Objective
Clinical gingival inflammation is a well‐defined site‐specific condition for which several measurement systems have been proposed and validated, and epidemiological studies consistently ...indicate its high prevalence globally. However, it is clear that defining and grading a gingival inflammatory condition at a site level (i.e. a “gingivitis site”) is completely different from defining and grading a “gingivitis case” (GC) (i.e. a patient affected by gingivitis), and that a “gingivitis site” does not necessarily mean a “GC”. The purpose of the present review is to summarize the evidence on clinical, biochemical, microbiologic, genetic markers as well as symptoms associated with plaque‐induced gingivitis and to propose a set of criteria to define GC.
Importance
A universally accepted case definition for gingivitis would provide the necessary information to enable oral health professionals to assess the effectiveness of their prevention strategies and treatment regimens; help set priorities for therapeutic actions/programs by health care providers; and undertake surveillance.
Findings
Based on available methods to assess gingival inflammation, GC could be simply, objectively and accurately identified and graded using bleeding on probing score (BOP%)
Conclusions
A patient with intact periodontium would be diagnosed as a GC according to a BOP score ≥ 10%, further classified as localized (BOP score ≥ 10% and ≤30%) or generalized (BOP score > 30%). The proposed classification may also apply to patients with a reduced periodontium, where a GC would characterize a patient with attachment loss and BOP score ≥ 10%, but without BOP in any site probing ≥4 mm in depth.
Aims
To systematically review the evidence evaluating the efficacy of long‐term, routine, professional mechanical plaque removal (PMPR) in the prevention of periodontitis progression.
Methods
A ...literature search was conducted to identify prospective studies evaluating the effect of PMPR in periodontitis patients undergoing active periodontal therapy and enrolled in a maintenance programme including PMPR for at least 3 years.
Results
No RCTs evaluating the efficacy of the intervention when compared with no treatment during maintenance were found. Nineteen prospective studies assessing the effect of PMPR as part of the supportive therapy were included. In general, studies reported no to low incidence of tooth loss during follow‐up. The weighted mean yearly rate of tooth loss was 0.15 ± 0.14 and 0.09 ± 0.08 for follow‐up of 5 years or 12–14 years, respectively, with no significant differences between groups. Mean clinical attachment loss was <1 mm at follow‐up ranging from 5 to 12 years.
Conclusions
Supportive therapy, which encompasses PMPR, may limit the incidence and yearly rate of tooth loss as well as the loss in clinical attachment in patients treated for periodontitis. However, whether and to what extent the intervention may impact on long‐term periodontal parameters still needs to be assessed.
Background
To propose a novel composite outcome measure (COM) for periodontal regenerative treatment of intraosseous defects.
Methods
COM is based on the combination of clinically relevant clinical ...attachment level (CAL) gain (≥3 mm) and pocket closure (post‐surgery probing depth PD ≤ 4 mm). Treatment was regarded as successful when a clinically relevant CAL gain was associated with pocket closure, and failing when either clinically relevant CAL gain and pocket closure were not achieved. The effect of the different regenerative treatments was both collectively and separately evaluated according to COM in a defect cohort accessed by Single Flap Approach (SFA).
Results
In the entire study cohort, the procedure resulted in a 6‐month CAL gain of 3.7 ± 1.9 mm, which was clinically relevant in 71.8% of patients. Six‐month residual PD was 3.7 ± 1.1 mm, with pocket closure recorded in 79.6% of patients. COM revealed a successful treatment in 60 patients (58%), and a treatment failure in 7 patients (7%). Mean CAL gain was clinically relevant for each treatment, whereas the residual PD values were consistent with pocket closure for the majority of treatment options. However, when COM was used to rate the treatment outcome of each procedure, it appeared that a successful treatment ranged from 41.5% to 77.5%, whereas treatment failure varied from 3% to 15% for different treatments.
Conclusions
Compared to single probing measurements, COM seems (1) more accurate in capturing the overall benefit of the regenerative procedure and (2) to better identify which factor (CAL gain, residual pocket) mainly contributed to determine a treatment failure.
