maintenance, age, and sex, the index showed an excellent predictive capacity for TLP with a Harrell C-index of 0.947. The periodontal risk score (PRS) displayed excellent predictive capability for anterior as well as posterior tooth loss due to periodontitis. This system was able to predict long-term tooth loss with a very high accuracy in a population treated mainly by dental students and periodontics residents. The use of this/similar prognosis system is advisable as a means to establish tooth prognosis.