Objective
Clinical gingival inflammation is a well‐defined site‐specific condition for which several measurement systems have been proposed and validated, and epidemiological studies consistently ...indicate its high prevalence globally. However, it is clear that defining and grading a gingival inflammatory condition at a site level (i.e. a “gingivitis site”) is completely different from defining and grading a “gingivitis case” (GC) (i.e. a patient affected by gingivitis), and that a “gingivitis site” does not necessarily mean a “GC”. The purpose of the present review is to summarize the evidence on clinical, biochemical, microbiologic, genetic markers as well as symptoms associated with plaque‐induced gingivitis and to propose a set of criteria to define GC.
Importance
A universally accepted case definition for gingivitis would provide the necessary information to enable oral health professionals to assess the effectiveness of their prevention strategies and treatment regimens; help set priorities for therapeutic actions/programs by health care providers; and undertake surveillance.
Findings
Based on available methods to assess gingival inflammation, GC could be simply, objectively and accurately identified and graded using bleeding on probing score (BOP%)
Conclusions
A patient with intact periodontium would be diagnosed as a GC according to a BOP score ≥ 10%, further classified as localized (BOP score ≥ 10% and ≤30%) or generalized (BOP score > 30%). The proposed classification may also apply to patients with a reduced periodontium, where a GC would characterize a patient with attachment loss and BOP score ≥ 10%, but without BOP in any site probing ≥4 mm in depth.
Aim
To (i) identify factors associated with the probability of a peri‐implant site to be positive to bleeding on probing (BoP+) and (ii) compare BoP+ probability around dental implants and ...contra‐lateral teeth.
Methods
In 112 patients, data related to 1725 peri‐implant sites and 1020 contra‐lateral dental sites were retrospectively obtained. To analyse the association between patient‐, implant‐ and site‐related factors and BoP+ probability, a logistic, three‐level model was built with BoP as the binary outcome variable (+/−).
Results
BoP+ probability for a peri‐implant site with probing depth (PD) of 4 mm was 27%, and the odds ratio increased by 1.6 for each 1‐mm increment in PD (p < 0.001). Also, BoP+ probability was higher in females compared to males (OR = 1.61; p = 0.048), and lower at posterior compared to anterior dental implants (OR = 0.55; p < 0.01). No significant difference in BoP+ probability was observed between peri‐implant and contra‐lateral dental sites when controlling for the difference in PD.
Conclusions
The probability of a peri‐implant site to bleed upon probing is (i) associated with PD, implant position and gender, and (ii) similar to that observed at contra‐lateral dental sites when controlling for the effect of PD.
Aims
To systematically review the literature addressing the following focused questions: “What is the efficacy of either (#1) alternative or (#2) additional methods to professional mechanical plaque ...removal (PMPR) on progression of attachment loss during supportive periodontal therapy (SPT) in periodontitis patients?”.
Methods
A systematic search for randomized clinical trials was performed. Change in clinical attachment level (CAL) from baseline was the primary outcome.
Results
Routine PMPR performed with either a combination of ultrasonic/hand instruments or Er:Yag laser showed similarly effective in preventing CAL loss. Moreover, a routine SPT regimen based on PMPR led to stability of CAL irrespective of a daily sub‐antimicrobial doxycycline dose (SDD). Finally, an adjunctive photodynamic therapy (PDT) did not enhance the magnitude of CAL gain when sites with probing depth ≥4 mm were repeatedly treated. After pooling all data, the results of the meta‐analysis showed no statistical differences in CAL change from baseline: mean overall CAL change was −0.233 mm (95% confidence interval: −1.065, 0.598; p = .351).
Conclusions
Weak evidence indicate that in treated periodontitis patients enrolled in a 3–4 month SPT based on PMPR, Er:Yag laser (as alternative), SDD and PDT (as additional) do not produce a greater clinical effect on periodontal conditions compared to PMPR.
Recall sessions are an integral part of supportive periodontal therapy. The aim of the current article is to review the existing evidence to support if and to what extent a predefined frequency of ...periodontal recall sessions ensures periodontal health and stability. Factors that potentially affect the time interval for recall are described. Moreover, original data on the relevance of residual diseased sites (ie, bleeding pockets) at patient level to predict the progression of periodontitis are presented. Overall, wide heterogeneity was found in the published literature with regards to the proposed supportive periodontal therapy recall frequency once active periodontal therapy has been completed. Available data clearly show that a primary and secondary preventive regimen based on routine supportive periodontal therapy is beneficial to preserve a periodontally healthy dentition and prevent tooth loss. However, convincing evidence regarding the appropriateness, risk‐benefit, and cost‐effectiveness of different recall intervals is currently scarce. In patients affected by moderate to advanced periodontitis, a supportive periodontal therapy protocol based on a 2‐4 month recall interval appears reasonable. Limited data suggest that the amount/proportion of residual diseased sites (intended as pockets or bleeding pockets) and risk assessment tools may be of value in establishing the appropriate recall frequency.
The treatment of major depressive disorder (MDD) is still a challenge. In the search for novel antidepressants, glutamatergic neuromodulators have been investigated as possible fast-acting ...antidepressants. Innovative studies suggest that the purine cycle and/or the purinergic signaling can be dysregulated in MDD, and the endogenous nucleoside guanosine has gained attention due to its extracellular effects. This study aimed to verify if guanosine produces fast-onset effects in the well-validated, reliable and sensitive olfactory bulbectomy (OBX) model of depression. The involvement of the mTOR pathway, a key target for the fast-onset effect of ketamine, was also investigated. Results show that a single i.p. injection of guanosine, or ketamine, completely reversed the OBX-induced anhedonic-like behavior 24 or 48 h post treatment, as well as the short-term recognition memory impairment 48 h post treatment. The antidepressant-like effects of guanosine and ketamine were completely abolished by rapamycin. This study shows, for the first time, that guanosine, in a way similar to ketamine, is able to elicit a fast antidepressant response in the OBX model in mice. The results support the notion that guanosine represents a new road for therapeutic improvement in MDD.
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•A methodology is proposed to prioritize WWTPs at territorial level.•Social, economic and environmental WWTPs impacts are considered.•The methodology is applied to a 44 wastewater ...treatment plants case study.•The developed composite indicator is validated using UA, SA and statistical tools.•The work provides a robust composite indicator and a path for its implementation.
Successful implementation of the European Urban Wastewater Treatment Directive requires a deepened and multidisciplinary knowledge of the wastewater systems. The development of ready-to-use tools for decision makers is, in this sense, a challenge. This paper proposes a methodology to efficiently prioritize wastewater treatment plants (WWTPs) on the basis of the relative environmental, social and public health impacts, taking into account the territorial context issues. The proposed methodology has led to the implementation of a composite indicator. The several choices made for its development, from the definition of framework to the final outcomes, have been evaluated in depth and are supported through methodological and statistical techniques. The potential use of the composite indicator with the inherent advantages and limitations are discussed in order to provide a ready-to-use tool for final users for WWTPs prioritization. Moreover, a concise methodology for composite index implementation is described.
Aim
To evaluate the association between the probability of a sulcus/pocket to bleed on probing (BoP) and patient related as well as site‐specific characteristics.
Methods
Data from 88960 sites were ...retrospectively derived from the clinical record charts of 601 adult patients. BoP (positive/negative) had been recorded at the initial periodontal visit after probing pocket depth (PPD) assessment. To analyse the influence of patient‐, tooth‐ and site‐related factors on the probability for a site to be BoP+, a logistic, 3‐level model was built with BoP as the binary outcome variable.
Results
(i) The mean probability to be BoP+ for a site with PPD = 3 mm was 18%, and the log odds increased by 0.69 for each 1 mm increment in PPD; (ii) a significantly higher risk for BoP+ was observed for inter‐proximal versus approximal surfaces, posterior teeth versus anterior teeth, females versus males, while a significantly lower risk was observed for smokers versus non‐smokers; (iii) when controlling for the significant covariates, different BoP+ probabilities could still be observed among sites in patients with a different susceptibility to BoP.
Conclusions
The probability of a site to be BoP+ was associated with either site‐specific (i.e. PPD, tooth aspect, tooth type) or patient‐related factors (i.e. gender, smoking status).
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